{ "built": "2026-09-18", "count": 342, "nodes": [ { "schema": 1, "id": "argentina", "type": "destination", "names": { "name": "Argentina", "aliases": [ "República Argentina", "Argentine Republic" ], "said": "Buenos Aires, and mostly for neighbours. Argentine surgeons name Brazil, Paraguay and the United States as the places their foreign patients come from, in that order." }, "region": [ "south-america" ], "facets": { "iso2": "AR", "direction": "inbound", "currency": "ARS", "languages": [ "Spanish" ], "draws": [ "rhinoplasty", "breast-augmentation", "liposuction", "dental-implant" ] }, "text": { "what": "A regional cosmetic and dental destination with a deep specialist base and a currency that has moved faster than its price lists. Buenos Aires carries almost all of it. The foreign share is modest and regional: a median 5.0% of patients from other locations, at the worldwide median, with an average of 11.6%.", "story": "Argentina is the one country in this batch where the mix tips away from the knife. In the ISAPS survey of 2024 it reported 435,936 aesthetic procedures, of which 226,176 were non-surgical and 209,760 surgical — the only one of the Latin American countries this site carries where injectables and devices outnumber operations. Botulinum toxin alone accounted for 59,006 of them.\n\nThe professional body is the Sociedad Argentina de Cirugía Plástica, Estética y Reparadora, which maintains a public surgeon finder and puts the reason for it plainly: \"Cuando elige un cirujano plástico que sea miembro de la SACPER, puede estar seguro de que su cirujano está calificado\". *Inference —* a society directory answers one question, whether a surgeon is a member of that society. It does not answer what a hospital's infection rate is, or who is on call at the weekend, and no register in this subject answers all three.\n\n*Trade practice —* the pull for a foreign patient here has usually been the exchange rate rather than a waiting list, and a peso price read in a foreign currency is a different number every few months. This site carries no Argentine price for that reason: a price with a date is a fact, and a converted peso price without one is arithmetic.", "how": "*Trade practice —* consultations are booked directly with the surgeon's consulting room in Recoleta or Palermo, quoted in pesos or in US dollars depending on the practice, and paid on arrival. Domestic private insurance — prepagas — covers reconstructive work and not aesthetic work, and covers nothing for a visitor. Dental courses are staged across two visits in the same way they are everywhere.", "today": "As of the 2024 survey year Argentina's reported volume is 435,936 procedures, majority non-surgical, and its foreign-patient share sits at the worldwide median. The figures are survey extrapolations from board-certified plastic surgeons and count no dentistry, which is part of what brings patients across from Paraguay and Brazil." }, "geo": { "lat": -34.6037, "lon": -58.3816, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "435,936 aesthetic procedures in 2024, 209,760 surgical and 226,176 non-surgical; a reported median 5.0% / average 11.6% of patients attending from other locations. ISAPS survey extrapolations from 2,975 responding board-certified plastic surgeons across 32 locations; aesthetic work by plastic surgeons only.", "as_of": "2024", "source": "s:isaps-global-survey-2024", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf" }, "kin": [ { "to": "brazil", "as": "The first origin Argentine surgeons name, and the regional giant next door.", "rel": "contrast" }, { "to": "rhinoplasty", "as": "One of the operations Buenos Aires is known for.", "rel": "procedure" }, { "to": "breast-augmentation", "as": "A staple of the surgical half of the country's count.", "rel": "procedure" }, { "to": "dental-implant", "as": "The work that brings patients across the land borders, and that no survey here counts.", "rel": "procedure" }, { "to": "isaps", "as": "The society whose survey supplies the counts on this page.", "rel": "measured-by" }, { "to": "package-price", "as": "The pricing form this country mostly does not use, quoting per procedure instead.", "rel": "term" }, { "to": "counting-patients", "as": "Why a procedure count is not a patient count, here as everywhere.", "rel": "story" } ], "links": [ { "label": "Sociedad Argentina de Cirugía Plástica, Estética y Reparadora", "url": "https://www.sacper.org.ar/" }, { "label": "ISAPS survey of procedures performed in 2024", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf" } ], "sources": [ "s:isaps-global-survey-2024", "s:sacper", "s:natural-earth" ], "provenance": { "default": { "tier": "cited", "source": "s:isaps-global-survey-2024" }, "fields": { "text.story": { "tier": "cited", "note": "survey figures from ISAPS, the quotation from the society's own page; the readings after each are marked inline" }, "text.how": { "tier": "tradition", "note": "the shape of a Buenos Aires booking, hedged in the prose" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Buenos Aires skyline.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A regional cosmetic and dental destination with a deep specialist base and a currency that has moved faster than its price lists. Buenos Aires carries almost all of it.", "region_terms": [ { "key": "south-america", "name": "South America", "note": "Colombia, Brazil, Argentina, Chile, Peru" } ], "kin_out": [ { "to": "brazil", "type": "destination", "name": "Brazil", "as": "The first origin Argentine surgeons name, and the regional giant next door.", "rel": "contrast" }, { "to": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "One of the operations Buenos Aires is known for.", "rel": "procedure" }, { "to": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "A staple of the surgical half of the country's count.", "rel": "procedure" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The work that brings patients across the land borders, and that no survey here counts.", "rel": "procedure" }, { "to": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "The society whose survey supplies the counts on this page.", "rel": "measured-by" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The pricing form this country mostly does not use, quoting per procedure instead.", "rel": "term" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a procedure count is not a patient count, here as everywhere.", "rel": "story" } ], "source_list": [ { "id": "s:isaps-global-survey-2024", "kind": "report", "title": "ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2024", "publisher": "International Society of Aesthetic Plastic Surgery, tabulated by Industry Insights Inc.", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf", "accessed": "2026-09-16" }, { "id": "s:sacper", "kind": "web", "title": "Sociedad Argentina de Cirugía Plástica, Estética y Reparadora", "publisher": "SACPER, Buenos Aires", "url": "https://www.sacper.org.ar/", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:isaps-global-survey-2024" }, "text.story": { "tier": "cited", "note": "survey figures from ISAPS, the quotation from the society's own page; the readings after each are marked inline" }, "text.how": { "tier": "tradition", "note": "the shape of a Buenos Aires booking, hedged in the prose" }, "text.today": { "tier": "cited", "source": "s:isaps-global-survey-2024" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:isaps-global-survey-2024" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "brazil", "type": "destination", "name": "Brazil", "as": "The neighbour Brazilian patients travel to, and that names Brazil as its own first origin.", "rel": "contrast" } ] }, { "schema": 1, "id": "australia", "type": "destination", "names": { "name": "Australia", "aliases": [ "Commonwealth of Australia" ], "said": "A source market with a Bali-adjacent geography and a Thai-and-Turkish booking habit. The trade phrase here is cosmetic tourism, and the professional body that uses it does so to argue against it." }, "region": [ "oceania" ], "facets": { "iso2": "AU", "direction": "outbound", "currency": "AUD", "languages": [ "English" ], "draws": [] }, "text": { "what": "A country people leave for dental and cosmetic work and almost never arrive at for either. Australians fly to Thailand, Türkiye, Malaysia, South Korea and India for procedures their own system either does not fund or prices out of reach; Medicare does not follow them, and private cover usually does not either. The best-measured thing about the flow is what comes back: patients presenting at Australian public hospitals with complications after surgery abroad.", "story": "The measurement problem here is the usual one. A Victorian government health page carries two figures — around 15,000 Australians travelling overseas for healthcare each year, and about $300 million a year spent on cosmetic surgery abroad — and names no source for either; the page's own review date is December 2017. This record repeats them as what that page says and not as facts.\n\nThe firm number is smaller and much more specific. Res and colleagues, in the ANZ Journal of Surgery in 2026, reviewed patients presenting to Westmead Hospital in New South Wales with complications after cosmetic surgery overseas across two windows, July 2022 to January 2023 and May to December 2024. Twenty-four patients met the criteria. Türkiye was the country of surgery in 54.2 per cent of them, Thailand in 12.5 per cent, Lebanon in 8.3 per cent, with single cases from Jordan, Syria, Korea, India, Iraq and Mongolia. Abdominoplasty was the commonest procedure at 54.2 per cent, liposuction 25 per cent, breast augmentation 20.8 per cent, and 58.3 per cent had multiple procedures in one sitting. Wound dehiscence appeared in 45.8 per cent, infection in 41.7 per cent, seroma in 20.8 per cent. Median time from surgery to presentation was 3.8 weeks; mean stay was 3.3 days. The authors state that costing was outside the study's scope.\n\n*Inference —* twenty-four patients at one Sydney hospital across roughly thirteen months of sampling is a denominator-free number, and it should not be read as a complication rate. What it does show is the shape: the operations that come back are the long abdominal ones done several at a time, and they come back about a month later, which is after the travel insurance and after the surgeon abroad has closed the file.\n\nThe Australian Society of Plastic Surgeons, in a statement dated January 2024, opposes the practice and names its own concern that restricted private theatre access at home may be pushing patients out. That is the argument, from a body with an interest in where its members' patients are operated on, and it is reported here as such.", "how": "An agency or a clinic abroad quotes a package; the patient books flights and a recovery hotel; the consultation is often the day before the operation. On return, follow-up falls to a general practitioner, a public emergency department or a plastic surgeon who did not do the case. Medicare does not reimburse treatment abroad and Australia's reciprocal health agreements cover a short list of countries for immediate need, not elective surgery. Devices implanted overseas may arrive without documentation, which is the practical problem a revision surgeon meets first.", "today": "As of September 2026 the published Australian evidence on this flow is a single-centre complications series and a government consumer page whose two headline numbers carry no source. Inbound care is not a meaningful trade in this country and this record carries no inbound figure.", "notes": "The single-centre series counts presentations at one hospital. It has no denominator and is not a rate." }, "geo": { "lat": -33.8688, "lon": 151.2093, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "No outbound count is carried as a fact. The Victorian government's consumer page states around 15,000 Australians travelling overseas for healthcare a year and about $300 million a year on cosmetic surgery abroad, and names no source for either; its review date is 5 December 2017. The 24-patient figure from Westmead Hospital is a count of presentations with complications at one hospital across two sampling windows in 2022-23 and 2024, with no denominator, and is not a complication rate.", "as_of": "2026", "source": "s:anzjs-cosmetic-tourism-2026", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13006713/" }, "kin": [ { "to": "thailand", "as": "The destination Australians have used longest, and the country of surgery in 12.5% of the Westmead series.", "rel": "destination" }, { "to": "turkiye", "as": "Where most of the complications presenting at Westmead had been operated on.", "rel": "destination" }, { "to": "abdominoplasty", "as": "The procedure that came back most often in the Australian series.", "rel": "procedure" }, { "to": "dental-implant", "as": "The other half of the Australian outflow, and the one that rarely reaches a hospital.", "rel": "procedure" }, { "to": "revision-at-home", "as": "Who fixes it, and at whose cost, once the patient has landed.", "rel": "risk" }, { "to": "follow-up-gap", "as": "A median of 3.8 weeks from surgery to presentation is the gap, measured.", "rel": "risk" }, { "to": "insurance-exclusions", "as": "Medicare does not travel, and private cover usually does not either.", "rel": "governed-by" }, { "to": "surgical-site-infection", "as": "Present in 41.7% of the Australian series.", "rel": "risk" }, { "to": "is-it-cheaper", "as": "The question a returned patient's second operation reopens.", "rel": "story" } ], "links": [ { "label": "The Impact of Overseas Cosmetic Tourism on the Australian Public Hospital System", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13006713/" }, { "label": "Medical tourism and insurance — Better Health Channel, Victoria", "url": "https://www.betterhealth.vic.gov.au/health/healthyliving/medical-tourism" } ], "sources": [ "s:anzjs-cosmetic-tourism-2026", "s:betterhealth-vic-medical-tourism", "s:asps-cosmetic-tourism-2024", "s:natural-earth", "s:worldbank-open-data" ], "provenance": { "default": { "tier": "cited", "source": "s:anzjs-cosmetic-tourism-2026" }, "fields": { "text.story": { "tier": "cited", "source": "s:anzjs-cosmetic-tourism-2026", "note": "the study figures are read off the open-access paper; the reading of what 24 patients can and cannot show is marked inline as inference" }, "text.how": { "tier": "tradition", "note": "the ordinary route; the Medicare point follows the Victorian government page" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "needs_verification": false, "confidence": "high", "updated": "2026-09-16", "blurb": "A country people leave for dental and cosmetic work and almost never arrive at for either.", "region_terms": [ { "key": "oceania", "name": "Oceania", "note": "Australia, New Zealand, the Pacific" } ], "kin_out": [ { "to": "thailand", "type": "destination", "name": "Thailand", "as": "The destination Australians have used longest, and the country of surgery in 12.5% of the Westmead series.", "rel": "destination" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "Where most of the complications presenting at Westmead had been operated on.", "rel": "destination" }, { "to": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "The procedure that came back most often in the Australian series.", "rel": "procedure" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The other half of the Australian outflow, and the one that rarely reaches a hospital.", "rel": "procedure" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who fixes it, and at whose cost, once the patient has landed.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "A median of 3.8 weeks from surgery to presentation is the gap, measured.", "rel": "risk" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "Medicare does not travel, and private cover usually does not either.", "rel": "governed-by" }, { "to": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "Present in 41.7% of the Australian series.", "rel": "risk" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The question a returned patient's second operation reopens.", "rel": "story" } ], "source_list": [ { "id": "s:anzjs-cosmetic-tourism-2026", "kind": "journal", "title": "The Impact of Overseas Cosmetic Tourism on the Australian Public Hospital System", "publisher": "Res A, He B, Karunaratne YG, Cheung M, Hsieh F. ANZ Journal of Surgery 2026;96(3):607–613", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13006713/", "accessed": "2026-09-16", "note": "doi 10.1111/ans.70513; retrospective review of patients presenting to one Sydney hospital with complications after cosmetic surgery abroad" }, { "id": "s:betterhealth-vic-medical-tourism", "kind": "gov", "title": "Medical tourism and insurance", "publisher": "Better Health Channel, Department of Health, State Government of Victoria", "url": "https://www.betterhealth.vic.gov.au/health/healthyliving/medical-tourism", "accessed": "2026-09-16", "note": "page review date 5 December 2017; carries the 15,000-travellers and $300 million figures without naming where either comes from" }, { "id": "s:asps-cosmetic-tourism-2024", "kind": "org", "title": "ASPS statement re Cosmetic Tourism, January 2024", "publisher": "Australian Society of Plastic Surgeons", "url": "https://plasticsurgery.org.au/wp-content/uploads/2024/01/FINAL-ASPS-cosmetic-tourism-statement-for-Sunrise-Jan-2024.pdf", "accessed": "2026-09-16", "note": "the position of a professional body with a direct interest in where its members' patients are operated on; read as such" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:anzjs-cosmetic-tourism-2026" }, "text.story": { "tier": "cited", "source": "s:anzjs-cosmetic-tourism-2026", "note": "the study figures are read off the open-access paper; the reading of what 24 patients can and cannot show is marked inline as inference" }, "text.how": { "tier": "tradition", "note": "the ordinary route; the Medicare point follows the Victorian government page" }, "text.today": { "tier": "cited", "source": "s:anzjs-cosmetic-tourism-2026" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:anzjs-cosmetic-tourism-2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "acl-reconstruction", "type": "procedure", "name": "Anterior cruciate ligament reconstruction", "as": "Whose schedule pays the same fee for this as for a hip replacement.", "rel": "destination" }, { "from": "angioplasty-stent", "type": "procedure", "name": "Coronary angioplasty and stent", "as": "Where the schedule pays for one coronary territory at a time.", "rel": "destination" }, { "from": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "Where the state prices the surgeon's service rather than the admission.", "rel": "destination" }, { "from": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "Where the state pays for the cataract lens and names the refractive exclusion in the same sentence.", "rel": "destination" }, { "from": "cochlear-implant", "type": "procedure", "name": "Cochlear implant", "as": "Where the shortfall in replacement processors has been measured and published.", "rel": "place" }, { "from": "disc-replacement", "type": "procedure", "name": "Artificial disc replacement", "as": "Whose schedule attaches a five-part eligibility test to the fee.", "rel": "destination" }, { "from": "gallbladder-removal", "type": "procedure", "name": "Gallbladder removal", "as": "Where one fee covers the operation by any approach.", "rel": "destination" }, { "from": "heart-valve-replacement", "type": "procedure", "name": "Heart valve replacement", "as": "Where the schedule prices the surgeon's service at a fixed fee whichever valve it is.", "rel": "destination" }, { "from": "hernia-repair", "type": "procedure", "name": "Hernia repair", "as": "Where one schedule fee covers every route to the same repair.", "rel": "destination" }, { "from": "hysterectomy", "type": "procedure", "name": "Hysterectomy", "as": "Where the state prices the surgeon's service and the hospital bills separately.", "rel": "destination" }, { "from": "knee-arthroscopy", "type": "procedure", "name": "Knee arthroscopy", "as": "Whose schedule writes the disputed indication into the item's own wording.", "rel": "destination" }, { "from": "prostatectomy", "type": "procedure", "name": "Prostatectomy", "as": "Where the schedule names nerve sparing and pays the surgeon alone.", "rel": "destination" }, { "from": "shoulder-replacement", "type": "procedure", "name": "Total shoulder replacement", "as": "Whose payer sets the schedule fee on this page, and prices the shoulder above the hip.", "rel": "destination" }, { "from": "spinal-fusion", "type": "procedure", "name": "Spinal fusion", "as": "Whose schedule prices fusion by the motion segment, one item number per level.", "rel": "destination" }, { "from": "achsi", "type": "org", "name": "ACHS International", "as": "The system these standards were written for, and where a regulator stands behind them.", "rel": "place" }, { "from": "john-connell", "type": "person", "name": "John Connell", "as": "Where he writes from, and a country that both sends and receives patients.", "rel": "destination" }, { "from": "the-follow-up-nobody-books", "type": "story", "name": "The follow-up nobody books", "as": "Where the newest series puts the median interval before presentation at 3.8 weeks.", "rel": "destination" } ] }, { "schema": 1, "id": "belgium", "type": "destination", "names": { "name": "Belgium", "aliases": [ "België", "Belgique", "Belgien", "Royaume de Belgique" ], "said": "In the trade Belgium means an hour's drive: Dutch patients to Antwerp and Genk, French patients to Lille's Belgian side, British patients to Brussels for a fertility clinic that will treat them." }, "region": [ "europe-west" ], "facets": { "iso2": "BE", "direction": "inbound", "currency": "EUR", "languages": [ "Dutch", "French", "German", "English" ], "draws": [ "ivf", "egg-donation", "sperm-donation", "hip-replacement", "knee-replacement" ] }, "text": { "what": "The classic European cross-border case: a small country with spare hospital capacity, short waits and three land borders, which has been treating its neighbours' patients since long before the EU wrote a directive about it. Belgian fertility centres in particular draw patients from across Western Europe. And Belgium is the country that could not report its own cross-border numbers to the Commission, because its sickness funds do not collect them the same way.", "story": "The ESHRE taskforce counted the fertility side in a single month in 2010, across six receiving countries: Belgium took the largest share of the 1,230 patients surveyed, 29.7%. Of the patients in that study overall, 31.8% came from Italy, 14.4% from Germany, 12.1% from the Netherlands and 8.7% from France, and the reason they gave, again and again, was law rather than price.\n\nThe Commission's data for 2022 shows what the state can and cannot see. Belgium received 47 requests for prior authorisation and granted six — 12.7%, among the lowest rates in the EU — and reimbursed EUR 11,880 for authorised cross-border care in the whole year. For care not needing authorisation, it reported nothing at all: the national contact point told the Commission that not all health insurance funds had supplied data and it would rather report none than part.\n\n*Inference —* a country whose hospitals have treated foreign patients for decades and whose central reporting cannot count them is not unusual; it is the normal case, stated plainly for once. The trade that shows up in the Commission's tables is the small, authorised, state-mediated part. The rest is a Dutch family in a Belgian waiting room, paying an insurer that settles the bill without anyone writing the word cross-border on it.", "how": "Two routes and a private one. Under the Directive the patient pays the Belgian hospital and reclaims at home at home rates; under the older social-security coordination the home fund authorises first and the treatment is billed between the systems; privately, the patient simply pays. Belgian hospitals are used to all three and quote in euro against the national fee schedule, which is published and applies to residents.", "today": "Belgium's most recent reported cross-border figures remain those for 2022: 47 authorisation requests, six granted, EUR 11,880 reimbursed, and a blank where the larger column should be." }, "geo": { "lat": 50.8503, "lon": 4.3517, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "No inbound patient count is carried. Belgium's national contact point reported no data on reimbursement for care not subject to prior authorisation in 2022 because its sickness funds had not all supplied it; the authorised figures are 47 requests, six granted, EUR 11,880 reimbursed.", "as_of": "2022", "source": "s:ec-crossborder-2022" }, "kin": [ { "to": "ivf", "as": "The treatment that brings patients here from countries that restrict it.", "rel": "procedure" }, { "to": "egg-donation", "as": "One of the reasons a French or Italian patient books a Brussels clinic.", "rel": "procedure" }, { "to": "eu-directive-2011-24", "as": "The route it applies and cannot fully count.", "rel": "governed-by" }, { "to": "eu-national-contact-points", "as": "The office that reported a blank rather than a partial number.", "rel": "org" }, { "to": "germany", "as": "The neighbour that sends fertility patients across this border and receives complex cases in return.", "rel": "contrast" }, { "to": "spain", "as": "The bigger fertility destination working the same European restrictions.", "rel": "contrast" }, { "to": "counting-patients", "as": "A country that treats its neighbours and cannot say how many.", "rel": "story" }, { "to": "donor-anonymity-law", "as": "The rule that decides which patients cross this border and which stay home.", "rel": "governed-by" } ], "sources": [ "s:ec-crossborder-2022", "s:shenfield-2010", "s:eu-directive-2011-24", "s:natural-earth" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:ec-crossborder-2022", "note": "survey and Commission figures cited; the closing paragraph is marked inference" }, "text.how": { "tier": "tradition", "note": "the two state routes are set out in the Directive and the coordination regulations; the working practice is the trade's" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Brussels UZ Brussel hospital.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "The classic European cross-border case: a small country with spare hospital capacity, short waits and three land borders, which has been treating its neighbours' patients since long before the EU wrote a directive about…", "region_terms": [ { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment that brings patients here from countries that restrict it.", "rel": "procedure" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "One of the reasons a French or Italian patient books a Brussels clinic.", "rel": "procedure" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route it applies and cannot fully count.", "rel": "governed-by" }, { "to": "eu-national-contact-points", "type": "org", "name": "EU National Contact Points for cross-border healthcare", "as": "The office that reported a blank rather than a partial number.", "rel": "org" }, { "to": "germany", "type": "destination", "name": "Germany", "as": "The neighbour that sends fertility patients across this border and receives complex cases in return.", "rel": "contrast" }, { "to": "spain", "type": "destination", "name": "Spain", "as": "The bigger fertility destination working the same European restrictions.", "rel": "contrast" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "A country that treats its neighbours and cannot say how many.", "rel": "story" }, { "to": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The rule that decides which patients cross this border and which stay home.", "rel": "governed-by" } ], "source_list": [ { "id": "s:ec-crossborder-2022", "kind": "report", "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU — reference year 2022", "publisher": "European Commission, DG Health and Food Safety, Unit B.3; written by PredictBy Research and Consulting and Baltic Media; Publications Office of the European Union", "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf", "license": "CC BY 4.0", "accessed": "2026-09-16", "note": "final version January 2024, ISBN 978-92-68-14858-7. 23 countries reported 547,890 reimbursement requests for care not needing prior authorisation in 2022, of which France 300,254 and Germany 160,647 are 84%; Poland 14,176, Slovakia 13,904, Ireland 1,841, Romania 889, Czechia 440, Croatia 192, Lithuania 131, Greece 56, Cyprus 44, Portugal 27 (all refused), Spain 9. Total reimbursed EUR 86,462,491. For care needing prior authorisation, 4,552 requests and EUR 7,708,041. Belgium and Hungary could not report; Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway run no prior-authorisation system; only Denmark and Romania have a mechanism to limit inflow." }, { "id": "s:shenfield-2010", "kind": "paper", "title": "Cross border reproductive care in six European countries", "publisher": "Human Reproduction 25(6):1361-1368, ESHRE Taskforce on Cross Border Reproductive Care", "url": "https://academic.oup.com/humrep/article/25/6/1361/2915759", "accessed": "2026-09-16" }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:ec-crossborder-2022", "note": "survey and Commission figures cited; the closing paragraph is marked inference" }, "text.how": { "tier": "tradition", "note": "the two state routes are set out in the Directive and the coordination regulations; the working practice is the trade's" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [] }, { "schema": 1, "id": "brazil", "type": "destination", "names": { "name": "Brazil", "aliases": [ "República Federativa do Brasil", "Federative Republic of Brazil" ], "said": "Cirurgia plástica. Brazil's cosmetic surgery is famous abroad and domestic at home: the survey that ranks it first in the world for surgical procedures also records that only about one patient in twenty comes from another country." }, "region": [ "south-america" ], "facets": { "iso2": "BR", "direction": "inbound", "currency": "BRL", "languages": [ "Portuguese" ], "draws": [ "liposuction", "breast-augmentation", "abdominoplasty", "bbl", "facelift" ] }, "text": { "what": "The country that performs more cosmetic surgery than any other and exports very little of it. In the ISAPS survey of 2024, Brazilian plastic surgeons accounted for 2,354,513 surgical procedures — 13.5% of the world's, more than the United States — inside a total of 3,123,758. The foreign share of that work is small. Brazil is on this site as the largest domestic cosmetic market in the world, and as a destination that is smaller than its reputation.", "story": "The professional base is deep and old. The Sociedade Brasileira de Cirurgia Plástica was founded in São Paulo in 1948 and states \"aproximadamente 6.700 cirurgiões plásticos, entre titulares, associados e aspirantes a membros\". ISAPS separately estimates 6,497 plastic surgeons in Brazil, second in the world after the United States and ahead of China.\n\nThe travel figures are the quiet part. Brazilian surgeons reported a median 5.0% of patients attending from other locations and an average of 8.2% — at, and just above, the worldwide median of 5.0%. The three origins named most often were the United States, Portugal and Italy, which is the shape of a diaspora rather than a package trade.\n\nWhere the work is done is its own fact: 76.0% of Brazilian cosmetic procedures were performed in a hospital, against 52.6% worldwide, and 7.0% in a free-standing surgicentre against 16.3% worldwide. *Inference —* that is the opposite profile to Colombia's, and it is the single most useful comparison on either page: the same operations, the same region, different premises.", "how": "*Trade practice —* Brazil sells to Brazilians. A foreign patient books the same clinic a São Paulo or Rio patient books, in Portuguese, usually through a surgeon's own consulting room rather than a facilitator, and pays in reais. Multi-procedure operating lists are common and the hospital admission is the norm rather than the exception. Nothing on this page describes a state promotion scheme, because this record found none to describe.", "today": "As of the 2024 survey year Brazil ranks second in the world for total aesthetic procedures and first for surgical ones, with 769,245 non-surgical procedures against 2,354,513 surgical — the inverse of the United States, where non-surgical work is two-thirds of the total. Both figures are extrapolations from a survey of board-certified plastic surgeons, and neither counts a dentist, a fertility clinic or an orthopaedic ward." }, "geo": { "lat": -15.7939, "lon": -47.8828, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "3,123,758 aesthetic procedures in 2024, 2,354,513 of them surgical; an estimated 6,497 plastic surgeons; a reported median 5.0% / average 8.2% of patients attending from other locations. All ISAPS survey extrapolations from 2,975 responding surgeons across 32 locations, counting aesthetic work by board-certified plastic surgeons and nothing else.", "as_of": "2024", "source": "s:isaps-global-survey-2024", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf" }, "kin": [ { "to": "albert-einstein-sao-paulo", "as": "The São Paulo hospital that takes the complex international work.", "rel": "part" }, { "to": "liposuction", "as": "One of the operations behind the country's surgical count.", "rel": "procedure" }, { "to": "abdominoplasty", "as": "A Brazilian staple, and one of the pairings sold on a single list.", "rel": "procedure" }, { "to": "bbl", "as": "The buttock operation whose technique argument is partly Brazilian.", "rel": "procedure" }, { "to": "colombia", "as": "The regional contrast: a fifth of the volume, four times the foreign share, and the operations done in surgicentres rather than hospitals.", "rel": "contrast" }, { "to": "argentina", "as": "The neighbour Brazilian patients travel to, and that names Brazil as its own first origin.", "rel": "contrast" }, { "to": "isaps", "as": "The society whose survey supplies the counts on this page.", "rel": "measured-by" }, { "to": "counting-patients", "as": "Why a procedure count and a patient count are different animals.", "rel": "story" } ], "links": [ { "label": "Sociedade Brasileira de Cirurgia Plástica", "url": "https://www.cirurgiaplastica.org.br/" }, { "label": "ISAPS survey of procedures performed in 2024", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf" } ], "sources": [ "s:isaps-global-survey-2024", "s:sbcp", "s:natural-earth" ], "provenance": { "default": { "tier": "cited", "source": "s:isaps-global-survey-2024" }, "fields": { "text.story": { "tier": "cited", "note": "society membership from its own page; survey figures from ISAPS; the closing comparison is marked inference" }, "text.how": { "tier": "tradition", "note": "the domestic shape of the Brazilian trade, hedged in the prose" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:São Paulo skyline.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "The country that performs more cosmetic surgery than any other and exports very little of it.", "region_terms": [ { "key": "south-america", "name": "South America", "note": "Colombia, Brazil, Argentina, Chile, Peru" } ], "kin_out": [ { "to": "albert-einstein-sao-paulo", "type": "facility", "name": "Hospital Israelita Albert Einstein", "as": "The São Paulo hospital that takes the complex international work.", "rel": "part" }, { "to": "liposuction", "type": "procedure", "name": "Liposuction", "as": "One of the operations behind the country's surgical count.", "rel": "procedure" }, { "to": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "A Brazilian staple, and one of the pairings sold on a single list.", "rel": "procedure" }, { "to": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "The buttock operation whose technique argument is partly Brazilian.", "rel": "procedure" }, { "to": "colombia", "type": "destination", "name": "Colombia", "as": "The regional contrast: a fifth of the volume, four times the foreign share, and the operations done in surgicentres rather than hospitals.", "rel": "contrast" }, { "to": "argentina", "type": "destination", "name": "Argentina", "as": "The neighbour Brazilian patients travel to, and that names Brazil as its own first origin.", "rel": "contrast" }, { "to": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "The society whose survey supplies the counts on this page.", "rel": "measured-by" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a procedure count and a patient count are different animals.", "rel": "story" } ], "source_list": [ { "id": "s:isaps-global-survey-2024", "kind": "report", "title": "ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2024", "publisher": "International Society of Aesthetic Plastic Surgery, tabulated by Industry Insights Inc.", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf", "accessed": "2026-09-16" }, { "id": "s:sbcp", "kind": "web", "title": "Sociedade Brasileira de Cirurgia Plástica", "publisher": "Sociedade Brasileira de Cirurgia Plástica, São Paulo", "url": "https://www.cirurgiaplastica.org.br/", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:isaps-global-survey-2024" }, "text.story": { "tier": "cited", "note": "society membership from its own page; survey figures from ISAPS; the closing comparison is marked inference" }, "text.how": { "tier": "tradition", "note": "the domestic shape of the Brazilian trade, hedged in the prose" }, "text.today": { "tier": "cited", "source": "s:isaps-global-survey-2024" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:isaps-global-survey-2024" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "argentina", "type": "destination", "name": "Argentina", "as": "The first origin Argentine surgeons name, and the regional giant next door.", "rel": "contrast" }, { "from": "albert-einstein-sao-paulo", "type": "facility", "name": "Hospital Israelita Albert Einstein", "as": "The Brazilian hospital foreign referrals reach first, in a country whose larger flow is Brazilians leaving.", "rel": "destination" }, { "from": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "The largest domestic aesthetic market in its 2024 count, and a small foreign share inside it.", "rel": "place" } ] }, { "schema": 1, "id": "canada", "type": "destination", "names": { "name": "Canada", "aliases": [ "Dominion of Canada" ], "said": "The queue is the story. A Canadian who leaves is not escaping a bill; the operation at home is free and the date is not." }, "region": [ "north-america" ], "facets": { "iso2": "CA", "direction": "outbound", "currency": "CAD", "languages": [ "English", "French" ], "draws": [ "knee-replacement", "hip-replacement", "cataract-surgery", "dental-implant" ] }, "text": { "what": "One of the two largest source markets in the world, and the one whose patients leave for a date rather than a discount. Provincial insurance covers medically necessary hospital and physician care at home; it does not cover the wait, and it barely follows a patient across the border. Canadians appear as inbound patients in Mexico, Costa Rica, the Caribbean and the United States, and Canadian surgeons appear in this site's data mostly as the comparison.", "story": "The wait has a published measure. The Canadian Institute for Health Information reports the share of patients treated inside a national benchmark of 182 days — 26 weeks from the date a patient was ready to be treated — and for 2024 it recorded 68% of hip replacements and 61% of knee replacements done inside it, alongside 69% of cataract surgeries within their 112-day benchmark, 94% of radiation therapy within 28 days and 83% of hip fracture repairs within 48 hours. That report was published on 12 June 2025. CIHI's joint replacement indicator, updated in June 2026 on the April-to-September window, put hip and knee replacements combined at 65% inside the six-month target.\n\nRead the complement instead and the market appears: in 2024 close to four knee patients in ten were still waiting more than six months after being ready for surgery, in a country where the surgery itself carries no bill.\n\nWhat the state pays when they go is set by statute. The Canada Health Act, R.S.C. 1985, c. C-6, makes portability a criterion of a provincial plan: for insured services provided outside Canada, section 11(1)(b) requires payment \"on the basis of the amount that would have been paid by the province for similar services rendered in the province\". *Inference —* that clause is the whole economics of leaving. A province reimburses at its own domestic rate, which for an operation bought privately in Florida or Tijuana is a fraction of the invoice, and the patient carries the difference. Portability pays for an emergency abroad; it does not fund an elective trip.\n\n*Trade practice —* Canadian outflow also runs inside the country's own borders in a way this site cannot chart: to private surgical clinics in provinces that permit them, and to Quebec's parallel arrangements. The traffic that leaves the country is the visible end of a larger domestic argument about who may sell an operation to a Canadian.", "how": "A Canadian patient referred for an elective joint replacement enters a provincial queue measured from the decision to treat. Where the wait is long, the routes out are three: pay privately in the United States, usually in cash and usually within a day's drive; buy a package abroad, most often in Mexico, Costa Rica or the Caribbean; or wait. None of the three is reimbursed as a matter of course, and prior authorisation for out-of-country care is a provincial process with its own criteria. Dentistry sits outside the public plans altogether, which is why Canadians are one of the three origins Mexican surgeons name most often.", "today": "As of the June 2026 CIHI update, 65% of hip and knee replacements in the April-to-September window were done inside the 182-day target. This record carries no count of Canadians treated abroad: the estimates in circulation come from think-tank surveys of physicians rather than from a register, and they are left to their own publishers rather than repeated here." }, "geo": { "lat": 45.4215, "lon": -75.6972, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "Hip replacements 68% and knee replacements 61% within the 182-day benchmark in 2024, published 12 June 2025; hip and knee combined 65% within the target on the April-to-September window, data updated June 2026. These are shares of patients treated inside a benchmark, not waiting times: a person still waiting is not in the denominator of the operation they have not had.", "as_of": "2024", "source": "s:cihi-wait-times-2025", "url": "https://www.cihi.ca/en/wait-times-for-priority-procedures-in-canada-2025" }, "kin": [ { "to": "united-states", "as": "The other big source market, and the first place a Canadian in a hurry pays cash.", "rel": "contrast" }, { "to": "mexico", "as": "Where Canadians are one of the three origins surgeons name, and where the dentistry is.", "rel": "destination" }, { "to": "costa-rica", "as": "The winter destination that sells dentistry and surgery to the same travellers.", "rel": "destination" }, { "to": "knee-replacement", "as": "61% of them done inside six months in 2024 — the operation that defines this market.", "rel": "procedure" }, { "to": "hip-replacement", "as": "68% inside six months in 2024, and the better half of the same queue.", "rel": "procedure" }, { "to": "cataract-surgery", "as": "69% inside 112 days in 2024, on its own shorter benchmark.", "rel": "procedure" }, { "to": "oecd-waiting-times", "as": "The series that puts this country's queue beside everyone else's.", "rel": "measured-by" }, { "to": "follow-up-gap", "as": "Who sees the wound at six weeks when the operation happened in another country.", "rel": "risk" }, { "to": "insurance-exclusions", "as": "What a provincial plan will not pay for, which is most of an elective trip.", "rel": "governed-by" } ], "links": [ { "label": "CIHI — wait times for priority procedures in Canada, 2025", "url": "https://www.cihi.ca/en/wait-times-for-priority-procedures-in-canada-2025" }, { "label": "Canada Health Act, section 11", "url": "https://laws-lois.justice.gc.ca/eng/acts/C-6/page-1.html" } ], "sources": [ "s:cihi-wait-times-2025", "s:cihi-joint-replacement-waits", "s:canada-health-act", "s:cdc-yellowbook-medical-tourism", "s:natural-earth" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:cihi-wait-times-2025", "note": "CIHI for the benchmark shares, the Canada Health Act for portability; the reading of the clause is marked inference" }, "text.how": { "tier": "tradition", "note": "the three routes out, hedged; the benchmark figures are cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Parliament Hill Ottawa.jpg" ], "needs_verification": true, "confidence": "high", "updated": "2026-09-16", "blurb": "One of the two largest source markets in the world, and the one whose patients leave for a date rather than a discount.", "region_terms": [ { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "united-states", "type": "destination", "name": "United States", "as": "The other big source market, and the first place a Canadian in a hurry pays cash.", "rel": "contrast" }, { "to": "mexico", "type": "destination", "name": "Mexico", "as": "Where Canadians are one of the three origins surgeons name, and where the dentistry is.", "rel": "destination" }, { "to": "costa-rica", "type": "destination", "name": "Costa Rica", "as": "The winter destination that sells dentistry and surgery to the same travellers.", "rel": "destination" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "61% of them done inside six months in 2024 — the operation that defines this market.", "rel": "procedure" }, { "to": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "68% inside six months in 2024, and the better half of the same queue.", "rel": "procedure" }, { "to": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "69% inside 112 days in 2024, on its own shorter benchmark.", "rel": "procedure" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The series that puts this country's queue beside everyone else's.", "rel": "measured-by" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who sees the wound at six weeks when the operation happened in another country.", "rel": "risk" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "What a provincial plan will not pay for, which is most of an elective trip.", "rel": "governed-by" } ], "source_list": [ { "id": "s:cihi-wait-times-2025", "kind": "report", "title": "Wait times for priority procedures in Canada, 2025", "publisher": "Canadian Institute for Health Information, published 12 June 2025", "url": "https://www.cihi.ca/en/wait-times-for-priority-procedures-in-canada-2025", "accessed": "2026-09-16" }, { "id": "s:cihi-joint-replacement-waits", "kind": "web", "title": "Joint Replacement Wait Times", "publisher": "Canadian Institute for Health Information, data updated June 2026", "url": "https://www.cihi.ca/en/indicators/joint-replacement-wait-times", "accessed": "2026-09-16" }, { "id": "s:canada-health-act", "kind": "statute", "title": "Canada Health Act, R.S.C. 1985, c. C-6, section 11 (portability)", "publisher": "Justice Laws Website, Government of Canada, consolidation current to 21 July 2026", "url": "https://laws-lois.justice.gc.ca/eng/acts/C-6/page-1.html", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:cihi-wait-times-2025", "note": "CIHI for the benchmark shares, the Canada Health Act for portability; the reading of the clause is marked inference" }, "text.how": { "tier": "tradition", "note": "the three routes out, hedged; the benchmark figures are cited" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "cuba", "type": "destination", "name": "Cuba", "as": "The source market that reaches Cuba without a licensing question.", "rel": "contrast" }, { "from": "united-states", "type": "destination", "name": "United States", "as": "The other big source market, and a neighbour whose patients arrive here paying cash.", "rel": "contrast" }, { "from": "waiting-lists", "type": "story", "name": "The queue is the product", "as": "Measures the same thing as a share inside a benchmark, which reads better until you take the complement.", "rel": "destination" } ] }, { "schema": 1, "id": "china", "type": "destination", "names": { "name": "China", "aliases": [ "中华人民共和国", "People's Republic of China", "PRC" ], "said": "China's cross-border story runs inside the country as much as across the border: a special zone on Hainan where drugs the mainland has not approved may be used, and patients who fly domestically to reach it." }, "region": [ "east-asia" ], "facets": { "iso2": "CN", "direction": "both", "currency": "CNY", "languages": [ "Mandarin", "English" ], "draws": [ "proton-therapy", "car-t" ] }, "text": { "what": "Two flows at once. Chinese patients are among the largest groups of foreign patients recorded in South Korea and Japan; inside China, a designated zone at Boao Lecheng on Hainan is allowed to use medicines and devices approved abroad but not yet registered on the mainland, which turns a regulatory gap into a destination.", "story": "The State Council's own account, published on 5 July 2025, reports that the Boao Lecheng International Medical Tourism Pilot Zone received \"over 410,000 medical visitors, up 36.76 percent year on year\" in 2024, drew 188,300 in the first part of 2025 \"from countries including Canada, Spain, Russia, Uzbekistan and Cuba\", holds \"over 30 top-tier domestic and international medical institutions\", and has used \"485 advanced medicines and medical devices approved overseas but not yet available in the domestic market\" to treat \"over 130,000 patients\".\n\n*Inference —* the release does not break the 410,000 down by country of residence, and the zone's founding purpose is to give Chinese patients access to therapies not yet registered in China. Most of those visitors are therefore very likely Chinese, travelling domestically. The figure is real and the framing is not: this is a count of people reaching a regulatory exception, not a count of foreigners flying to China for treatment.\n\nThe outbound side is documented by the receiving state. South Korea's health ministry recorded China as the second-largest source of its 1.17 million foreign patients in 2024, with arrivals from China up 132.4 per cent.\n\n*Trade practice —* what Chinese patients buy abroad clusters in dermatology, cosmetic surgery, screening and fertility, with oncology and cell therapy for those who can pay for them. What the state is building at Lecheng is the same list, onshore.", "how": "*Trade practice —* the Lecheng route runs through a hospital in the zone, which applies for permission to import the specific product for the specific patient. Prices are set by the institution and paid privately; the national insurance schemes do not cover the imported items. A foreign patient reaching a mainland hospital outside the zone deals with the hospital's own international department, and the language requirement is absolute.", "today": "The zone's 2024 figure is the most recent published in the source read for this record. No national count of foreign patients treated in China was read." }, "geo": { "lat": 31.2304, "lon": 121.4737, "precision": "city", "source": "s:osm" }, "metrics": { "inbound_patients_year": 410000, "note": "\"Over 410,000 medical visitors, up 36.76 percent year on year\" at the Boao Lecheng pilot zone on Hainan in 2024 — one designated zone, not the country, and not broken down by country of residence. The zone exists so that patients can reach drugs and devices registered abroad but not on the mainland, so the visitor is most likely a domestic traveller. This is not a count of foreigners treated in China; no such national count was read for this record.", "as_of": "2024", "source": "s:govcn-lecheng-2025", "url": "https://english.www.gov.cn/news/202507/05/content_WS6868ce92c6d0868f4e8f3dc5.html" }, "kin": [ { "to": "south-korea", "as": "The destination that recorded China as its second-largest source of foreign patients in 2024.", "rel": "contrast" }, { "to": "japan", "as": "The other short-haul destination Chinese patients travel to for screening and cell therapy.", "rel": "contrast" }, { "to": "car-t", "as": "Cell therapy pulled onshore through the Hainan exception.", "rel": "procedure" }, { "to": "proton-therapy", "as": "The expensive radiotherapy the zone was built to make reachable without a visa.", "rel": "procedure" }, { "to": "stem-cell-regulation", "as": "The rules that decide what a hospital in the zone may actually give a patient.", "rel": "governed-by" }, { "to": "circumvention", "as": "Travel to reach a treatment the law at home has not approved — here arranged by the state itself.", "rel": "story" }, { "to": "transplant-prohibition", "as": "The prohibition that shaped this country's reputation in cross-border care before any zone existed.", "rel": "governed-by" }, { "to": "istanbul-declaration-2008", "as": "The declaration written partly with this country's transplant practice in view.", "rel": "event" }, { "to": "counting-patients", "as": "How a zone's visitor count becomes a national destination claim.", "rel": "story" } ], "links": [ { "label": "Hainan emerges as China's medical travel zone — gov.cn, 5 July 2025", "url": "https://english.www.gov.cn/news/202507/05/content_WS6868ce92c6d0868f4e8f3dc5.html" } ], "sources": [ "s:govcn-lecheng-2025", "s:mohw-kr-foreign-patients-2024", "s:worldbank-open-data", "s:osm" ], "provenance": { "default": { "tier": "cited", "source": "s:govcn-lecheng-2025" }, "fields": { "text.story": { "tier": "cited", "source": "s:govcn-lecheng-2025", "note": "quotations from the State Council release; the Korean figures are cited to the Korean ministry; the reading is marked inference" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "Shanghai as the country point; the cross-border zone this record describes is at Boao Lecheng on Hainan" }, "metrics": { "tier": "cited", "source": "s:govcn-lecheng-2025" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "Two flows at once. Chinese patients are among the largest groups of foreign patients recorded in South Korea and Japan; inside China, a designated zone at Boao Lecheng on Hainan is allowed to use medicines and devices…", "region_terms": [ { "key": "east-asia", "name": "East Asia", "note": "South Korea, Japan, Taiwan, China" } ], "kin_out": [ { "to": "south-korea", "type": "destination", "name": "South Korea", "as": "The destination that recorded China as its second-largest source of foreign patients in 2024.", "rel": "contrast" }, { "to": "japan", "type": "destination", "name": "Japan", "as": "The other short-haul destination Chinese patients travel to for screening and cell therapy.", "rel": "contrast" }, { "to": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "Cell therapy pulled onshore through the Hainan exception.", "rel": "procedure" }, { "to": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "The expensive radiotherapy the zone was built to make reachable without a visa.", "rel": "procedure" }, { "to": "stem-cell-regulation", "type": "rule", "name": "Regulating cell and tissue therapies", "as": "The rules that decide what a hospital in the zone may actually give a patient.", "rel": "governed-by" }, { "to": "circumvention", "type": "story", "name": "Circumvention", "as": "Travel to reach a treatment the law at home has not approved — here arranged by the state itself.", "rel": "story" }, { "to": "transplant-prohibition", "type": "rule", "name": "Buying an organ, and being transplanted abroad", "as": "The prohibition that shaped this country's reputation in cross-border care before any zone existed.", "rel": "governed-by" }, { "to": "istanbul-declaration-2008", "type": "event", "name": "The Declaration of Istanbul, 2008", "as": "The declaration written partly with this country's transplant practice in view.", "rel": "event" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "How a zone's visitor count becomes a national destination claim.", "rel": "story" } ], "source_list": [ { "id": "s:govcn-lecheng-2025", "kind": "web", "title": "Hainan emerges as China's premier international medical tourism destination", "publisher": "Xinhua, on the State Council of the People's Republic of China website", "url": "https://english.www.gov.cn/news/202507/05/content_WS6868ce92c6d0868f4e8f3dc5.html", "accessed": "2026-09-16", "note": "dated 5 July 2025; figures for the Boao Lecheng International Medical Tourism Pilot Zone" }, { "id": "s:mohw-kr-foreign-patients-2024", "kind": "web", "title": "Korea Attracts 1.17 Million Foreign Patients in 2024", "publisher": "Ministry of Health and Welfare (Republic of Korea)", "url": "https://www.mohw.go.kr/board.es?mid=a20401000000&bid=0032&act=view&list_no=1485207", "accessed": "2026-09-16", "note": "press release of 3 April 2025; the annual foreign-patient statistics are compiled for the ministry by the Korea Health Industry Development Institute" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:govcn-lecheng-2025" }, "text.story": { "tier": "cited", "source": "s:govcn-lecheng-2025", "note": "quotations from the State Council release; the Korean figures are cited to the Korean ministry; the reading is marked inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited", "source": "s:govcn-lecheng-2025" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "Shanghai as the country point; the cross-border zone this record describes is at Boao Lecheng on Hainan" }, "metrics": { "tier": "cited", "source": "s:govcn-lecheng-2025" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [] }, { "schema": 1, "id": "colombia", "type": "destination", "names": { "name": "Colombia", "aliases": [ "República de Colombia", "Republic of Colombia" ], "said": "Two cities carry it. Medellín is the cosmetic surgery name; Bogotá is where the teaching hospitals and the complex cases are." }, "region": [ "south-america" ], "facets": { "iso2": "CO", "direction": "inbound", "currency": "COP", "languages": [ "Spanish", "English" ], "draws": [ "liposuction", "bbl", "breast-augmentation", "rhinoplasty", "abdominoplasty" ] }, "text": { "what": "The South American country whose surgeons report the highest share of foreign patients anywhere in the ISAPS survey. Cosmetic surgery is the trade — liposuction, buttock augmentation, breast and body work — concentrated in Medellín and Bogotá, sold mostly to the United States and to Colombians living abroad. The country also runs a large domestic insurance system that the visiting patient does not touch.", "story": "The number worth carrying here is a proportion, not a headcount. In the ISAPS survey of procedures performed in 2024, Colombian plastic surgeons reported a median 20.0% of their patients attending from other locations, and an average of 30.0% — against a worldwide median of 5.0% and average of 14.3%. The three origins Colombian surgeons named most often were the United States, Spain and Canada. Only Tunisia, at a median 45.0%, and the UAE, at 30.0%, report higher; Singapore ties it. It is a survey answer from surgeons about their own practices, extrapolated across an estimated surgeon population, and not a count of arrivals.\n\nThe volume behind that share is 490,944 aesthetic procedures in 2024, 321,408 of them surgical. Where they happen is unusual: 46.5% of Colombian cosmetic procedures were performed in a free-standing surgicentre, against 16.3% worldwide and 30.9% in a hospital. *Inference —* a free-standing centre is not by itself a worse place to be operated in, but it is a different place to have a complication in, because the intensive care unit is somewhere else and somebody has to decide to move you.\n\n*Trade practice —* the argument in Colombia is over who holds the knife: the specialist register on one side, the unlicensed operator on the other, and a professional society in between publishing a searchable list of its own members. A patient booking from abroad is buying at one remove from every one of those registers, and this record did not read the Colombian ones.", "how": "*Trade practice —* the Colombian trade runs through co-ordinators who bundle the operation, a recovery apartment or hotel, post-operative massage and drains, and a driver. Multiple procedures in one anaesthetic is the house style and the reason the quoted totals look low per item. Payment is a deposit by transfer and the balance in cash or card on arrival. Colombian law and Colombian professional registers govern the surgeon; a complication that appears three weeks later appears in another country's hospital.", "today": "As of the 2024 survey year Colombia's reported foreign-patient share leads the Americas and its procedure mix is body-led. No Colombian government arrival series is carried on this page: the ProColombia figures the trade press quotes were not read off a publisher's page for this record, and they are left out rather than repeated." }, "geo": { "lat": 4.711, "lon": -74.0721, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "490,944 aesthetic procedures in 2024, 321,408 surgical, and a reported median 20.0% / average 30.0% of patients attending from other locations. These are ISAPS survey extrapolations from 2,975 responding board-certified plastic surgeons across 32 locations, built on an estimated count of surgeons per country. They count aesthetic work by plastic surgeons and nothing else — no dentistry, no fertility, no orthopaedics, and no procedure done by anyone outside that specialty.", "as_of": "2024", "source": "s:isaps-global-survey-2024", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf" }, "kin": [ { "to": "medellin", "as": "The cosmetic surgery cluster, and the name the trade sells.", "rel": "part" }, { "to": "bogota", "as": "The capital cluster, where the teaching hospitals and complex cases sit.", "rel": "part" }, { "to": "clinica-las-americas", "as": "One of the Medellín institutions the trade routes patients to.", "rel": "part" }, { "to": "fundacion-santa-fe", "as": "The Bogotá hospital on the complex end of the same country.", "rel": "part" }, { "to": "bbl", "as": "The operation most argued over here, and the one with a published mortality literature.", "rel": "procedure" }, { "to": "liposuction", "as": "The volume operation behind the country's surgical count.", "rel": "procedure" }, { "to": "bbl-mortality", "as": "The risk attached to the operation this country is best known for.", "rel": "risk" }, { "to": "surgical-site-infection", "as": "What a free-standing surgicentre manages differently from a hospital.", "rel": "risk" }, { "to": "united-states", "as": "The origin Colombian surgeons name most often for their foreign patients.", "rel": "contrast" }, { "to": "isaps", "as": "The society whose survey supplies every number on this page.", "rel": "measured-by" } ], "links": [ { "label": "ISAPS survey of procedures performed in 2024", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf" } ], "sources": [ "s:isaps-global-survey-2024", "s:cdc-yellowbook-medical-tourism", "s:natural-earth" ], "provenance": { "default": { "tier": "cited", "source": "s:isaps-global-survey-2024" }, "fields": { "text.story": { "tier": "cited", "source": "s:isaps-global-survey-2024", "note": "the surgicentre reading and the society paragraph are marked inline as inference and trade practice" }, "text.how": { "tier": "tradition", "note": "the shape of a co-ordinated Colombian cosmetic trip, hedged in the prose" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Medellín skyline.jpg", "File:Bogotá skyline.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "The South American country whose surgeons report the highest share of foreign patients anywhere in the ISAPS survey.", "region_terms": [ { "key": "south-america", "name": "South America", "note": "Colombia, Brazil, Argentina, Chile, Peru" } ], "kin_out": [ { "to": "medellin", "type": "hub", "name": "Medellín", "as": "The cosmetic surgery cluster, and the name the trade sells.", "rel": "part" }, { "to": "bogota", "type": "hub", "name": "Bogotá", "as": "The capital cluster, where the teaching hospitals and complex cases sit.", "rel": "part" }, { "to": "clinica-las-americas", "type": "facility", "name": "Clínica Las Américas", "as": "One of the Medellín institutions the trade routes patients to.", "rel": "part" }, { "to": "fundacion-santa-fe", "type": "facility", "name": "Fundación Santa Fe de Bogotá", "as": "The Bogotá hospital on the complex end of the same country.", "rel": "part" }, { "to": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "The operation most argued over here, and the one with a published mortality literature.", "rel": "procedure" }, { "to": "liposuction", "type": "procedure", "name": "Liposuction", "as": "The volume operation behind the country's surgical count.", "rel": "procedure" }, { "to": "bbl-mortality", "type": "risk", "name": "Death from gluteal fat grafting", "as": "The risk attached to the operation this country is best known for.", "rel": "risk" }, { "to": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "What a free-standing surgicentre manages differently from a hospital.", "rel": "risk" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The origin Colombian surgeons name most often for their foreign patients.", "rel": "contrast" }, { "to": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "The society whose survey supplies every number on this page.", "rel": "measured-by" } ], "source_list": [ { "id": "s:isaps-global-survey-2024", "kind": "report", "title": "ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2024", "publisher": "International Society of Aesthetic Plastic Surgery, tabulated by Industry Insights Inc.", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:isaps-global-survey-2024" }, "text.story": { "tier": "cited", "source": "s:isaps-global-survey-2024", "note": "the surgicentre reading and the society paragraph are marked inline as inference and trade practice" }, "text.how": { "tier": "tradition", "note": "the shape of a co-ordinated Colombian cosmetic trip, hedged in the prose" }, "text.today": { "tier": "cited", "source": "s:isaps-global-survey-2024" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:isaps-global-survey-2024" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "brazil", "type": "destination", "name": "Brazil", "as": "The regional contrast: a fifth of the volume, four times the foreign share, and the operations done in surgicentres rather than hospitals.", "rel": "contrast" }, { "from": "panama", "type": "destination", "name": "Panama", "as": "The regional heavyweight, and one of the three origins Panamanian surgeons name.", "rel": "contrast" }, { "from": "bogota", "type": "hub", "name": "Bogotá", "as": "The country whose complex hospital work concentrates here rather than in Medellín.", "rel": "destination" }, { "from": "medellin", "type": "hub", "name": "Medellín", "as": "The country whose cosmetic surgery trade is concentrated here.", "rel": "destination" }, { "from": "clinica-las-americas", "type": "facility", "name": "Clínica Las Américas", "as": "The Medellín route into Colombian private medicine, run through an international office that starts with the visa.", "rel": "destination" }, { "from": "fundacion-santa-fe", "type": "facility", "name": "Fundación Santa Fe de Bogotá", "as": "The country's first JCI-accredited organisation, and the one that sells complexity rather than a price.", "rel": "destination" }, { "from": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "Where its respondents reported the highest share of patients attending from other locations, a median of 20 per cent.", "rel": "place" } ] }, { "schema": 1, "id": "costa-rica", "type": "destination", "names": { "name": "Costa Rica", "aliases": [ "República de Costa Rica", "Republic of Costa Rica" ], "said": "The trade says Costa Rica and means San José: two private hospitals, a ring of dental and cosmetic clinics in Escazú and Santa Ana, and a recovery week somewhere with a view." }, "region": [ "central-america" ], "facets": { "iso2": "CR", "direction": "inbound", "currency": "CRC", "languages": [ "Spanish", "English" ], "draws": [ "dental-implant", "all-on-four", "full-mouth-restoration", "abdominoplasty" ] }, "text": { "what": "The Central American destination that organised itself earliest. Dentistry and cosmetic surgery are the volume trades, sold to North Americans on a two-to-three-hour flight from Houston or Miami, and the country's private hospitals in San José take the complex work. Costa Rica also runs a universal public system, the Caja, which the visiting patient does not enter and is not counted by.", "story": "The organising body is PROMED, the Consejo para la Promoción Internacional de la Medicina de Costa Rica — a national council that certifies and lists providers for international patients, and the only Latin American body of its kind on this site's recognizer list. *Inference —* a council that certifies its own members is a trade association with an inspection attached, and the certificate says a provider paid for and passed that inspection, not that the outcome of an operation there is better. On 16 September 2026 the promedcostarica.org address answered with a redirect to the Cámara Costarricense de la Salud, a health-sector chamber in San José; whether the council has been folded into the chamber or has only moved its web address is not something this record could establish, and the PROMED entry is flagged for verification because of it.\n\nThe hospital side is older than the trade. Hospital Clínica Bíblica in San José describes itself as \"Costa Rica's longest-running private hospital\", at \"96 years\", and carries accreditation by Joint Commission International — a US-derived hospital standard, run on a three-year cycle, which the applicant pays for.\n\n*Trade practice —* dentistry is the reason most patients come, and dentistry is the part with the least public data anywhere. A country can have a certifying council, a JCI-accredited hospital and no register at all of who fitted an implant in a shopfront in Escazú.", "how": "*Trade practice —* the usual Costa Rican arrangement is the co-ordinator: a clinic or a facilitator quotes the treatment, the airport transfer and the recovery hotel as one line, and books the consultation for the morning after landing. Long dental courses are staged across two trips with a temporary fitted in between, which is why the flight cost appears twice in the real total and once in the quoted one. Payment is a deposit to hold the surgical date and the balance on arrival; North American dental insurance rarely pays any of it.", "today": "As of September 2026 this record carries no national count of foreign patients: the Costa Rican figure most often quoted in the trade press comes from market summaries whose method this project could not read, and it is left out rather than repeated. What is carried is narrower — the accreditation Clínica Bíblica states, and PROMED's own role as the certifying council." }, "geo": { "lat": 9.9281, "lon": -84.0907, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "No inbound patient count is carried. Costa Rica's volume trade is dentistry, which no national register counts; the country does not publish a medical-travel arrival series this project could read.", "as_of": "2026-09-16", "source": "s:camara-costarricense-salud" }, "kin": [ { "to": "san-jose-cr", "as": "The city that is nearly all of it.", "rel": "part" }, { "to": "promed", "as": "The national council that certifies providers here, and the reason this country organised before its neighbours.", "rel": "org" }, { "to": "clinica-biblica", "as": "The San José private hospital that carries the JCI mark and the longest history.", "rel": "part" }, { "to": "hospital-cima-san-jose", "as": "The other San José hospital the trade routes complex work to.", "rel": "part" }, { "to": "dental-implant", "as": "The item that brings most patients here.", "rel": "procedure" }, { "to": "all-on-four", "as": "The full-arch course sold across two trips, with the second flight in the total.", "rel": "procedure" }, { "to": "united-states", "as": "The source market, two to three hours away by air.", "rel": "contrast" }, { "to": "panama", "as": "The neighbour selling the same mix to the same market, with a smaller surgeon base.", "rel": "contrast" }, { "to": "jci", "as": "The accreditor whose mark the San José hospitals hold.", "rel": "accredited-by" } ], "links": [ { "label": "Hospital Clínica Bíblica", "url": "https://www.clinicabiblica.com/en/" }, { "label": "Cámara Costarricense de la Salud", "url": "https://salud.co.cr/" } ], "sources": [ "s:clinica-biblica", "s:camara-costarricense-salud", "s:cdc-yellowbook-medical-tourism", "s:natural-earth" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "the redirect was read on 16 September 2026; the reading of what it means is marked as inference and flagged for verification" }, "text.how": { "tier": "tradition", "note": "the shape of a co-ordinated Costa Rican trip, hedged in the prose" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:San José Costa Rica skyline.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "The Central American destination that organised itself earliest.", "region_terms": [ { "key": "central-america", "name": "Central America", "note": "Costa Rica, Panama, Guatemala, Belize" } ], "kin_out": [ { "to": "san-jose-cr", "type": "hub", "name": "San José, Costa Rica", "as": "The city that is nearly all of it.", "rel": "part" }, { "to": "promed", "type": "org", "name": "PROMED", "as": "The national council that certifies providers here, and the reason this country organised before its neighbours.", "rel": "org" }, { "to": "clinica-biblica", "type": "facility", "name": "Hospital Clínica Bíblica", "as": "The San José private hospital that carries the JCI mark and the longest history.", "rel": "part" }, { "to": "hospital-cima-san-jose", "type": "facility", "name": "Hospital CIMA San José", "as": "The other San José hospital the trade routes complex work to.", "rel": "part" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The item that brings most patients here.", "rel": "procedure" }, { "to": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "The full-arch course sold across two trips, with the second flight in the total.", "rel": "procedure" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The source market, two to three hours away by air.", "rel": "contrast" }, { "to": "panama", "type": "destination", "name": "Panama", "as": "The neighbour selling the same mix to the same market, with a smaller surgeon base.", "rel": "contrast" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The accreditor whose mark the San José hospitals hold.", "rel": "accredited-by" } ], "source_list": [ { "id": "s:clinica-biblica", "kind": "web", "title": "Hospital Clínica Bíblica", "publisher": "Hospital Clínica Bíblica, San José, Costa Rica", "url": "https://www.clinicabiblica.com/en/", "accessed": "2026-09-16" }, { "id": "s:camara-costarricense-salud", "kind": "web", "title": "Cámara Costarricense de la Salud", "publisher": "Cámara Costarricense de la Salud, San José", "url": "https://salud.co.cr/", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "the redirect was read on 16 September 2026; the reading of what it means is marked as inference and flagged for verification" }, "text.how": { "tier": "tradition", "note": "the shape of a co-ordinated Costa Rican trip, hedged in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "canada", "type": "destination", "name": "Canada", "as": "The winter destination that sells dentistry and surgery to the same travellers.", "rel": "destination" }, { "from": "panama", "type": "destination", "name": "Panama", "as": "The neighbour with the same mix, a certifying council and more surgeons.", "rel": "contrast" }, { "from": "san-jose-cr", "type": "hub", "name": "San José, Costa Rica", "as": "The country this cluster is, for practical purposes, the whole of.", "rel": "destination" }, { "from": "clinica-biblica", "type": "facility", "name": "Hospital Clínica Bíblica", "as": "The country's largest private hospital, and the institution most often meant when Costa Rica is named as a destination.", "rel": "destination" }, { "from": "hospital-cima-san-jose", "type": "facility", "name": "Hospital CIMA San José", "as": "An American-built hospital on Costa Rican soil, which is what the country's route to North American patients largely is.", "rel": "destination" }, { "from": "promed", "type": "org", "name": "PROMED", "as": "The destination this council exists to promote.", "rel": "place" } ] }, { "schema": 1, "id": "croatia", "type": "destination", "names": { "name": "Croatia", "aliases": [ "Hrvatska", "Republika Hrvatska" ], "said": "In the trade Croatia means Istria and Rijeka for teeth — an hour or two from Trieste, Ljubljana or Graz — and Zagreb for everything else." }, "region": [ "europe-central" ], "facets": { "iso2": "HR", "direction": "both", "currency": "EUR", "languages": [ "Croatian", "Italian", "German", "English" ], "draws": [ "dental-implant", "dental-crown", "all-on-four", "veneers" ] }, "text": { "what": "A border dental trade with a coastline attached. Croatian practices in Istria and around Rijeka are within a short drive of northern Italy, Slovenia and Austria, and they price and advertise for those markets; the treatment is itemised dental work paid privately, and the holiday is the reason the second week of the trip is bookable at all.", "story": "Croatia joined the EU in 2013 and the euro in 2023, and the Commission's cross-border data catches the changeover: for reference year 2022 Croatia reported all its financial figures in kuna, converted at 7.5345 to the euro. In that year it received 192 requests for reimbursement of care not subject to prior authorisation and granted 123 — 64%, one of the lower grant rates reported — and it told the Commission that its average handling time for a reimbursement request, 19 working days, sits inside a 60-day legal limit.\n\n*Trade practice —* the dental corridor itself predates all of that. Italian patients crossed for cheaper crowns and implants before either country shared a currency, and the practices that grew on that traffic now publish price lists in euro with Italian and German pages. Croatian cross-border dentistry has not been measured in the way Hungary's was surveyed twice; this record carries no patient count because none was found.\n\n*Inference —* an inbound trade that runs on day trips and short drives is the hardest kind to count. Nobody registers as a visiting patient at a border a car crosses without stopping.", "how": "Itemised dental pricing, implant work split across two visits, and clinic-side help with accommodation rather than a bundled package. Guarantees are written by the practice and usually require the patient to come back to it, which is a shorter drive from Trieste than from Manchester.", "today": "The measurable facts about Croatian cross-border care in 2026 remain the reimbursement ones: 192 requests in 2022, 123 granted. The dental trade sits outside them, privately paid and uncounted." }, "geo": { "lat": 45.815, "lon": 15.9819, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "192 requests for reimbursement of care not subject to prior authorisation in 2022, 123 granted; 3 requests for care subject to prior authorisation, 1 authorised. These count Croatian patients treated abroad. No official count of patients travelling into Croatia was found on this pass.", "as_of": "2022", "source": "s:ec-crossborder-2022" }, "kin": [ { "to": "dental-implant", "as": "The item the Istrian practices are built on.", "rel": "procedure" }, { "to": "all-on-four", "as": "The full-arch case that makes a two-visit trip worth the drive.", "rel": "procedure" }, { "to": "hungary", "as": "The older, larger dental corridor selling to overlapping markets.", "rel": "contrast" }, { "to": "romania", "as": "The other newer EU dental destination, with a different set of neighbours.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "as": "The reimbursement route whose figures are the only official measure of this traffic.", "rel": "governed-by" }, { "to": "counting-patients", "as": "Why a trade crossing a land border by car leaves almost no countable trace.", "rel": "story" } ], "sources": [ "s:ec-crossborder-2022", "s:eu-directive-2011-24", "s:natural-earth" ], "provenance": { "default": { "tier": "cited", "source": "s:ec-crossborder-2022" }, "fields": { "text.what": { "tier": "tradition" }, "text.story": { "tier": "cited", "source": "s:ec-crossborder-2022", "note": "the first paragraph is cited; the second is marked trade practice and the third inference" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Rovinj old town Croatia.jpg" ], "needs_verification": true, "confidence": "low", "updated": "2026-09-16", "blurb": "A border dental trade with a coastline attached. Croatian practices in Istria and around Rijeka are within a short drive of northern Italy, Slovenia and Austria, and they price and advertise for those markets; the…", "region_terms": [ { "key": "europe-central", "name": "Central Europe", "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia" } ], "kin_out": [ { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The item the Istrian practices are built on.", "rel": "procedure" }, { "to": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "The full-arch case that makes a two-visit trip worth the drive.", "rel": "procedure" }, { "to": "hungary", "type": "destination", "name": "Hungary", "as": "The older, larger dental corridor selling to overlapping markets.", "rel": "contrast" }, { "to": "romania", "type": "destination", "name": "Romania", "as": "The other newer EU dental destination, with a different set of neighbours.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The reimbursement route whose figures are the only official measure of this traffic.", "rel": "governed-by" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a trade crossing a land border by car leaves almost no countable trace.", "rel": "story" } ], "source_list": [ { "id": "s:ec-crossborder-2022", "kind": "report", "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU — reference year 2022", "publisher": "European Commission, DG Health and Food Safety, Unit B.3; written by PredictBy Research and Consulting and Baltic Media; Publications Office of the European Union", "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf", "license": "CC BY 4.0", "accessed": "2026-09-16", "note": "final version January 2024, ISBN 978-92-68-14858-7. 23 countries reported 547,890 reimbursement requests for care not needing prior authorisation in 2022, of which France 300,254 and Germany 160,647 are 84%; Poland 14,176, Slovakia 13,904, Ireland 1,841, Romania 889, Czechia 440, Croatia 192, Lithuania 131, Greece 56, Cyprus 44, Portugal 27 (all refused), Spain 9. Total reimbursed EUR 86,462,491. For care needing prior authorisation, 4,552 requests and EUR 7,708,041. Belgium and Hungary could not report; Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway run no prior-authorisation system; only Denmark and Romania have a mechanism to limit inflow." }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "tradition" }, "text.story": { "tier": "cited", "source": "s:ec-crossborder-2022", "note": "the first paragraph is cited; the second is marked trade practice and the third inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited", "source": "s:ec-crossborder-2022" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:ec-crossborder-2022" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "romania", "type": "destination", "name": "Romania", "as": "The other newer EU dental destination, working a different border.", "rel": "contrast" } ] }, { "schema": 1, "id": "cuba", "type": "destination", "names": { "name": "Cuba", "aliases": [ "República de Cuba", "Republic of Cuba" ], "said": "Servicios Médicos Cubanos. One state company sells the care, and one foreign government's rules decide which Americans may buy it." }, "region": [ "caribbean" ], "facets": { "iso2": "CU", "direction": "inbound", "currency": "CUP", "languages": [ "Spanish", "English" ], "draws": [ "addiction-rehab", "cataract-surgery", "executive-health-screening" ] }, "text": { "what": "The one destination in this directory where the seller is the state. Cuba markets treatment to foreigners through a single government commercial entity, Servicios Médicos Cubanos, which lists medical assistance, teaching and academic services, wellness care, pharmacy and optical services, border medical services and medical services provided abroad. Cuba also sends doctors overseas under government contracts, which makes it an exporter of clinicians as well as a destination for patients. And it is the only destination here whose largest neighbouring source market is restricted by that neighbour's own law.", "story": "The commercial arrangement is unusual and plainly stated: a foreign patient buys from a company, the company is the government's, and the hospitals are the public system's. There is no private hospital sector to compare, no competing price list, and no independent register of outcomes to read.\n\nThe American side is a body of sanctions law rather than a health rule. Under the Cuban Assets Control Regulations, 31 C.F.R. § 515.560, travel-related transactions by persons subject to US jurisdiction are authorised for twelve categories of activity — family visits, official business, journalistic activity, professional research and professional meetings, educational activities, religious activities, public performances and competitions, support for the Cuban people, humanitarian projects, activities of private foundations or research or educational institutes, the exportation or transmission of information or informational materials, and certain authorised export transactions. Travelling to be treated is not among the twelve. The section authorises insurance services for authorised travellers and \"the receipt of emergency medical services and the making of payments related thereto\", and states that \"Nothing in this section authorizes transactions in connection with tourist travel to Cuba.\"\n\n*Inference —* those two facts together define the market. A Canadian, a Spaniard or a Latin American patient deals with an ordinary state seller; an American faces a licensing question before a clinical one, and the emergency provision covers the traveller who falls ill, not the traveller who came to be operated on. Nothing here is legal advice, and the categories move with US administrations: the reading above is of the section as published, on the date in this record.\n\n*Trade practice —* the treatments Cuba has long been known for abroad — eye surgery, neurological rehabilitation, addiction programmes, skin conditions — are courses of weeks rather than single operations, which fits a state seller quoting a stay rather than a procedure. This record carries no patient count: the figures quoted for Cuba in the general literature are old, undated in their retelling, and were not read off a publisher's page for this entry.", "how": "*Trade practice —* the booking runs through the state company or an agency acting for it rather than through a hospital's own international office: a written quotation covering treatment, accommodation and transfers, paid in advance in foreign currency. Foreign patients are treated in designated facilities rather than alongside the domestic queue. For a US-connected traveller the prior question is the licence, and payment routes through American banks are themselves restricted by the same regulations.", "today": "As of 16 September 2026, 31 C.F.R. § 515.560 as published lists twelve categories of authorised travel, none of which is treatment, and states that nothing in it authorises transactions connected with travel to Cuba as a holiday. Servicios Médicos Cubanos continues to publish its service catalogue in English, French, Russian and Spanish." }, "geo": { "lat": 23.1136, "lon": -82.3666, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "No patient count is carried. Cuba's medical-travel figures in general circulation are undated in their retelling and were not read off a publisher's page for this record; the state seller publishes a service catalogue rather than a count.", "as_of": "2026-09-16", "source": "s:smc-cuba" }, "kin": [ { "to": "havana", "as": "Where the designated facilities and the state seller sit.", "rel": "part" }, { "to": "united-states", "as": "The neighbouring source market whose own regulations decide who may come.", "rel": "contrast" }, { "to": "canada", "as": "The source market that reaches Cuba without a licensing question.", "rel": "contrast" }, { "to": "dominican-republic", "as": "The Caribbean contrast: private clinics, a US patient base, and an outbreak record.", "rel": "contrast" }, { "to": "addiction-rehab", "as": "A course of weeks, which is the shape of what the state seller quotes.", "rel": "procedure" }, { "to": "circumvention-travel", "as": "The word for travelling because a rule at home forbids it — here the rule points the other way, at entry rather than at treatment.", "rel": "term" }, { "to": "insurance-exclusions", "as": "What no foreign insurer will settle here, and why payment is in advance.", "rel": "governed-by" } ], "links": [ { "label": "Servicios Médicos Cubanos", "url": "http://www.smcsalud.cu/en/" }, { "label": "31 CFR § 515.560", "url": "https://www.law.cornell.edu/cfr/text/31/515.560" } ], "sources": [ "s:smc-cuba", "s:cfr-31-515-560", "s:natural-earth" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:cfr-31-515-560", "note": "the twelve categories and the quoted sentences are read off the published section; the reading of what they mean for a patient is marked inference" }, "text.how": { "tier": "tradition", "note": "the booking shape, hedged in the prose" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Havana skyline.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "The one destination in this directory where the seller is the state.", "region_terms": [ { "key": "caribbean", "name": "The Caribbean", "note": "the Dominican Republic, Cuba, Barbados, the Caymans" } ], "kin_out": [ { "to": "havana", "type": "hub", "name": "Havana", "as": "Where the designated facilities and the state seller sit.", "rel": "part" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The neighbouring source market whose own regulations decide who may come.", "rel": "contrast" }, { "to": "canada", "type": "destination", "name": "Canada", "as": "The source market that reaches Cuba without a licensing question.", "rel": "contrast" }, { "to": "dominican-republic", "type": "destination", "name": "Dominican Republic", "as": "The Caribbean contrast: private clinics, a US patient base, and an outbreak record.", "rel": "contrast" }, { "to": "addiction-rehab", "type": "procedure", "name": "Residential addiction treatment", "as": "A course of weeks, which is the shape of what the state seller quotes.", "rel": "procedure" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The word for travelling because a rule at home forbids it — here the rule points the other way, at entry rather than at treatment.", "rel": "term" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "What no foreign insurer will settle here, and why payment is in advance.", "rel": "governed-by" } ], "source_list": [ { "id": "s:smc-cuba", "kind": "web", "title": "Servicios Médicos Cubanos", "publisher": "Comercializadora de Servicios Médicos Cubanos, Havana", "url": "http://www.smcsalud.cu/en/", "accessed": "2026-09-16" }, { "id": "s:cfr-31-515-560", "kind": "regulation", "title": "31 CFR § 515.560 — Travel-related transactions to, from, and within Cuba by persons subject to U.S. jurisdiction", "publisher": "Cuban Assets Control Regulations, via Legal Information Institute, Cornell Law School", "url": "https://www.law.cornell.edu/cfr/text/31/515.560", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:cfr-31-515-560", "note": "the twelve categories and the quoted sentences are read off the published section; the reading of what they mean for a patient is marked inference" }, "text.how": { "tier": "tradition", "note": "the booking shape, hedged in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "havana", "type": "hub", "name": "Havana", "as": "The country whose entire health sector is the state, and whose export trade in care runs through one company.", "rel": "destination" } ] }, { "schema": 1, "id": "cyprus", "type": "destination", "names": { "name": "Cyprus", "aliases": [ "Κύπρος", "Kıbrıs", "Republic of Cyprus", "Κυπριακή Δημοκρατία" ], "said": "In the fertility trade Cyprus means two answers to the same question, twenty minutes apart. This record is the southern one: the Republic, the EU member, the licensing council." }, "region": [ "europe-south" ], "facets": { "iso2": "CY", "direction": "both", "currency": "EUR", "languages": [ "Greek", "English", "Turkish" ], "draws": [ "ivf", "egg-donation", "icsi", "pgt" ] }, "text": { "what": "An EU island whose fertility clinics work under a single national statute and a council that licenses them. The Republic of Cyprus runs medically assisted reproduction under the Law of 2015, 69(I)/2015, amended four times since, and a Council of Medically Assisted Reproduction that publishes the framework. The island's other jurisdiction, across the line, writes its own rules — which is the whole reason patients compare the two.", "story": "The statute is recent and it has moved: 69(I)/2015 and then 194(I)/2015, 92(I)/2016, 113(I)/2018 and 166(I)/2023. A fertility law amended four times in eight years is a fertility law under pressure, and in a jurisdiction that treats foreign patients the pressure is partly external — every amendment changes who may be treated here rather than somewhere else.\n\nThe Republic is also one of the few EU countries that has taken a prior-authorisation system away rather than adding one: the Commission's data records Cyprus removing its regime, and for 2022 it lists Cyprus receiving 44 reimbursement requests for care not subject to prior authorisation and granting 43. That is the whole official cross-border traffic of the country, in both directions, for a year.\n\n*Inference —* the gap between 44 reimbursement claims and a clinic sector that advertises across Europe is the same gap that appears in every record in this batch. The Directive counts refunds. Fertility patients pay privately, so they are not in the table at all.", "how": "Treatment is provided by units licensed under the 2015 law, and the Council of Medically Assisted Reproduction is the body that publishes the framework they work to. Clinics quote programmes in euro with medication outside; patients fly in for retrieval or transfer. A patient comparing the island's two sides is comparing two legal systems, not two price lists, and the tell is which authority licenses the clinic.", "today": "The law in force in the Republic, as this record was written, is 69(I)/2015 as amended, most recently by 166(I)/2023. Nothing here describes the rules across the line; that is the north's own record." }, "geo": { "lat": 35.1856, "lon": 33.3823, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "44 requests for reimbursement of care not subject to prior authorisation in 2022, 43 granted. Cyprus runs no prior-authorisation system, having removed it. No count of inbound fertility patients is published by the Republic that this project could read.", "as_of": "2022", "source": "s:ec-crossborder-2022" }, "legality": [ { "country": "CY", "status": "lawful-with-conditions", "conditions": "Medically assisted reproduction is regulated by statute and practised through units working under the framework the Council of Medically Assisted Reproduction publishes; the terms have been amended four times since 2015.", "instrument": "Medically Assisted Reproduction Law 69(I)/2015, as amended by 194(I)/2015, 92(I)/2016, 113(I)/2018 and 166(I)/2023", "as_of": "2026-09-16", "source": "s:cmar-cyprus", "url": "https://cmar.org.cy/en/law_eng/", "note": "the Council's own legal-framework page names the law and its amendments. This row records that the statute governs and is current; the detailed conditions inside it are for the donor-anonymity and surrogacy rule records, each with its own reading and date." } ], "kin": [ { "to": "north-cyprus", "as": "The other half of the island and the other answer: same twenty-minute drive, different fertility law.", "rel": "contrast" }, { "to": "nicosia", "as": "The capital the two jurisdictions share, and the line runs through it.", "rel": "part" }, { "to": "ivf", "as": "The treatment its licensed units are built around.", "rel": "procedure" }, { "to": "egg-donation", "as": "The programme patients compare across the island's line.", "rel": "procedure" }, { "to": "donor-anonymity-law", "as": "The rule whose terms decide which side of the line a patient books.", "rel": "governed-by" }, { "to": "greece", "as": "The nearest comparable destination, with a court rather than a council at the centre.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "as": "The route it applies with no prior-authorisation regime at all.", "rel": "governed-by" }, { "to": "circumvention", "as": "What a border twenty minutes wide does to a fertility law.", "rel": "story" } ], "links": [ { "label": "Council of Medically Assisted Reproduction — legal framework", "url": "https://cmar.org.cy/en/law_eng/" } ], "sources": [ "s:cmar-cyprus", "s:ec-crossborder-2022", "s:eu-directive-2011-24", "s:natural-earth" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:cmar-cyprus", "note": "the statute and amendment chain come from the Council's own page and the cross-border figures from the Commission; the closing paragraph is marked inference" }, "text.how": { "tier": "tradition", "note": "the licensing point is cited; the programme shape is the trade's" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Nicosia Ledra Street crossing.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "An EU island whose fertility clinics work under a single national statute and a council that licenses them.", "region_terms": [ { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" } ], "kin_out": [ { "to": "north-cyprus", "type": "destination", "name": "Northern Cyprus", "as": "The other half of the island and the other answer: same twenty-minute drive, different fertility law.", "rel": "contrast" }, { "to": "nicosia", "type": "hub", "name": "Nicosia", "as": "The capital the two jurisdictions share, and the line runs through it.", "rel": "part" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment its licensed units are built around.", "rel": "procedure" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The programme patients compare across the island's line.", "rel": "procedure" }, { "to": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The rule whose terms decide which side of the line a patient books.", "rel": "governed-by" }, { "to": "greece", "type": "destination", "name": "Greece", "as": "The nearest comparable destination, with a court rather than a council at the centre.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route it applies with no prior-authorisation regime at all.", "rel": "governed-by" }, { "to": "circumvention", "type": "story", "name": "Circumvention", "as": "What a border twenty minutes wide does to a fertility law.", "rel": "story" } ], "source_list": [ { "id": "s:cmar-cyprus", "kind": "org", "title": "Legal Framework — Council of Medically Assisted Reproduction", "publisher": "Council of Medically Assisted Reproduction, Republic of Cyprus", "url": "https://cmar.org.cy/en/law_eng/", "accessed": "2026-09-16", "note": "names the Medically Assisted Reproduction Law 2015, 69(I)/2015, and its amendments 194(I)/2015, 92(I)/2016, 113(I)/2018 and 166(I)/2023" }, { "id": "s:ec-crossborder-2022", "kind": "report", "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU — reference year 2022", "publisher": "European Commission, DG Health and Food Safety, Unit B.3; written by PredictBy Research and Consulting and Baltic Media; Publications Office of the European Union", "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf", "license": "CC BY 4.0", "accessed": "2026-09-16", "note": "final version January 2024, ISBN 978-92-68-14858-7. 23 countries reported 547,890 reimbursement requests for care not needing prior authorisation in 2022, of which France 300,254 and Germany 160,647 are 84%; Poland 14,176, Slovakia 13,904, Ireland 1,841, Romania 889, Czechia 440, Croatia 192, Lithuania 131, Greece 56, Cyprus 44, Portugal 27 (all refused), Spain 9. Total reimbursed EUR 86,462,491. For care needing prior authorisation, 4,552 requests and EUR 7,708,041. Belgium and Hungary could not report; Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway run no prior-authorisation system; only Denmark and Romania have a mechanism to limit inflow." }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:cmar-cyprus", "note": "the statute and amendment chain come from the Council's own page and the cross-border figures from the Commission; the closing paragraph is marked inference" }, "text.how": { "tier": "tradition", "note": "the licensing point is cited; the programme shape is the trade's" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "legality": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "greece", "type": "destination", "name": "Greece", "as": "The other Eastern Mediterranean fertility destination, with its own licensing council.", "rel": "contrast" }, { "from": "north-cyprus", "type": "destination", "name": "Northern Cyprus", "as": "The same island under the other law, and the comparison that makes both markets.", "rel": "contrast" }, { "from": "nicosia", "type": "hub", "name": "Nicosia", "as": "The state whose capital the southern half is, and whose 2015 statute governs treatment there.", "rel": "whole" } ] }, { "schema": 1, "id": "czechia", "type": "destination", "names": { "name": "Czechia", "aliases": [ "Czech Republic", "Česko", "Česká republika" ], "said": "In the fertility trade Czechia means Prague and Brno, and it means donated eggs. In the border trade it means the Slovak, Polish and German patients who drive in for dentistry and surgery and drive home the same day." }, "region": [ "europe-central" ], "facets": { "iso2": "CZ", "direction": "both", "currency": "CZK", "languages": [ "Czech", "English", "German", "Italian" ], "draws": [ "ivf", "egg-donation", "icsi", "pgt", "dental-implant" ] }, "text": { "what": "Europe's second workshop for donor-egg treatment, and a border country whose clinics are the destination for more authorised cross-border patients than anywhere else in the EU. Czech fertility clinics publish euro price lists, run waiting times for donated eggs measured in weeks rather than years, and draw patients from Germany, Italy, Britain and the Nordic countries. The country runs no prior-authorisation system of its own for care abroad.", "story": "In the ESHRE registry returns for 2019 the highest egg-donation volumes in Europe came from Spain, Czechia and Russia — registry counts of cycles reported by clinics, not a market estimate. The older ESHRE taskforce survey put numbers on who was in the waiting rooms: of 1,230 cross-border patients surveyed across six receiving countries in a single month in 2010, 20.5% were being treated in Czechia, and legal reasons at home dominated the answers of German patients at 80.2% and Italian patients at 70.6%.\n\nThe Commission's 2022 data shows the other half of the country's position. Czechia authorised no prior-authorisation regime at all — it is one of eight countries with none — received 440 reimbursement requests from its own insured and granted 380, and was the single most common country of treatment in the EU for authorised cross-border patients, with 513, most of them from Slovakia.\n\n*Trade practice —* what draws the fertility patient is anonymity and supply. Donation is anonymous on both sides in Czech practice, the donor pool is young, and the waiting time is short; this project did not read the Czech statute for this record and does not state its terms here. The distinction matters because the same patient would be turned away, or put on a years-long list, in the country she flew from.", "how": "Fertility clinics quote a programme rather than an operation: stimulation and laboratory work as one line, with medication, genetic testing and storage outside it. Donor programmes are sold with a guarantee attached to a number of embryos or attempts, which is a commercial term and not a clinical one. Payment is in euro, up front, and the treatment is timed to two short visits so that the patient can fly in for retrieval or transfer and fly home.", "today": "As of 16 September 2026 a Prague clinic lists IVF with the patient's own eggs from EUR 3,000 including basic laboratory methods, a guaranteed donor-egg programme from EUR 5,950, a frozen embryo transfer from EUR 990 and egg freezing for non-medical reasons from EUR 1,990, the last excluding medication and including two years of storage. Every one of those is a starting price: what the cycle costs depends on what the laboratory is asked to do." }, "geo": { "lat": 50.0755, "lon": 14.4378, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "513 authorised cross-border patients were treated in Czechia in 2022, the highest of any country of treatment in the EU that year, most of them Slovak. That counts only patients whose home system authorised the trip in advance; the fertility trade this country is known for sits almost entirely outside it, paid privately.", "as_of": "2022", "source": "s:ec-crossborder-2022" }, "prices": [ { "procedure": "ivf", "country": "CZ", "city": "Prague", "amount": 3000, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "the cycle with the patient's own eggs", "basic laboratory methods" ], "excludes": [ "medication", "genetic testing", "storage", "travel" ], "source": "s:pronatal-prices", "url": "https://www.pronatal.cz/en/price-list/", "note": "PRONATAL, Prague, stated as a starting price. Medication is the line most often left out of a fertility comparison and can run to four figures on its own.", "tier": "cited", "usd": 3461.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "egg-donation", "country": "CZ", "city": "Prague", "amount": 5950, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "donor egg programme with guarantee", "basic laboratory methods" ], "excludes": [ "medication", "genetic testing", "storage", "travel" ], "source": "s:pronatal-prices", "url": "https://www.pronatal.cz/en/price-list/", "note": "the guarantee is a commercial term set out by the clinic, not a clinical prediction; what it promises is defined on the clinic's own page.", "tier": "cited", "usd": 6865.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "egg-freezing", "country": "CZ", "city": "Prague", "amount": 1990, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "retrieval and vitrification", "two years of storage" ], "excludes": [ "medication", "storage beyond two years", "any later thaw and transfer" ], "source": "s:pronatal-prices", "url": "https://www.pronatal.cz/en/price-list/", "note": "the two-year storage window is the term that sets the next bill; the thaw and transfer are priced separately, from EUR 990 on the same list.", "tier": "cited", "usd": 2296.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "prague", "as": "Where most of the clinics and the euro price lists are.", "rel": "part" }, { "to": "egg-donation", "as": "The treatment this country is known for across Europe.", "rel": "procedure" }, { "to": "ivf", "as": "Sold here as a programme in euro, priced from a published list.", "rel": "procedure" }, { "to": "donor-anonymity-law", "as": "The rule that decides whether a patient must travel for a donor at all.", "rel": "governed-by" }, { "to": "spain", "as": "The larger donor-egg destination it is measured against.", "rel": "contrast" }, { "to": "germany", "as": "The neighbour whose restrictions send its patients across this border.", "rel": "contrast" }, { "to": "poland", "as": "The source of the busiest patient flow into this country in the EU data.", "rel": "contrast" }, { "to": "reproductive-exile", "as": "The word for what a patient does when the treatment is lawful next door and not at home.", "rel": "term" }, { "to": "eshre", "as": "The society whose registry counts these cycles, clinic by clinic.", "rel": "org" } ], "links": [ { "label": "ART in Europe, 2019 — ESHRE registry report", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10694409/" } ], "sources": [ "s:eshre-eim-2019", "s:shenfield-2010", "s:ec-crossborder-2022", "s:pronatal-prices", "s:natural-earth" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:eshre-eim-2019", "note": "registry and Commission figures are cited; the closing paragraph is marked trade practice because the Czech statute was not read for this record" }, "text.how": { "tier": "tradition", "note": "the standard shape of a Czech fertility programme; the prices below are cited to the clinic's page" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Prague Old Town Square panorama.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "Europe's second workshop for donor-egg treatment, and a border country whose clinics are the destination for more authorised cross-border patients than anywhere else in the EU.", "region_terms": [ { "key": "europe-central", "name": "Central Europe", "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia" } ], "kin_out": [ { "to": "prague", "type": "hub", "name": "Prague", "as": "Where most of the clinics and the euro price lists are.", "rel": "part" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The treatment this country is known for across Europe.", "rel": "procedure" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "Sold here as a programme in euro, priced from a published list.", "rel": "procedure" }, { "to": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The rule that decides whether a patient must travel for a donor at all.", "rel": "governed-by" }, { "to": "spain", "type": "destination", "name": "Spain", "as": "The larger donor-egg destination it is measured against.", "rel": "contrast" }, { "to": "germany", "type": "destination", "name": "Germany", "as": "The neighbour whose restrictions send its patients across this border.", "rel": "contrast" }, { "to": "poland", "type": "destination", "name": "Poland", "as": "The source of the busiest patient flow into this country in the EU data.", "rel": "contrast" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The word for what a patient does when the treatment is lawful next door and not at home.", "rel": "term" }, { "to": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "The society whose registry counts these cycles, clinic by clinic.", "rel": "org" } ], "source_list": [ { "id": "s:eshre-eim-2019", "kind": "web", "title": "ART in Europe, 2019: results generated from European registries by ESHRE", "publisher": "Human Reproduction (Oxford University Press) for the European IVF-monitoring Consortium of ESHRE", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10694409/", "accessed": "2026-09-16", "note": "Smeenk J, Wyns C, De Geyter C, et al., Human Reproduction 2023;38(12):2321–2338, doi:10.1093/humrep/dead197. Registry returns, not a market estimate: 1,077,813 cycles from 1,488 clinics in 40 countries for 2019. Spain reported 137,276 cycles, second in Europe after Russia, from 244 IVF clinics; the highest egg-donation volumes came from Spain, Czechia and Russia." }, { "id": "s:shenfield-2010", "kind": "paper", "title": "Cross border reproductive care in six European countries", "publisher": "Human Reproduction 25(6):1361-1368, ESHRE Taskforce on Cross Border Reproductive Care", "url": "https://academic.oup.com/humrep/article/25/6/1361/2915759", "accessed": "2026-09-16" }, { "id": "s:ec-crossborder-2022", "kind": "report", "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU — reference year 2022", "publisher": "European Commission, DG Health and Food Safety, Unit B.3; written by PredictBy Research and Consulting and Baltic Media; Publications Office of the European Union", "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf", "license": "CC BY 4.0", "accessed": "2026-09-16", "note": "final version January 2024, ISBN 978-92-68-14858-7. 23 countries reported 547,890 reimbursement requests for care not needing prior authorisation in 2022, of which France 300,254 and Germany 160,647 are 84%; Poland 14,176, Slovakia 13,904, Ireland 1,841, Romania 889, Czechia 440, Croatia 192, Lithuania 131, Greece 56, Cyprus 44, Portugal 27 (all refused), Spain 9. Total reimbursed EUR 86,462,491. For care needing prior authorisation, 4,552 requests and EUR 7,708,041. Belgium and Hungary could not report; Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway run no prior-authorisation system; only Denmark and Romania have a mechanism to limit inflow." }, { "id": "s:pronatal-prices", "kind": "web", "title": "Price list", "publisher": "PRONATAL, Prague", "url": "https://www.pronatal.cz/en/price-list/", "accessed": "2026-09-16", "note": "read 16 September 2026: IVF with own eggs from EUR 3,000 including basic laboratory methods; donor egg programme with guarantee from EUR 5,950 including basic laboratory methods; frozen embryo transfer from EUR 990; egg freezing for non-medical reasons from EUR 1,990, which excludes medication and includes two years of storage; IUI from EUR 400; donor embryo transfer from EUR 1,850" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:eshre-eim-2019", "note": "registry and Commission figures are cited; the closing paragraph is marked trade practice because the Czech statute was not read for this record" }, "text.how": { "tier": "tradition", "note": "the standard shape of a Czech fertility programme; the prices below are cited to the clinic's page" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "germany", "type": "destination", "name": "Germany", "as": "Where German patients cross for dentistry and for treatment German law restricts.", "rel": "contrast" }, { "from": "poland", "type": "destination", "name": "Poland", "as": "Where Polish patients themselves cross for care, the busiest flow in the EU reimbursement data.", "rel": "contrast" }, { "from": "spain", "type": "destination", "name": "Spain", "as": "The other big donor-egg destination, cheaper and smaller.", "rel": "contrast" }, { "from": "prague", "type": "hub", "name": "Prague", "as": "The country whose egg-donation volume this city carries most of.", "rel": "whole" }, { "from": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "Where the mini and the full operation are priced a line apart.", "rel": "destination" }, { "from": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "A European price list for the same operation, in koruna.", "rel": "destination" }, { "from": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "Where a published cycle price names the donor's compensation among its inclusions.", "rel": "destination" }, { "from": "facelift", "type": "procedure", "name": "Facelift", "as": "Where the price names the layer of the face it lifts.", "rel": "destination" }, { "from": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "Where the cheapest published cycle on this page is sold.", "rel": "destination" }, { "from": "liposuction", "type": "procedure", "name": "Liposuction", "as": "Where the price is published per area, with the area count on the page.", "rel": "destination" }, { "from": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "The European price list this record reads, in koruna.", "rel": "destination" } ] }, { "schema": 1, "id": "dominican-republic", "type": "destination", "names": { "name": "Dominican Republic", "aliases": [ "República Dominicana", "DR" ], "said": "In the trade it is Santo Domingo, and the operation is body work — liposuction, abdominoplasty, buttock augmentation, often in one list." }, "region": [ "caribbean" ], "facets": { "iso2": "DO", "direction": "inbound", "currency": "DOP", "languages": [ "Spanish", "English" ], "draws": [ "liposuction", "abdominoplasty", "bbl", "breast-augmentation" ] }, "text": { "what": "A Caribbean cosmetic surgery destination, two to four hours from the US east coast, selling body contouring largely to women travelling from the United States. It also carries the longest published outbreak record of any destination in this directory: two multi-state clusters of rapidly growing nontuberculous mycobacteria — environmental bacteria that infect surgical wounds and take months of antibiotics to clear — traced to cosmetic surgery here, four years apart, and named in the CDC's own chapter on care abroad.", "story": "The first cluster ran March 2013 to February 2014. The CDC counted 19 cases in five states — New York 11, Massachusetts three, Connecticut two, Maryland two, Pennsylvania one — 16 confirmed and three probable. Twelve of the 19 had been operated on at one clinic; the other seven at seven different Dominican clinics. The commonest procedures were liposuction in 74%, abdominoplasty in 58% and breast implantation in 32%. Fourteen of the 19 were admitted to hospital in the United States and needed repeated corrective surgery and long courses of antibiotics. Of the 16 confirmed, 13 were Mycobacterium abscessus and two M. fortuitum.\n\nThe second ran through 2017 and was larger. By 8 November 2017 the CDC had been notified of 52 patients from nine states with a surgical site infection after cosmetic surgery in the Dominican Republic; 38 met the confirmed case definition, \"a diagnosed SSI and laboratory evidence confirming the presence of NTM in a U.S. resident who underwent a cosmetic surgery procedure in the Dominican Republic since January 1, 2017\". All confirmed cases were women, operated on between 4 January and 14 July 2017. The confirmed patients named 14 surgeons at seven surgical centres. Twenty-six of the 32 with information available — 81% — had been operated on at one centre, CIPLA, which closed temporarily on 8 July 2017. One patient died.\n\n*Inference —* the pattern in both clusters is the same and it is not a pattern about surgeons. Rapidly growing mycobacteria live in water and in solutions; a cluster that concentrates in one building, then appears in six others, is describing a practice, not a person. Neither report reached a denominator: nobody published how many patients travelled for cosmetic surgery to the country in either period, so no rate can be computed from these counts, and this record does not compute one.", "how": "*Trade practice —* the Dominican trade is booked directly with a surgeon's office or through a co-ordinator, and sold as a package that names the operating fee, a recovery house with a nurse, post-operative garments and lymphatic massage. Stays run one to two weeks because drains and dressings need attending. The patient flies home with sutures in and the surgeon who placed them four hours behind. That gap is where both outbreaks were detected: by American infectious disease physicians, weeks later, and not by the clinic that operated.", "today": "As of September 2026 the two CDC reports remain the clearest published record of what has gone wrong here, and they are eight and twelve years old. This record carries no current national count of foreign patients and no current inspection register: the Dominican Republic did not appear among the 32 locations reported individually in the ISAPS 2024 survey, and no Dominican register was read for this record." }, "geo": { "lat": 18.4861, "lon": -69.9312, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "No patient count is carried. The two CDC clusters — 19 cases in 2013-14, 52 notified and 38 confirmed in 2017 — are counts of US residents who fell ill and were reported, not of patients treated; neither report carries a denominator, so neither supports a rate.", "as_of": "2018", "source": "s:mmwr-ntm-dominican-2018", "url": "https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a5.htm" }, "kin": [ { "to": "santo-domingo", "as": "Where the clinics named in both CDC reports sit.", "rel": "part" }, { "to": "dominican-republic-ntm-outbreak", "as": "The two clusters, in their own record.", "rel": "event" }, { "to": "nontuberculous-mycobacteria", "as": "The organism that made this country a case study.", "rel": "risk" }, { "to": "surgical-site-infection", "as": "What 38 confirmed patients flew home with in 2017.", "rel": "risk" }, { "to": "liposuction", "as": "The commonest procedure in the 2013-14 cluster, at 74% of cases.", "rel": "procedure" }, { "to": "abdominoplasty", "as": "The second commonest, at 58%.", "rel": "procedure" }, { "to": "bbl", "as": "The body operation the trade here is currently known for.", "rel": "procedure" }, { "to": "revision-at-home", "as": "Fourteen of 19 in the first cluster were admitted in the United States for it.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Both outbreaks were found by doctors at home, weeks after discharge abroad.", "rel": "risk" }, { "to": "united-states", "as": "Where every counted patient in both clusters lived.", "rel": "contrast" } ], "links": [ { "label": "MMWR 2018 — NTM infections after plastic surgery, Dominican Republic 2017", "url": "https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a5.htm" }, { "label": "MMWR 2014 — NTM wound infections, March 2013–February 2014", "url": "https://www.cdc.gov/Mmwr/preview/mmwrhtml/mm6309a5.htm" } ], "sources": [ "s:mmwr-ntm-dominican-2018", "s:mmwr-ntm-dominican-2014", "s:cdc-yellowbook-medical-tourism", "s:natural-earth" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:mmwr-ntm-dominican-2018", "note": "both clusters are read off the two MMWR reports; the closing paragraph is marked inference" }, "text.how": { "tier": "tradition", "note": "the shape of a Dominican cosmetic package, hedged in the prose" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Santo Domingo skyline.jpg" ], "needs_verification": true, "confidence": "high", "updated": "2026-09-16", "blurb": "A Caribbean cosmetic surgery destination, two to four hours from the US east coast, selling body contouring largely to women travelling from the United States.", "region_terms": [ { "key": "caribbean", "name": "The Caribbean", "note": "the Dominican Republic, Cuba, Barbados, the Caymans" } ], "kin_out": [ { "to": "santo-domingo", "type": "hub", "name": "Santo Domingo", "as": "Where the clinics named in both CDC reports sit.", "rel": "part" }, { "to": "dominican-republic-ntm-outbreak", "type": "event", "name": "The Dominican mycobacterial outbreaks, 2013–14 and 2017", "as": "The two clusters, in their own record.", "rel": "event" }, { "to": "nontuberculous-mycobacteria", "type": "risk", "name": "Nontuberculous mycobacteria", "as": "The organism that made this country a case study.", "rel": "risk" }, { "to": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "What 38 confirmed patients flew home with in 2017.", "rel": "risk" }, { "to": "liposuction", "type": "procedure", "name": "Liposuction", "as": "The commonest procedure in the 2013-14 cluster, at 74% of cases.", "rel": "procedure" }, { "to": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "The second commonest, at 58%.", "rel": "procedure" }, { "to": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "The body operation the trade here is currently known for.", "rel": "procedure" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Fourteen of 19 in the first cluster were admitted in the United States for it.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Both outbreaks were found by doctors at home, weeks after discharge abroad.", "rel": "risk" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "Where every counted patient in both clusters lived.", "rel": "contrast" } ], "source_list": [ { "id": "s:mmwr-ntm-dominican-2018", "kind": "journal", "title": "Notes from the Field: Nontuberculous Mycobacteria Infections in U.S. Medical Tourists Associated with Plastic Surgery — Dominican Republic, 2017", "publisher": "MMWR Morbidity and Mortality Weekly Report 2018;67(12):369-370, 30 March 2018", "url": "https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a5.htm", "accessed": "2026-09-16" }, { "id": "s:mmwr-ntm-dominican-2014", "kind": "journal", "title": "Notes from the Field: Rapidly Growing Nontuberculous Mycobacterium Wound Infections Among Medical Tourists Undergoing Cosmetic Surgeries in the Dominican Republic — Multiple States, March 2013–February 2014", "publisher": "MMWR Morbidity and Mortality Weekly Report 2014;63(9), 7 March 2014", "url": "https://www.cdc.gov/Mmwr/preview/mmwrhtml/mm6309a5.htm", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:mmwr-ntm-dominican-2018", "note": "both clusters are read off the two MMWR reports; the closing paragraph is marked inference" }, "text.how": { "tier": "tradition", "note": "the shape of a Dominican cosmetic package, hedged in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "cuba", "type": "destination", "name": "Cuba", "as": "The Caribbean contrast: private clinics, a US patient base, and an outbreak record.", "rel": "contrast" }, { "from": "united-states", "type": "destination", "name": "United States", "as": "Where every patient counted in two CDC outbreak reports had travelled from here.", "rel": "destination" }, { "from": "santo-domingo", "type": "hub", "name": "Santo Domingo", "as": "The country whose cosmetic surgery export runs almost entirely through this city.", "rel": "destination" }, { "from": "bbl-mortality", "type": "risk", "name": "Death from gluteal fat grafting", "as": "One of the destinations the published case series name.", "rel": "place" }, { "from": "nontuberculous-mycobacteria", "type": "risk", "name": "Nontuberculous mycobacteria", "as": "Where both clusters were traced to.", "rel": "place" }, { "from": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "Where the clearest documented cluster of these infections among travelling patients was traced to.", "rel": "place" }, { "from": "dominican-republic-ntm-outbreak", "type": "event", "name": "The Dominican mycobacterial outbreaks, 2013–14 and 2017", "as": "The country page, where these two clusters sit beside the trade that produced them.", "rel": "destination" } ] }, { "schema": 1, "id": "egypt", "type": "destination", "names": { "name": "Egypt", "aliases": [ "جمهورية مصر العربية", "Arab Republic of Egypt", "Miṣr" ], "said": "Cairo sells dentistry, dermatology, hair and eyes to Arabic-speaking neighbours and to Europeans on a Nile itinerary. The Egyptian trade talks in Arabic first and English second, which is who it is selling to." }, "region": [ "africa-north" ], "facets": { "iso2": "EG", "direction": "inbound", "currency": "EGP", "languages": [ "Arabic", "English" ], "draws": [ "dental-implant", "hair-transplant-fue", "lasik", "rhinoplasty" ] }, "text": { "what": "The Arab world's largest country selling private care to visitors, mostly cosmetic, dental, hair and eye work, to buyers from the Gulf, Libya, Sudan and Europe. Behind that trade sits a domestic system where households pay for most of their own care: out-of-pocket spending has run at more than 60 per cent of total health expenditure, and the 1,145 private hospitals counted in 2021 exist substantially to take that money from Egyptians, not from foreigners.", "story": "Egypt's private hospital sector grew 23.69 per cent between 2011 and 2021, to 1,145 hospitals. Physician density in 2020 was 1.19 per 1,000 people. Law No. 2 of 2018 established universal health insurance, a reform intended to move the country off an out-of-pocket model that has been above 60 per cent of health spending, and it is being rolled out governorate by governorate rather than at once.\n\n*Inference —* a foreign patient arriving in Cairo is buying into the private tier of a system in which most domestic patients are also paying cash. That is different from Thailand, where the export hospitals sit clearly apart from a public scheme almost everyone uses, and it is different again from Israel, where the export work happens inside public hospitals. The Egyptian private clinic is not a separate export channel; it is the ordinary way a middle-class Egyptian gets an operation, with a foreign price list added.\n\n*Trade practice —* the Egyptian inbound trade is sold on price and language and the currency. Successive devaluations of the pound have repriced everything sold here in dollars or euros, and the sector's growth is discussed in Cairo in those terms. This record carries no arrivals count, because no publisher this project could reach has issued one with a method attached.", "how": "A clinic quotes in Egyptian pounds or in dollars, often through an agency, and bundles hotel nights and transfers where the buyer is foreign. Cairo and Alexandria carry most of the volume; the Red Sea resorts carry the dental and dermatology work sold alongside a holiday. Accreditation is through the national accreditation and regulation authority created under the 2018 insurance law, and a handful of hospitals also hold an international mark.", "today": "As of September 2026 the numbers this record can cite about Egypt are numbers about the Egyptian health system rather than about its foreign patients: 1,145 private hospitals in 2021, 1.19 physicians per 1,000 in 2020, out-of-pocket spending above 60 per cent. The inbound trade is real and nobody has published a countable figure for it.", "notes": "Absence of a published figure is not evidence that the flow is small. It is evidence that nobody has counted it in public." }, "geo": { "lat": 30.0444, "lon": 31.2357, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "No inbound patient count is carried: this project found no published figure with a stated method. What can be cited describes the domestic system — 1,145 private hospitals as of 2021, up 23.69% since 2011; 121,394 physicians in 2020, or 1.19 per 1,000 people; out-of-pocket payments running at more than 60% of total health expenditure.", "as_of": "2021", "source": "s:wp-healthcare-egypt", "url": "https://en.wikipedia.org/wiki/Healthcare_in_Egypt" }, "kin": [ { "to": "cairo", "as": "Where most of the clinics and nearly all of the agencies are.", "rel": "part" }, { "to": "tunisia", "as": "The North African neighbour whose ministry publishes the figures Egypt's does not.", "rel": "contrast" }, { "to": "jordan", "as": "The other regional destination Arabic-speaking patients choose between.", "rel": "contrast" }, { "to": "dental-implant", "as": "One of the things the inbound trade here is built on.", "rel": "procedure" }, { "to": "hair-transplant-fue", "as": "Sold here against Istanbul, on price and on language.", "rel": "procedure" }, { "to": "world-bank-out-of-pocket", "as": "The series behind the share of Egyptian health spending households pay themselves.", "rel": "measured-by" }, { "to": "what-the-data-cannot-see", "as": "A trade that exists and has never been counted in public is the case this page stands on.", "rel": "story" } ], "links": [ { "label": "Healthcare in Egypt", "url": "https://en.wikipedia.org/wiki/Healthcare_in_Egypt" } ], "sources": [ "s:wp-healthcare-egypt", "s:natural-earth", "s:worldbank-open-data" ], "provenance": { "default": { "tier": "cited", "source": "s:wp-healthcare-egypt" }, "fields": { "text.story": { "tier": "cited", "source": "s:wp-healthcare-egypt", "note": "the second and third paragraphs are marked inline; the first is cited" }, "text.how": { "tier": "tradition", "note": "the ordinary shape of the trade, hedged" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "needs_verification": true, "confidence": "low", "updated": "2026-09-16", "blurb": "The Arab world's largest country selling private care to visitors, mostly cosmetic, dental, hair and eye work, to buyers from the Gulf, Libya, Sudan and Europe.", "region_terms": [ { "key": "africa-north", "name": "North Africa", "note": "Tunisia, Morocco, Egypt" } ], "kin_out": [ { "to": "cairo", "type": "hub", "name": "Cairo", "as": "Where most of the clinics and nearly all of the agencies are.", "rel": "part" }, { "to": "tunisia", "type": "destination", "name": "Tunisia", "as": "The North African neighbour whose ministry publishes the figures Egypt's does not.", "rel": "contrast" }, { "to": "jordan", "type": "destination", "name": "Jordan", "as": "The other regional destination Arabic-speaking patients choose between.", "rel": "contrast" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "One of the things the inbound trade here is built on.", "rel": "procedure" }, { "to": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "Sold here against Istanbul, on price and on language.", "rel": "procedure" }, { "to": "world-bank-out-of-pocket", "type": "dataset", "name": "Out-of-pocket share of health spending", "as": "The series behind the share of Egyptian health spending households pay themselves.", "rel": "measured-by" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "A trade that exists and has never been counted in public is the case this page stands on.", "rel": "story" } ], "source_list": [ { "id": "s:wp-healthcare-egypt", "kind": "web", "title": "Healthcare in Egypt", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Healthcare_in_Egypt", "accessed": "2026-09-16", "note": "read for the private hospital count, physician density, the out-of-pocket share and Law No. 2 of 2018" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:wp-healthcare-egypt" }, "text.story": { "tier": "cited", "source": "s:wp-healthcare-egypt", "note": "the second and third paragraphs are marked inline; the first is cited" }, "text.how": { "tier": "tradition", "note": "the ordinary shape of the trade, hedged" }, "text.today": { "tier": "cited", "source": "s:wp-healthcare-egypt" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:wp-healthcare-egypt" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "cairo", "type": "hub", "name": "Cairo", "as": "The country this metropolitan cluster carries most of the private capacity of.", "rel": "whole" } ] }, { "schema": 1, "id": "georgia", "type": "destination", "names": { "name": "Georgia", "aliases": [ "საქართველო", "Sakartvelo" ], "said": "Sakartvelo. Not the American state, which is the first thing every search for it has to get past." }, "region": [ "west-asia", "europe-east" ], "facets": { "iso2": "GE", "direction": "both", "currency": "GEL", "languages": [ "Georgian", "Russian", "English" ] }, "text": { "what": "A small, almost entirely privatised health system on the edge of Europe, selling to patients from the Caucasus, the Russian-speaking world and the Gulf. Its draw is a combination three other destinations rarely offer together: no visa for most arrivals, prices below Türkiye's, and a set of treatments that are lawful here and restricted next door.", "story": "The system was privatised between 2007 and 2012, and most primary and secondary providers are private for-profit entities. A universal government-sponsored programme followed in 2013, covering Georgian residents; the trade in foreign patients sits alongside it and on the same hospital floors.\n\n*Trade practice —* what brings foreign patients is usually a rule rather than a price. Surrogacy and donor treatment have drawn patients from countries that prohibit them, and the regional traffic in dentistry and cosmetic work runs on the same logic as every border corridor: the next country over is dearer or closed.\n\n*Inference —* the country publishes very little about any of it. Licensing sits with the State Regulation Agency for Medical Activities, which registers facilities rather than counting the people who fly to them, so this record carries no arrival number at all rather than repeating one from a trade summary." }, "geo": { "lat": 41.7151, "lon": 44.8271, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "No inbound patient count is carried. Nothing this project could read publishes one for Georgia.", "as_of": "2026-09-17", "source": "s:wp-healthcare-georgia" }, "kin": [ { "to": "tbilisi", "as": "Where nearly all of it happens.", "rel": "part" }, { "to": "turkiye", "as": "The larger neighbour it undercuts, and the one most of its own outbound patients fly to.", "rel": "contrast" }, { "to": "surrogacy", "as": "One of the treatments that brings patients here from countries that prohibit it.", "rel": "procedure" }, { "to": "circumvention-travel", "as": "The word for most of why anyone flies here.", "rel": "term" } ], "sources": [ "s:wp-healthcare-georgia", "s:natural-earth" ], "provenance": { "default": { "tier": "cited", "source": "s:wp-healthcare-georgia" }, "fields": { "text.story": { "tier": "tradition", "note": "the privatisation dates and the 2013 programme are cited; the inline marks say which stretches are trade practice and which are inference" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "needs_verification": true, "confidence": "low", "updated": "2026-09-17", "blurb": "A small, almost entirely privatised health system on the edge of Europe, selling to patients from the Caucasus, the Russian-speaking world and the Gulf.", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" }, { "key": "europe-east", "name": "Eastern Europe", "note": "Romania, Bulgaria, Serbia, Ukraine, Moldova, Albania, North Macedonia" } ], "kin_out": [ { "to": "tbilisi", "type": "hub", "name": "Tbilisi", "as": "Where nearly all of it happens.", "rel": "part" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The larger neighbour it undercuts, and the one most of its own outbound patients fly to.", "rel": "contrast" }, { "to": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "One of the treatments that brings patients here from countries that prohibit it.", "rel": "procedure" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The word for most of why anyone flies here.", "rel": "term" } ], "source_list": [ { "id": "s:wp-healthcare-georgia", "kind": "wikipedia", "title": "Healthcare in Georgia (country)", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Healthcare_in_Georgia_(country)", "accessed": "2026-09-17", "license": "CC BY-SA 4.0" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:wp-healthcare-georgia" }, "text.story": { "tier": "tradition", "note": "the privatisation dates and the 2013 programme are cited; the inline marks say which stretches are trade practice and which are inference" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:wp-healthcare-georgia" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [] }, { "schema": 1, "id": "germany", "type": "destination", "names": { "name": "Germany", "aliases": [ "Deutschland", "Bundesrepublik Deutschland" ], "said": "In the trade Germany means university hospitals — Berlin, Heidelberg, Munich, Hamburg — and the international office attached to one. Patients arrive for oncology, cardiac surgery and diagnosis, not for a price." }, "region": [ "europe-west" ], "facets": { "iso2": "DE", "direction": "both", "currency": "EUR", "languages": [ "German", "English", "Russian", "Arabic" ], "draws": [ "proton-therapy", "bone-marrow-transplant", "cabg", "executive-health-screening", "gamma-knife" ] }, "text": { "what": "An inbound destination for complex care and an outbound one for everything cheap. German university hospitals run international offices that take patients from Russia, the Gulf, the Netherlands and Eastern Europe for oncology, cardiac and neurosurgical work billed at German rates; German residents, meanwhile, file more cross-border reimbursement claims than any country in the EU except France, mostly for dentistry and routine care over a nearby border.", "story": "The inbound count is old and worth carrying with its age. In 2009 Deutsches Ärzteblatt reported work by Jens Juszczak of Hochschule Bonn-Rhein-Sieg putting about 71,000 foreign patients in German hospitals in 2008, led by Dutch, French and Belgian patients with growth from Russia, the UAE and China. The finding that matters more than the headline sat underneath it: in 85% of the hospitals surveyed, foreign patients accounted for under 1% of revenue. A trade that fills the trade press is, for almost every German hospital, a rounding error. No newer national count was read for this record.\n\nThe outbound side is measured much better, by accident. Germany reported data to the Commission's cross-border survey for the first time in 2022 and immediately became the second largest reporter in the EU: 160,647 requests for reimbursement of care not subject to prior authorisation, 141,411 granted, plus 2,781 requests for care that did need authorisation, 2,377 granted. The German contact point told the Commission the figure is not clean — German law applies the Directive's rules to claims that fall outside the Directive, so the cases cannot be separated. The largest cross-border number in Europe comes with a warning attached to it by the people who produced it.\n\nGerman patients also travel for what German law does not allow. In the ESHRE taskforce survey of cross-border fertility patients in six receiving countries, Germans were 14.4% of those surveyed, and 80.2% of them gave legal reasons at home as the motive — the highest proportion of any nationality in the study.\n\n*Inference —* the two directions do not balance and are not meant to. Inbound Germany sells what is hard; outbound Germany buys what is restricted or nearer.", "how": "The inbound patient is quoted a cost estimate by a university hospital's international office, pays a deposit into an escrow-style account before admission, and is billed against the German DRG system — a case-rate schedule — with a surcharge that foreign self-payers are charged and domestic insurers are not. An interpreter and a visa letter come from the same office. The outbound patient pays the foreign dentist or clinic directly and claims back at German rates afterwards, which caps the refund at what the treatment would have cost at home.", "today": "The German figure that can be stated for 2026 is a reimbursement figure, not a patient figure: 160,647 requests in reference year 2022, with the caveat its own reporter attached. What a German hospital charges an overseas self-payer for a course of proton therapy is not published anywhere this project could read." }, "geo": { "lat": 52.52, "lon": 13.405, "precision": "country", "source": "s:natural-earth" }, "metrics": { "annual_foreign_patients": 71000, "note": "Foreign patients in German hospitals in 2008, as reported in 2009 from Jens Juszczak's survey work. Seventeen years old at the time of writing and carried only because it is the narrowest published figure read for this record; in 85% of the hospitals surveyed foreign patients were under 1% of revenue.", "as_of": "2008", "source": "s:aerzteblatt-auslaendische-patienten-2009", "url": "https://aerzteblatt.de/nachrichten/37490/Auslaendische-Patienten-bescheren-Kliniken-Millionenerloese" }, "kin": [ { "to": "charite-international", "as": "The Berlin university hospital's international office, one of the main inbound doors.", "rel": "part" }, { "to": "heidelberg-university-hospital", "as": "The other, with the proton centre attached.", "rel": "part" }, { "to": "proton-therapy", "as": "The treatment foreign patients most often fly here to buy.", "rel": "procedure" }, { "to": "czechia", "as": "Where German patients cross for dentistry and for treatment German law restricts.", "rel": "contrast" }, { "to": "poland", "as": "The other near border German patients cross, and a source of patients in return.", "rel": "contrast" }, { "to": "hungary", "as": "The dental corridor German patients have used for thirty years.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "as": "The route its residents use more than anyone's except France's, on figures its own contact point calls impure.", "rel": "governed-by" }, { "to": "drg", "as": "The case-rate schedule a German hospital bills a foreign patient against.", "rel": "term" }, { "to": "counting-patients", "as": "Why the largest cross-border number in Europe is not a count of journeys.", "rel": "story" } ], "sources": [ "s:aerzteblatt-auslaendische-patienten-2009", "s:ec-crossborder-2022", "s:shenfield-2010", "s:eu-directive-2011-24", "s:natural-earth" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:ec-crossborder-2022", "note": "all three counts are cited to their own publications; the closing line is marked inference" }, "text.how": { "tier": "tradition", "note": "the standard working of a German international patient office and the self-payer surcharge; the reimbursement cap is cited to the Directive" }, "metrics": { "tier": "cited", "source": "s:aerzteblatt-auslaendische-patienten-2009" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Charité Campus Mitte Berlin.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "An inbound destination for complex care and an outbound one for everything cheap.", "region_terms": [ { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "charite-international", "type": "facility", "name": "Charité International Patients", "as": "The Berlin university hospital's international office, one of the main inbound doors.", "rel": "part" }, { "to": "heidelberg-university-hospital", "type": "facility", "name": "Heidelberg University Hospital", "as": "The other, with the proton centre attached.", "rel": "part" }, { "to": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "The treatment foreign patients most often fly here to buy.", "rel": "procedure" }, { "to": "czechia", "type": "destination", "name": "Czechia", "as": "Where German patients cross for dentistry and for treatment German law restricts.", "rel": "contrast" }, { "to": "poland", "type": "destination", "name": "Poland", "as": "The other near border German patients cross, and a source of patients in return.", "rel": "contrast" }, { "to": "hungary", "type": "destination", "name": "Hungary", "as": "The dental corridor German patients have used for thirty years.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route its residents use more than anyone's except France's, on figures its own contact point calls impure.", "rel": "governed-by" }, { "to": "drg", "type": "term", "name": "DRG", "as": "The case-rate schedule a German hospital bills a foreign patient against.", "rel": "term" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why the largest cross-border number in Europe is not a count of journeys.", "rel": "story" } ], "source_list": [ { "id": "s:aerzteblatt-auslaendische-patienten-2009", "kind": "news", "title": "Ausländische Patienten bescheren Kliniken Millionenerlöse", "publisher": "Deutsches Ärzteblatt, 27 July 2009, reporting work by Jens Juszczak of Hochschule Bonn-Rhein-Sieg", "url": "https://aerzteblatt.de/nachrichten/37490/Auslaendische-Patienten-bescheren-Kliniken-Millionenerloese", "accessed": "2026-09-16", "note": "around 71,000 foreign patients treated in German hospitals in 2008, led by Dutch, French and Belgian patients with growth from Russia, the UAE and China; in 85% of the hospitals surveyed foreign patients were under 1% of revenue. The figure is old and no newer national count was read for this record." }, { "id": "s:ec-crossborder-2022", "kind": "report", "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU — reference year 2022", "publisher": "European Commission, DG Health and Food Safety, Unit B.3; written by PredictBy Research and Consulting and Baltic Media; Publications Office of the European Union", "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf", "license": "CC BY 4.0", "accessed": "2026-09-16", "note": "final version January 2024, ISBN 978-92-68-14858-7. 23 countries reported 547,890 reimbursement requests for care not needing prior authorisation in 2022, of which France 300,254 and Germany 160,647 are 84%; Poland 14,176, Slovakia 13,904, Ireland 1,841, Romania 889, Czechia 440, Croatia 192, Lithuania 131, Greece 56, Cyprus 44, Portugal 27 (all refused), Spain 9. Total reimbursed EUR 86,462,491. For care needing prior authorisation, 4,552 requests and EUR 7,708,041. Belgium and Hungary could not report; Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway run no prior-authorisation system; only Denmark and Romania have a mechanism to limit inflow." }, { "id": "s:shenfield-2010", "kind": "paper", "title": "Cross border reproductive care in six European countries", "publisher": "Human Reproduction 25(6):1361-1368, ESHRE Taskforce on Cross Border Reproductive Care", "url": "https://academic.oup.com/humrep/article/25/6/1361/2915759", "accessed": "2026-09-16" }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:ec-crossborder-2022", "note": "all three counts are cited to their own publications; the closing line is marked inference" }, "text.how": { "tier": "tradition", "note": "the standard working of a German international patient office and the self-payer surcharge; the reimbursement cap is cited to the Directive" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:aerzteblatt-auslaendische-patienten-2009" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "belgium", "type": "destination", "name": "Belgium", "as": "The neighbour that sends fertility patients across this border and receives complex cases in return.", "rel": "contrast" }, { "from": "czechia", "type": "destination", "name": "Czechia", "as": "The neighbour whose restrictions send its patients across this border.", "rel": "contrast" }, { "from": "hungary", "type": "destination", "name": "Hungary", "as": "A neighbour that supplies patients rather than receiving them, in dentistry at least.", "rel": "contrast" }, { "from": "saudi-arabia", "type": "destination", "name": "Saudi Arabia", "as": "A destination the state's own referral counts name, alongside the United States and Britain.", "rel": "contrast" }, { "from": "switzerland", "type": "destination", "name": "Switzerland", "as": "The neighbour that shares its patients and undercuts its prices.", "rel": "contrast" }, { "from": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "Holds more qualified centres than any other European country, and reached access the month the product was authorised.", "rel": "destination" }, { "from": "panchakarma", "type": "procedure", "name": "Panchakarma", "as": "Where the same fortnight costs about five times the Kerala price.", "rel": "destination" }, { "from": "charite-international", "type": "facility", "name": "Charité International Patients", "as": "The country's largest university hospital, and the shape its inbound work takes: a public hospital with a company beside it.", "rel": "destination" }, { "from": "heidelberg-university-hospital", "type": "facility", "name": "Heidelberg University Hospital", "as": "The German university hospital that publishes its payment terms, which is as close as this country gets to a tariff for a foreign self-payer.", "rel": "destination" }, { "from": "schengen-medical-visa", "type": "rule", "name": "The Schengen visa, for treatment", "as": "Another, drawing patients from the Gulf and the former Soviet states.", "rel": "destination" }, { "from": "drg", "type": "term", "name": "DRG", "as": "Where a foreign self-payer is billed against this schedule with a surcharge.", "rel": "destination" } ] }, { "schema": 1, "id": "greece", "type": "destination", "names": { "name": "Greece", "aliases": [ "Ελλάδα", "Hellenic Republic", "Ελληνική Δημοκρατία" ], "said": "In the fertility trade Greece means Athens and Thessaloniki clinics with English-language desks, donor programmes, and a court that has to approve a surrogacy before it happens." }, "region": [ "europe-south" ], "facets": { "iso2": "GR", "direction": "both", "currency": "EUR", "languages": [ "Greek", "English" ], "draws": [ "ivf", "egg-donation", "surrogacy", "icsi", "dental-implant" ] }, "text": { "what": "A fertility destination with a court in the middle of it. Greek clinics run donor-egg and IVF programmes for patients from Britain, Italy, Germany and the Balkans; Greek surrogacy is distinctive in Europe because a court authorises the arrangement in advance rather than a registry resolving it afterwards. The rest of Greek cross-border care is small: 56 reimbursement requests in 2022, of which 54 were granted.", "story": "*Trade practice —* the trade's account of Greece is price against Spain and law against almost everywhere else: donor programmes at lower fees than Spanish clinics charge, and a surrogacy route open to people whose own countries treat the arrangement as unenforceable or unlawful. The specific terms of Greek assisted-reproduction law, the age limits and the residence conditions, have been amended repeatedly; this project did not read the statutes for this record and states no article numbers here.\n\nWhat can be read is the state machinery around it. Greece runs a prior-notification system — one of ten in the EU — and a prior-authorisation system that handled four requests in 2022, authorising two. For care needing no authorisation it received 56 requests and granted 54. Those are the movements of Greek residents, and they are almost nothing.\n\n*Inference —* a country can be a significant destination in one specialty and invisible in every official cross-border table, because the patients who come are paying privately and the tables count refunds. Greece is the clearest case of that gap in Southern Europe.", "how": "Fertility programmes quoted in euro, medication outside the quote, two visits timed to stimulation and transfer. Where a surrogacy is involved the sequence begins with a court application rather than a clinic booking, and the timetable is the court's. English-language coordination is standard at the clinics that advertise abroad.", "today": "Greek fertility law has moved more than once in the last decade and the direction of the most recent changes, including who must be resident in Greece for a surrogacy to be approved, is the subject of that law's own record rather than this one. Nothing here should be read as the current rule." }, "geo": { "lat": 37.9838, "lon": 23.7275, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "56 requests for reimbursement of care not subject to prior authorisation in 2022, 54 granted; four prior-authorisation requests, two authorised. These count Greek residents treated abroad. No official count of patients travelling into Greece for treatment was found on this pass.", "as_of": "2022", "source": "s:ec-crossborder-2022" }, "kin": [ { "to": "ivf", "as": "The treatment its export clinics are built on.", "rel": "procedure" }, { "to": "egg-donation", "as": "The programme priced against Spain's.", "rel": "procedure" }, { "to": "surrogacy", "as": "The arrangement a Greek court authorises before it begins.", "rel": "procedure" }, { "to": "surrogacy-law", "as": "Where the conditions, including residence, are set out and dated.", "rel": "governed-by" }, { "to": "cyprus", "as": "The other Eastern Mediterranean fertility destination, with its own licensing council.", "rel": "contrast" }, { "to": "spain", "as": "The larger donor-egg market it competes with on price.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "as": "The route that carries almost none of this traffic.", "rel": "governed-by" } ], "sources": [ "s:ec-crossborder-2022", "s:eu-directive-2011-24", "s:natural-earth" ], "provenance": { "default": { "tier": "cited", "source": "s:ec-crossborder-2022" }, "fields": { "text.what": { "tier": "tradition", "note": "the reimbursement figures are cited; the description of the court route is the trade's and is not tied here to an article of Greek law" }, "text.story": { "tier": "cited", "source": "s:ec-crossborder-2022", "note": "first paragraph marked trade practice, third marked inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "inference" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Athens Acropolis view.jpg" ], "needs_verification": true, "confidence": "low", "updated": "2026-09-16", "blurb": "A fertility destination with a court in the middle of it. Greek clinics run donor-egg and IVF programmes for patients from Britain, Italy, Germany and the Balkans; Greek surrogacy is distinctive in Europe because a…", "region_terms": [ { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" } ], "kin_out": [ { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment its export clinics are built on.", "rel": "procedure" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The programme priced against Spain's.", "rel": "procedure" }, { "to": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "The arrangement a Greek court authorises before it begins.", "rel": "procedure" }, { "to": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "Where the conditions, including residence, are set out and dated.", "rel": "governed-by" }, { "to": "cyprus", "type": "destination", "name": "Cyprus", "as": "The other Eastern Mediterranean fertility destination, with its own licensing council.", "rel": "contrast" }, { "to": "spain", "type": "destination", "name": "Spain", "as": "The larger donor-egg market it competes with on price.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route that carries almost none of this traffic.", "rel": "governed-by" } ], "source_list": [ { "id": "s:ec-crossborder-2022", "kind": "report", "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU — reference year 2022", "publisher": "European Commission, DG Health and Food Safety, Unit B.3; written by PredictBy Research and Consulting and Baltic Media; Publications Office of the European Union", "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf", "license": "CC BY 4.0", "accessed": "2026-09-16", "note": "final version January 2024, ISBN 978-92-68-14858-7. 23 countries reported 547,890 reimbursement requests for care not needing prior authorisation in 2022, of which France 300,254 and Germany 160,647 are 84%; Poland 14,176, Slovakia 13,904, Ireland 1,841, Romania 889, Czechia 440, Croatia 192, Lithuania 131, Greece 56, Cyprus 44, Portugal 27 (all refused), Spain 9. Total reimbursed EUR 86,462,491. For care needing prior authorisation, 4,552 requests and EUR 7,708,041. Belgium and Hungary could not report; Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway run no prior-authorisation system; only Denmark and Romania have a mechanism to limit inflow." }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "tradition", "note": "the reimbursement figures are cited; the description of the court route is the trade's and is not tied here to an article of Greek law" }, "text.story": { "tier": "cited", "source": "s:ec-crossborder-2022", "note": "first paragraph marked trade practice, third marked inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "inference" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:ec-crossborder-2022" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "cyprus", "type": "destination", "name": "Cyprus", "as": "The nearest comparable destination, with a court rather than a council at the centre.", "rel": "contrast" }, { "from": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "Where the guaranteed-blastocyst packages on this page are sold.", "rel": "destination" }, { "from": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "One of the four Member States with a working altruistic regime, and a residence requirement.", "rel": "destination" } ] }, { "schema": 1, "id": "hungary", "type": "destination", "names": { "name": "Hungary", "aliases": [ "Magyarország" ], "said": "In the trade Hungary means teeth. Sopron, on the Austrian border, is where the traffic started; Budapest is where it grew a waiting room and an airport transfer." }, "region": [ "europe-central" ], "facets": { "iso2": "HU", "direction": "inbound", "currency": "HUF", "languages": [ "Hungarian", "German", "English" ], "draws": [ "dental-implant", "all-on-four", "dental-crown", "veneers", "full-mouth-restoration" ] }, "text": { "what": "The oldest dental corridor in Europe, built on a border. Austrian patients crossed to Sopron for crowns and implants before Hungary joined the EU; Budapest practices now draw from further away and sell whole treatment plans across two trips. The work is almost entirely dental and almost entirely private, paid out of pocket, and it sits beside a Hungarian public health system the visiting patient never sees.", "story": "The first measurement of the trade was a survey of dentists rather than a market forecast. Österle, Balázs and Delgado wrote to practices in Western Hungary and Budapest in 2009 — 25.3% and 20.7% answered — and found the border region dominated by patients from neighbouring countries while Budapest drew from further afield. The dentists ranked relative price first among motives, and service second.\n\nKovács and Szócska went back in 2013 with 273 dentists and ten interviews with professional bodies. They put the complication rate in Hungarian dental care at around 5% and called it comparable with the rest of Europe, and they recorded the profession's own worry: that price differences were narrowing and the selling point was shifting to something harder to quote.\n\nThe cross-border care Directive barely touches any of this. In the Commission's data for 2022 Hungary could not report reimbursement figures at all, and told the Commission that the planned treatments of Hungarian insured people abroad — over 500 cases a year — run under the older social-security Regulations instead. Hungary received three requests for prior authorisation that year and authorised none, and it brought in a prior-notification system, the tenth in the EU. *Inference —* a dental trade of tens of thousands of patients and a reimbursement system that handles single figures are the same country described by two instruments that do not meet.", "how": "A dental plan here is priced item by item off a published list rather than as one package: an implant, an abutment, a crown, each with its own line. The treatment runs in two visits — surgery and healing on the first, the fixed work on the second — with three to six months between them, which is why the airline ticket is bought twice. Guarantees are written by the practice and depend on the patient returning to it, which is the clause that decides what a failure costs.", "today": "Hungarian practices still quote against Austrian, German, British and Irish price lists, and the comparison column is the practice's own. *Trade practice —* Sopron's density of surgeries per head is the trade's standing boast about itself, repeated more often than it is measured." }, "geo": { "lat": 47.4979, "lon": 19.0402, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "No inbound count is carried here. The two published surveys measured dentists, not patients, and the widely repeated figures for Hungarian dental volume come from market summaries whose method this project could not read.", "as_of": "2026-09-16", "source": "s:osterle-2009-hungary" }, "kin": [ { "to": "budapest", "as": "Where the longer-distance patients land and the bigger practices are.", "rel": "part" }, { "to": "dental-implant", "as": "The item at the centre of every treatment plan sold here.", "rel": "procedure" }, { "to": "all-on-four", "as": "The full-arch job this corridor sells to patients who have run out of teeth.", "rel": "procedure" }, { "to": "germany", "as": "A neighbour that supplies patients rather than receiving them, in dentistry at least.", "rel": "contrast" }, { "to": "poland", "as": "The other Central European dental corridor, selling the same work to different markets.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "as": "The reimbursement route that carries almost none of this country's dental traffic.", "rel": "governed-by" }, { "to": "revision-at-home", "as": "Who refits a crown that fails after the second flight home.", "rel": "risk" }, { "to": "package-price", "as": "The form this country does not use: the bill here is itemised, not bundled.", "rel": "term" } ], "links": [ { "label": "Travelling for teeth (British Dental Journal, 2009)", "url": "https://pubmed.ncbi.nlm.nih.gov/19396208/" } ], "sources": [ "s:osterle-2009-hungary", "s:kovacs-szocska-2013-hungary", "s:ec-crossborder-2022", "s:eu-directive-2011-24", "s:natural-earth" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "tradition", "note": "the standard two-visit implant sequence and the practice-held guarantee, as the trade runs them" }, "text.today": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Sopron - Fő tér.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "The oldest dental corridor in Europe, built on a border. Austrian patients crossed to Sopron for crowns and implants before Hungary joined the EU; Budapest practices now draw from further away and sell whole treatment…", "region_terms": [ { "key": "europe-central", "name": "Central Europe", "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia" } ], "kin_out": [ { "to": "budapest", "type": "hub", "name": "Budapest", "as": "Where the longer-distance patients land and the bigger practices are.", "rel": "part" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The item at the centre of every treatment plan sold here.", "rel": "procedure" }, { "to": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "The full-arch job this corridor sells to patients who have run out of teeth.", "rel": "procedure" }, { "to": "germany", "type": "destination", "name": "Germany", "as": "A neighbour that supplies patients rather than receiving them, in dentistry at least.", "rel": "contrast" }, { "to": "poland", "type": "destination", "name": "Poland", "as": "The other Central European dental corridor, selling the same work to different markets.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The reimbursement route that carries almost none of this country's dental traffic.", "rel": "governed-by" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who refits a crown that fails after the second flight home.", "rel": "risk" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The form this country does not use: the bill here is itemised, not bundled.", "rel": "term" } ], "source_list": [ { "id": "s:osterle-2009-hungary", "kind": "paper", "title": "Travelling for teeth: characteristics and perspectives of dental care tourism in Hungary", "publisher": "British Dental Journal 2009;206(8):425-428 (Österle A, Balázs P, Delgado J), doi:10.1038/sj.bdj.2009.308", "url": "https://pubmed.ncbi.nlm.nih.gov/19396208/", "accessed": "2026-09-16", "note": "postal survey of dentists, response rate 25.3% in Western Hungary and 20.7% in Budapest: border practices are dominated by patients from neighbouring countries, Budapest draws from further away, and dentists rank relative price first among motives" }, { "id": "s:kovacs-szocska-2013-hungary", "kind": "paper", "title": "'Vacation for your teeth' — dental tourists in Hungary from the perspective of Hungarian dentists", "publisher": "British Dental Journal 2013;215(8):415-418 (Kovács E, Szócska G), doi:10.1038/sj.bdj.2013.995", "url": "https://pubmed.ncbi.nlm.nih.gov/24157766/", "accessed": "2026-09-16", "note": "questionnaire of 273 Hungarian dentists plus 10 interviews with professional bodies; reports a complication rate in Hungarian dental care of around 5%, which the authors call similar to other European countries" }, { "id": "s:ec-crossborder-2022", "kind": "report", "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU — reference year 2022", "publisher": "European Commission, DG Health and Food Safety, Unit B.3; written by PredictBy Research and Consulting and Baltic Media; Publications Office of the European Union", "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf", "license": "CC BY 4.0", "accessed": "2026-09-16", "note": "final version January 2024, ISBN 978-92-68-14858-7. 23 countries reported 547,890 reimbursement requests for care not needing prior authorisation in 2022, of which France 300,254 and Germany 160,647 are 84%; Poland 14,176, Slovakia 13,904, Ireland 1,841, Romania 889, Czechia 440, Croatia 192, Lithuania 131, Greece 56, Cyprus 44, Portugal 27 (all refused), Spain 9. Total reimbursed EUR 86,462,491. For care needing prior authorisation, 4,552 requests and EUR 7,708,041. Belgium and Hungary could not report; Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway run no prior-authorisation system; only Denmark and Romania have a mechanism to limit inflow." }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "the standard two-visit implant sequence and the practice-held guarantee, as the trade runs them" }, "text.today": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "croatia", "type": "destination", "name": "Croatia", "as": "The older, larger dental corridor selling to overlapping markets.", "rel": "contrast" }, { "from": "germany", "type": "destination", "name": "Germany", "as": "The dental corridor German patients have used for thirty years.", "rel": "contrast" }, { "from": "poland", "type": "destination", "name": "Poland", "as": "The older dental corridor it competes with.", "rel": "contrast" }, { "from": "romania", "type": "destination", "name": "Romania", "as": "The neighbouring dental corridor, older and better surveyed.", "rel": "contrast" }, { "from": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The older dental destination for the same patients.", "rel": "contrast" }, { "from": "budapest", "type": "hub", "name": "Budapest", "as": "The country whose dental trade this city is the airport end of.", "rel": "whole" }, { "from": "sopron", "type": "hub", "name": "Sopron", "as": "The country whose border-town dentistry this place is the emblem of.", "rel": "whole" }, { "from": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "Where the laboratory fee for the bridge is printed as its own line.", "rel": "destination" }, { "from": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "Where the laboratory fee is a line of its own beside every crown.", "rel": "destination" }, { "from": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "Where the lab fee is printed as its own line beside every implant.", "rel": "destination" }, { "from": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "Where the arch price is a treatment line plus a laboratory line.", "rel": "destination" }, { "from": "root-canal", "type": "procedure", "name": "Root canal treatment", "as": "Where endodontics is sold by the half hour.", "rel": "destination" }, { "from": "veneers", "type": "procedure", "name": "Dental veneers", "as": "Where the veneer and the crown are priced within a few euro of each other.", "rel": "destination" }, { "from": "eu-national-contact-points", "type": "org", "name": "EU National Contact Points for cross-border healthcare", "as": "The destination most of this reporting's dental traffic goes to.", "rel": "place" }, { "from": "eurostat", "type": "org", "name": "Eurostat", "as": "A destination whose dental export trade is invisible in its own health accounts.", "rel": "place" } ] }, { "schema": 1, "id": "india", "type": "destination", "names": { "name": "India", "aliases": [ "भारत", "Republic of India", "Bharat" ], "said": "The trade says India and means four clusters — Chennai, the Delhi capital region, Mumbai and Bengaluru — and a handful of listed hospital chains inside them. The state says Medical Value Travel, abbreviated MVT, and runs it as a brand called Heal in India." }, "region": [ "south-asia" ], "facets": { "iso2": "IN", "direction": "inbound", "currency": "INR", "languages": [ "English", "Hindi", "Bengali", "Arabic", "Tamil" ], "draws": [ "cabg", "kidney-transplant", "liver-transplant", "bone-marrow-transplant", "knee-replacement", "ivf", "panchakarma" ] }, "text": { "what": "The inbound flow an immigration desk counts. India issues a medical visa and an attendant visa, and the arrival is recorded by purpose, so the figure a reader gets is an arrivals count rather than a hospital's estimate of itself. In 2025 that count was 507,244, against 9.15 million foreign arrivals of every kind. The work is heavy — cardiac surgery, transplants, cancer, orthopaedics — and the patients come overwhelmingly from India's own region.", "story": "Bangladesh alone supplied 325,127 of the 2025 medical arrivals. Iraq followed at 30,989, then Uzbekistan at 13,699, Somalia at 11,506, Turkmenistan at 10,231, Oman at 9,738 and Kenya at 9,357.\n\n*Inference —* that shape matters more than the total. Roughly three in five arrivals came from one neighbouring country, and the rest of the top seven are places where the alternative is not a long queue but no operating theatre. The Western patient trading a waiting list for a package price, who supplies most of the writing about cross-border care, is a rounding error in India's numbers.\n\nThe count itself is an arrival, not a person. A patient who flies home between cycles of chemotherapy and returns is counted twice; an attendant travelling on a separate visa class is counted separately again. India's advantage is that it says which of these it is counting, which most national figures in this subject do not.\n\n*Trade practice —* the hospitals doing the work are private chains that grew from single institutions founded by named cardiologists in the 1980s and 1990s, and the capital behind them is listed on Indian exchanges. Pricing is per item more often than per package, and the quotation a foreign patient receives is usually assembled by a hospital's international office from a tariff the hospital does not publish.", "how": "The e-Medical Visa and the e-Medical Attendant Visa are open to nationals of 172 countries, and e-AYUSH and e-AYUSH Attendant classes were added for treatment under Indian systems of medicine. A Medical Value Travel portal handles planning and payment, and concierge desks at major airports are planned. The National Medical and Wellness Tourism Promotion Board, constituted by the Ministry of Tourism in 2015 and chaired by the Union Minister for Tourism, coordinates the ministries and the states.\n\nAccreditation runs through the National Accreditation Board for Hospitals and Healthcare Providers, which had accredited more than 1,299 hospitals as of 2026 against more than 600 safety parameters, and which is recognised internationally through its affiliation with the International Society for Quality in Healthcare. Several Indian hospitals also hold Joint Commission International accreditation.", "today": "The Press Information Bureau's May 2026 backgrounder states the 2025 arrival figures and then reaches for a market size: \"Industry estimates place the medical tourism market at about USD 8.7 billion in 2025, with projections of USD 16.2 billion by 2030.\" It does not name the industry, the method, or what a dollar in that total is a dollar of. The arrivals count and the market estimate sit two lines apart on the same page and are not the same kind of number.", "notes": "India has 69,364 hospitals — 43,486 private and 25,778 public — and 1.2 million registered doctors, on the same government page. Those describe the system Indians use; the hospitals in this directory are a small and expensive slice of it." }, "geo": { "lat": 13.0827, "lon": 80.2707, "precision": "city", "source": "s:osm" }, "metrics": { "inbound_patients_year": 507244, "note": "Foreign nationals arriving in India specifically for medical treatment in 2025, about 5.5 per cent of 9.15 million foreign arrivals. It counts arrivals recorded by visa purpose, not individual people: a patient who leaves and returns is two. Attendants travel on their own visa class and are counted apart.", "as_of": "2025", "source": "s:pib-medical-wellness-tourism-2026", "url": "https://static.pib.gov.in/WriteReadData/specificdocs/documents/2026/may/doc202652862301.pdf" }, "kin": [ { "to": "india-e-medical-visa", "as": "The visa class whose arrivals are the number this page carries.", "rel": "governed-by" }, { "to": "chennai", "as": "The cluster this country is most often named for, and where its oldest corporate hospital chain started.", "rel": "part" }, { "to": "delhi-ncr", "as": "The capital-region cluster that takes most of the arrivals from West Asia and Africa.", "rel": "part" }, { "to": "mumbai", "as": "The financial capital's hospital cluster, and the one closest to the listed-company money.", "rel": "part" }, { "to": "bengaluru", "as": "Where the volume-surgery model was built and costed.", "rel": "part" }, { "to": "apollo-chennai", "as": "The hospital the country's private sector is usually dated from.", "rel": "part" }, { "to": "narayana-health", "as": "The chain that made cardiac surgery a volume calculation.", "rel": "part" }, { "to": "nabh", "as": "The national accreditor, holding more than 1,299 hospitals as of 2026.", "rel": "accredited-by" }, { "to": "cabg", "as": "The operation most often named in this country's inbound cardiac work.", "rel": "procedure" }, { "to": "kidney-transplant", "as": "Sought here, and the reason the transplant rules are read closely.", "rel": "procedure" }, { "to": "panchakarma", "as": "The AYUSH course that earned its own visa class.", "rel": "procedure" }, { "to": "ndm-1-2010", "as": "The 2010 resistance-gene naming row, argued over this country's name and over surgery abroad.", "rel": "event" }, { "to": "counting-patients", "as": "Why an arrivals count and a market estimate are not the same number.", "rel": "story" }, { "to": "thailand", "as": "The other Asian country with a long-running inbound trade, and a different patient at the door.", "rel": "contrast" } ], "links": [ { "label": "Medical and Wellness Tourism in India — PIB backgrounder, 2 May 2026", "url": "https://static.pib.gov.in/WriteReadData/specificdocs/documents/2026/may/doc202652862301.pdf" } ], "sources": [ "s:pib-medical-wellness-tourism-2026", "s:worldbank-open-data", "s:osm", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited", "source": "s:pib-medical-wellness-tourism-2026" }, "fields": { "text.story": { "tier": "cited", "source": "s:pib-medical-wellness-tourism-2026", "note": "the arrival figures and source countries are the government's; the inline marks say which stretches are inference and which are trade practice" }, "text.how": { "tier": "cited", "source": "s:pib-medical-wellness-tourism-2026" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "Chennai, the city most often called the country's care capital; the flow is spread across four clusters" }, "metrics": { "tier": "cited", "source": "s:pib-medical-wellness-tourism-2026" } } }, "x_commons_files": [ "File:Apollo Hospitals Chennai.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "The inbound flow an immigration desk counts. India issues a medical visa and an attendant visa, and the arrival is recorded by purpose, so the figure a reader gets is an arrivals count rather than a hospital's estimate…", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" } ], "kin_out": [ { "to": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The visa class whose arrivals are the number this page carries.", "rel": "governed-by" }, { "to": "chennai", "type": "hub", "name": "Chennai", "as": "The cluster this country is most often named for, and where its oldest corporate hospital chain started.", "rel": "part" }, { "to": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "The capital-region cluster that takes most of the arrivals from West Asia and Africa.", "rel": "part" }, { "to": "mumbai", "type": "hub", "name": "Mumbai", "as": "The financial capital's hospital cluster, and the one closest to the listed-company money.", "rel": "part" }, { "to": "bengaluru", "type": "hub", "name": "Bengaluru", "as": "Where the volume-surgery model was built and costed.", "rel": "part" }, { "to": "apollo-chennai", "type": "facility", "name": "Apollo Hospitals, Greams Road, Chennai", "as": "The hospital the country's private sector is usually dated from.", "rel": "part" }, { "to": "narayana-health", "type": "facility", "name": "Narayana Health", "as": "The chain that made cardiac surgery a volume calculation.", "rel": "part" }, { "to": "nabh", "type": "org", "name": "National Accreditation Board for Hospitals and Healthcare Providers", "as": "The national accreditor, holding more than 1,299 hospitals as of 2026.", "rel": "accredited-by" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The operation most often named in this country's inbound cardiac work.", "rel": "procedure" }, { "to": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "Sought here, and the reason the transplant rules are read closely.", "rel": "procedure" }, { "to": "panchakarma", "type": "procedure", "name": "Panchakarma", "as": "The AYUSH course that earned its own visa class.", "rel": "procedure" }, { "to": "ndm-1-2010", "type": "event", "name": "NDM-1, 2010", "as": "The 2010 resistance-gene naming row, argued over this country's name and over surgery abroad.", "rel": "event" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why an arrivals count and a market estimate are not the same number.", "rel": "story" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "The other Asian country with a long-running inbound trade, and a different patient at the door.", "rel": "contrast" } ], "source_list": [ { "id": "s:pib-medical-wellness-tourism-2026", "kind": "web", "title": "Medical and Wellness Tourism in India", "publisher": "Press Information Bureau, Government of India", "url": "https://static.pib.gov.in/WriteReadData/specificdocs/documents/2026/may/doc202652862301.pdf", "accessed": "2026-09-16", "note": "backgrounder dated 2 May 2026; carries the 2025 medical-purpose arrival count, the top source countries, the NABH accreditation count and the visa categories" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:pib-medical-wellness-tourism-2026" }, "text.story": { "tier": "cited", "source": "s:pib-medical-wellness-tourism-2026", "note": "the arrival figures and source countries are the government's; the inline marks say which stretches are inference and which are trade practice" }, "text.how": { "tier": "cited", "source": "s:pib-medical-wellness-tourism-2026" }, "text.today": { "tier": "cited", "source": "s:pib-medical-wellness-tourism-2026" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "Chennai, the city most often called the country's care capital; the flow is spread across four clusters" }, "metrics": { "tier": "cited", "source": "s:pib-medical-wellness-tourism-2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "kenya", "type": "destination", "name": "Kenya", "as": "Where the outflow goes, and the state that counts it.", "rel": "destination" }, { "from": "nepal", "type": "destination", "name": "Nepal", "as": "Where 88.80 per cent of surveyed Nepali patients went.", "rel": "destination" }, { "from": "nigeria", "type": "destination", "name": "Nigeria", "as": "The destination the rhetoric names, and the state whose own published counts do not list Nigeria among its seven largest sources.", "rel": "destination" }, { "from": "sri-lanka", "type": "destination", "name": "Sri Lanka", "as": "Where Sri Lankan patients go for what Colombo cannot do, an hour away.", "rel": "destination" }, { "from": "bengaluru", "type": "hub", "name": "Bengaluru", "as": "The country whose highest-volume cardiac programmes sit here.", "rel": "whole" }, { "from": "chennai", "type": "hub", "name": "Chennai", "as": "The country whose private tertiary format was proved in this city.", "rel": "whole" }, { "from": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "The country whose largest private tertiary cluster this is.", "rel": "whole" }, { "from": "mumbai", "type": "hub", "name": "Mumbai", "as": "The country whose oncology referrals converge on this city.", "rel": "whole" }, { "from": "angioplasty-stent", "type": "procedure", "name": "Coronary angioplasty and stent", "as": "Where the state caps what a stent may be sold for and hospitals publish the ceiling.", "rel": "destination" }, { "from": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "Built large half-matched transplant programmes that take patients from countries with no unit.", "rel": "destination" }, { "from": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "Where the volume argument about this operation was made.", "rel": "destination" }, { "from": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "Approved a domestically made CD19 product in October 2023 at a fraction of the US price.", "rel": "destination" }, { "from": "cochlear-implant", "type": "procedure", "name": "Cochlear implant", "as": "Runs implant programmes and a state subsidy scheme, and takes patients from neighbouring countries with none.", "rel": "destination" }, { "from": "disc-replacement", "type": "procedure", "name": "Artificial disc replacement", "as": "Where the hospital's own undated range on this page comes from.", "rel": "destination" }, { "from": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "Where the only hospital-published liver transplant price read for this record is sold.", "rel": "destination" }, { "from": "panchakarma", "type": "procedure", "name": "Panchakarma", "as": "Where the state licenses Ayurvedic hospitals and the resort tariff is written in euro for visitors.", "rel": "destination" }, { "from": "apollo-chennai", "type": "facility", "name": "Apollo Hospitals, Greams Road, Chennai", "as": "The hospital most often meant when India is called a destination for heart surgery.", "rel": "destination" }, { "from": "fortis-gurgaon", "type": "facility", "name": "Fortis Memorial Research Institute, Gurugram", "as": "The northern half of India's inbound trade, against Chennai's southern half.", "rel": "destination" }, { "from": "kokilaben", "type": "facility", "name": "Kokilaben Dhirubhai Ambani Hospital", "as": "A Mumbai hospital built to hold referrals inside the country as much as to attract them from outside.", "rel": "destination" }, { "from": "max-saket", "type": "facility", "name": "Max Super Speciality Hospital, Saket", "as": "A northern Indian tertiary hospital whose foreign trade is not separately reported.", "rel": "destination" }, { "from": "medanta", "type": "facility", "name": "Medanta — The Medicity, Gurugram", "as": "An Indian hospital that publishes what the implant costs as well as what the check-up costs.", "rel": "destination" }, { "from": "narayana-health", "type": "facility", "name": "Narayana Health", "as": "The group whose volume argument is what people mean when they say Indian heart surgery is cheap.", "rel": "destination" }, { "from": "antimicrobial-resistance", "type": "risk", "name": "Antimicrobial resistance acquired abroad", "as": "Where two of the four isolate collections in the founding study were taken.", "rel": "place" }, { "from": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The country that issues it.", "rel": "destination" }, { "from": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "The destination that closed by nationality in 2021.", "rel": "destination" }, { "from": "nabh", "type": "org", "name": "National Accreditation Board for Hospitals and Healthcare Providers", "as": "The country whose hospitals this scheme gates, for domestic payment as much as for foreign patients.", "rel": "place" }, { "from": "devi-shetty", "type": "person", "name": "Devi Prasad Shetty", "as": "The country whose low-cost cardiac surgery he is the public face of.", "rel": "destination" }, { "from": "prathap-reddy", "type": "person", "name": "Prathap C. Reddy", "as": "The country whose private hospital sector his group defined the shape of.", "rel": "destination" }, { "from": "ndm-1-2010", "type": "event", "name": "NDM-1, 2010", "as": "The country named in the gene and in the argument that followed.", "rel": "destination" }, { "from": "world-bank-beds", "type": "dataset", "name": "Hospital beds per 1,000 people", "as": "1.59 per 1,000 in 2021, in the country with the largest private hospital export trade in this directory.", "rel": "measures" }, { "from": "world-bank-doctors", "type": "dataset", "name": "Physicians per 1,000 people", "as": "0.72 per 1,000 in 2020, the lowest of the large destinations in this series.", "rel": "measures" }, { "from": "world-bank-out-of-pocket", "type": "dataset", "name": "Out-of-pocket share of health spending", "as": "43.89% in 2023, in a country that is both a destination and a large source of outbound patients.", "rel": "measures" }, { "from": "counting-patients", "type": "story", "name": "Counting patients", "as": "Arrivals counted by visa purpose, so a patient who returns is two.", "rel": "destination" }, { "from": "who-travels", "type": "story", "name": "Who travels", "as": "The receiving state that counts by source country, which is why the regional shape of this trade is visible at all.", "rel": "destination" } ] }, { "schema": 1, "id": "indonesia", "type": "destination", "names": { "name": "Indonesia", "aliases": [ "Republik Indonesia", "Republic of Indonesia" ], "said": "berobat ke luar negeri — to go abroad for treatment. The phrase is ordinary Indonesian, which tells you how ordinary the journey is." }, "region": [ "southeast-asia" ], "facets": { "iso2": "ID", "direction": "outbound", "currency": "IDR", "languages": [ "Indonesian", "English" ] }, "text": { "what": "The largest source market in Southeast Asia, and the country whose departing patients built its neighbours' hospitals. Indonesians fly to Penang, Kuala Lumpur and Singapore in numbers their own government describes in the hundreds of thousands to a million a year, and the state has spent a decade trying to keep them home.", "story": "On 25 March 2022 the Deputy Minister of Health, Dante Saksono Harbuwono, put it in one sentence: \"Every year, we lose 11.5 billion US dollars because many Indonesians, about 600 thousand to one million people, seek medical treatment abroad.\" The destinations he named were Malaysia, Singapore and Thailand.\n\nThat is a minister's estimate, given in a range that spans a factor of nearly two, and this record carries it as a statement rather than as a series. It is nonetheless the clearest official account of an outflow anywhere in Asia, and it is stated as a loss — which is how a source market's government sees this subject, and why so few of them fund a count.\n\nThe receiving end agrees. Indonesians were 75 per cent of Malaysia's foreign patients in 2008 and still 57 per cent in 2011, the share falling only because other nationalities grew.\n\n*Trade practice —* the geography does most of the work. Penang is a forty-minute flight from Medan and has run a Sumatran patient trade for decades; Singapore takes the harder cases and the richer patients from Jakarta. The complaint that drives the journey is rarely price — it is waiting, referral and the way patients are spoken to, the same complaint a survey of Nepali travellers found.\n\n*Inference —* an outflow described in dollars lost is a policy argument, not a measurement. The 11.5 billion figure has no published method attached to it, and nothing in this directory should be built on it.", "how": "*Trade practice —* the trip is booked the way any regional trip is booked: a low-cost flight, a hospital's Indonesian-language desk, a deposit paid by transfer, and an interpreter who is often a Malaysian nurse who speaks Malay. Indonesian doctors' referrals travel informally, and the discharge summary comes home to a doctor who did not order the operation.", "today": "Indonesia's own hospital beds, doctors and health spending per person sit on the country page's chart from the World Bank series with their own years. They are the reason for the outflow more than any hospital abroad is." }, "geo": { "lat": -6.2088, "lon": 106.8456, "precision": "city", "source": "s:osm" }, "metrics": { "inbound_patients_year": null, "note": "No inbound count is carried; Indonesia is a source market on this page. The outbound figure that exists is a statement, not a series: the Deputy Minister of Health said on 25 March 2022 that about 600,000 to 1,000,000 Indonesians seek treatment abroad each year at a cost he put at 11.5 billion US dollars. No published method accompanies either number.", "as_of": "2022", "source": "s:antara-indonesia-outbound-2022", "url": "https://en.antaranews.com/news/221741/one-million-indonesians-annually-seek-medical-treatment-abroad-govt" }, "kin": [ { "to": "malaysia", "as": "Where most of these patients land, and the destination their numbers built.", "rel": "destination" }, { "to": "penang", "as": "Forty minutes from Medan, and the cluster that lives on this outflow.", "rel": "destination" }, { "to": "singapore", "as": "Where the harder diagnoses and the larger bills go.", "rel": "destination" }, { "to": "thailand", "as": "The third destination the deputy minister named in 2022.", "rel": "destination" }, { "to": "executive-health-screening", "as": "The check-up that starts most of these journeys and sometimes is the whole of it.", "rel": "procedure" }, { "to": "follow-up-gap", "as": "The Indonesian doctor reading a discharge summary from an operation they did not order.", "rel": "risk" }, { "to": "who-travels", "as": "A source market whose government counts the money leaving, not the people.", "rel": "story" }, { "to": "world-bank-health-spending", "as": "The series behind what this country spends on health per person, and behind the outflow.", "rel": "measured-by" } ], "links": [ { "label": "One million Indonesians annually seek medical treatment abroad — ANTARA, 25 March 2022", "url": "https://en.antaranews.com/news/221741/one-million-indonesians-annually-seek-medical-treatment-abroad-govt" } ], "sources": [ "s:antara-indonesia-outbound-2022", "s:wp-medical-tourism-malaysia", "s:worldbank-open-data", "s:osm" ], "provenance": { "default": { "tier": "cited", "source": "s:antara-indonesia-outbound-2022" }, "fields": { "text.story": { "tier": "cited", "source": "s:antara-indonesia-outbound-2022", "note": "the quotation and the Malaysian shares are cited; the last two stretches are marked trade practice and inference" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:antara-indonesia-outbound-2022" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "The largest source market in Southeast Asia, and the country whose departing patients built its neighbours' hospitals.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "malaysia", "type": "destination", "name": "Malaysia", "as": "Where most of these patients land, and the destination their numbers built.", "rel": "destination" }, { "to": "penang", "type": "hub", "name": "Penang", "as": "Forty minutes from Medan, and the cluster that lives on this outflow.", "rel": "destination" }, { "to": "singapore", "type": "destination", "name": "Singapore", "as": "Where the harder diagnoses and the larger bills go.", "rel": "destination" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "The third destination the deputy minister named in 2022.", "rel": "destination" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The check-up that starts most of these journeys and sometimes is the whole of it.", "rel": "procedure" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The Indonesian doctor reading a discharge summary from an operation they did not order.", "rel": "risk" }, { "to": "who-travels", "type": "story", "name": "Who travels", "as": "A source market whose government counts the money leaving, not the people.", "rel": "story" }, { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "The series behind what this country spends on health per person, and behind the outflow.", "rel": "measured-by" } ], "source_list": [ { "id": "s:antara-indonesia-outbound-2022", "kind": "web", "title": "One million Indonesians annually seek medical treatment abroad: gov't", "publisher": "ANTARA News", "url": "https://en.antaranews.com/news/221741/one-million-indonesians-annually-seek-medical-treatment-abroad-govt", "accessed": "2026-09-16", "note": "dated 25 March 2022, quoting Deputy Minister of Health Dante Saksono Harbuwono" }, { "id": "s:wp-medical-tourism-malaysia", "kind": "web", "title": "Medical tourism in Malaysia", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_Malaysia", "accessed": "2026-09-16", "note": "used for the year-by-year MHTC series 2011-2016 and the Indonesian share of arrivals" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:antara-indonesia-outbound-2022" }, "text.story": { "tier": "cited", "source": "s:antara-indonesia-outbound-2022", "note": "the quotation and the Malaysian shares are cited; the last two stretches are marked trade practice and inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited", "source": "s:antara-indonesia-outbound-2022" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:antara-indonesia-outbound-2022" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "malaysia", "type": "destination", "name": "Malaysia", "as": "The source market that built this destination, and still supplies most of it.", "rel": "contrast" }, { "from": "singapore", "type": "destination", "name": "Singapore", "as": "The source market that fills these wards, and the reason Jakarta wants them filled at home.", "rel": "contrast" }, { "from": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "Where about two-thirds of this country's foreign patients come from, on one 2024 analysis.", "rel": "kin" }, { "from": "penang", "type": "hub", "name": "Penang", "as": "The catchment: Medan is under an hour away, and about two-thirds of Malaysia's foreign patients are Indonesian on one 2024 analysis.", "rel": "kin" } ] }, { "schema": 1, "id": "iran", "type": "destination", "names": { "name": "Iran", "aliases": [ "ایران", "Islamic Republic of Iran", "Persia" ], "said": "Tehran calls it health tourism and counts it by the million. The patients are overwhelmingly from the countries next door, and almost none of them can pay by card." }, "region": [ "west-asia" ], "facets": { "iso2": "IR", "direction": "both", "currency": "IRR", "languages": [ "Persian", "Arabic", "Azerbaijani", "English" ], "draws": [ "rhinoplasty", "hair-transplant-fue", "ivf" ] }, "text": { "what": "A large regional destination that operates outside the international payment system. Iran's tourism minister said in June 2025 that the country had received 1.2 million health travellers in the previous Iranian year, generating more than two billion dollars, and set a target of more than two million a year under the Seventh Development Plan. The patients come from neighbouring states; the work is cosmetic surgery, fertility treatment and general specialist care.", "story": "The figure is an announcement rather than a series. Seyyed Reza Salehi-Amiri, the tourism minister, gave 1.2 million and \"more than $2 billion in revenue\" for the Iranian year 1403, which ran from 21 March 2024 to 20 March 2025, and the same statement carried the Seventh Development Plan's targets of more than two million travellers and revenue of around six billion dollars.\n\nThis directory carries the number and says what it is: a minister's total, reported in the press, with no published definition, no breakdown and no method. It is the only official figure for Iran read for this record.\n\n*Trade practice —* the patients come from Iraq, Afghanistan, Azerbaijan, Turkmenistan, Oman and Pakistan, and the single best-known product is rhinoplasty, which Tehran performs at a volume that has made it a national joke as well as an industry.\n\n*Inference —* sanctions shape everything about how this trade works. A patient cannot pay an Iranian hospital by international card or bank transfer, so money arrives as cash, through exchange houses, or through an agency abroad. That makes the flow hard to audit from outside, hard for a foreign insurer to touch, and unusually dependent on brokers — and it means the revenue figure in the minister's statement rests on estimates of cash.\n\n*Trade practice —* the flow runs outward too. Iranians travel to Türkiye and the Gulf for care they cannot get at home or cannot get quickly, and for procedures involving imported devices that sanctions have made scarce.", "how": "*Trade practice —* a foreign patient is usually brought in by an agency that handles the visa, the airport pickup, the hospital and the hotel as one price, quoted in dollars and settled in cash on arrival. Prices are low in hard currency because the rial is weak, and they move with the exchange rate rather than with the medicine.", "today": "As of 16 September 2026 the 1403 figure remains the most recent official total read for this record. It is carried with medium confidence and marked for verification." }, "geo": { "lat": 35.6892, "lon": 51.389, "precision": "city", "source": "s:osm" }, "metrics": { "inbound_patients_year": 1200000, "note": "Health travellers in the Iranian year 1403 (21 March 2024 to 20 March 2025), with revenue put at more than two billion US dollars. Stated by the tourism minister, Seyyed Reza Salehi-Amiri, and reported on 7 June 2025; it is a ministerial statement, not a published statistical series, and carries no definition, breakdown or method. Treat it as an announcement with a date on it.", "as_of": "2024", "source": "s:tehran-times-health-travel-2025", "url": "https://www.tehrantimes.com/news/513984/Iran-sets-target-to-attract-two-million-medical-tourists-over" }, "kin": [ { "to": "rhinoplasty", "as": "The operation this country performs at the volume it is known for.", "rel": "procedure" }, { "to": "hair-transplant-fue", "as": "The other cosmetic staple of the Tehran clinics.", "rel": "procedure" }, { "to": "ivf", "as": "Fertility treatment sought here by patients from across the region.", "rel": "procedure" }, { "to": "turkiye", "as": "The neighbour competing for the same patients, and the place Iranians themselves travel to.", "rel": "contrast" }, { "to": "facilitator", "as": "The broker who books the visa, the hotel and the surgeon as one price — and who handles the cash.", "rel": "term" }, { "to": "deposit-and-refund", "as": "What happens to money paid in cash to an agency when the operation does not happen.", "rel": "risk" }, { "to": "malpractice-recourse", "as": "What a foreign patient can do afterwards, in a jurisdiction their own courts cannot reach.", "rel": "risk" }, { "to": "counting-patients", "as": "A national total announced by a minister, with no series behind it.", "rel": "story" }, { "to": "the-price-that-isnt", "as": "Prices that move with the exchange rate rather than with the medicine.", "rel": "story" } ], "links": [ { "label": "Iran sets target to attract two million medical travellers — Tehran Times, 7 June 2025", "url": "https://www.tehrantimes.com/news/513984/Iran-sets-target-to-attract-two-million-medical-tourists-over" } ], "sources": [ "s:tehran-times-health-travel-2025", "s:worldbank-open-data", "s:osm" ], "provenance": { "default": { "tier": "cited", "source": "s:tehran-times-health-travel-2025" }, "fields": { "text.story": { "tier": "cited", "source": "s:tehran-times-health-travel-2025", "note": "the minister's figures and targets are cited; the source countries, the payment account and the outflow are marked trade practice or inference" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:tehran-times-health-travel-2025" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A large regional destination that operates outside the international payment system.", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "The operation this country performs at the volume it is known for.", "rel": "procedure" }, { "to": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The other cosmetic staple of the Tehran clinics.", "rel": "procedure" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "Fertility treatment sought here by patients from across the region.", "rel": "procedure" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The neighbour competing for the same patients, and the place Iranians themselves travel to.", "rel": "contrast" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The broker who books the visa, the hotel and the surgeon as one price — and who handles the cash.", "rel": "term" }, { "to": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "What happens to money paid in cash to an agency when the operation does not happen.", "rel": "risk" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "What a foreign patient can do afterwards, in a jurisdiction their own courts cannot reach.", "rel": "risk" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "A national total announced by a minister, with no series behind it.", "rel": "story" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "Prices that move with the exchange rate rather than with the medicine.", "rel": "story" } ], "source_list": [ { "id": "s:tehran-times-health-travel-2025", "kind": "web", "title": "Iran sets target to attract two million medical tourists over five years", "publisher": "Tehran Times", "url": "https://www.tehrantimes.com/news/513984/Iran-sets-target-to-attract-two-million-medical-tourists-over", "accessed": "2026-09-16", "note": "dated 7 June 2025, reporting tourism minister Seyyed Reza Salehi-Amiri" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:tehran-times-health-travel-2025" }, "text.story": { "tier": "cited", "source": "s:tehran-times-health-travel-2025", "note": "the minister's figures and targets are cited; the source countries, the payment account and the outflow are marked trade practice or inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited", "source": "s:tehran-times-health-travel-2025" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:tehran-times-health-travel-2025" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "transplant-prohibition", "type": "rule", "name": "Buying an organ, and being transplanted abroad", "as": "The one state running a regulated compensated donation programme, and the row this project could not source.", "rel": "destination" } ] }, { "schema": 1, "id": "ireland", "type": "destination", "names": { "name": "Ireland", "aliases": [ "Republic of Ireland", "Éire" ], "said": "In the trade Ireland is a source market with a land border. The queue is published monthly, the border is an hour's drive from a third of the population, and the reimbursement form is the product." }, "region": [ "europe-west" ], "facets": { "iso2": "IE", "direction": "both", "currency": "EUR", "languages": [ "English", "Irish" ] }, "text": { "what": "A country that mostly sends patients out and takes very few in. The driver is the public hospital waiting list, which the National Treatment Purchase Fund publishes every month, and there are three ways off it that involve leaving: the Cross Border Directive scheme to another EU or EEA state, the Northern Ireland Planned Healthcare Scheme to private providers across the land border, and the Treatment Abroad Scheme, which is Ireland's S2 route for care the public system cannot provide in time. All three end in a form. Two of them start with the patient paying the bill.", "story": "The queue first, because everything else follows it. At the end of August 2026 the NTPF counted 687,839 people waiting for a first hospital outpatient consultation, 114,921 waiting for an inpatient or day case appointment, and 42,726 waiting for a GI endoscopy, with a further 37,951 suspended and 113,675 on the planned procedure list. Those are counts of people waiting, not waiting times; the NTPF publishes no median, so this record carries none.\n\nThe outbound flow is then measured, unusually well, from the money. The European Commission's data for reference year 2024 records Ireland receiving 2,566 requests for reimbursement of care not subject to prior authorisation and granting 2,266 of them, and paying out €11,881,494 — an average of €5,243 per granted request, the second highest in the European Union after Cyprus and nearly four times the EU average of €1,351. Only five countries reimbursed more than €10 million in total: Germany, Sweden, Norway, Ireland and Belgium.\n\nWhere those patients went is the second finding. Of the 2,266 reimbursements, 186 were for treatment in the United Kingdom under post-Brexit transitional arrangements. The remaining 2,080 break down by country of treatment as Spain 1,108, Poland 371, Lithuania 294, Germany 101, Latvia 54, Romania 45, Czechia 33, Hungary 18, Belgium 10 and small numbers elsewhere. More than half of Ireland's Directive traffic goes to one country.\n\nThe border is the part the European table cannot see. The Directive once carried Irish patients to private hospitals in Northern Ireland, an hour or two by road. It no longer does: \"You can no longer use the CBD to access healthcare in the UK. This is because the UK left the EU on 31 December 2020.\" That traffic runs instead through a domestic arrangement, the Northern Ireland Planned Healthcare Scheme, which the HSE calls \"similar to the Cross Border Directive\" and which covers planned care bought from private providers in the North. It repays the lesser of what the patient paid there and the price of the same care in the Irish public system, capped for an outpatient appointment at €194 from 1 May 2023. *Inference —* a scheme created because the Directive stopped applying is not counted in the Directive's returns, and no published figure for its volume was found on this pass — which is not evidence that none exists. The consequence is that Ireland's best-measured outbound flow is the one that crosses a sea, and the one that crosses a field is the one nobody here can count.\n\nThe prices attached to all this are the Irish public system's own. The HSE's guide to the most common procedures under both schemes prices lens interventions — cataract surgery — at €1,171 as a day case, colonoscopy at €1,001 and gastroscopy at €726, taken from its 2024 activity-based-funding price list. Those are not what the operation costs in Belfast, Alicante or Vilnius. They are the ceiling on what a patient gets back.\n\nInbound is the short paragraph. In the same European return for 2024, 27 granted reimbursement requests across all reporting countries named Ireland as the country of treatment, against Spain's 32,495 and Germany's 19,719. *Inference —* that counts only patients who claimed the money back at home under the Directive and so misses anyone who simply paid an Irish private hospital, but the order of magnitude is the point: a country that sends 2,080 people abroad on that route receives 27 back on it. Ireland is in this directory because of the outflow.", "how": "Under the Cross Border Directive scheme the referral must come from \"a GP or a consultant you see as a public patient\"; the patient is treated in one of the 27 EU states or in Iceland, Liechtenstein or Norway, \"must pay the provider\" in full, and then claims back from the HSE at the Irish public price for the relevant diagnosis-related group — a code that fixes a single price for a category of care — or the amount actually paid, whichever is lower. Prior authorisation applies to almost nothing: Ireland has notified the Commission of one procedure only, Enzyme Replacement Therapy, and has received no prior authorisation request since 2020. What it runs instead is voluntary Prior Notification for inpatient episodes, which tells the applicant in advance what DRG code and what figure to expect. The Northern Ireland scheme works the same way across the land border, on the same referral rule and the same pay-first rule, against the same Irish price list.\n\nThe Treatment Abroad Scheme is the opposite shape. It covers planned treatment in the EU, EEA, United Kingdom or Switzerland on the E112 (IE) form, which is the S2 certificate; referral is only by a public hospital consultant currently treating the patient — \"We do not accept referrals from GPs or self-referrals\" — and the treatment must be \"not available in Ireland, or not available in the time normally necessary to get it in Ireland\". Where it is granted the states settle between themselves and no treatment invoice reaches the patient. Travel, accommodation and food are outside it.", "today": "As of 17 September 2026 the most recent NTPF figures are August 2026, published on 11 September, and the most recent European return is reference year 2024. The Northern Ireland scheme has been running since the Directive stopped applying to the United Kingdom.", "notes": "Nothing here is legal advice and nothing here is medical advice. A reimbursement rate is not a price and a waiting list count is not a waiting time." }, "geo": { "lat": 53.3498, "lon": -6.2603, "precision": "country", "source": "s:natural-earth" }, "metrics": { "wait_days_home": null, "note": "Ireland's queue is published as counts of people waiting, not as a waiting time, so no median can be carried here. At the end of August 2026 the NTPF counted 687,839 waiting for a first outpatient consultation, 114,921 for an inpatient or day case appointment and 42,726 for a GI endoscopy. Separately, the European Commission's 2024 return records 2,266 Cross Border Directive reimbursements granted to Irish patients at €11,881,494, and 27 granted requests from all reporting countries naming Ireland as the country of treatment.", "as_of": "2026-08", "source": "s:ntpf-august-2026", "url": "https://www.ntpf.ie/news_and_events/ntpf-publishes-august-2026-national-public-hospital-waiting-list-data/" }, "kin": [ { "to": "united-kingdom", "as": "The other mostly outbound country in this region, with a monthly queue of its own and a land border in common.", "rel": "contrast" }, { "to": "spain", "as": "Where more than half of this country's Directive traffic goes — 1,108 granted reimbursements in 2024.", "rel": "contrast" }, { "to": "poland", "as": "Second destination on the same return, at 371, and the dental corridor priced in euro.", "rel": "contrast" }, { "to": "lithuania", "as": "Third on the same return, at 294, two and a half hours away.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "as": "The route that reimburses at this country's own DRG price, and the one the land border fell out of at Brexit.", "rel": "governed-by" }, { "to": "s2-route", "as": "Run here as the Treatment Abroad Scheme, on consultant referral, for care the public system cannot provide in time.", "rel": "governed-by" }, { "to": "cataract-surgery", "as": "The operation behind the most-quoted number in the whole scheme: €1,171 repaid as a day case.", "rel": "procedure" }, { "to": "drg", "as": "The code that fixes what a patient gets back, and the reason a quote abroad has to be read against a category rather than a bill.", "rel": "term" }, { "to": "abortion-care", "as": "The journey the euro column on a British price list was written for.", "rel": "procedure" }, { "to": "oecd-waiting-times", "as": "The series that would put this queue beside other countries', if the counts were of the same thing.", "rel": "measured-by" }, { "to": "waiting-lists", "as": "The queue as the thing that moves patients, published here monthly as a headcount rather than a wait.", "rel": "story" }, { "to": "counting-patients", "as": "A country whose best-counted flow crosses a sea and whose largest may cross a field.", "rel": "story" } ], "links": [ { "label": "NTPF waiting list data", "url": "https://www.ntpf.ie/" }, { "label": "HSE — Cross Border Directive Scheme", "url": "https://www2.hse.ie/services/schemes-allowances/cross-border-directive/" }, { "label": "HSE — Northern Ireland Planned Healthcare Scheme", "url": "https://www2.hse.ie/services/schemes-allowances/niphs/" }, { "label": "HSE — Treatment Abroad Scheme", "url": "https://www2.hse.ie/services/schemes-allowances/treatment-abroad-scheme/" } ], "sources": [ "s:ntpf-august-2026", "s:ntpf-may-2026", "s:ec-crossborder-2024", "s:hse-cbd-scheme", "s:hse-cbd-how-to-get", "s:hse-niphs-getting", "s:hse-niphs-claim", "s:hse-cbd-niphs-drg-guide", "s:hse-abf-2024-inpatient", "s:hse-tas", "s:ec-cross-border-overview", "s:natural-earth" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:ec-crossborder-2024", "note": "the queue counts are the NTPF's August 2026 release, the reimbursement counts, amounts and countries of treatment are read off the European Commission's 2024 tables, the €194 outpatient cap and the DRG prices off the HSE's own pages; the two paragraphs marked inference are this project's reading" }, "text.how": { "tier": "cited", "source": "s:hse-tas", "note": "the referral rule, the pay-first rule and the country list are quoted from the HSE's own Cross Border Directive and NIPHS pages; the prior notification arrangement is from the European Commission's note on Ireland; the Treatment Abroad Scheme quotations are the HSE's own" }, "metrics": { "tier": "cited", "source": "s:ntpf-august-2026" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Border crossing Ireland Northern Ireland.jpg" ], "confidence": "high", "needs_verification": false, "updated": "2026-09-17", "blurb": "A country that mostly sends patients out and takes very few in.", "region_terms": [ { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The other mostly outbound country in this region, with a monthly queue of its own and a land border in common.", "rel": "contrast" }, { "to": "spain", "type": "destination", "name": "Spain", "as": "Where more than half of this country's Directive traffic goes — 1,108 granted reimbursements in 2024.", "rel": "contrast" }, { "to": "poland", "type": "destination", "name": "Poland", "as": "Second destination on the same return, at 371, and the dental corridor priced in euro.", "rel": "contrast" }, { "to": "lithuania", "type": "destination", "name": "Lithuania", "as": "Third on the same return, at 294, two and a half hours away.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route that reimburses at this country's own DRG price, and the one the land border fell out of at Brexit.", "rel": "governed-by" }, { "to": "s2-route", "type": "rule", "name": "The S2 route", "as": "Run here as the Treatment Abroad Scheme, on consultant referral, for care the public system cannot provide in time.", "rel": "governed-by" }, { "to": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "The operation behind the most-quoted number in the whole scheme: €1,171 repaid as a day case.", "rel": "procedure" }, { "to": "drg", "type": "term", "name": "DRG", "as": "The code that fixes what a patient gets back, and the reason a quote abroad has to be read against a category rather than a bill.", "rel": "term" }, { "to": "abortion-care", "type": "procedure", "name": "Abortion", "as": "The journey the euro column on a British price list was written for.", "rel": "procedure" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The series that would put this queue beside other countries', if the counts were of the same thing.", "rel": "measured-by" }, { "to": "waiting-lists", "type": "story", "name": "The queue is the product", "as": "The queue as the thing that moves patients, published here monthly as a headcount rather than a wait.", "rel": "story" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "A country whose best-counted flow crosses a sea and whose largest may cross a field.", "rel": "story" } ], "source_list": [ { "id": "s:ntpf-august-2026", "kind": "gov", "title": "NTPF Publishes August 2026 National Public Hospital Waiting List Data", "publisher": "National Treatment Purchase Fund (Ireland)", "year": 2026, "url": "https://www.ntpf.ie/news_and_events/ntpf-publishes-august-2026-national-public-hospital-waiting-list-data/", "accessed": "2026-09-17", "note": "published 11 September 2026. At the end of August 2026: 687,839 waiting for a first hospital outpatient consultation, 114,921 for an inpatient or day case appointment, 42,726 for a GI endoscopy, 36,138 pre-admit with a date, 113,675 on the planned procedure list, 37,951 suspended. Counts of patients waiting, not a waiting time; the NTPF publishes no median." }, { "id": "s:ntpf-may-2026", "kind": "gov", "title": "NTPF Publishes May 2026 National Public Hospital Waiting List Data", "publisher": "National Treatment Purchase Fund (Ireland)", "url": "https://www.ntpf.ie/news_and_events/ntpf-publishes-may-2026-national-public-hospital-waiting-list-data/", "accessed": "2026-09-16", "note": "at the end of May 2026: 669,506 waiting for a first outpatient consultation, 115,450 for an inpatient or day-case appointment, 40,986 for a GI endoscopy, 34,049 suspended, 111,643 on the planned-procedure list" }, { "id": "s:ec-crossborder-2024", "kind": "report", "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU - reference year 2024", "publisher": "European Commission, Directorate-General for Health and Food Safety", "year": 2025, "url": "https://health.ec.europa.eu/publications/data-cross-border-patient-healthcare-following-directive-201124eu-reference-year-2024_en", "accessed": "2026-09-17", "note": "Ireland: 2,566 requests for reimbursement of healthcare not subject to prior authorisation received in 2024, 2,266 granted (88.3%), 119 refused; EUR 11,881,494 reimbursed, an average of EUR 5,243 per granted request, second highest in the EU after Cyprus. Of the 2,266, 186 were for treatment in the UK under post-Brexit transitional arrangements, leaving 2,080 by EU/EEA country of treatment: Spain 1,108, Poland 371, Lithuania 294, Germany 101, Latvia 54, Romania 45, Czechia 33, Hungary 18, Croatia 8, Slovakia 8, Italy 7, Greece 5, France 5, Cyprus 4, Portugal 4, Netherlands 2, Austria 2, Sweden 1, Belgium 10. Ireland as country of treatment: 27 granted requests from all reporting countries. Prior authorisation in Ireland is required only for Enzyme Replacement Therapy and no request has been received since 2020; what Ireland operates is Prior Notification, voluntary, inpatient only. EU total reimbursed for healthcare not subject to prior authorisation in 2024: EUR 118,151,033.13." }, { "id": "s:hse-cbd-scheme", "kind": "gov", "title": "Cross Border Directive Scheme", "publisher": "Health Service Executive (Ireland)", "url": "https://www2.hse.ie/services/schemes-allowances/cross-border-directive/", "accessed": "2026-09-17", "note": "the HSE's own scheme pages: healthcare in another EU or EEA country, with sections on how to get it, prior notification, and how much can be claimed. The HSE is Ireland's National Contact Point under Directive 2011/24/EU." }, { "id": "s:hse-cbd-how-to-get", "kind": "gov", "title": "Cross Border Directive - How to get healthcare abroad", "publisher": "Health Service Executive (Ireland)", "url": "https://www2.hse.ie/services/schemes-allowances/cross-border-directive/how-to-get/", "accessed": "2026-09-17", "note": "'You can only use a referral from a GP or a consultant you see as a public patient.' 'Under the CBD scheme, you must pay the provider for your healthcare. After you have the healthcare, you can apply to the HSE for payment towards the cost.' Prior notification is optional and does not replace the claim afterwards. 'You can no longer use the CBD to access healthcare in the UK. This is because the UK left the EU on 31 December 2020.' Covers the 27 EU states plus Iceland, Liechtenstein and Norway." }, { "id": "s:hse-niphs-getting", "kind": "gov", "title": "Get healthcare in Northern Ireland with the NIPHS", "publisher": "Health Service Executive (Ireland)", "url": "https://www2.hse.ie/services/schemes-allowances/niphs/getting-healthcare-ni/", "accessed": "2026-09-17", "note": "planned healthcare in private healthcare services in Northern Ireland; 'The NIPHS is similar to the Cross Border Directive (CBD)'; referral only from 'a GP or a consultant you see as a public patient'; 'You must pay the provider for your healthcare. After you have the healthcare, you can apply to the HSE for payment towards the cost.' The page read on 17 September 2026 carries no statement that the scheme is temporary." }, { "id": "s:hse-niphs-claim", "kind": "gov", "title": "Northern Ireland Planned Healthcare Scheme — how much you can claim", "publisher": "Health Service Executive (Ireland)", "url": "https://www2.hse.ie/services/schemes-allowances/niphs/how-much-you-can-claim/", "accessed": "2026-09-16", "note": "the HSE repays the lesser of what the patient paid in Northern Ireland and the price of the same care in the Irish public system, using diagnosis-related group codes; the maximum for an outpatient appointment is EUR 194 from 1 May 2023, EUR 178 for claims between 1 March 2021 and 30 April 2023. The patient pays first." }, { "id": "s:hse-cbd-niphs-drg-guide", "kind": "gov", "title": "CBD / NIPHS Most Common Procedures DRG Guide", "publisher": "Health Service Executive (Ireland)", "url": "https://assets.hse.ie/media/documents/CBD-NIPHS-Most-Common-Procedures-DRG-Guide.pdf", "accessed": "2026-09-16", "note": "the tariff behind both the Cross Border Directive scheme and the Northern Ireland Planned Healthcare Scheme. Cataract procedures map to DRG C16Z LENS INTERVENTIONS at a day-case price of EUR 1,171, covering phacoemulsification or other extraction of the crystalline lens and capsulotomy; colonoscopy G48B EUR 1,001; gastroscopy G47C EUR 726. Same figure as the HSE's 2024 activity-based-funding day-case price list." }, { "id": "s:hse-abf-2024-inpatient", "kind": "gov", "title": "ABF 2024 Admitted Patient Price List — Inpatient Only", "publisher": "Health Service Executive (Ireland)", "url": "https://assets.hse.ie/media/documents/ABF_2024_Admitted_Patient_Price_List_-_Inpatient_Only.pdf", "accessed": "2026-09-17", "note": "the activity-based-funding inlier inpatient price per diagnosis-related group, linked from the HSE's Northern Ireland Planned Healthcare Scheme claim page and the list behind the CBD and NIPHS repayments. Rows read on 17 September 2026: F06C CRNRY BYPSS-INV INVES MINC EUR 30,040, F06B EUR 34,430, F06A EUR 50,579; F05B CRNRY BYPSS+INV INVES MINC EUR 45,093; F04C CRD VLV INTERVTN+PMP-INV INVES MINC EUR 40,253, F04B EUR 50,628, F04A EUR 80,201; F19B TRNS-VSCLR PERC CRDC INTERVTN MINC EUR 9,887, F19A EUR 42,060; F10B INTERVENTIONAL CRNRY PR + AMI MINC EUR 8,857; M01B MAJOR MALE PELVIC INTERVTNS MINC EUR 19,899, M01A EUR 26,820; M02B TRANSURTH PROSTMY MINC EUR 8,363; N04B HYSTERECTOMY FOR N-MAL MINC EUR 13,282; G10B HERNIA INTERVENTIONS MINC EUR 9,046, G10A MAJC EUR 15,366; H08B LAP CHOLECYSTECTOMY MINC EUR 9,867, H07C OPEN CHOLECYSTECTOMY MINC EUR 16,206. An inlier price assumes a length of stay between the low and high boundaries printed beside it." }, { "id": "s:hse-tas", "kind": "gov", "title": "Treatment Abroad Scheme", "publisher": "Health Service Executive (Ireland)", "url": "https://www2.hse.ie/services/schemes-allowances/treatment-abroad-scheme/", "accessed": "2026-09-17", "note": "'The Treatment abroad scheme (TAS) covers the cost of planned treatment in another country in the European Union (EU), European Economic Area (EEA), United Kingdom or Switzerland', on the E112 (IE) or S2 form. Referral only by a public hospital consultant currently treating the patient: 'We do not accept referrals from GPs or self-referrals.' Treatment must be 'not available in Ireland, or not available in the time normally necessary to get it in Ireland'. Travel, accommodation and food are not covered." }, { "id": "s:ec-cross-border-overview", "kind": "web", "title": "Cross-border healthcare — overview", "publisher": "European Commission, Directorate-General for Health and Food Safety", "url": "https://health.ec.europa.eu/cross-border-healthcare/overview_en", "accessed": "2026-09-16", "note": "National Contact Points, the cross-border prescription rules, and the annual Member State data reports on prior authorisation and reimbursement" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:ec-crossborder-2024", "note": "the queue counts are the NTPF's August 2026 release, the reimbursement counts, amounts and countries of treatment are read off the European Commission's 2024 tables, the €194 outpatient cap and the DRG prices off the HSE's own pages; the two paragraphs marked inference are this project's reading" }, "text.how": { "tier": "cited", "source": "s:hse-tas", "note": "the referral rule, the pay-first rule and the country list are quoted from the HSE's own Cross Border Directive and NIPHS pages; the prior notification arrangement is from the European Commission's note on Ireland; the Treatment Abroad Scheme quotations are the HSE's own" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:ntpf-august-2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "lithuania", "type": "destination", "name": "Lithuania", "as": "A source market two and a half hours away, with a queue at home.", "rel": "contrast" }, { "from": "poland", "type": "destination", "name": "Poland", "as": "The second source market, priced in euro on the same page.", "rel": "contrast" }, { "from": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The other mostly outbound country in this region, with a different queue and a different scheme.", "rel": "contrast" }, { "from": "abortion-care", "type": "procedure", "name": "Abortion", "as": "The route the euro column on the British list was written for.", "rel": "destination" } ] }, { "schema": 1, "id": "israel", "type": "destination", "names": { "name": "Israel", "aliases": [ "מדינת ישראל", "State of Israel" ], "said": "The trade means the big public teaching hospitals — Sheba at Tel HaShomer, Hadassah in Jerusalem, Ichilov in Tel Aviv — selling a foreign patient a slot in a system built for residents. That is the arrangement the 2018 statute was written about." }, "region": [ "west-asia" ], "facets": { "iso2": "IL", "direction": "inbound", "currency": "ILS", "languages": [ "Hebrew", "Arabic", "English", "Russian" ], "draws": [ "ivf", "proton-therapy", "bone-marrow-transplant", "car-t" ] }, "text": { "what": "A small inbound trade run largely inside public hospitals, regulated since 2019 by a statute that exists to stop foreign patients from displacing Israeli ones. The Ministry of Health puts arrivals at roughly 30,000 a year on Ministry of Tourism data, most of them from Russia, Ukraine, eastern Europe, Cyprus and neighbouring countries. Israel also sits inside a system of movement permits that determines whether Palestinian patients referred out of the occupied territory reach their appointments, and that system is counted separately, by the World Health Organization.", "story": "The commercial argument arrived before the law did: public hospitals with spare theatre capacity, salaried consultants, and foreign patients paying cash rates several times the domestic tariff. The counter-argument was that an Israeli patient waiting for the same theatre was being moved down a list. The Knesset settled it in statute. The Medical Tourism Law, 5778-2018 came into force on 29 January 2019, and the Ministry of Health describes its purpose in those terms — \"to prevent negative impact on the treatment provided to the Israeli patient, to increase revenues to the Israeli economy from medical tourism activity and to ensure professional and ethical treatment of the medical tourist\".\n\nWhat the law does is register the middlemen and bind the hospitals. Agents must appear on a Ministry of Health register and operate to the statute; an institution treating a foreign patient must send a written invitation setting out the treatment offered and its price quote, and may not give that patient preference over a non-travelling one in appointments, admission or hotel services. *Inference —* a rule that has to say a paying foreigner may not be given the earlier slot is a rule written because that was happening.\n\nSeparately, and on a different footing, Palestinians from the West Bank and Gaza Strip referred to hospitals in East Jerusalem, Israel or abroad require an Israeli-issued permit to travel. WHO's report to the Seventy-sixth World Health Assembly, dated 17 May 2023, records that in 2022 a third — 33 per cent, over 6,500 — of the 20,295 patient permit applications from the Gaza Strip were not approved in time for the hospital appointment, and 15 per cent, over 13,000, of the 87,721 patient permit applications from the West Bank were denied. Approval varied by reason for referral: 87 per cent for oncology against 58 per cent for neurology among Gaza patients in December 2022. Companions fared worse: 62 per cent of 26,461 companion applications from Gaza were not approved by the date of the patient's appointment.", "how": "An inbound patient is quoted in writing by the institution, books through a registered agent or directly, and is treated in a department whose main work is domestic. Fertility, oncology and bone-marrow work are the specialties most often named. Payment is private and priced separately from the national health basket. A referral out of the occupied Palestinian territory follows a different route entirely: a Palestinian Ministry of Health referral, a permit application, and an appointment that may or may not survive the permit's timing.", "today": "As of September 2026 the Ministry of Health's own published estimate — roughly 30,000 arrivals a year — is the figure this record carries, and it is an estimate credited to the Ministry of Tourism rather than a register of treated patients. The 2018 law is in force. The permit figures above are the most recent annual set this project read in a WHO governing-body document.", "notes": "Two different things are described on this page and they are not the same subject: a priced private trade, and an access regime measured in permit approvals. This record reports both and argues neither." }, "geo": { "lat": 32.0853, "lon": 34.7818, "precision": "country", "source": "s:natural-earth" }, "metrics": { "inbound_patients_year": 30000, "note": "The Israeli Ministry of Health's page puts arrivals for medical treatment at approximately 30,000 a year, citing Ministry of Tourism data; published November 2021 and updated March 2023. It is an arrivals estimate, not a count of treated patients, and it carries no year of its own. Leading origins are given as Russia, Ukraine, eastern European countries, Cyprus and other neighbouring countries.", "as_of": "2023", "source": "s:israel-moh-medical-tourism", "url": "https://www.gov.il/en/pages/medical-tourism-israel" }, "kin": [ { "to": "tel-aviv", "as": "Where most of the inbound work is done.", "rel": "part" }, { "to": "sheba", "as": "One of the public hospitals the trade runs through.", "rel": "part" }, { "to": "hadassah", "as": "The Jerusalem teaching hospital that takes referrals from across the region and beyond it.", "rel": "part" }, { "to": "jordan", "as": "The neighbour whose regional trade is several times larger and regulated by a trade body rather than a statute.", "rel": "contrast" }, { "to": "advertising-rules", "as": "Registered agents and written price quotes are what this country's statute requires of the middle layer.", "rel": "governed-by" }, { "to": "facilitator", "as": "The role this country put on a public register in 2019.", "rel": "term" }, { "to": "the-escort-burden", "as": "Counted here in permit refusals: most Gaza companion applications in 2022 were not approved in time.", "rel": "risk" }, { "to": "ivf", "as": "One of the treatments the inbound flow is built on.", "rel": "procedure" }, { "to": "who", "as": "The body that counts the permit approvals this page reports.", "rel": "measures" } ], "links": [ { "label": "Medical Tourism in Israel — Ministry of Health", "url": "https://www.gov.il/en/pages/medical-tourism-israel" }, { "label": "WHO A76/15, health conditions in the occupied Palestinian territory", "url": "https://apps.who.int/gb/ebwha/pdf_files/WHA76/A76_15-en.pdf" } ], "sources": [ "s:israel-moh-medical-tourism", "s:loc-israel-medical-tourism-law", "s:who-a76-15-opt", "s:natural-earth", "s:worldbank-open-data" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:who-a76-15-opt", "note": "the law and its purpose are quoted from the Ministry of Health page; the permit figures are quoted from WHO A76/15; the single inference is marked inline" }, "text.how": { "tier": "tradition", "note": "the ordinary route, hedged as trade knowledge" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A small inbound trade run largely inside public hospitals, regulated since 2019 by a statute that exists to stop foreign patients from displacing Israeli ones.", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "tel-aviv", "type": "hub", "name": "Tel Aviv", "as": "Where most of the inbound work is done.", "rel": "part" }, { "to": "sheba", "type": "facility", "name": "Sheba Medical Center", "as": "One of the public hospitals the trade runs through.", "rel": "part" }, { "to": "hadassah", "type": "facility", "name": "Hadassah Medical Center", "as": "The Jerusalem teaching hospital that takes referrals from across the region and beyond it.", "rel": "part" }, { "to": "jordan", "type": "destination", "name": "Jordan", "as": "The neighbour whose regional trade is several times larger and regulated by a trade body rather than a statute.", "rel": "contrast" }, { "to": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "Registered agents and written price quotes are what this country's statute requires of the middle layer.", "rel": "governed-by" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The role this country put on a public register in 2019.", "rel": "term" }, { "to": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "Counted here in permit refusals: most Gaza companion applications in 2022 were not approved in time.", "rel": "risk" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "One of the treatments the inbound flow is built on.", "rel": "procedure" }, { "to": "who", "type": "org", "name": "World Health Organization", "as": "The body that counts the permit approvals this page reports.", "rel": "measures" } ], "source_list": [ { "id": "s:israel-moh-medical-tourism", "kind": "gov", "title": "Medical Tourism in Israel", "publisher": "Israel Ministry of Health", "url": "https://www.gov.il/en/pages/medical-tourism-israel", "accessed": "2026-09-16", "note": "published 15 November 2021, updated 20 March 2023; carries the Ministry of Tourism's arrivals estimate and the ministry's account of the 2018 law" }, { "id": "s:loc-israel-medical-tourism-law", "kind": "law", "title": "Israel: Knesset Passes Medical Tourism Legislation", "publisher": "Library of Congress, Global Legal Monitor", "url": "https://www.loc.gov/item/global-legal-monitor/2018-09-25/israel-knesset-passes-medical-tourism-legislation/", "accessed": "2026-09-16", "note": "names the instrument as the Medical Tourism Law, 5778-2018, passed 18 July 2018. The page would not open for this project on the access date — a bot check stood in front of it — so the provisions here were taken from the Israeli Ministry of Health's own summary and flagged for verification against the statute." }, { "id": "s:who-a76-15-opt", "kind": "org", "title": "Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan — Report by the Director-General (A76/15)", "publisher": "World Health Organization, Seventy-sixth World Health Assembly", "url": "https://apps.who.int/gb/ebwha/pdf_files/WHA76/A76_15-en.pdf", "accessed": "2026-09-16", "note": "dated 17 May 2023; paragraphs 21 and 22 carry the 2022 permit application and approval counts for patients and their companions. Permit data for the Gaza Strip is attributed in the report to the Health Liaison Office of the Palestinian Ministry of Health." }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:who-a76-15-opt", "note": "the law and its purpose are quoted from the Ministry of Health page; the permit figures are quoted from WHO A76/15; the single inference is marked inline" }, "text.how": { "tier": "tradition", "note": "the ordinary route, hedged as trade knowledge" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "jordan", "type": "destination", "name": "Jordan", "as": "The neighbour whose inbound trade is a tenth the size and regulated by statute.", "rel": "contrast" }, { "from": "tel-aviv", "type": "hub", "name": "Tel Aviv", "as": "The country whose registration requirement governs the agents who bring patients here.", "rel": "whole" }, { "from": "hadassah", "type": "facility", "name": "Hadassah Medical Center", "as": "Jerusalem's teaching hospital, owned by an American organisation and governed by Israel's 2018 medical tourism law.", "rel": "destination" }, { "from": "sheba", "type": "facility", "name": "Sheba Medical Center", "as": "The country's largest hospital, and the one the 2018 medical tourism law was written around.", "rel": "destination" }, { "from": "who-travels", "type": "story", "name": "Who travels", "as": "Where reaching a hospital is decided by a permit, and the permits are counted by WHO.", "rel": "destination" } ] }, { "schema": 1, "id": "japan", "type": "destination", "names": { "name": "Japan", "aliases": [ "日本", "Nippon", "Nihon" ], "said": "Japan runs a Medical Stay visa and a hospital survey, and neither produces a patient count. In the trade Japan is talked about as a destination and shows up in the data as a source market." }, "region": [ "east-asia" ], "facets": { "iso2": "JP", "direction": "both", "currency": "JPY", "languages": [ "Japanese", "English", "Mandarin" ], "draws": [ "proton-therapy", "car-t", "executive-health-screening" ] }, "text": { "what": "A country with a Medical Stay visa, a national programme to receive foreign patients, and no published count of how many arrive for treatment. Japan's measurable role in cross-border care is the opposite of its reputation: in 2024 Japanese patients were the largest single group of foreign patients recorded in South Korea.", "story": "The Ministry of Health, Labour and Welfare runs an annual survey on the reception of foreign patients at medical institutions, covering every hospital in the country and clinics in selected prefectures. The 2023 round was published on 31 July 2024 and corrected twice after. It asks whether a facility received foreign patients and how it is equipped to do so. It does not separate a resident foreigner from a traveller who came for treatment, and it produces a picture of institutions, not of patients.\n\nThe Ministry of Foreign Affairs publishes visa issuances by category each year, on a calendar year, and states on the page that its totals differ from immigration counts because some nationalities need no visa at all. A medical-stay issuance is an issuance: it is not an admission, not an operation, and not a person who arrived.\n\n*Inference —* between a survey of hospitals and a count of visas there is no series that says how many people flew to Japan to be treated, and this directory carries none.\n\nMeanwhile South Korea's health ministry recorded Japan as the leading country of origin for its 1.17 million foreign patients in 2024, with arrivals from Japan up 135.0 per cent on the year. Whatever else Japan is in this subject, it is a documented source market for the clinic next door.", "how": "*Trade practice —* a foreign patient is usually routed through a hospital's international department or an accredited coordinator, who handles the visa letter, the guarantor requirement and the estimate. Language is the binding constraint: consultation, consent and discharge instructions are in Japanese unless the facility has staffed against it. Advanced radiotherapy — proton and carbon-ion beams — is the offer most often named to patients from elsewhere in Asia.", "today": "The 2025 visa issuance tables were published on 23 June 2026 and the 2026 tables are expected around May 2027. No national inbound patient figure is carried on this page." }, "geo": { "lat": 35.6895, "lon": 139.6917, "precision": "city", "source": "s:osm" }, "metrics": { "inbound_patients_year": null, "note": "No count is carried. The health ministry's annual survey covers medical institutions and records whether they received foreign patients, without separating residents from travellers; the foreign ministry's visa statistics count issuances by category, not arrivals or admissions. Neither series answers how many people travelled to Japan for treatment, so this record leaves the field empty rather than fill it from a market summary.", "as_of": "2026-09-16", "source": "s:mhlw-foreign-patient-survey", "url": "https://www.mhlw.go.jp/stf/newpage_41976.html" }, "kin": [ { "to": "south-korea", "as": "The neighbour whose official figures record Japan as its largest source of foreign patients in 2024.", "rel": "contrast" }, { "to": "proton-therapy", "as": "The treatment Japan is most often named for by patients arriving from elsewhere in Asia.", "rel": "procedure" }, { "to": "car-t", "as": "Cell therapy available here, and priced for it.", "rel": "procedure" }, { "to": "executive-health-screening", "as": "The short admission — the ningen dock — that most foreign visitors to Japanese medicine actually buy.", "rel": "procedure" }, { "to": "language-consent", "as": "The constraint that decides which Japanese hospitals can take a foreign patient at all.", "rel": "risk" }, { "to": "what-the-data-cannot-see", "as": "A rich country with two official series and no answer to the simple question.", "rel": "story" }, { "to": "taiwan", "as": "The other East Asian health system that counts its residents well and its visitors not at all.", "rel": "contrast" } ], "links": [ { "label": "FY2023 survey on foreign patient reception — MHLW", "url": "https://www.mhlw.go.jp/stf/newpage_41976.html" }, { "label": "Visa issuance statistics — MOFA", "url": "https://www.mofa.go.jp/mofaj/toko/tokei/hakkyu/index.html" } ], "sources": [ "s:mhlw-foreign-patient-survey", "s:mofa-jp-visa-statistics", "s:mohw-kr-foreign-patients-2024", "s:worldbank-open-data", "s:osm" ], "provenance": { "default": { "tier": "cited", "source": "s:mhlw-foreign-patient-survey" }, "fields": { "text.story": { "tier": "cited", "source": "s:mhlw-foreign-patient-survey", "note": "the survey and the visa series are described from their own pages; the Korean figure is cited to the Korean health ministry" }, "text.how": { "tier": "tradition", "note": "the general shape of an international department at a Japanese hospital" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:mhlw-foreign-patient-survey" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A country with a Medical Stay visa, a national programme to receive foreign patients, and no published count of how many arrive for treatment.", "region_terms": [ { "key": "east-asia", "name": "East Asia", "note": "South Korea, Japan, Taiwan, China" } ], "kin_out": [ { "to": "south-korea", "type": "destination", "name": "South Korea", "as": "The neighbour whose official figures record Japan as its largest source of foreign patients in 2024.", "rel": "contrast" }, { "to": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "The treatment Japan is most often named for by patients arriving from elsewhere in Asia.", "rel": "procedure" }, { "to": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "Cell therapy available here, and priced for it.", "rel": "procedure" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The short admission — the ningen dock — that most foreign visitors to Japanese medicine actually buy.", "rel": "procedure" }, { "to": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "The constraint that decides which Japanese hospitals can take a foreign patient at all.", "rel": "risk" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "A rich country with two official series and no answer to the simple question.", "rel": "story" }, { "to": "taiwan", "type": "destination", "name": "Taiwan", "as": "The other East Asian health system that counts its residents well and its visitors not at all.", "rel": "contrast" } ], "source_list": [ { "id": "s:mhlw-foreign-patient-survey", "kind": "web", "title": "Results of the FY2023 survey on the reception of foreign patients at medical institutions", "publisher": "Ministry of Health, Labour and Welfare (Japan)", "url": "https://www.mhlw.go.jp/stf/newpage_41976.html", "accessed": "2026-09-16", "note": "published 31 July 2024, corrected 21 August 2024 and 20 May 2025; surveys every hospital nationwide plus clinics in selected prefectures, and records whether foreign patients were received, not how many travelled for treatment" }, { "id": "s:mofa-jp-visa-statistics", "kind": "web", "title": "Visa issuance statistics", "publisher": "Ministry of Foreign Affairs of Japan", "url": "https://www.mofa.go.jp/mofaj/toko/tokei/hakkyu/index.html", "accessed": "2026-09-16", "note": "annual counts of visas issued by Japanese missions abroad, by category, on a calendar year; the 2025 tables were published 23 June 2026. The page states that the figures differ from immigration counts because some nationalities are visa-exempt" }, { "id": "s:mohw-kr-foreign-patients-2024", "kind": "web", "title": "Korea Attracts 1.17 Million Foreign Patients in 2024", "publisher": "Ministry of Health and Welfare (Republic of Korea)", "url": "https://www.mohw.go.kr/board.es?mid=a20401000000&bid=0032&act=view&list_no=1485207", "accessed": "2026-09-16", "note": "press release of 3 April 2025; the annual foreign-patient statistics are compiled for the ministry by the Korea Health Industry Development Institute" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:mhlw-foreign-patient-survey" }, "text.story": { "tier": "cited", "source": "s:mhlw-foreign-patient-survey", "note": "the survey and the visa series are described from their own pages; the Korean figure is cited to the Korean health ministry" }, "text.how": { "tier": "tradition", "note": "the general shape of an international department at a Japanese hospital" }, "text.today": { "tier": "cited", "source": "s:mhlw-foreign-patient-survey" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:mhlw-foreign-patient-survey" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "china", "type": "destination", "name": "China", "as": "The other short-haul destination Chinese patients travel to for screening and cell therapy.", "rel": "contrast" }, { "from": "south-korea", "type": "destination", "name": "South Korea", "as": "The largest single source of its foreign patients in 2024.", "rel": "contrast" }, { "from": "taiwan", "type": "destination", "name": "Taiwan", "as": "The other East Asian system with excellent domestic statistics and no traveller count.", "rel": "contrast" }, { "from": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "The densest network of particle therapy centres per head, proton and carbon-ion both.", "rel": "destination" }, { "from": "stem-cell-regulation", "type": "rule", "name": "Regulating cell and tissue therapies", "as": "The one jurisdiction that wrote a statute aimed at the clinic rather than the manufacturer.", "rel": "destination" } ] }, { "schema": 1, "id": "jordan", "type": "destination", "names": { "name": "Jordan", "aliases": [ "المملكة الأردنية الهاشمية", "Hashemite Kingdom of Jordan" ], "said": "In the region Jordan means Amman, and Amman means a ring of private hospitals in Shmeisani and Abdali that have taken Arabic-speaking patients from countries whose own hospitals stopped working." }, "region": [ "west-asia" ], "facets": { "iso2": "JO", "direction": "inbound", "currency": "JOD", "languages": [ "Arabic", "English" ], "draws": [ "cabg", "ivf", "kidney-transplant", "gastric-sleeve" ] }, "text": { "what": "The Arab world's long-standing destination for patients from its own region. Jordan's private hospitals have taken patients from Iraq, Libya, Yemen, Sudan, Syria and Palestine for decades, and the trade association that speaks for those hospitals publishes an annual figure for them. The flow is driven by war, sanctions and health systems that stopped functioning, not by price shopping, and describing it as a bargain hunt misdescribes almost every patient in it.", "story": "The Private Hospitals Association has existed since 1984 and does the counting the state does not. Its president, Fawzi Hammouri, put 2025 at almost US$1 billion of earnings from 230,000 foreign patients, up four per cent on the year, and said a quarter of them were treated in hospitals and the rest in clinics and specialised medical centres. He named Iraq, Saudi Arabia, Palestine, Syria, Yemen and Libya as the largest markets, and put investment in the private hospital sector at $4 billion, supporting 40,000 direct healthcare jobs.\n\nThe sector's own history is a record of other countries' emergencies. It took Iraqi patients through sanctions and after 2003; Libyan patients after 2011, many of them war-wounded and paid for by a Libyan state that then stopped paying; Yemeni and Sudanese patients as those two systems collapsed in turn. It has also lost patients the same way. When Jordan tightened visas for Sudanese, Libyan, Yemeni and Iraqi nationals, the association reported a 40 per cent drop across the first nine months of 2016. The sector's largest single variable is not its prices. It is who can get a visa.\n\n*Inference —* a figure of 230,000 counted by the hospitals that bill them is a count of admissions and episodes rather than of people, and three quarters of it is outpatient work in clinics on the association's own account. The revenue figure is the association's, published by the association, in a year it was arguing for the sector.", "how": "A patient from Baghdad or Benghazi arrives on a visa that must be obtained first, often with a hospital's letter behind it, and is treated on cash terms or against a sponsor — a foreign ministry, an embassy, an employer, or a family that has sold something. Interpretation is not a service here; the staff and the patient share a language, which is most of why the flow came to Amman rather than to Delhi. The King Hussein Cancer Center sits apart from the private ring as a specialist non-profit taking regional referrals.", "today": "As of September 2026 the most recent published figure is the association's own for 2025: 230,000 patients and almost $1 billion. Jordan was accredited by the World Tourism Organisation in 2023 as a destination for medical and wellness travel, which is a promotion mark rather than a clinical one.", "notes": "Patients arriving from a war do not choose a destination the way a reader in London chooses one. This page describes the trade; it does not describe the choice as a free one." }, "geo": { "lat": 31.9454, "lon": 35.9284, "precision": "country", "source": "s:natural-earth" }, "metrics": { "inbound_patients_year": 230000, "note": "2025, as given by Fawzi Hammouri, president of the Private Hospitals Association, reported June 2026. It is the association's own count of the patients its members billed, covering hospital and clinic episodes together — the association itself says only a quarter were treated in hospitals. It counts episodes, not people, and it is published by a body arguing for the sector it counts. Earnings were given as almost US$1 billion, up 4% year on year.", "as_of": "2025", "source": "s:agbi-jordan-2026", "url": "https://www.agbi.com/tourism/2026/06/middle-east-drives-jordans-medical-tourism-earnings-to-1bn/" }, "kin": [ { "to": "amman", "as": "Where the private hospital ring is, and where nearly all of it happens.", "rel": "part" }, { "to": "king-hussein-cancer-center", "as": "The specialist centre regional oncology referrals go to.", "rel": "part" }, { "to": "israel", "as": "The neighbour whose inbound trade is a tenth the size and regulated by statute.", "rel": "contrast" }, { "to": "saudi-arabia", "as": "Named by the hospitals here among their largest source markets.", "rel": "contrast" }, { "to": "schengen-medical-visa", "as": "The contrast: here the binding constraint on the trade is a visa, and the association has measured what happens when one tightens.", "rel": "governed-by" }, { "to": "who-travels", "as": "The case that undoes the bargain-hunting picture of who a cross-border patient is.", "rel": "story" }, { "to": "counting-patients", "as": "Why a trade body's count of its own members' patients is read slowly here.", "rel": "story" }, { "to": "world-bank-health-spending", "as": "The series behind what this country spends on health per person.", "rel": "measured-by" } ], "links": [ { "label": "Jordan's medical travel earnings, reported June 2026", "url": "https://www.agbi.com/tourism/2026/06/middle-east-drives-jordans-medical-tourism-earnings-to-1bn/" } ], "sources": [ "s:agbi-jordan-2026", "s:jordantimes-2016-drop", "s:wp-pha-jordan", "s:natural-earth", "s:worldbank-open-data" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:agbi-jordan-2026", "note": "the 2016 visa-driven drop is the association's own reported figure; the closing reading of what 230,000 counts is marked inline as inference" }, "text.how": { "tier": "tradition", "note": "the ordinary shape of the route, hedged as trade knowledge" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "The Arab world's long-standing destination for patients from its own region.", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "amman", "type": "hub", "name": "Amman", "as": "Where the private hospital ring is, and where nearly all of it happens.", "rel": "part" }, { "to": "king-hussein-cancer-center", "type": "facility", "name": "King Hussein Cancer Center", "as": "The specialist centre regional oncology referrals go to.", "rel": "part" }, { "to": "israel", "type": "destination", "name": "Israel", "as": "The neighbour whose inbound trade is a tenth the size and regulated by statute.", "rel": "contrast" }, { "to": "saudi-arabia", "type": "destination", "name": "Saudi Arabia", "as": "Named by the hospitals here among their largest source markets.", "rel": "contrast" }, { "to": "schengen-medical-visa", "type": "rule", "name": "The Schengen visa, for treatment", "as": "The contrast: here the binding constraint on the trade is a visa, and the association has measured what happens when one tightens.", "rel": "governed-by" }, { "to": "who-travels", "type": "story", "name": "Who travels", "as": "The case that undoes the bargain-hunting picture of who a cross-border patient is.", "rel": "story" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a trade body's count of its own members' patients is read slowly here.", "rel": "story" }, { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "The series behind what this country spends on health per person.", "rel": "measured-by" } ], "source_list": [ { "id": "s:agbi-jordan-2026", "kind": "news", "title": "Middle East drives Jordan's medical tourism earnings to $1bn", "publisher": "AGBI (Arabian Gulf Business Insight)", "url": "https://www.agbi.com/tourism/2026/06/middle-east-drives-jordans-medical-tourism-earnings-to-1bn/", "accessed": "2026-09-16", "note": "published 17 June 2026, reporting Fawzi Hammouri, president of the Private Hospitals Association, as carried by the Jordan Times" }, { "id": "s:jordantimes-2016-drop", "kind": "news", "title": "'Medical tourism sector witnessed 40% drop in first nine months of 2016'", "publisher": "The Jordan Times", "url": "http://www.jordantimes.com/news/local/medical-tourism-sector-witnessed-40-drop-first-nine-months-2016", "accessed": "2026-09-16", "note": "the Private Hospitals Association attributing the drop to visa restrictions on Sudanese, Libyan, Yemeni and Iraqi nationals. The page would not open for this project on the access date; the figure is carried from the publisher's own listing and is flagged for verification." }, { "id": "s:wp-pha-jordan", "kind": "web", "title": "Private Hospitals Association (Jordan)", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Private_Hospitals_Association_(Jordan)", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:agbi-jordan-2026", "note": "the 2016 visa-driven drop is the association's own reported figure; the closing reading of what 230,000 counts is marked inline as inference" }, "text.how": { "tier": "tradition", "note": "the ordinary shape of the route, hedged as trade knowledge" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "egypt", "type": "destination", "name": "Egypt", "as": "The other regional destination Arabic-speaking patients choose between.", "rel": "contrast" }, { "from": "israel", "type": "destination", "name": "Israel", "as": "The neighbour whose regional trade is several times larger and regulated by a trade body rather than a statute.", "rel": "contrast" }, { "from": "saudi-arabia", "type": "destination", "name": "Saudi Arabia", "as": "One of the places Saudi patients and their escorts have gone for decades.", "rel": "contrast" }, { "from": "amman", "type": "hub", "name": "Amman", "as": "The country this cluster is effectively the whole of.", "rel": "whole" }, { "from": "king-hussein-cancer-center", "type": "facility", "name": "King Hussein Cancer Center", "as": "The reason the country is a destination and not only a source market.", "rel": "destination" }, { "from": "counting-patients", "type": "story", "name": "Counting patients", "as": "Counted by the hospitals that billed them, three quarters of it outpatient work.", "rel": "destination" }, { "from": "who-travels", "type": "story", "name": "Who travels", "as": "The trade built on other countries' wars, where the binding constraint is a visa rather than a price.", "rel": "destination" } ] }, { "schema": 1, "id": "kenya", "type": "destination", "names": { "name": "Kenya", "aliases": [ "Republic of Kenya", "Jamhuri ya Kenya" ], "said": "In the trade Kenya is a departure board, not an arrivals hall. The flights that matter are Nairobi to Mumbai, Nairobi to Chennai and Nairobi to Delhi, and the agencies that sell them advertise in Nairobi newspapers." }, "region": [ "africa-east" ], "facets": { "iso2": "KE", "direction": "outbound", "currency": "KES", "languages": [ "Swahili", "English" ], "draws": [] }, "text": { "what": "A source market. Kenyans with money or with an employer scheme fly to India for cancer treatment, cardiac surgery, transplants and neurosurgery; Kenyans without either do not go. India's own tourism ministry counted 9,357 arrivals from Kenya for medical purposes in 2025, which makes Kenya the seventh-largest source country on India's published list. Nairobi is also a regional referral centre for its own neighbours, which is the part of the picture a departures-only reading loses.", "story": "The Indian figure is the one worth holding, because India counts it and publishes it by source country. In 2025 India recorded 507,244 foreign nationals arriving for medical treatment, about 5.5 per cent of all foreign arrivals; Bangladesh supplied 325,127 of them, Iraq 30,989, Uzbekistan 13,699, Somalia 11,506, Turkmenistan 10,231, Oman 9,738 and Kenya 9,357. That is a count made by the receiving state, on its own arrivals data, and it is a firmer thing than any estimate made at the sending end.\n\n*Inference —* what a country loses when its citizens fly out is not mainly money, and the money argument is the one usually made. It is the caseload. A cancer service is built by treating cancers; a cardiac unit gets good by operating. Every complex case that boards a plane is a case the Kenyan hospital did not do, the Kenyan registrar did not see, and the Kenyan oncologist did not record. The patients who cannot afford the ticket stay behind and are treated by a service whose experience has been exported with the people who could pay for it.\n\n*Trade practice —* the flow runs on facilitators. Indian hospital groups keep representative offices and liaison desks in Nairobi, airlines have marketed medical itineraries directly, and the referral often starts with an agent rather than a doctor. Where the agent is paid by the hospital, the referral is a sale.", "how": "An Indian e-medical visa, a quotation from the receiving hospital, a companion where the family can fund one, and payment in cash or by a Kenyan insurer with an overseas benefit. National insurance cover for treatment abroad has existed in Kenya as a limited, approval-gated benefit rather than an open entitlement, which is what keeps the flow to those who can pay the remainder.", "today": "As of September 2026 the number this record carries for Kenya is India's, not Kenya's: 9,357 arrivals for medical purposes in 2025. Figures circulating for what Kenyans spend abroad in a year are attributed to the Kenyan health ministry in press reporting this project could not open, and are not carried here.", "notes": "This page describes an outflow. It does not describe Kenyan hospitals, and the absence of an inbound figure here is not a judgement about them." }, "geo": { "lat": -1.2921, "lon": 36.8219, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "9,357 arrivals in India from Kenya for medical purposes in 2025, from the Press Information Bureau backgrounder of 2 May 2026 citing Ministry of Tourism figures. It counts arrivals recorded at the Indian border under a medical purpose of visit, so it counts trips rather than people and misses anyone who travelled on another visa class. No Kenyan government figure for the outflow is carried here.", "as_of": "2025", "source": "s:pib-india-mvt-2026", "url": "https://www.pib.gov.in/PressReleasePage.aspx?PRID=2257447®=3&lang=1" }, "kin": [ { "to": "india", "as": "Where the outflow goes, and the state that counts it.", "rel": "destination" }, { "to": "india-e-medical-visa", "as": "The visa class the outflow travels on.", "rel": "governed-by" }, { "to": "nigeria", "as": "The other big African source market, and the one whose numbers are argued over.", "rel": "kin" }, { "to": "south-africa", "as": "The continental destination Kenyan patients use less than the Indian one.", "rel": "contrast" }, { "to": "facilitator", "as": "The middle layer that starts most of these referrals.", "rel": "term" }, { "to": "apollo-chennai", "as": "One of the Indian groups that has kept a liaison presence in East Africa.", "rel": "performed-at" }, { "to": "who-travels", "as": "The patients who can buy the ticket, and the ones left with what remains.", "rel": "story" }, { "to": "world-bank-doctors", "as": "The series behind the specialist density the outflow is a response to.", "rel": "measured-by" } ], "links": [ { "label": "Medical and Wellness Tourism in India — PIB backgrounder, 2 May 2026", "url": "https://www.pib.gov.in/PressReleasePage.aspx?PRID=2257447®=3&lang=1" } ], "sources": [ "s:pib-india-mvt-2026", "s:natural-earth", "s:worldbank-open-data" ], "provenance": { "default": { "tier": "cited", "source": "s:pib-india-mvt-2026" }, "fields": { "text.story": { "tier": "cited", "source": "s:pib-india-mvt-2026", "note": "the first paragraph is India's published count; the second and third are marked inline" }, "text.how": { "tier": "tradition", "note": "the ordinary route; the insurance point is hedged and not cited to an instrument" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A source market. Kenyans with money or with an employer scheme fly to India for cancer treatment, cardiac surgery, transplants and neurosurgery; Kenyans without either do not go.", "region_terms": [ { "key": "africa-east", "name": "East Africa", "note": "Kenya, Tanzania, Ethiopia, Rwanda" } ], "kin_out": [ { "to": "india", "type": "destination", "name": "India", "as": "Where the outflow goes, and the state that counts it.", "rel": "destination" }, { "to": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The visa class the outflow travels on.", "rel": "governed-by" }, { "to": "nigeria", "type": "destination", "name": "Nigeria", "as": "The other big African source market, and the one whose numbers are argued over.", "rel": "kin" }, { "to": "south-africa", "type": "destination", "name": "South Africa", "as": "The continental destination Kenyan patients use less than the Indian one.", "rel": "contrast" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The middle layer that starts most of these referrals.", "rel": "term" }, { "to": "apollo-chennai", "type": "facility", "name": "Apollo Hospitals, Greams Road, Chennai", "as": "One of the Indian groups that has kept a liaison presence in East Africa.", "rel": "performed-at" }, { "to": "who-travels", "type": "story", "name": "Who travels", "as": "The patients who can buy the ticket, and the ones left with what remains.", "rel": "story" }, { "to": "world-bank-doctors", "type": "dataset", "name": "Physicians per 1,000 people", "as": "The series behind the specialist density the outflow is a response to.", "rel": "measured-by" } ], "source_list": [ { "id": "s:pib-india-mvt-2026", "kind": "gov", "title": "Medical and Wellness Tourism in India — PIB Backgrounder", "publisher": "Press Information Bureau, Government of India", "url": "https://www.pib.gov.in/PressReleasePage.aspx?PRID=2257447®=3&lang=1", "accessed": "2026-09-16", "note": "posted 2 May 2026; gives 2025 arrivals in India for medical purpose in total and for the seven leading source countries" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:pib-india-mvt-2026" }, "text.story": { "tier": "cited", "source": "s:pib-india-mvt-2026", "note": "the first paragraph is India's published count; the second and third are marked inline" }, "text.how": { "tier": "tradition", "note": "the ordinary route; the insurance point is hedged and not cited to an instrument" }, "text.today": { "tier": "cited", "source": "s:pib-india-mvt-2026" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:pib-india-mvt-2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "nigeria", "type": "destination", "name": "Nigeria", "as": "The other big African source market, and the one with a receiving state's count behind it.", "rel": "kin" }, { "from": "south-africa", "type": "destination", "name": "South Africa", "as": "The other African country with a tertiary sector its neighbours use — and an outflow of its own.", "rel": "contrast" }, { "from": "who-travels", "type": "story", "name": "Who travels", "as": "India's seventh-largest source, counted at the Indian border rather than the Kenyan one.", "rel": "destination" } ] }, { "schema": 1, "id": "lithuania", "type": "destination", "names": { "name": "Lithuania", "aliases": [ "Lietuva", "Lietuvos Respublika" ], "said": "In the trade Lithuania means Vilnius and Kaunas, dentistry and cosmetic surgery, and a short flight from Dublin, Oslo or London." }, "region": [ "europe-north" ], "facets": { "iso2": "LT", "direction": "both", "currency": "EUR", "languages": [ "Lithuanian", "English", "Russian" ], "draws": [ "dental-implant", "all-on-four", "rhinoplasty", "breast-augmentation", "abdominoplasty" ] }, "text": { "what": "The smallest of the European dental and cosmetic corridors, and the one that grew on emigration. Lithuanian clinics in Vilnius, Kaunas and Klaipėda advertise in English and Norwegian as well as Lithuanian, and sell implant work, full-arch restorations and cosmetic surgery to patients from Ireland, Britain and the Nordic countries. The country operates no prior-authorisation system for its own residents seeking care abroad.", "story": "The official cross-border numbers are tiny and worth reading precisely for that. In the Commission's 2022 data Lithuania received 131 requests for reimbursement of care not subject to prior authorisation and granted 125, and it sits among the eight countries that run no prior-authorisation regime at all. Whatever traffic the clinics carry is not passing through any reimbursement channel that counts it.\n\n*Trade practice —* the trade's own account is a diaspora account. Lithuanian emigration after 2004 built the routes and the language skills; the clinics that served returning Lithuanians were already working in English when other patients started arriving, and the low-cost carriers that made the labour migration cheap made the dental trip cheap with it.\n\n*Inference —* the country is small enough that its inbound trade is a handful of clinics rather than an industry, which changes what a reader can check: there is no national register of foreign patients to consult, and the evidence available is what individual clinics publish about themselves.", "how": "Itemised dental pricing in euro, with implant work staged across two trips and full-arch cases often quoted as one figure. Cosmetic clinics sell a fixed price with a stated number of nights and follow-up before the flight home; the clot risk sets that interval, not the calendar of the booking.", "today": "No published national count of inbound patients was found for this record. The figure that can be read is the reimbursement one: 131 requests in 2022, which describes Lithuanians treated abroad rather than anyone treated here." }, "geo": { "lat": 54.6872, "lon": 25.2797, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "131 requests for reimbursement of care not subject to prior authorisation in 2022, 125 granted. That counts outbound Lithuanian patients reclaiming at home. No inbound count is carried: none was found on this pass, which is not evidence that none exists.", "as_of": "2022", "source": "s:ec-crossborder-2022" }, "kin": [ { "to": "vilnius", "as": "The capital cluster, where most of the English-language clinics are.", "rel": "part" }, { "to": "dental-implant", "as": "The commonest reason a foreign patient books a flight here.", "rel": "procedure" }, { "to": "ireland", "as": "A source market two and a half hours away, with a queue at home.", "rel": "contrast" }, { "to": "poland", "as": "The bigger corridor selling the same work to the same markets.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "as": "The reimbursement route this country's residents use, and its visitors do not.", "rel": "governed-by" }, { "to": "flying-after-surgery", "as": "What sets the number of nights between a cosmetic operation and the flight home.", "rel": "risk" } ], "sources": [ "s:ec-crossborder-2022", "s:eu-directive-2011-24", "s:natural-earth" ], "provenance": { "default": { "tier": "cited", "source": "s:ec-crossborder-2022" }, "fields": { "text.what": { "tier": "tradition", "note": "the clinics' own self-description; the prior-authorisation point is cited" }, "text.story": { "tier": "cited", "source": "s:ec-crossborder-2022", "note": "the second and third paragraphs are marked trade practice and inference" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Vilnius Old Town.jpg" ], "needs_verification": true, "confidence": "low", "updated": "2026-09-16", "blurb": "The smallest of the European dental and cosmetic corridors, and the one that grew on emigration.", "region_terms": [ { "key": "europe-north", "name": "Northern Europe", "note": "the Nordics and the Baltics" } ], "kin_out": [ { "to": "vilnius", "type": "hub", "name": "Vilnius", "as": "The capital cluster, where most of the English-language clinics are.", "rel": "part" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The commonest reason a foreign patient books a flight here.", "rel": "procedure" }, { "to": "ireland", "type": "destination", "name": "Ireland", "as": "A source market two and a half hours away, with a queue at home.", "rel": "contrast" }, { "to": "poland", "type": "destination", "name": "Poland", "as": "The bigger corridor selling the same work to the same markets.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The reimbursement route this country's residents use, and its visitors do not.", "rel": "governed-by" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "What sets the number of nights between a cosmetic operation and the flight home.", "rel": "risk" } ], "source_list": [ { "id": "s:ec-crossborder-2022", "kind": "report", "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU — reference year 2022", "publisher": "European Commission, DG Health and Food Safety, Unit B.3; written by PredictBy Research and Consulting and Baltic Media; Publications Office of the European Union", "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf", "license": "CC BY 4.0", "accessed": "2026-09-16", "note": "final version January 2024, ISBN 978-92-68-14858-7. 23 countries reported 547,890 reimbursement requests for care not needing prior authorisation in 2022, of which France 300,254 and Germany 160,647 are 84%; Poland 14,176, Slovakia 13,904, Ireland 1,841, Romania 889, Czechia 440, Croatia 192, Lithuania 131, Greece 56, Cyprus 44, Portugal 27 (all refused), Spain 9. Total reimbursed EUR 86,462,491. For care needing prior authorisation, 4,552 requests and EUR 7,708,041. Belgium and Hungary could not report; Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway run no prior-authorisation system; only Denmark and Romania have a mechanism to limit inflow." }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "tradition", "note": "the clinics' own self-description; the prior-authorisation point is cited" }, "text.story": { "tier": "cited", "source": "s:ec-crossborder-2022", "note": "the second and third paragraphs are marked trade practice and inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited", "source": "s:ec-crossborder-2022" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:ec-crossborder-2022" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "ireland", "type": "destination", "name": "Ireland", "as": "Third on the same return, at 294, two and a half hours away.", "rel": "contrast" }, { "from": "vilnius", "type": "hub", "name": "Vilnius", "as": "The country this cluster is the capital of.", "rel": "whole" }, { "from": "acl-reconstruction", "type": "procedure", "name": "Anterior cruciate ligament reconstruction", "as": "Where the advertised floor price on this page comes from.", "rel": "destination" }, { "from": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "Where the advertised floor price on this page comes from, refund paperwork offered with it.", "rel": "destination" }, { "from": "knee-arthroscopy", "type": "procedure", "name": "Knee arthroscopy", "as": "Where the cheapest advertised orthopaedic price in this batch comes from.", "rel": "destination" }, { "from": "shoulder-replacement", "type": "procedure", "name": "Total shoulder replacement", "as": "Where the advertised floor price on this page comes from.", "rel": "destination" } ] }, { "schema": 1, "id": "malaysia", "type": "destination", "names": { "name": "Malaysia", "aliases": [ "Federation of Malaysia" ], "said": "Two places, not one. Kuala Lumpur sells cardiac work and fertility; Penang sells everything to Sumatra, forty minutes away by air." }, "region": [ "southeast-asia" ], "facets": { "iso2": "MY", "direction": "inbound", "currency": "MYR", "languages": [ "Malay", "English", "Mandarin", "Tamil", "Indonesian" ], "draws": [ "ivf", "executive-health-screening", "cabg", "knee-replacement" ] }, "text": { "what": "A destination built on one neighbour. Malaysia's healthcare-travel figures are published by a council inside the Ministry of Health, and the patients behind them are mostly Indonesian, mostly arriving through Penang and Kuala Lumpur, and mostly buying screening, fertility and cardiac care rather than the cosmetic work that carries the trade's reputation elsewhere.", "story": "The Malaysia Healthcare Travel Council was set up in 2009 by the Ministry of Health, replacing an earlier committee, and it has published a traveller count ever since. Its series runs 641,000 in 2011, 728,800 in 2012, 881,000 in 2013, 882,000 in 2014, 859,000 in 2015 and 921,000 in 2016. Revenue went from 299 million ringgit in 2008 to 527 million in 2011 to 1.7 billion in 2019. For 2024 the council reported 1.6 million healthcare travellers, up 14 per cent, and 2.72 billion ringgit, up 21 per cent.\n\nIndonesians were 75 per cent of the foreign patients in 2008 and 57 per cent by 2011, the share falling as other nationalities grew rather than because Indonesians stopped coming.\n\n*Inference —* the jump from 921,000 in 2016 to 1.6 million in 2024 is steeper than any plausible growth in operations, and the council does not publish what a healthcare traveller is. A figure that size in a country of about 34 million reads as a count of foreign patients seen at member facilities — every check-up, every follow-up visit, every expatriate with a fever — rather than a count of people who crossed a border for treatment. The council's revenue figure is the number with a defensible denominator.", "how": "Hospitals join the council as members and report through it, which is how the national figure is assembled. Malaysian private hospitals quote in ringgit, publish package prices for screening and fertility more readily than for surgery, and market through the council's own channels. The council also runs awards, which are marketing instruments and are counted here, never weighted.", "today": "As of July 2025 the council was promoting 2026 as a national year for the trade and holding a target of 12 billion ringgit in industry revenue by 2030. The 2024 traveller and revenue figures are the council's own and have not been audited by this project." }, "geo": { "lat": 3.139, "lon": 101.6869, "precision": "city", "source": "s:osm" }, "metrics": { "inbound_patients_year": 1600000, "note": "The council's own count of \"healthcare travellers\" for 2024, alongside 2.72 billion ringgit of revenue. The release does not define the unit, so it cannot be told from a count of people, of visits, or of foreign patients seen at member hospitals. Read against the council's own earlier series — 921,000 in 2016 — the rise is steeper than the operating theatres.", "as_of": "2024", "source": "s:mhtc-mymt-2026", "url": "https://www.prnewswire.com/apac/news-releases/malaysia-healthcare-travel-council-launches-mymt-2026-malaysias-first-medical-tourism-year-302513594.html" }, "kin": [ { "to": "mhtc", "as": "The council inside the health ministry that publishes this country's traveller count.", "rel": "measured-by" }, { "to": "malaysia-mhtc-licence", "as": "The registration a hospital passes through to be counted and marketed as a destination facility.", "rel": "governed-by" }, { "to": "kuala-lumpur", "as": "The cardiac and fertility half of the trade.", "rel": "part" }, { "to": "penang", "as": "The Indonesian half, forty minutes from Medan.", "rel": "part" }, { "to": "indonesia", "as": "The source market that built this destination, and still supplies most of it.", "rel": "contrast" }, { "to": "gleneagles-kl", "as": "One of the private hospitals the council's figures are assembled from.", "rel": "part" }, { "to": "prince-court", "as": "The Kuala Lumpur hospital most often named in the country's marketing.", "rel": "part" }, { "to": "island-hospital-penang", "as": "The Penang hospital that made the Sumatra route ordinary.", "rel": "part" }, { "to": "ivf", "as": "The treatment Malaysia sells hardest, and the one its neighbours travel for.", "rel": "procedure" }, { "to": "executive-health-screening", "as": "The package that fills the appointment book between operations.", "rel": "procedure" }, { "to": "counting-patients", "as": "Why a 1.6 million figure with no published definition is a marketing number.", "rel": "story" }, { "to": "thailand", "as": "The neighbour whose package-price format arrived here in the 2000s.", "rel": "contrast" } ], "links": [ { "label": "Malaysia Healthcare Travel Council", "url": "https://www.mhtc.org.my/" } ], "sources": [ "s:mhtc-mymt-2026", "s:wp-medical-tourism-malaysia", "s:worldbank-open-data", "s:osm" ], "provenance": { "default": { "tier": "cited", "source": "s:mhtc-mymt-2026" }, "fields": { "text.story": { "tier": "cited", "source": "s:wp-medical-tourism-malaysia", "note": "the 2011-2016 series and the Indonesian share come from the Wikipedia article citing MHTC; the 2024 figures come from MHTC's own release; the closing paragraph is marked inference" }, "text.how": { "tier": "tradition", "note": "the general shape of council membership and reporting; not read off an instrument" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:mhtc-mymt-2026" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A destination built on one neighbour. Malaysia's healthcare-travel figures are published by a council inside the Ministry of Health, and the patients behind them are mostly Indonesian, mostly arriving through Penang and…", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "mhtc", "type": "org", "name": "Malaysia Healthcare Travel Council", "as": "The council inside the health ministry that publishes this country's traveller count.", "rel": "measured-by" }, { "to": "malaysia-mhtc-licence", "type": "rule", "name": "Malaysia's healthcare travel registration", "as": "The registration a hospital passes through to be counted and marketed as a destination facility.", "rel": "governed-by" }, { "to": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "The cardiac and fertility half of the trade.", "rel": "part" }, { "to": "penang", "type": "hub", "name": "Penang", "as": "The Indonesian half, forty minutes from Medan.", "rel": "part" }, { "to": "indonesia", "type": "destination", "name": "Indonesia", "as": "The source market that built this destination, and still supplies most of it.", "rel": "contrast" }, { "to": "gleneagles-kl", "type": "facility", "name": "Gleneagles Hospital Kuala Lumpur", "as": "One of the private hospitals the council's figures are assembled from.", "rel": "part" }, { "to": "prince-court", "type": "facility", "name": "Prince Court Medical Centre", "as": "The Kuala Lumpur hospital most often named in the country's marketing.", "rel": "part" }, { "to": "island-hospital-penang", "type": "facility", "name": "Island Hospital", "as": "The Penang hospital that made the Sumatra route ordinary.", "rel": "part" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment Malaysia sells hardest, and the one its neighbours travel for.", "rel": "procedure" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The package that fills the appointment book between operations.", "rel": "procedure" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a 1.6 million figure with no published definition is a marketing number.", "rel": "story" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "The neighbour whose package-price format arrived here in the 2000s.", "rel": "contrast" } ], "source_list": [ { "id": "s:mhtc-mymt-2026", "kind": "web", "title": "Malaysia Healthcare Travel Council Launches MYMT 2026, Malaysia's First Medical Tourism Year", "publisher": "Malaysia Healthcare Travel Council", "url": "https://www.prnewswire.com/apac/news-releases/malaysia-healthcare-travel-council-launches-mymt-2026-malaysias-first-medical-tourism-year-302513594.html", "accessed": "2026-09-16", "note": "MHTC's own release, dated 25 July 2025, carrying its 2024 healthcare-traveller and revenue figures. The council's own site returned a server error on the date of access" }, { "id": "s:wp-medical-tourism-malaysia", "kind": "web", "title": "Medical tourism in Malaysia", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_Malaysia", "accessed": "2026-09-16", "note": "used for the year-by-year MHTC series 2011-2016 and the Indonesian share of arrivals" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:mhtc-mymt-2026" }, "text.story": { "tier": "cited", "source": "s:wp-medical-tourism-malaysia", "note": "the 2011-2016 series and the Indonesian share come from the Wikipedia article citing MHTC; the 2024 figures come from MHTC's own release; the closing paragraph is marked inference" }, "text.how": { "tier": "tradition", "note": "the general shape of council membership and reporting; not read off an instrument" }, "text.today": { "tier": "cited", "source": "s:mhtc-mymt-2026" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:mhtc-mymt-2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "indonesia", "type": "destination", "name": "Indonesia", "as": "Where most of these patients land, and the destination their numbers built.", "rel": "destination" }, { "from": "philippines", "type": "destination", "name": "Philippines", "as": "The regional competitor with a council, a count, and a marketing budget.", "rel": "contrast" }, { "from": "singapore", "type": "destination", "name": "Singapore", "as": "The cheaper neighbour, and the place Singaporeans themselves cross to.", "rel": "contrast" }, { "from": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "The country whose capital cluster this is, and which counts its patients by passport.", "rel": "whole" }, { "from": "penang", "type": "hub", "name": "Penang", "as": "The country whose second cluster takes almost as much revenue as its capital.", "rel": "whole" }, { "from": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "Where the package is graded by the buyer's age and sex.", "rel": "destination" }, { "from": "gleneagles-kl", "type": "facility", "name": "Gleneagles Hospital Kuala Lumpur", "as": "A hospital whose pricing exists in the gap between Singapore's and Thailand's.", "rel": "destination" }, { "from": "island-hospital-penang", "type": "facility", "name": "Island Hospital", "as": "The clearest case in Malaysia of regional rather than intercontinental cross-border care.", "rel": "destination" }, { "from": "prince-court", "type": "facility", "name": "Prince Court Medical Centre", "as": "A Malaysian hospital that publishes cosmetic surgery prices with the implant brand named.", "rel": "destination" }, { "from": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "The state that licenses the advertisement itself.", "rel": "destination" }, { "from": "malaysia-mhtc-licence", "type": "rule", "name": "Malaysia's healthcare travel registration", "as": "The country whose two regimes these are.", "rel": "destination" }, { "from": "mhtc", "type": "org", "name": "Malaysia Healthcare Travel Council", "as": "The country whose inbound trade it markets and reports on.", "rel": "place" }, { "from": "counting-patients", "type": "story", "name": "Counting patients", "as": "The council series that runs from 641,000 to 1.6 million without publishing a definition.", "rel": "destination" } ] }, { "schema": 1, "id": "mexico", "type": "destination", "names": { "name": "Mexico", "aliases": [ "Estados Unidos Mexicanos", "United Mexican States" ], "said": "In the trade Mexico means the border first — Los Algodones for teeth, Tijuana for weight-loss surgery — and Monterrey, Guadalajara and Cancún after that. A patient who drives to a border town and walks back the same evening never books a flight, and never appears in an arrivals statistic." }, "region": [ "mexico", "north-america" ], "facets": { "iso2": "MX", "direction": "inbound", "currency": "MXN", "languages": [ "Spanish", "English" ], "draws": [ "dental-implant", "all-on-four", "gastric-sleeve", "gastric-bypass" ] }, "text": { "what": "The country most US residents cross into for care, and the only destination on this site reachable on foot. The CDC's own chapter names it first in the list of places US patients most commonly travel to for care, ahead of Canada, the Caribbean and several countries in South America. The trade divides into three: dental streets in the border towns, weight-loss surgery in Tijuana and Monterrey, and cosmetic and orthopaedic work in the interior cities. The same chapter names Mexico in three of its documented outbreaks.", "story": "Border dentistry is the oldest of it. Los Algodones, in Baja California across the line from Yuma, reported 5,474 people at the 2010 Mexican census; the health researcher Krystyna Adams, who spent four months there in 2015–16, counted \"more than 500 practising dentists\" in \"an intense clustering of dental clinics within a four block radius\". The town is called Molar City in the English-language press. Adams's own conclusion was not about price: her fieldwork was published under the heading that the industry exploits the workers who staff it.\n\nWeight-loss surgery is the newer trade, and the one with a measured tail. Surgeons at the University of California San Diego, thirty miles from the border, reviewed 91 patients who had bariatric surgery in Mexico and then presented to them with complications between 2014 and 2024: a sleeve gastrectomy in 69.2% of them, a leak at the staple line or the join in 33.0%, admission in 56.0%, intensive care in 19.8%, and three deaths, 3.3%. Mean total hospital charges came to $193,445.08 per patient, and to $424,975.89 where the complication was a leak. The paper counts the patients who reached one American hospital, not the patients who travelled — a denominator nobody has.\n\nIn 2023 two clinics in Matamoros, Tamaulipas — River Side Surgical Center and Clinica K-3 — were closed on 13 May after US patients who had received epidural anaesthesia there developed fungal meningitis. The Mexican Ministry of Health gave the CDC a list of US residents treated at the two clinics between 1 January and 13 May 2023. By 31 August 2023 the CDC's tally was 10 confirmed cases, 14 probable, 9 suspected, 151 persons under investigation, and 12 deaths. The organism found in the spinal fluid was of the Fusarium solani species complex.\n\n*Inference —* those three stories describe the same country and nothing about them resolves. A dental crown fitted by a licensed dentist in Los Algodones and an epidural given in Matamoros sit in the same jurisdiction, and the tell that separated them was not available to the patient in advance.", "how": "*Trade practice —* the border trade runs on the day trip: park on the US side, walk the pedestrian crossing, see the dentist, walk back. Prices are quoted per item on clinic boards and handbills rather than as packages. The bariatric trade runs on the airport pickup instead — a facilitator meets the patient at San Diego, drives to a Tijuana hospital, and returns them to the border after two or three nights, with follow-up by telephone. Payment is usually cash or card at the clinic, and neither trade bills a US insurer. The interior hospitals in Monterrey, Guadalajara and Mexico City work the way large private hospitals work anywhere: an international office, a quote, a deposit.", "today": "The ISAPS survey of plastic surgeons put 1,294,946 aesthetic procedures in Mexico in 2024, 734,082 of them surgical — an extrapolation from the surgeons who answered, not a count of operations. The same survey asked those surgeons what share of their patients came from elsewhere: the median answer in Mexico was 12.0% and the average 23.4%, with the United States, Canada and Colombia the three origins named most often. No figure on this page counts dental patients, who are most of the traffic and almost none of the data." }, "geo": { "lat": 19.4326, "lon": -99.1332, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "No inbound patient count is carried here. Mexico's largest medical-travel flow is dental work at land border crossings, which no register counts as health travel; the ISAPS figures in text.today count aesthetic procedures by board-certified plastic surgeons, extrapolated from 2,975 survey responses across 32 locations, and count nothing else.", "as_of": "2024", "source": "s:isaps-global-survey-2024", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf" }, "kin": [ { "to": "los-algodones", "as": "The dental street that made the border trade, four blocks of it.", "rel": "part" }, { "to": "tijuana", "as": "Where the weight-loss surgery is done, half an hour from a US hospital.", "rel": "part" }, { "to": "monterrey", "as": "The interior counterweight: large private hospitals rather than a border street.", "rel": "part" }, { "to": "cancun", "as": "The resort end of the trade, sold alongside a holiday.", "rel": "part" }, { "to": "united-states", "as": "The source market next door, and the reason the trade is a drive rather than a flight.", "rel": "contrast" }, { "to": "dental-implant", "as": "The item the border clinics sell most, priced per tooth.", "rel": "procedure" }, { "to": "gastric-sleeve", "as": "The operation behind the Tijuana trade, and behind the complication series at San Diego.", "rel": "procedure" }, { "to": "mexico-fungal-meningitis-2023", "as": "The Matamoros outbreak, in its own record.", "rel": "event" }, { "to": "fungal-meningitis", "as": "What the two Matamoros clinics sent home with their patients.", "rel": "risk" }, { "to": "antimicrobial-resistance", "as": "The CDC names CRE infections after invasive procedures in this country.", "rel": "risk" }, { "to": "revision-at-home", "as": "Who fixes it, and what that bill looks like: $193,445.08 a patient in the San Diego series.", "rel": "risk" }, { "to": "hospital-angeles-tijuana", "as": "One of the named hospitals on the Tijuana side.", "rel": "part" } ], "links": [ { "label": "CDC — fungal meningitis outbreak, Matamoros", "url": "https://archive.cdc.gov/www_cdc_gov/hai/outbreaks/meningitis-epidural-anesthesia.html" }, { "label": "Managing complications of bariatric travel at UC San Diego", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12222374/" } ], "sources": [ "s:cdc-yellowbook-medical-tourism", "s:cdc-meningitis-matamoros", "s:spurzem-bariatric-tourism-2025", "s:adams-dental-tourism-2017", "s:wp-los-algodones", "s:isaps-global-survey-2024", "s:natural-earth" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "each stretch names its source; the closing paragraph is marked as this project's inference" }, "text.how": { "tier": "tradition", "note": "the operating shape of the border day trip and the Tijuana pickup, hedged in the prose" }, "text.today": { "tier": "cited", "source": "s:isaps-global-survey-2024" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Los Algodones, Baja California.jpg", "File:Tijuana skyline.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "The country most US residents cross into for care, and the only destination on this site reachable on foot.", "region_terms": [ { "key": "mexico", "name": "Mexico", "note": "its own entry because the border towns are a category of their own" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "The dental street that made the border trade, four blocks of it.", "rel": "part" }, { "to": "tijuana", "type": "hub", "name": "Tijuana", "as": "Where the weight-loss surgery is done, half an hour from a US hospital.", "rel": "part" }, { "to": "monterrey", "type": "hub", "name": "Monterrey", "as": "The interior counterweight: large private hospitals rather than a border street.", "rel": "part" }, { "to": "cancun", "type": "hub", "name": "Cancún", "as": "The resort end of the trade, sold alongside a holiday.", "rel": "part" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The source market next door, and the reason the trade is a drive rather than a flight.", "rel": "contrast" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The item the border clinics sell most, priced per tooth.", "rel": "procedure" }, { "to": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "The operation behind the Tijuana trade, and behind the complication series at San Diego.", "rel": "procedure" }, { "to": "mexico-fungal-meningitis-2023", "type": "event", "name": "The Matamoros fungal meningitis outbreak, 2023", "as": "The Matamoros outbreak, in its own record.", "rel": "event" }, { "to": "fungal-meningitis", "type": "risk", "name": "Fungal meningitis after epidural anaesthesia", "as": "What the two Matamoros clinics sent home with their patients.", "rel": "risk" }, { "to": "antimicrobial-resistance", "type": "risk", "name": "Antimicrobial resistance acquired abroad", "as": "The CDC names CRE infections after invasive procedures in this country.", "rel": "risk" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who fixes it, and what that bill looks like: $193,445.08 a patient in the San Diego series.", "rel": "risk" }, { "to": "hospital-angeles-tijuana", "type": "facility", "name": "Hospital Angeles Tijuana", "as": "One of the named hospitals on the Tijuana side.", "rel": "part" } ], "source_list": [ { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:cdc-meningitis-matamoros", "kind": "web", "title": "Fungal Meningitis Outbreak Associated with Procedures Performed under Epidural Anesthesia in Matamoros, Mexico", "publisher": "US Centers for Disease Control and Prevention (archived page, last updated 27 October 2023)", "url": "https://archive.cdc.gov/www_cdc_gov/hai/outbreaks/meningitis-epidural-anesthesia.html", "accessed": "2026-09-16" }, { "id": "s:spurzem-bariatric-tourism-2025", "kind": "journal", "title": "Getting more than what you pay for? Managing complications of bariatric tourism at an academic center near the US-Mexico border", "publisher": "Spurzem GJ et al., Surgical Endoscopy, 2025, doi:10.1007/s00464-025-11850-x", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12222374/", "accessed": "2026-09-16" }, { "id": "s:adams-dental-tourism-2017", "kind": "web", "title": "Dental tourism industry exploits workers in Mexico", "publisher": "Krystyna Adams, The Conversation, 12 October 2017", "url": "https://theconversation.com/dental-tourism-industry-exploits-workers-in-mexico-85071", "accessed": "2026-09-16" }, { "id": "s:wp-los-algodones", "kind": "encyclopedia", "title": "Los Algodones", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Los_Algodones", "accessed": "2026-09-16" }, { "id": "s:isaps-global-survey-2024", "kind": "report", "title": "ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2024", "publisher": "International Society of Aesthetic Plastic Surgery, tabulated by Industry Insights Inc.", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "each stretch names its source; the closing paragraph is marked as this project's inference" }, "text.how": { "tier": "tradition", "note": "the operating shape of the border day trip and the Tijuana pickup, hedged in the prose" }, "text.today": { "tier": "cited", "source": "s:isaps-global-survey-2024" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "canada", "type": "destination", "name": "Canada", "as": "Where Canadians are one of the three origins surgeons name, and where the dentistry is.", "rel": "destination" }, { "from": "united-states", "type": "destination", "name": "United States", "as": "The destination reached by road, and the one the CDC names first.", "rel": "destination" }, { "from": "cancun", "type": "hub", "name": "Cancún", "as": "The country whose resort economy this cluster grew inside.", "rel": "destination" }, { "from": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "The country this cluster sits in, though almost nothing about it is aimed at Mexicans.", "rel": "destination" }, { "from": "monterrey", "type": "hub", "name": "Monterrey", "as": "The country whose hospital-grade export trade concentrates here rather than on the border.", "rel": "destination" }, { "from": "nuevo-progreso", "type": "hub", "name": "Nuevo Progreso", "as": "The country the bridge lands in.", "rel": "destination" }, { "from": "tijuana", "type": "hub", "name": "Tijuana", "as": "The country whose surgical export trade is most concentrated here.", "rel": "destination" }, { "from": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "Where the trademark is sold in three implant brands with a US comparison column beside it.", "rel": "destination" }, { "from": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "Where the border clinics price the implant against a US comparison of their own.", "rel": "destination" }, { "from": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "Where the whole ladder from a $320 denture to $13,310 of All-on-6 is printed on one page.", "rel": "destination" }, { "from": "gastric-balloon", "type": "procedure", "name": "Gastric balloon", "as": "Where the cheapest published price for this device was read.", "rel": "destination" }, { "from": "gastric-bypass", "type": "procedure", "name": "Gastric bypass", "as": "Where both published prices on this page are sold, a short drive from the border.", "rel": "destination" }, { "from": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "The other high-volume destination, reached by road from San Diego rather than by air.", "rel": "destination" }, { "from": "root-canal", "type": "procedure", "name": "Root canal treatment", "as": "Where one price covers any tooth in the mouth.", "rel": "destination" }, { "from": "stem-cell-unproven", "type": "procedure", "name": "Unapproved stem cell treatment", "as": "Where one of the two published price pages sits, and where the border survey counted 76 locations in one city.", "rel": "destination" }, { "from": "veneers", "type": "procedure", "name": "Dental veneers", "as": "Where the veneer is quoted against a US comparison the clinic supplies.", "rel": "destination" }, { "from": "hospital-angeles-tijuana", "type": "facility", "name": "Hospital Angeles Tijuana", "as": "The border-town end of Mexican private medicine, where the patient walks across rather than flies in.", "rel": "destination" }, { "from": "fungal-meningitis", "type": "risk", "name": "Fungal meningitis after epidural anaesthesia", "as": "Where both clinics were, and one of the two countries named in the CDC's outbreak list.", "rel": "place" }, { "from": "mexico-fungal-meningitis-2023", "type": "event", "name": "The Matamoros fungal meningitis outbreak, 2023", "as": "The country page where this outbreak sits alongside the border dental trade and the Tijuana bariatric trade.", "rel": "destination" }, { "from": "world-bank-tourism-arrivals", "type": "dataset", "name": "International arrivals", "as": "51,128,000 arrivals in 2020, in the country whose dental trade mostly walks across a line.", "rel": "measures" }, { "from": "the-follow-up-nobody-books", "type": "story", "name": "The follow-up nobody books", "as": "Where the largest per-patient charge in this file originated, in bariatric work counted from San Diego.", "rel": "destination" }, { "from": "who-travels", "type": "story", "name": "Who travels", "as": "The one flow that resembles the brochure, and the one whose tail is counted from the other side of the border.", "rel": "destination" } ] }, { "schema": 1, "id": "morocco", "type": "destination", "names": { "name": "Morocco", "aliases": [ "المملكة المغربية", "Royaume du Maroc", "Kingdom of Morocco", "ⵜⴰⴳⵍⴷⵉⵜ ⵏ ⵍⵎⵖⵔⵉⴱ" ], "said": "Sold in French, like Tunisia, and later than Tunisia. The clinics are in Casablanca, Rabat, Marrakech, Agadir and Tangier, and Marrakech sells the hotel as hard as the operation." }, "region": [ "africa-north" ], "facets": { "iso2": "MA", "direction": "inbound", "currency": "MAD", "languages": [ "Arabic", "French", "Amazigh" ], "draws": [ "rhinoplasty", "liposuction", "hair-transplant-fue", "dental-implant" ] }, "text": { "what": "A francophone cosmetic and dental destination that sells to France, to the Moroccan diaspora in Europe and to Gulf visitors, from specialised private clinics in five cities. It is the smaller of North Africa's two trades and the one where the gap between the promotion and the published evidence is widest: the country's own business press has described the sector as underperforming its advantages rather than leading the region.", "story": "The ingredients are the ones every destination lists — geography, climate, political stability, French, a tourism industry that already works. What Morocco does not have is a health system its own auditors are satisfied with. Its Cour des comptes, in the annual report for 2019-2020 published in March 2022, set out shortages of medical, paramedical, administrative and technical staff, and a shortage of the infrastructure and equipment needed to receive and treat patients. Morocco ranked 31st of 46 destinations on the Medical Tourism Index for 2020-21, a ranking that put the shortfall down to workforce and to facilities and services that had not visibly improved.\n\n*Trade practice —* the figure quoted in the sector for annual arrivals is around half a million, attributed to professionals in the industry rather than to a ministry or a statistics office. No publisher this project could reach stands behind it, so it is not carried in the metrics block.\n\nThe workforce point cuts both ways, and that is the shape of the Moroccan story: the country exports doctors to France at the same time as it tries to import patients from France. Dr Tayeb Hamdi, a physician and health-systems researcher quoted in October 2022, put certification, visa procedures, pricing and airport-to-clinic handling at the centre of what would have to change.", "how": "A clinic or an agency quotes a package in euros or dirhams covering the operation, the clinic stay, a hotel and transfers; the consultation is in French and often the first one is by video. Payment is up front. Cosmetic surgery, hair restoration and dentistry dominate the European end. Gulf visitors buy a different mix, closer to check-ups and dermatology, alongside a holiday.", "today": "As of September 2026 this record carries no arrivals figure for Morocco, because the one in circulation has no publisher behind it. What can be cited is the rank, the auditor's findings on the public system, and the clinic cities.", "notes": "The absence of a number here is a fact about what has been published, not a claim that the trade is small." }, "geo": { "lat": 34.0209, "lon": -6.8416, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "No arrivals figure is carried. The number quoted in the Moroccan sector — roughly half a million a year — is attributed to industry professionals and this project could not trace it to a ministry, a statistics office or any published method. Morocco's Medical Tourism Index rank for 2020-21 was 31st of 46 destinations.", "as_of": "2022", "source": "s:laquotidienne-maroc-2022", "url": "https://laquotidienne.ma/article/economie/tourisme-medical-un-serieux-manque-a-gagner-pour-le-maroc" }, "kin": [ { "to": "tunisia", "as": "The neighbour that built the same trade first and counts more of it.", "rel": "contrast" }, { "to": "turkiye", "as": "Where the European hair and cosmetic trade mostly went instead.", "rel": "contrast" }, { "to": "hair-transplant-fue", "as": "One of the procedures sold here to European buyers.", "rel": "procedure" }, { "to": "dental-implant", "as": "The other half of the European end of this trade.", "rel": "procedure" }, { "to": "facilitator", "as": "The middle layer most European bookings here pass through.", "rel": "term" }, { "to": "the-price-that-isnt", "as": "Why a package quoted in euros is not the whole bill.", "rel": "story" }, { "to": "world-bank-doctors", "as": "The series behind the workforce shortage its own auditors describe.", "rel": "measured-by" } ], "links": [ { "label": "Tourisme médical: un sérieux manque à gagner pour le Maroc", "url": "https://laquotidienne.ma/article/economie/tourisme-medical-un-serieux-manque-a-gagner-pour-le-maroc" } ], "sources": [ "s:laquotidienne-maroc-2022", "s:wp-health-morocco", "s:natural-earth", "s:worldbank-open-data" ], "provenance": { "default": { "tier": "cited", "source": "s:laquotidienne-maroc-2022" }, "fields": { "text.story": { "tier": "cited", "source": "s:laquotidienne-maroc-2022", "note": "the half-million figure is marked inline as trade practice because no publisher stands behind it" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "needs_verification": true, "confidence": "low", "updated": "2026-09-16", "blurb": "A francophone cosmetic and dental destination that sells to France, to the Moroccan diaspora in Europe and to Gulf visitors, from specialised private clinics in five cities.", "region_terms": [ { "key": "africa-north", "name": "North Africa", "note": "Tunisia, Morocco, Egypt" } ], "kin_out": [ { "to": "tunisia", "type": "destination", "name": "Tunisia", "as": "The neighbour that built the same trade first and counts more of it.", "rel": "contrast" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "Where the European hair and cosmetic trade mostly went instead.", "rel": "contrast" }, { "to": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "One of the procedures sold here to European buyers.", "rel": "procedure" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The other half of the European end of this trade.", "rel": "procedure" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The middle layer most European bookings here pass through.", "rel": "term" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "Why a package quoted in euros is not the whole bill.", "rel": "story" }, { "to": "world-bank-doctors", "type": "dataset", "name": "Physicians per 1,000 people", "as": "The series behind the workforce shortage its own auditors describe.", "rel": "measured-by" } ], "source_list": [ { "id": "s:laquotidienne-maroc-2022", "kind": "news", "title": "Tourisme médical: un sérieux manque à gagner pour le Maroc", "publisher": "La Quotidienne (Morocco)", "url": "https://laquotidienne.ma/article/economie/tourisme-medical-un-serieux-manque-a-gagner-pour-le-maroc", "accessed": "2026-09-16", "note": "published 15 October 2022; carries Morocco's Medical Tourism Index rank for 2020-21, the Cour des comptes finding on the health system, and quotes Dr Tayeb Hamdi" }, { "id": "s:wp-health-morocco", "kind": "web", "title": "Health in Morocco", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Healthcare_in_Morocco", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:laquotidienne-maroc-2022" }, "text.story": { "tier": "cited", "source": "s:laquotidienne-maroc-2022", "note": "the half-million figure is marked inline as trade practice because no publisher stands behind it" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited", "source": "s:laquotidienne-maroc-2022" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:laquotidienne-maroc-2022" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "tunisia", "type": "destination", "name": "Tunisia", "as": "The other francophone North African destination, smaller and later.", "rel": "contrast" } ] }, { "schema": 1, "id": "nepal", "type": "destination", "names": { "name": "Nepal", "aliases": [ "नेपाल", "Federal Democratic Republic of Nepal" ], "said": "In Kathmandu the question is not whether to go to India but which Indian city, and the answer usually comes from whoever in the family went last." }, "region": [ "south-asia" ], "facets": { "iso2": "NP", "direction": "outbound", "currency": "NPR", "languages": [ "Nepali", "English", "Hindi" ] }, "text": { "what": "A source market with one dominant destination and a published reason for going that is not the one the field assumes. A survey of 382 Nepali patients who had been treated abroad found 88.80 per cent went to India, and ranked the way they were treated at home above cost as the thing that moved them.", "story": "Biswakarma and Basnet surveyed 382 Nepali respondents who had undergone treatment overseas and published the result in the International Hospitality Review in 2025. India took 88.80 per cent of them; Thailand 5.73 per cent; Singapore 4.95 per cent; the United States and United Kingdom together 0.52 per cent.\n\nWhat they went for was serious. Cancer treatment accounted for 39.32 per cent of cases, organ transplants 13.54 per cent and cardiovascular surgery 10.68 per cent. This is not a trade in elective cosmetic work.\n\nThe motivations are the finding. \"Healthcare provider attitude and poor service\" ranked highest at 22.4 per cent, ahead of the availability of advanced medical technology at 20.6 per cent, and the authors report that service quality had a large effect while price alone did not carry the decision.\n\n*Inference —* that inverts the standard account of this subject, which starts from the price gap and reasons forward. In the poorest country in this batch, the travelling patient's stated complaint is how they were spoken to. A survey of 382 people is not a census, and the sample is of people who already travelled — but it is a published figure with a method attached, which is more than most national totals in this directory have.\n\n*Trade practice —* the route runs overland as often as by air. An open border, shared language across the Terai, and Indian hospitals with Nepali-speaking coordinators make Delhi, Lucknow, Chennai and Vellore ordinary destinations rather than foreign ones.", "how": "*Trade practice —* Nepali patients pay out of pocket, frequently on borrowed money or on remittances from a family member working abroad. No entry visa is needed for India. Referral travels by word of mouth and by the consultant who saw the patient in Kathmandu; the follow-up, when there is one, happens at home with a discharge summary and no operating surgeon.", "today": "No Nepali government series counting patients who leave for treatment was read for this record, and none is carried. The 2025 survey is what this page stands on." }, "geo": { "lat": 27.7172, "lon": 85.324, "precision": "city", "source": "s:osm" }, "metrics": { "inbound_patients_year": null, "note": "None carried. The figures on this page come from one published survey of 382 Nepali patients treated abroad (Biswakarma and Basnet, 2025), not from a register: 88.80 per cent went to India, 5.73 per cent to Thailand, 4.95 per cent to Singapore. A survey of people who already travelled cannot say how many travelled.", "as_of": "2025", "source": "s:biswakarma-nepal-outbound-2025", "url": "https://www.emerald.com/insight/content/doi/10.1108/ihr-12-2023-0062/full/html" }, "kin": [ { "to": "india", "as": "Where 88.80 per cent of surveyed Nepali patients went.", "rel": "destination" }, { "to": "delhi-ncr", "as": "One of the northern Indian clusters a Kathmandu referral lands in.", "rel": "destination" }, { "to": "chennai", "as": "The southern destination for transplant and cancer work.", "rel": "destination" }, { "to": "thailand", "as": "The second destination in the survey, at 5.73 per cent, and a different kind of patient.", "rel": "destination" }, { "to": "sri-lanka", "as": "The other South Asian country whose patients cross to India for the top of the acuity range.", "rel": "contrast" }, { "to": "kidney-transplant", "as": "Among the operations Nepali patients most often leave for.", "rel": "procedure" }, { "to": "follow-up-gap", "as": "The Kathmandu review after an operation done across the border.", "rel": "risk" }, { "to": "who-travels", "as": "A survey that puts how a patient was treated ahead of what they were charged.", "rel": "story" }, { "to": "is-it-cheaper", "as": "The question this survey's respondents did not answer the way the field expects.", "rel": "story" } ], "links": [ { "label": "Motivational factors affecting outbound medical tourism: the case of Nepal", "url": "https://www.emerald.com/insight/content/doi/10.1108/ihr-12-2023-0062/full/html" } ], "sources": [ "s:biswakarma-nepal-outbound-2025", "s:worldbank-open-data", "s:osm" ], "provenance": { "default": { "tier": "cited", "source": "s:biswakarma-nepal-outbound-2025" }, "fields": { "text.story": { "tier": "cited", "source": "s:biswakarma-nepal-outbound-2025", "note": "all percentages from the published survey; the last two stretches are marked inference and trade practice" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:biswakarma-nepal-outbound-2025" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A source market with one dominant destination and a published reason for going that is not the one the field assumes.", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" } ], "kin_out": [ { "to": "india", "type": "destination", "name": "India", "as": "Where 88.80 per cent of surveyed Nepali patients went.", "rel": "destination" }, { "to": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "One of the northern Indian clusters a Kathmandu referral lands in.", "rel": "destination" }, { "to": "chennai", "type": "hub", "name": "Chennai", "as": "The southern destination for transplant and cancer work.", "rel": "destination" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "The second destination in the survey, at 5.73 per cent, and a different kind of patient.", "rel": "destination" }, { "to": "sri-lanka", "type": "destination", "name": "Sri Lanka", "as": "The other South Asian country whose patients cross to India for the top of the acuity range.", "rel": "contrast" }, { "to": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "Among the operations Nepali patients most often leave for.", "rel": "procedure" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The Kathmandu review after an operation done across the border.", "rel": "risk" }, { "to": "who-travels", "type": "story", "name": "Who travels", "as": "A survey that puts how a patient was treated ahead of what they were charged.", "rel": "story" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The question this survey's respondents did not answer the way the field expects.", "rel": "story" } ], "source_list": [ { "id": "s:biswakarma-nepal-outbound-2025", "kind": "paper", "title": "Motivational factors affecting outbound medical tourism: the case of Nepal, a developing nation", "publisher": "International Hospitality Review (Emerald)", "url": "https://www.emerald.com/insight/content/doi/10.1108/ihr-12-2023-0062/full/html", "accessed": "2026-09-16", "note": "Biswakarma, G. and Basnet, B., 2025; doi 10.1108/IHR-12-2023-0062; survey of 382 Nepali respondents who had been treated abroad" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:biswakarma-nepal-outbound-2025" }, "text.story": { "tier": "cited", "source": "s:biswakarma-nepal-outbound-2025", "note": "all percentages from the published survey; the last two stretches are marked inference and trade practice" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited", "source": "s:biswakarma-nepal-outbound-2025" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:biswakarma-nepal-outbound-2025" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "sri-lanka", "type": "destination", "name": "Sri Lanka", "as": "The other South Asian country whose patients leave for India, and which has been surveyed on why.", "rel": "contrast" } ] }, { "schema": 1, "id": "nigeria", "type": "destination", "names": { "name": "Nigeria", "aliases": [ "Federal Republic of Nigeria", "Naijíríyà" ], "said": "A source market that discusses itself in dollars lost. Lagos and Abuja agencies book India, the United Kingdom, Dubai, Egypt and Turkey, and the phrase used in the Nigerian press for the outflow is a sum of money rather than a number of patients." }, "region": [ "africa-west" ], "facets": { "iso2": "NG", "direction": "outbound", "currency": "NGN", "languages": [ "English", "Hausa", "Yoruba", "Igbo" ], "draws": [] }, "text": { "what": "Africa's largest source market by reputation and the one where the size of the outflow is least settled. Nigerian ministers have put the annual cost at figures ranging from roughly one billion to two billion US dollars; the country's own central bank publishes health-related travel outflows in its balance of payments, and the numbers reported from that series differ between accounts by orders of magnitude. This record carries no annual dollar figure, and the reason it does not is the subject of the page.", "story": "The claim in widest circulation is that Nigeria loses about two billion dollars a year to treatment abroad. It is attributed to Professor Muhammad Ali Pate, Coordinating Minister of Health and Social Welfare, reported in April 2025, who tied it to a lack of confidence in local care. Earlier ministers gave other numbers: an information minister put it between 1.2 and 1.6 billion in 2022, a health minister at two billion before that. *Inference —* a figure that moves by a factor of two between cabinet members, with no series named behind it, is a rhetorical quantity being used in an argument about domestic investment. It may still be roughly right. It is not a measurement, and this directory does not print it as one.\n\nThe counting problem has a second half. India, the destination Nigerian patients are most often said to use, publishes arrivals for medical purposes by source country: in 2025 it named Bangladesh, Iraq, Uzbekistan, Somalia, Turkmenistan, Oman and Kenya as its leading seven. Nigeria is not among the seven that release names. *Inference —* either the Nigerian flow to India is smaller than the rhetoric implies, or it travels on visa classes India does not count under a medical purpose, or it goes elsewhere — to the United Kingdom, to Dubai, to Egypt, to Türkiye. Each of those is a different policy problem and the single dollar figure conceals which one it is.\n\nWhat is not in dispute is the distribution. The people who fly out are the people with foreign exchange: officials, executives, the diaspora's relatives, the insured. The people who do not fly are treated in the same hospitals the fliers declined, by staff who watch the complex cases leave.", "how": "A referral, or more often a self-referral through an agency, a visa, and payment in foreign currency at a time when foreign currency has been rationed. Nigerian insurers sell overseas benefits on the upper tiers only. The Central Bank's foreign-exchange allocations are themselves part of the mechanism, which is why the Nigerian argument about treatment abroad is conducted by the central bank as much as by the health ministry.", "today": "As of September 2026 this record carries no annual outflow figure for Nigeria. The ministerial figures are named above with their dates; the central bank series exists and this project could not open a page stating it directly, so it is described rather than quoted.", "notes": "Nothing here says the outflow is small. It says the published quantities disagree with each other and none of them names a method." }, "geo": { "lat": 6.5244, "lon": 3.3792, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "No annual outflow figure is carried. The figure most widely quoted — about US$2 billion a year — is attributed to Professor Muhammad Ali Pate, Coordinating Minister of Health and Social Welfare, in April 2025, and this project read the attribution in the publisher's listing rather than on the page itself. Other ministers have given 1.2 to 1.6 billion. None of these names a statistical series. Nigeria does not appear among the seven leading source countries India named for medical-purpose arrivals in 2025.", "as_of": "2025", "source": "s:allafrica-nigeria-pate-2025", "url": "https://allafrica.com/stories/202504160076.html" }, "kin": [ { "to": "india", "as": "The destination the rhetoric names, and the state whose own published counts do not list Nigeria among its seven largest sources.", "rel": "destination" }, { "to": "united-kingdom", "as": "The other long-standing destination for Nigerians who can pay, and one that counts them as private patients rather than as travellers.", "rel": "destination" }, { "to": "uae", "as": "A destination whose own arrivals count sweeps in visitors from West Africa without separating them out.", "rel": "destination" }, { "to": "kenya", "as": "The other big African source market, and the one with a receiving state's count behind it.", "rel": "kin" }, { "to": "counting-patients", "as": "The billion-dollar figure with no series behind it is this page's whole argument.", "rel": "story" }, { "to": "what-the-data-cannot-see", "as": "An outflow everybody agrees exists and nobody has measured the same way twice.", "rel": "story" }, { "to": "world-bank-out-of-pocket", "as": "The series behind what Nigerian households pay for care at home.", "rel": "measured-by" } ], "links": [ { "label": "Medical and Wellness Tourism in India — PIB backgrounder, 2 May 2026", "url": "https://www.pib.gov.in/PressReleasePage.aspx?PRID=2257447®=3&lang=1" } ], "sources": [ "s:allafrica-nigeria-pate-2025", "s:pib-india-mvt-2026", "s:natural-earth", "s:worldbank-open-data" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "inference", "note": "this project reporting that the published quantities disagree, rather than choosing between them" }, "text.story": { "tier": "cited", "source": "s:pib-india-mvt-2026", "note": "the Indian arrivals list is cited; the ministerial attributions are flagged for verification; the two readings are marked inline as inference" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "needs_verification": true, "confidence": "low", "updated": "2026-09-16", "blurb": "Africa's largest source market by reputation and the one where the size of the outflow is least settled.", "region_terms": [ { "key": "africa-west", "name": "West Africa", "note": "Nigeria, Ghana, Senegal — mostly outbound, and the outflow is itself the story" } ], "kin_out": [ { "to": "india", "type": "destination", "name": "India", "as": "The destination the rhetoric names, and the state whose own published counts do not list Nigeria among its seven largest sources.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The other long-standing destination for Nigerians who can pay, and one that counts them as private patients rather than as travellers.", "rel": "destination" }, { "to": "uae", "type": "destination", "name": "United Arab Emirates", "as": "A destination whose own arrivals count sweeps in visitors from West Africa without separating them out.", "rel": "destination" }, { "to": "kenya", "type": "destination", "name": "Kenya", "as": "The other big African source market, and the one with a receiving state's count behind it.", "rel": "kin" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "The billion-dollar figure with no series behind it is this page's whole argument.", "rel": "story" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "An outflow everybody agrees exists and nobody has measured the same way twice.", "rel": "story" }, { "to": "world-bank-out-of-pocket", "type": "dataset", "name": "Out-of-pocket share of health spending", "as": "The series behind what Nigerian households pay for care at home.", "rel": "measured-by" } ], "source_list": [ { "id": "s:allafrica-nigeria-pate-2025", "kind": "news", "title": "Nigeria Loses $2bn Annually to Medical Tourism — Govt", "publisher": "allAfrica", "url": "https://allafrica.com/stories/202504160076.html", "accessed": "2026-09-16", "note": "April 2025, attributing the figure to Professor Muhammad Ali Pate, Coordinating Minister of Health and Social Welfare. The page would not open for this project on the access date; the attribution is carried from the publisher's own listing and is flagged for verification." }, { "id": "s:pib-india-mvt-2026", "kind": "gov", "title": "Medical and Wellness Tourism in India — PIB Backgrounder", "publisher": "Press Information Bureau, Government of India", "url": "https://www.pib.gov.in/PressReleasePage.aspx?PRID=2257447®=3&lang=1", "accessed": "2026-09-16", "note": "posted 2 May 2026; gives 2025 arrivals in India for medical purpose in total and for the seven leading source countries" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" } ], "tiers": { "text.what": { "tier": "inference", "note": "this project reporting that the published quantities disagree, rather than choosing between them" }, "text.story": { "tier": "cited", "source": "s:pib-india-mvt-2026", "note": "the Indian arrivals list is cited; the ministerial attributions are flagged for verification; the two readings are marked inline as inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "kenya", "type": "destination", "name": "Kenya", "as": "The other big African source market, and the one whose numbers are argued over.", "rel": "kin" }, { "from": "south-africa", "type": "destination", "name": "South Africa", "as": "A source market whose patients go to India and to London rather than south.", "rel": "contrast" }, { "from": "world-bank-out-of-pocket", "type": "dataset", "name": "Out-of-pocket share of health spending", "as": "71.90% in 2023, in the country this directory treats as an outbound market first.", "rel": "measures" }, { "from": "who-travels", "type": "story", "name": "Who travels", "as": "The outflow whose published quantities disagree with each other by a factor of two.", "rel": "destination" } ] }, { "schema": 1, "id": "north-cyprus", "type": "destination", "names": { "name": "Northern Cyprus", "aliases": [ "Kuzey Kıbrıs", "Turkish Republic of Northern Cyprus", "KKTC", "TRNC", "N. Cyprus" ], "said": "In the trade it is simply north Cyprus, and it means fertility clinics in Kyrenia and north Nicosia that answer in Turkish and English and quote in euro or sterling." }, "region": [ "europe-south" ], "facets": { "iso2": "XN", "direction": "inbound", "currency": "TRY", "languages": [ "Turkish", "English" ], "draws": [ "ivf", "egg-donation", "sperm-donation", "pgt", "icsi" ] }, "text": { "what": "A fertility destination whose whole proposition is a legal line on a small island. Clinics in the north treat patients who cannot get the same treatment at home or in the Republic, work under the Turkish Cypriot Ministry of Health rather than the EU's framework, and sell to Britain, Turkey, the Gulf and Israel. The code this project carries for it is XN, which is what data/geo/countries.json holds for the territory it labels N. Cyprus, ISO3 CYN — not an ISO 3166-1 assignment but the mapping code the site's geometry uses.", "story": "The north regulates assisted reproduction through its own ministry. The Ministry of Health publishes a regulation on assisted reproduction centres numbered 381/2016, made under Article 32 of the law governing those centres, and runs an assisted-reproduction system of its own inside its online services. The PDF the ministry hosts is a scan and its text could not be extracted for this record, so what is stated here is the title, the number and the fact of ministry licensing — not the terms inside it.\n\n*Trade practice —* what the clinics sell on is the difference from the south. The two jurisdictions on this island write separate rules on donation, on who may be treated and on what may be tested for, and a patient can be refused in one and accepted in the other after a twenty-minute drive through a checkpoint. The trade advertises exactly that, and reports of what is permitted here have changed more than once; this record names no specific permission, because none was read from an instrument.\n\n*Inference —* recognition is the practical problem for a patient, not a political one. A territory recognised by one state has no European reimbursement route, no EU contact point to complain to, and no professional register another country's regulator will check. What a patient gets instead is a clinic's own undertaking, enforceable where the clinic is.", "how": "Programmes are quoted in euro or sterling as packages, with medication and travel outside; patients fly to Ercan through Türkiye or land at Larnaca in the Republic and cross by road. Payment is direct to the clinic, up front. No EU cross-border reimbursement applies, and a complaint has nowhere to go but the Turkish Cypriot ministry.", "today": "The record carries no patient count: none is published that this project could read. The verifiable facts are a ministry, a regulation number, and a line across an island that makes two fertility markets out of one." }, "geo": { "lat": 35.195, "lon": 33.365, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "No inbound count. The north is not in the EU cross-border reporting, has no ESHRE registry return read for this record, and publishes no figure this project found. Absence here means not found, not absent.", "as_of": "2026-09-16", "source": "s:trnc-moh-art-tuzuk" }, "legality": [ { "country": "XN", "status": "lawful-with-conditions", "conditions": "Assisted reproduction centres operate under the Turkish Cypriot Ministry of Health, which publishes a regulation numbered 381/2016 made under Article 32 of the law on those centres. The regulation's terms were not read for this record: the ministry's copy is a scan.", "instrument": "Üremeye Yardımcı Tedavi Merkezleri regulation 381/2016, made under Article 32 of the assisted reproduction centres law, Ministry of Health, Turkish Republic of Northern Cyprus", "as_of": "2026-09-16", "source": "s:trnc-moh-art-tuzuk", "url": "https://saglik.gov.ct.tr/Portals/9/Uremeye_Yardimci_Tedavi_Merkezleri_381-2016_Madde_32_Altinda_Yapilan_Tuzuk.pdf", "note": "the row records that a licensing regime exists and who runs it. It does not state what is permitted under it, and it should not be read as saying any particular treatment is lawful here." } ], "kin": [ { "to": "cyprus", "as": "The same island under the other law, and the comparison that makes both markets.", "rel": "contrast" }, { "to": "nicosia", "as": "The divided capital: the crossing is inside it.", "rel": "part" }, { "to": "ivf", "as": "The treatment nearly every clinic here sells.", "rel": "procedure" }, { "to": "egg-donation", "as": "The programme patients cross the line for.", "rel": "procedure" }, { "to": "turkiye", "as": "The state whose flights, currency and medical profession the north runs on.", "rel": "kin" }, { "to": "donor-anonymity-law", "as": "The rule this territory writes for itself, separately from the Republic.", "rel": "governed-by" }, { "to": "malpractice-recourse", "as": "What is left when no EU contact point and no home regulator can reach the clinic.", "rel": "risk" }, { "to": "circumvention", "as": "A twenty-minute drive as a legal strategy.", "rel": "story" } ], "sources": [ "s:trnc-moh-art-tuzuk", "s:cmar-cyprus", "s:natural-earth" ], "provenance": { "default": { "tier": "cited", "source": "s:trnc-moh-art-tuzuk" }, "fields": { "text.what": { "tier": "harvested", "source": "s:natural-earth", "note": "the XN code and the N. Cyprus label were read from data/geo/countries.json, which is built from Natural Earth" }, "text.story": { "tier": "cited", "source": "s:trnc-moh-art-tuzuk", "note": "first paragraph cited to the ministry's own published title; second marked trade practice, third marked inference" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Kyrenia harbour Cyprus.jpg" ], "needs_verification": true, "confidence": "low", "updated": "2026-09-16", "blurb": "A fertility destination whose whole proposition is a legal line on a small island.", "region_terms": [ { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" } ], "kin_out": [ { "to": "cyprus", "type": "destination", "name": "Cyprus", "as": "The same island under the other law, and the comparison that makes both markets.", "rel": "contrast" }, { "to": "nicosia", "type": "hub", "name": "Nicosia", "as": "The divided capital: the crossing is inside it.", "rel": "part" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment nearly every clinic here sells.", "rel": "procedure" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The programme patients cross the line for.", "rel": "procedure" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The state whose flights, currency and medical profession the north runs on.", "rel": "kin" }, { "to": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The rule this territory writes for itself, separately from the Republic.", "rel": "governed-by" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "What is left when no EU contact point and no home regulator can reach the clinic.", "rel": "risk" }, { "to": "circumvention", "type": "story", "name": "Circumvention", "as": "A twenty-minute drive as a legal strategy.", "rel": "story" } ], "source_list": [ { "id": "s:trnc-moh-art-tuzuk", "kind": "regulation", "title": "Üremeye Yardımcı Tedavi Merkezleri 381-2016 Madde 32 Altında Yapılan Tüzük (regulation on assisted reproduction centres, made under Article 32)", "publisher": "Ministry of Health, Turkish Republic of Northern Cyprus", "url": "https://saglik.gov.ct.tr/Portals/9/Uremeye_Yardimci_Tedavi_Merkezleri_381-2016_Madde_32_Altinda_Yapilan_Tuzuk.pdf", "accessed": "2026-09-16", "note": "the ministry hosts this regulation, numbered 381/2016 and made under Article 32 of the assisted reproduction centres law. The PDF is a scan of printed pages and its text could not be extracted on this pass; only the ministry-published title and number were read, and the ministry's separate Üremeye Yardımcı Tedavi (assisted reproduction) portal was seen in its own service menu." }, { "id": "s:cmar-cyprus", "kind": "org", "title": "Legal Framework — Council of Medically Assisted Reproduction", "publisher": "Council of Medically Assisted Reproduction, Republic of Cyprus", "url": "https://cmar.org.cy/en/law_eng/", "accessed": "2026-09-16", "note": "names the Medically Assisted Reproduction Law 2015, 69(I)/2015, and its amendments 194(I)/2015, 92(I)/2016, 113(I)/2018 and 166(I)/2023" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "harvested", "source": "s:natural-earth", "note": "the XN code and the N. Cyprus label were read from data/geo/countries.json, which is built from Natural Earth" }, "text.story": { "tier": "cited", "source": "s:trnc-moh-art-tuzuk", "note": "first paragraph cited to the ministry's own published title; second marked trade practice, third marked inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited", "source": "s:trnc-moh-art-tuzuk" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "legality": { "tier": "cited", "source": "s:trnc-moh-art-tuzuk" }, "metrics": { "tier": "cited", "source": "s:trnc-moh-art-tuzuk" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "cyprus", "type": "destination", "name": "Cyprus", "as": "The other half of the island and the other answer: same twenty-minute drive, different fertility law.", "rel": "contrast" }, { "from": "nicosia", "type": "hub", "name": "Nicosia", "as": "The entity administering the northern half, whose regime this record does not describe because it could not read one.", "rel": "whole" }, { "from": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "A destination British patients fly to, outside this licence and invisible to this register.", "rel": "contrast" }, { "from": "hfea-results", "type": "dataset", "name": "HFEA fertility treatment results", "as": "A destination British patients travel to, and one this register cannot see.", "rel": "destination" }, { "from": "natural-earth-countries", "type": "dataset", "name": "Natural Earth country outlines", "as": "Carried here under a placeholder code, and therefore absent from every series keyed on ISO.", "rel": "measures" } ] }, { "schema": 1, "id": "panama", "type": "destination", "names": { "name": "Panama", "aliases": [ "República de Panamá", "Republic of Panama" ], "said": "One city, a dollarised currency and a hub airport. The trade here is small enough that the surgeon base is countable." }, "region": [ "central-america" ], "facets": { "iso2": "PA", "direction": "inbound", "currency": "PAB", "languages": [ "Spanish", "English" ], "draws": [ "abdominoplasty", "liposuction", "dental-implant", "executive-health-screening" ] }, "text": { "what": "The smallest of the three Latin American clusters this site carries, and the one with the fewest surgeons. Panama City has private hospitals, a US-dollar economy — the balboa is fixed one to one with the dollar and US notes circulate — and Tocumen airport, which connects the isthmus to most of the Americas. The trade sells cosmetic surgery, dentistry and health screening, mostly to Americans and to Venezuelans and Colombians in the region.", "story": "The scale is the story. In the ISAPS survey of procedures performed in 2024, Panama reported 21,254 aesthetic procedures, 13,579 of them surgical — about a twenty-third of Colombia's count and a hundred and forty-seventh of Brazil's. Panamanian surgeons reported a median 10.0% of patients attending from other locations and an average of 12.4%, naming the United States, Venezuela and Colombia as the three origins.\n\nWhere the work happens is closer to Colombia's profile than to Brazil's: 57.9% of Panamanian cosmetic procedures were performed in a free-standing surgicentre, the highest share of any location in the survey, against 18.9% in a hospital and 16.3% in a surgicentre worldwide.\n\n*Inference —* a small market is not a safer or a riskier one, but it is a thinner one. A country with a few hundred procedures a year in any given operation gives a patient fewer surgeons to compare, fewer second opinions in the same city, and — when something goes wrong at three in the morning — fewer places to be taken.", "how": "*Trade practice —* the Panamanian arrangement looks like the Costa Rican one: a hospital international office or a private clinic quotes the procedure with transfers and a hotel, and the patient flies in for a consultation the day before. Prices are quoted in US dollars because the currency is pegged to it, which removes the exchange-rate argument that runs through most of this subject. Follow-up is by video call once the patient is home.", "today": "As of the 2024 survey year Panama's reported cosmetic volume is 21,254 procedures and its foreign-patient share sits near the worldwide median. No Panamanian government register or arrival series was read for this record, and none is carried." }, "geo": { "lat": 8.9824, "lon": -79.5199, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "21,254 aesthetic procedures in 2024, 13,579 surgical, median 10.0% / average 12.4% of patients from other locations. ISAPS survey extrapolations from 2,975 responding board-certified plastic surgeons across 32 locations; they count aesthetic work by plastic surgeons only, and nothing dental, screening or orthopaedic.", "as_of": "2024", "source": "s:isaps-global-survey-2024", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf" }, "kin": [ { "to": "panama-city", "as": "The whole of it, on one side of the canal.", "rel": "part" }, { "to": "costa-rica", "as": "The neighbour with the same mix, a certifying council and more surgeons.", "rel": "contrast" }, { "to": "colombia", "as": "The regional heavyweight, and one of the three origins Panamanian surgeons name.", "rel": "contrast" }, { "to": "united-states", "as": "The origin named first, and the currency the prices are quoted in.", "rel": "contrast" }, { "to": "executive-health-screening", "as": "The product a hub airport and a dollar economy sell well.", "rel": "procedure" }, { "to": "abdominoplasty", "as": "One of the body operations behind the surgical count.", "rel": "procedure" }, { "to": "isaps", "as": "The society whose survey supplies every number on this page.", "rel": "measured-by" } ], "links": [ { "label": "ISAPS survey of procedures performed in 2024", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf" } ], "sources": [ "s:isaps-global-survey-2024", "s:cdc-yellowbook-medical-tourism", "s:natural-earth" ], "provenance": { "default": { "tier": "cited", "source": "s:isaps-global-survey-2024" }, "fields": { "text.story": { "tier": "cited", "source": "s:isaps-global-survey-2024", "note": "the closing paragraph is this project's reading of what a small market means, marked inference" }, "text.how": { "tier": "tradition", "note": "the shape of a Panamanian booking, hedged in the prose" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Panama City skyline.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "The smallest of the three Latin American clusters this site carries, and the one with the fewest surgeons.", "region_terms": [ { "key": "central-america", "name": "Central America", "note": "Costa Rica, Panama, Guatemala, Belize" } ], "kin_out": [ { "to": "panama-city", "type": "hub", "name": "Panama City", "as": "The whole of it, on one side of the canal.", "rel": "part" }, { "to": "costa-rica", "type": "destination", "name": "Costa Rica", "as": "The neighbour with the same mix, a certifying council and more surgeons.", "rel": "contrast" }, { "to": "colombia", "type": "destination", "name": "Colombia", "as": "The regional heavyweight, and one of the three origins Panamanian surgeons name.", "rel": "contrast" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The origin named first, and the currency the prices are quoted in.", "rel": "contrast" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The product a hub airport and a dollar economy sell well.", "rel": "procedure" }, { "to": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "One of the body operations behind the surgical count.", "rel": "procedure" }, { "to": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "The society whose survey supplies every number on this page.", "rel": "measured-by" } ], "source_list": [ { "id": "s:isaps-global-survey-2024", "kind": "report", "title": "ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2024", "publisher": "International Society of Aesthetic Plastic Surgery, tabulated by Industry Insights Inc.", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:isaps-global-survey-2024" }, "text.story": { "tier": "cited", "source": "s:isaps-global-survey-2024", "note": "the closing paragraph is this project's reading of what a small market means, marked inference" }, "text.how": { "tier": "tradition", "note": "the shape of a Panamanian booking, hedged in the prose" }, "text.today": { "tier": "cited", "source": "s:isaps-global-survey-2024" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:isaps-global-survey-2024" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "costa-rica", "type": "destination", "name": "Costa Rica", "as": "The neighbour selling the same mix to the same market, with a smaller surgeon base.", "rel": "contrast" }, { "from": "panama-city", "type": "hub", "name": "Panama City", "as": "The country this cluster is, for practical purposes, the whole of.", "rel": "destination" }, { "from": "stem-cell-unproven", "type": "procedure", "name": "Unapproved stem cell treatment", "as": "Where the other published price page sits.", "rel": "destination" } ] }, { "schema": 1, "id": "philippines", "type": "destination", "names": { "name": "Philippines", "aliases": [ "Republic of the Philippines", "Pilipinas" ], "said": "The programme has a name — the Philippine Medical Tourism Program — and a list of hospitals. What it has never had is a number, and the government's own researcher said so in print." }, "region": [ "southeast-asia" ], "facets": { "iso2": "PH", "direction": "both", "currency": "PHP", "languages": [ "English", "Filipino" ], "draws": [ "dental-implant", "lasik", "rhinoplasty" ] }, "text": { "what": "A country that exports clinicians and has never managed to import many patients. Prices are competitive with its Asian neighbours, English is the working language of medicine, and the inbound trade has stayed small — concentrated in about twenty hospitals, served largely by the Filipino diaspora returning home, and, on the state's own account, barely measured at all.", "story": "The Philippine Institute for Development Studies, the government's own policy research body, published Oscar Picazo's assessment in October 2013. It is the most useful document in this record because of what it refuses to claim: \"The exact size of the market (number of medical tourists) and its revenue potential remain unclear, however, due to the absence of an agreed-upon definition of medical tourism.\"\n\nIts benchmarking table is blunter still. Against the benchmark for a standardised database system it records: \"Very weak; absence of key data; hesitance of private sector to share sensitive data.\" Against coordination: \"No medical tourism council or board; weak and informal coordination; too many offices and agencies involved (48), not counting private providers.\" Against marketing: the programme's \"lackluster performance\" is put down to its lack of a campaign.\n\nThe programme covered about twenty top-tier hospitals. A Long Stay Visitor Visa Extension good for 36 months was introduced in June 2013. Gross revenues for health and wellness activities ran to about 80 billion pesos in 2009 against costs of about 53 billion — a figure the note is careful to say covers the whole health and wellness industry, domestic included, not the spending of visiting patients.\n\n*Inference —* the study is thirteen years old and the specifics have moved. The structural finding has not: a country whose best-known health export is its nurses, whose private hospitals compete for a diaspora that is already coming home for Christmas, and whose state has no single body counting the trade, does not produce a national patient number.", "how": "*Trade practice —* the inbound work is dental, eye surgery, cosmetic surgery and executive screening, bought in Metro Manila and Cebu, frequently by Filipinos living abroad who are also visiting family. Prices are quoted in pesos, packages are commoner in dentistry than in surgery, and the facilitator layer is thin because most patients already know the country.", "today": "No official national count of foreign patients is carried on this page. The 2013 policy note remains the last government-published assessment read for this record." }, "geo": { "lat": 14.5995, "lon": 120.9842, "precision": "city", "source": "s:osm" }, "metrics": { "inbound_patients_year": null, "note": "None carried, on the government's own advice. The Philippine Institute for Development Studies recorded in 2013 that the size of the market was unclear for want of an agreed definition, and rated the country's database system \"very weak\" with an \"absence of key data\". The figures that circulate for the Philippines come from trade summaries, and this record does not repeat them.", "as_of": "2013", "source": "s:pids-medical-tourism-2013", "url": "https://pidswebs.pids.gov.ph/CDN/PUBLICATIONS/pidspn1311.pdf" }, "kin": [ { "to": "dental-implant", "as": "One of the few procedures sold here to visitors at a published price.", "rel": "procedure" }, { "to": "lasik", "as": "Eye surgery bought on short visits, often by returning Filipinos.", "rel": "procedure" }, { "to": "thailand", "as": "The neighbour that built the trade the Philippine programme was written to catch.", "rel": "contrast" }, { "to": "malaysia", "as": "The regional competitor with a council, a count, and a marketing budget.", "rel": "contrast" }, { "to": "counting-patients", "as": "A government research body writing down why it cannot give a number.", "rel": "story" }, { "to": "what-the-data-cannot-see", "as": "Forty-eight agencies, no register, no total.", "rel": "story" }, { "to": "facilitator", "as": "The layer that stayed thin here because the patients were already family.", "rel": "term" } ], "links": [ { "label": "Health-enhancing holidays — PIDS Policy Notes 2013-11", "url": "https://pidswebs.pids.gov.ph/CDN/PUBLICATIONS/pidspn1311.pdf" } ], "sources": [ "s:pids-medical-tourism-2013", "s:worldbank-open-data", "s:osm" ], "provenance": { "default": { "tier": "cited", "source": "s:pids-medical-tourism-2013" }, "fields": { "text.story": { "tier": "cited", "source": "s:pids-medical-tourism-2013", "note": "quotations are from the 2013 policy note; the closing paragraph is marked inference" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:pids-medical-tourism-2013" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A country that exports clinicians and has never managed to import many patients.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "One of the few procedures sold here to visitors at a published price.", "rel": "procedure" }, { "to": "lasik", "type": "procedure", "name": "LASIK", "as": "Eye surgery bought on short visits, often by returning Filipinos.", "rel": "procedure" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "The neighbour that built the trade the Philippine programme was written to catch.", "rel": "contrast" }, { "to": "malaysia", "type": "destination", "name": "Malaysia", "as": "The regional competitor with a council, a count, and a marketing budget.", "rel": "contrast" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "A government research body writing down why it cannot give a number.", "rel": "story" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "Forty-eight agencies, no register, no total.", "rel": "story" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The layer that stayed thin here because the patients were already family.", "rel": "term" } ], "source_list": [ { "id": "s:pids-medical-tourism-2013", "kind": "paper", "title": "Health-enhancing holidays: challenges in expanding medical tourism in the Philippines", "publisher": "Philippine Institute for Development Studies, Policy Notes No. 2013-11", "url": "https://pidswebs.pids.gov.ph/CDN/PUBLICATIONS/pidspn1311.pdf", "accessed": "2026-09-16", "note": "Oscar F. Picazo, October 2013, ISSN 1656-5266" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:pids-medical-tourism-2013" }, "text.story": { "tier": "cited", "source": "s:pids-medical-tourism-2013", "note": "quotations are from the 2013 policy note; the closing paragraph is marked inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited", "source": "s:pids-medical-tourism-2013" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:pids-medical-tourism-2013" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "Where a government research body said the count fails for want of a definition.", "rel": "destination" }, { "from": "counting-patients", "type": "story", "name": "Counting patients", "as": "The government research body that rated its own database very weak and published no total.", "rel": "destination" } ] }, { "schema": 1, "id": "poland", "type": "destination", "names": { "name": "Poland", "aliases": [ "Polska", "Rzeczpospolita Polska" ], "said": "In the trade Poland means Kraków and Wrocław for teeth, Warsaw for cosmetic work, and — for a decade — the flight a Polish family in Britain or Ireland was already taking home." }, "region": [ "europe-central" ], "facets": { "iso2": "PL", "direction": "both", "currency": "PLN", "languages": [ "Polish", "English", "German" ], "draws": [ "dental-implant", "dental-crown", "veneers", "rhinoplasty", "breast-augmentation" ] }, "text": { "what": "A dental and cosmetic destination whose first customers were its own emigrants. Polish practices price in sterling and euro, against columns labelled average UK price and average Irish price, because the patient flying in often has a Polish surname and a British dentist. Poland is also one of the heaviest users of the EU cross-border reimbursement route in the other direction: Poles going abroad, mostly next door.", "story": "The Commission's data for reference year 2022 makes the two-way traffic legible. Poland received 14,176 requests for reimbursement of care that needed no prior authorisation and granted 11,862 — more than any country except France and Germany — and the report names the flow from Poland to Czechia among the busiest in the EU. In the other direction Poland received one request for care subject to prior authorisation and authorised none.\n\n*Trade practice —* the inbound dental trade grew on the same aircraft routes. Budget airlines opened Kraków, Wrocław, Gdańsk and Rzeszów to British and Irish cities in the 2000s for a labour migration, and the practices that advertised in Polish to that migration were already set up in English when the non-Polish patient arrived.\n\n*Inference —* the price pages show what is actually being sold. A Kraków clinic's list prices an implant with its abutment and zirconia crown at GBP 1,450 or EUR 1,552 and sets it against columns it labels average UK and Irish prices of GBP 4,000 and EUR 3,750. Those comparison columns are the clinic's own reading of other people's websites, not a survey, and they are the number most quoted and least sourced in this trade.", "how": "Itemised price lists rather than bundles, with examination, x-rays and local anaesthetic often listed free — the loss leaders that get a treatment plan written. A deposit is taken against each stage rather than the whole plan: one Kraków clinic asks 80% of a stage on signing. Implant work runs across two visits months apart; crown and veneer work can be done in one week if the laboratory is in the building.", "today": "As of 16 September 2026 a Kraków clinic lists a complete implant at GBP 1,450 and a full-ceramic zirconia crown at GBP 429, and states that American Express and Diners Club are not accepted. What the list does not price is the flight taken twice, the week off work, or the dentist at home who inherits the case." }, "geo": { "lat": 52.2297, "lon": 21.0122, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "14,176 reimbursement requests for care not subject to prior authorisation, 11,862 granted, in reference year 2022. That counts Poles treated abroad and reclaiming at home; no comparable official count exists here for patients travelling into Poland.", "as_of": "2022", "source": "s:ec-crossborder-2022" }, "prices": [ { "procedure": "dental-implant", "country": "PL", "city": "Kraków", "amount": 1450, "currency": "GBP", "as_of": "2026-09-16", "kind": "list", "includes": [ "implant screw", "healing ring", "individual abutment", "full-ceramic zirconia crown" ], "excludes": [ "flights", "accommodation", "bone graft or sinus lift where needed", "treatment at home afterwards" ], "source": "s:indexmedica-prices", "url": "https://www.indexmedica.com/prices/", "note": "Index Medica, Kraków. The same page lists the implant screw alone at GBP 575, and the euro table prices the complete implant at EUR 1,552 for its Irish readers. The clinic's comparison columns — GBP 4,000 and EUR 3,750 — are its own estimate of prices at home, taken from other practices' websites.", "tier": "cited", "usd": 1954.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "warsaw", "as": "The capital cluster, weighted to cosmetic and aesthetic work.", "rel": "part" }, { "to": "dental-implant", "as": "The line item its price lists are built around.", "rel": "procedure" }, { "to": "united-kingdom", "as": "The source market its sterling price column is written for.", "rel": "contrast" }, { "to": "ireland", "as": "The second source market, priced in euro on the same page.", "rel": "contrast" }, { "to": "czechia", "as": "Where Polish patients themselves cross for care, the busiest flow in the EU reimbursement data.", "rel": "contrast" }, { "to": "hungary", "as": "The older dental corridor it competes with.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "as": "The route its own residents use heavily, and its inbound patients almost never.", "rel": "governed-by" }, { "to": "facilitator", "as": "The agent between a British patient and a Kraków chair, paid by the clinic.", "rel": "term" }, { "to": "the-price-that-isnt", "as": "The comparison column on a clinic's price list, and who wrote it.", "rel": "story" } ], "links": [ { "label": "Member State data on cross-border patient healthcare, reference year 2022", "url": "https://health.ec.europa.eu/publications/commission-report-operation-directive-201124eu-application-patients-rights-cross-border-healthcare-0_en" } ], "sources": [ "s:ec-crossborder-2022", "s:indexmedica-prices", "s:eu-directive-2011-24", "s:natural-earth" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:ec-crossborder-2022", "note": "the reimbursement figures are cited; the airline paragraph is marked trade practice and the price-column paragraph is marked inference" }, "text.how": { "tier": "tradition", "note": "the shape of a Polish dental price list; the 80% stage deposit is cited to the clinic's own page" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Kraków - Rynek Główny.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A dental and cosmetic destination whose first customers were its own emigrants.", "region_terms": [ { "key": "europe-central", "name": "Central Europe", "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia" } ], "kin_out": [ { "to": "warsaw", "type": "hub", "name": "Warsaw", "as": "The capital cluster, weighted to cosmetic and aesthetic work.", "rel": "part" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The line item its price lists are built around.", "rel": "procedure" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The source market its sterling price column is written for.", "rel": "contrast" }, { "to": "ireland", "type": "destination", "name": "Ireland", "as": "The second source market, priced in euro on the same page.", "rel": "contrast" }, { "to": "czechia", "type": "destination", "name": "Czechia", "as": "Where Polish patients themselves cross for care, the busiest flow in the EU reimbursement data.", "rel": "contrast" }, { "to": "hungary", "type": "destination", "name": "Hungary", "as": "The older dental corridor it competes with.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route its own residents use heavily, and its inbound patients almost never.", "rel": "governed-by" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The agent between a British patient and a Kraków chair, paid by the clinic.", "rel": "term" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "The comparison column on a clinic's price list, and who wrote it.", "rel": "story" } ], "source_list": [ { "id": "s:ec-crossborder-2022", "kind": "report", "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU — reference year 2022", "publisher": "European Commission, DG Health and Food Safety, Unit B.3; written by PredictBy Research and Consulting and Baltic Media; Publications Office of the European Union", "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf", "license": "CC BY 4.0", "accessed": "2026-09-16", "note": "final version January 2024, ISBN 978-92-68-14858-7. 23 countries reported 547,890 reimbursement requests for care not needing prior authorisation in 2022, of which France 300,254 and Germany 160,647 are 84%; Poland 14,176, Slovakia 13,904, Ireland 1,841, Romania 889, Czechia 440, Croatia 192, Lithuania 131, Greece 56, Cyprus 44, Portugal 27 (all refused), Spain 9. Total reimbursed EUR 86,462,491. For care needing prior authorisation, 4,552 requests and EUR 7,708,041. Belgium and Hungary could not report; Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway run no prior-authorisation system; only Denmark and Romania have a mechanism to limit inflow." }, { "id": "s:indexmedica-prices", "kind": "web", "title": "Prices — dental treatment in Kraków", "publisher": "Index Medica, Kraków", "url": "https://www.indexmedica.com/prices/", "accessed": "2026-09-16", "note": "two tables, one in sterling against a column the clinic labels average UK price, one in euro against average Irish price. Read 16 September 2026: complete implant including screw, healing ring, individual abutment and full-ceramic zirconia crown GBP 1,450 or EUR 1,552; implant screw alone GBP 575; full-ceramic zirconia crown GBP 429 or EUR 469; root canal on a front tooth GBP 120. Examination, x-rays and local anaesthetic are listed free. A deposit of 80% of each stage is due on signing the treatment plan; American Express and Diners Club are not accepted." }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:ec-crossborder-2022", "note": "the reimbursement figures are cited; the airline paragraph is marked trade practice and the price-column paragraph is marked inference" }, "text.how": { "tier": "tradition", "note": "the shape of a Polish dental price list; the 80% stage deposit is cited to the clinic's own page" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "czechia", "type": "destination", "name": "Czechia", "as": "The source of the busiest patient flow into this country in the EU data.", "rel": "contrast" }, { "from": "germany", "type": "destination", "name": "Germany", "as": "The other near border German patients cross, and a source of patients in return.", "rel": "contrast" }, { "from": "hungary", "type": "destination", "name": "Hungary", "as": "The other Central European dental corridor, selling the same work to different markets.", "rel": "contrast" }, { "from": "ireland", "type": "destination", "name": "Ireland", "as": "Second destination on the same return, at 371, and the dental corridor priced in euro.", "rel": "contrast" }, { "from": "lithuania", "type": "destination", "name": "Lithuania", "as": "The bigger corridor selling the same work to the same markets.", "rel": "contrast" }, { "from": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The dental corridor whose price list carries a column labelled average UK price.", "rel": "contrast" }, { "from": "warsaw", "type": "hub", "name": "Warsaw", "as": "The country this cluster is the capital of, and one that trades in both directions.", "rel": "whole" }, { "from": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "Where the ward day is a separate line from the operation.", "rel": "destination" }, { "from": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "Where a clinic publishes a price stated to cover post-operative care.", "rel": "destination" }, { "from": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "Where the ward day is priced separately from the operation.", "rel": "destination" }, { "from": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "Where the clinic prints an average UK price beside its own.", "rel": "destination" }, { "from": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "Where one page quotes both the screw alone and the finished tooth.", "rel": "destination" }, { "from": "root-canal", "type": "procedure", "name": "Root canal treatment", "as": "Where the front tooth is priced and the molar is not.", "rel": "destination" }, { "from": "veneers", "type": "procedure", "name": "Dental veneers", "as": "Where the comparison column is labelled average UK price.", "rel": "destination" } ] }, { "schema": 1, "id": "portugal", "type": "destination", "names": { "name": "Portugal", "aliases": [ "Portuguesa", "República Portuguesa" ], "said": "In the fertility trade Portugal is the country that lost its donors in a single ruling, and the clinics say so plainly when they explain the waiting list." }, "region": [ "europe-south" ], "facets": { "iso2": "PT", "direction": "both", "currency": "EUR", "languages": [ "Portuguese", "English", "Spanish", "French" ], "draws": [ "ivf", "egg-donation", "dental-implant", "hip-replacement" ] }, "text": { "what": "A country whose fertility market was rewritten by its own Constitutional Court. Portugal runs private clinics that treat Portuguese and foreign patients, but the rule on donor identity changed in 2018 and the donor supply changed with it. Portugal is also the one EU country that refused every cross-border reimbursement request it received in 2022.", "story": "In Ruling 225/2018 the Constitutional Court examined Law 32/2006 on medically assisted procreation, as amended in 2016, against the Constitution. The challenge ran at two provisions: Article 8 on gestational surrogacy and Article 15 on donor anonymity, which the applicants argued defeated a child's right to know its origins under Article 26. The court's page sets out that framing; what followed in practice is the part the clinics describe — donation in Portugal after that ruling is not anonymous, and a donor pool recruited on anonymity does not transfer to a register.\n\n*Inference —* the result was a redirection rather than a reduction. A treatment that needs a donor still needs one, and the nearest jurisdiction where donation stays anonymous is across the land border. Spain's registry records Portuguese residents in its 2022 foreign-patient table, though at 93 cycles, 0.3%, they are a small line — and small partly because Portuguese patients in Spain who give a Spanish address are not in that column at all.\n\nOn the state side Portugal is an outlier in the Commission's data for a different reason: it received 27 requests for reimbursement of care not subject to prior authorisation in 2022 and refused all 27, the only country in the EU to refuse everything it received. It authorised all seven of its prior-authorisation requests, and it was one of the main countries of treatment for patients affiliated in Luxembourg, with 137 authorised cases.", "how": "Private clinics quote fertility programmes in euro with medication outside; the state system treats residents. For a patient needing donated gametes the practical question is not price but supply, and the answer since 2018 has been a register rather than an anonymous pool. Cross-border reimbursement runs through the national contact point, which refused every application it received in the year last reported.", "today": "The dated facts are a 2018 ruling and 2022 reimbursement figures. What is not published anywhere this project could read is how many treatment cycles Portuguese clinics have run for foreign patients since the ruling, or how many Portuguese patients crossed into Spain because of it." }, "geo": { "lat": 38.7223, "lon": -9.1393, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "27 requests for reimbursement of care not subject to prior authorisation in 2022, all 27 refused — the only EU country to refuse every request. Seven prior-authorisation requests, all authorised; 137 patients affiliated in Luxembourg were authorised for treatment in Portugal.", "as_of": "2022", "source": "s:ec-crossborder-2022" }, "legality": [ { "country": "PT", "status": "lawful-with-conditions", "conditions": "Medically assisted procreation is governed by Law 32/2006 as amended; in Ruling 225/2018 the Constitutional Court considered the surrogacy and donor-anonymity provisions of that law against the constitutional right to know one's origins.", "instrument": "Law 32/2006 on medically assisted procreation, as amended by Laws 17/2016 and 25/2016; Constitutional Court Ruling 225/2018", "as_of": "2018", "source": "s:tc-portugal-225-2018", "url": "https://www.tribunalconstitucional.pt/tc/en/acordaos/20180225.html", "note": "read from the court's own English summary page. The row is dated 2018 and later amendments to the law are not read here; a stale row is a wrong row, and the donor-anonymity rule record carries its own reading." } ], "kin": [ { "to": "spain", "as": "The neighbour a Portuguese patient crosses to when a donor is needed.", "rel": "contrast" }, { "to": "ivf", "as": "The treatment the 2018 ruling reshaped here.", "rel": "procedure" }, { "to": "egg-donation", "as": "The programme whose donor pool the ruling emptied.", "rel": "procedure" }, { "to": "donor-anonymity-law", "as": "The rule this country changed by constitutional decision rather than by statute.", "rel": "governed-by" }, { "to": "eu-directive-2011-24", "as": "The route whose Portuguese applications were all refused in the last reported year.", "rel": "governed-by" }, { "to": "reproductive-exile", "as": "What a ruling about a child's rights did to its parents' travel plans.", "rel": "term" } ], "links": [ { "label": "Tribunal Constitucional — Ruling 225/2018", "url": "https://www.tribunalconstitucional.pt/tc/en/acordaos/20180225.html" } ], "sources": [ "s:tc-portugal-225-2018", "s:ec-crossborder-2022", "s:sef-registro-2022", "s:eu-directive-2011-24", "s:natural-earth" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:tc-portugal-225-2018", "note": "the ruling's framing is from the court's page and the figures from the Commission and the Spanish registry; the middle paragraph is marked inference" }, "text.how": { "tier": "tradition", "note": "clinic practice; the refusal figure is cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Lisbon Hospital de Santa Maria.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A country whose fertility market was rewritten by its own Constitutional Court.", "region_terms": [ { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" } ], "kin_out": [ { "to": "spain", "type": "destination", "name": "Spain", "as": "The neighbour a Portuguese patient crosses to when a donor is needed.", "rel": "contrast" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment the 2018 ruling reshaped here.", "rel": "procedure" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The programme whose donor pool the ruling emptied.", "rel": "procedure" }, { "to": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The rule this country changed by constitutional decision rather than by statute.", "rel": "governed-by" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route whose Portuguese applications were all refused in the last reported year.", "rel": "governed-by" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "What a ruling about a child's rights did to its parents' travel plans.", "rel": "term" } ], "source_list": [ { "id": "s:tc-portugal-225-2018", "kind": "law", "title": "Ruling 225/2018 (Acórdão n.º 225/2018) — medically assisted procreation, donor anonymity and surrogacy", "publisher": "Tribunal Constitucional, Portugal", "url": "https://www.tribunalconstitucional.pt/tc/en/acordaos/20180225.html", "accessed": "2026-09-16", "note": "the court's own English summary page. The challenge ran against Law 32/2006 as amended by Laws 17/2016 and 25/2016: Article 8 on gestational surrogacy and Article 15 on donor anonymity, argued against the child's right to know its origins under Article 26 of the Constitution." }, { "id": "s:ec-crossborder-2022", "kind": "report", "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU — reference year 2022", "publisher": "European Commission, DG Health and Food Safety, Unit B.3; written by PredictBy Research and Consulting and Baltic Media; Publications Office of the European Union", "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf", "license": "CC BY 4.0", "accessed": "2026-09-16", "note": "final version January 2024, ISBN 978-92-68-14858-7. 23 countries reported 547,890 reimbursement requests for care not needing prior authorisation in 2022, of which France 300,254 and Germany 160,647 are 84%; Poland 14,176, Slovakia 13,904, Ireland 1,841, Romania 889, Czechia 440, Croatia 192, Lithuania 131, Greece 56, Cyprus 44, Portugal 27 (all refused), Spain 9. Total reimbursed EUR 86,462,491. For care needing prior authorisation, 4,552 requests and EUR 7,708,041. Belgium and Hungary could not report; Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway run no prior-authorisation system; only Denmark and Romania have a mechanism to limit inflow." }, { "id": "s:sef-registro-2022", "kind": "dataset", "title": "Registro Nacional de Actividad 2022 — Registro SEF, Técnicas de Reproducción Asistida (FIV/ICSI and IA)", "publisher": "Sociedad Española de Fertilidad for the Spanish Ministry of Health; the official national ART registry", "url": "https://www.registrosef.com/public/docs/sef2022_IAFIV.pdf", "accessed": "2026-09-16", "note": "section 3.20: 27,564 fresh and frozen cycles in 2022 were for patients resident in other countries — France 39.0%, Italy 20.6%, the United Kingdom 9.0%, Germany 6.4%, Morocco 0.6%, Portugal 0.3%, other 18.3%, country not recorded 5.7%. Of those cycles 52.3% used donated eggs. The reason for coming was not recorded in 90.8% of them; where it was, 1.6% named a technique unlawful at home and 1.1% a patient who did not meet the legal conditions at home." }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:tc-portugal-225-2018", "note": "the ruling's framing is from the court's page and the figures from the Commission and the Spanish registry; the middle paragraph is marked inference" }, "text.how": { "tier": "tradition", "note": "clinic practice; the refusal figure is cited" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "legality": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "spain", "type": "destination", "name": "Spain", "as": "The neighbour whose donor supply collapsed when anonymity ended, sending patients this way.", "rel": "contrast" } ] }, { "schema": 1, "id": "romania", "type": "destination", "names": { "name": "Romania", "aliases": [ "România" ], "said": "In the trade Romania means Bucharest, Cluj-Napoca and Timișoara for dentistry, and it means Romanian patients abroad at least as much as foreign patients here." }, "region": [ "europe-east" ], "facets": { "iso2": "RO", "direction": "both", "currency": "RON", "languages": [ "Romanian", "English", "Italian", "German" ], "draws": [ "dental-implant", "all-on-four", "veneers", "dental-crown" ] }, "text": { "what": "A two-way country. Romanian dental groups in Bucharest, Cluj and Timișoara sell implant and full-arch work to Romanians living in Italy, Spain, Germany and Britain, and to their neighbours; at the same time Romanians travel out for care their own system cannot supply in time. Romania is also one of only two EU countries that has given itself a mechanism to limit patients coming in.", "story": "The Commission's 2022 data puts both directions on one page. Romania received 889 requests for reimbursement of care not needing prior authorisation and granted 512. It processes a prior-authorisation request faster than any other reporting country — an average of 3 days against a European average of 21, with a legal limit of 5 days, the shortest in the EU. And with Denmark it is one of two countries reporting a mechanism to limit inflow of foreign patients, though it recorded zero cases of anyone's access being limited in 2022.\n\n*Trade practice —* the inbound dental trade follows the diaspora. A Romanian family in Turin or Madrid flies home for the summer and books the dentist; the practices that grew on that traffic now advertise to non-Romanians in the same cities. The trade sells the full-arch case in particular, where the gap between an Italian and a Romanian quote is large enough to pay for two flights.\n\n*Inference —* the country's own outbound flow is the part the state can see, and even that is small against the number of Romanians who simply pay privately at home or abroad without claiming anything back.", "how": "Itemised dental pricing in euro or lei, full-arch cases quoted as one figure with the temporary bridge included and the final bridge billed on the second visit. Clinic-side coordination rather than a facilitator industry: the group's own international desk books the hotel.", "today": "The measurable facts are the state's: 889 reimbursement requests in 2022, 512 granted, a 3-day average for a prior-authorisation decision. The dental trade is privately paid and does not appear in any of those lines." }, "geo": { "lat": 44.4268, "lon": 26.1025, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "889 requests for reimbursement of care not subject to prior authorisation in 2022, 512 granted; 4 requests subject to prior authorisation, 1 authorised; average 3 days to decide a prior-authorisation request. All of these count Romanian patients treated abroad, not patients arriving.", "as_of": "2022", "source": "s:ec-crossborder-2022" }, "kin": [ { "to": "dental-implant", "as": "The item its clinics sell to the diaspora and to their neighbours.", "rel": "procedure" }, { "to": "all-on-four", "as": "The full-arch case where the price gap covers the flights.", "rel": "procedure" }, { "to": "hungary", "as": "The neighbouring dental corridor, older and better surveyed.", "rel": "contrast" }, { "to": "croatia", "as": "The other newer EU dental destination, working a different border.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "as": "The route whose Romanian figures are the only official count of this traffic.", "rel": "governed-by" }, { "to": "who-travels", "as": "The diaspora trip that is half of this country's inbound trade.", "rel": "story" } ], "sources": [ "s:ec-crossborder-2022", "s:eu-directive-2011-24", "s:natural-earth" ], "provenance": { "default": { "tier": "cited", "source": "s:ec-crossborder-2022" }, "fields": { "text.what": { "tier": "tradition", "note": "the inflow-limitation point is cited to the Commission report" }, "text.story": { "tier": "cited", "source": "s:ec-crossborder-2022", "note": "second paragraph marked trade practice, third marked inference" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Bucharest Calea Victoriei.jpg" ], "needs_verification": true, "confidence": "low", "updated": "2026-09-16", "blurb": "A two-way country. Romanian dental groups in Bucharest, Cluj and Timișoara sell implant and full-arch work to Romanians living in Italy, Spain, Germany and Britain, and to their neighbours; at the same time Romanians…", "region_terms": [ { "key": "europe-east", "name": "Eastern Europe", "note": "Romania, Bulgaria, Serbia, Ukraine, Moldova, Albania, North Macedonia" } ], "kin_out": [ { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The item its clinics sell to the diaspora and to their neighbours.", "rel": "procedure" }, { "to": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "The full-arch case where the price gap covers the flights.", "rel": "procedure" }, { "to": "hungary", "type": "destination", "name": "Hungary", "as": "The neighbouring dental corridor, older and better surveyed.", "rel": "contrast" }, { "to": "croatia", "type": "destination", "name": "Croatia", "as": "The other newer EU dental destination, working a different border.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route whose Romanian figures are the only official count of this traffic.", "rel": "governed-by" }, { "to": "who-travels", "type": "story", "name": "Who travels", "as": "The diaspora trip that is half of this country's inbound trade.", "rel": "story" } ], "source_list": [ { "id": "s:ec-crossborder-2022", "kind": "report", "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU — reference year 2022", "publisher": "European Commission, DG Health and Food Safety, Unit B.3; written by PredictBy Research and Consulting and Baltic Media; Publications Office of the European Union", "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf", "license": "CC BY 4.0", "accessed": "2026-09-16", "note": "final version January 2024, ISBN 978-92-68-14858-7. 23 countries reported 547,890 reimbursement requests for care not needing prior authorisation in 2022, of which France 300,254 and Germany 160,647 are 84%; Poland 14,176, Slovakia 13,904, Ireland 1,841, Romania 889, Czechia 440, Croatia 192, Lithuania 131, Greece 56, Cyprus 44, Portugal 27 (all refused), Spain 9. Total reimbursed EUR 86,462,491. For care needing prior authorisation, 4,552 requests and EUR 7,708,041. Belgium and Hungary could not report; Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway run no prior-authorisation system; only Denmark and Romania have a mechanism to limit inflow." }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "tradition", "note": "the inflow-limitation point is cited to the Commission report" }, "text.story": { "tier": "cited", "source": "s:ec-crossborder-2022", "note": "second paragraph marked trade practice, third marked inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited", "source": "s:ec-crossborder-2022" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:ec-crossborder-2022" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "croatia", "type": "destination", "name": "Croatia", "as": "The other newer EU dental destination, with a different set of neighbours.", "rel": "contrast" } ] }, { "schema": 1, "id": "saudi-arabia", "type": "destination", "names": { "name": "Saudi Arabia", "aliases": [ "المملكة العربية السعودية", "Kingdom of Saudi Arabia", "KSA" ], "said": "The trade says Saudi and means two different things at once: the largest single payer sending Gulf patients abroad, and a domestic hospital-building programme that intends to stop doing it." }, "region": [ "gulf", "west-asia" ], "facets": { "iso2": "SA", "direction": "both", "currency": "SAR", "languages": [ "Arabic", "English" ], "draws": [ "cabg", "kidney-transplant", "bone-marrow-transplant" ] }, "text": { "what": "A state that pays for its own citizens to be treated abroad through a committee route, and is at the same time rebuilding its hospital sector under a named national programme with the stated intention of keeping that care at home. The outbound programme is the flow with published numbers behind it. The inbound one is promoted, projected and forecast, but not counted in any figure this project could trace to a publisher.", "story": "Treatment abroad in Saudi Arabia is an administrative decision, not a purchase. A case goes to a medical committee, and approval carries the treatment, the travel and a companion with it; patients referred out have been paid a daily allowance while away. The destinations are the high-cost ones — a Health Ministry count reported in May 2021 put 488 patients sent abroad in 2020 against 2,842 in 2019, with the United States taking 245 of the 2020 cases, Germany 142 and the United Kingdom 101. Tumours were the largest single category. Those are small numbers per year and very large numbers per patient.\n\nThe Health Sector Transformation Program, one of the Vision 2030 realisation programmes, sets out the other direction: private-sector investment, a unified digital medical record across the whole population, a virtual hospital connecting more than 150 hospitals since 2022, and a set of published targets. *Inference —* what those published targets do not contain is a number for foreign patients. The objectives named on the programme's own page are access, value, prevention and road safety; the targets are beneficiary satisfaction, record coverage, readiness and road deaths. A reader shown a forecast of the kingdom's inbound trade is being shown a market-research projection, not a state target, and this record does not carry one.\n\n*Trade practice —* the reason Saudi patients dominate the waiting rooms of Amman, Dubai and Bangkok is not that Saudi hospitals are bad. It is that the state sponsorship travels, the escort travels with it, and a family that would have to pay out of pocket for a private consultation at home can be flown to a hospital that has taken the trouble to hire Arabic-speaking staff.", "how": "Outbound: a referral, a committee, an approval by recommendation or by royal decree, and a posting abroad with a companion and an allowance. Health attachés in the main destination countries handle the placements. Inbound: private hospitals sell directly and accreditation runs through CBAHI, the national board, which is compulsory for Saudi facilities rather than an optional badge bought for foreign readers — a difference worth holding onto when an accreditation count is put in front of a patient.", "today": "As of September 2026 the state programme is the half of this country's cross-border care that can be counted, and the most recent count this project could read is the 2020 one, a year the pandemic distorts. Whether the inbound flow is now the larger is a question nobody has published an answer to, and this record leaves it open rather than filling it with a forecast.", "notes": "Nothing here is a statement about the quality of Saudi hospitals. It is a statement about which flows somebody has counted." }, "geo": { "lat": 24.7136, "lon": 46.6753, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "No inbound foreign-patient count is carried. On the outbound side a Saudi Health Ministry report, as carried by Gulf News in May 2021, gave 488 patients sent abroad in 2020 against 2,842 in 2019 — a count of state-sponsored referrals, not of Saudis who paid their own way, and 2020 is a closed-borders year. This project could not trace a published inbound figure to its publisher.", "as_of": "2020", "source": "s:gulfnews-saudi-treatment-abroad-2021", "url": "https://gulfnews.com/world/gulf/saudi/saudi-arabia-82-drop-in-overseas-medical-treatment-1.79245048" }, "kin": [ { "to": "gcc-sponsored-treatment-abroad", "as": "The committee route by which this state buys care in other countries.", "rel": "governed-by" }, { "to": "cbahi", "as": "The national accreditor, compulsory at home rather than bought for a foreign audience.", "rel": "accredited-by" }, { "to": "uae", "as": "The neighbour running the same two flows, with a published inbound count this country lacks.", "rel": "kin" }, { "to": "jordan", "as": "One of the places Saudi patients and their escorts have gone for decades.", "rel": "contrast" }, { "to": "the-escort-burden", "as": "Paid for here by the sponsor, which is what makes this a source market rather than a trickle.", "rel": "risk" }, { "to": "germany", "as": "A destination the state's own referral counts name, alongside the United States and Britain.", "rel": "contrast" }, { "to": "counting-patients", "as": "Why this page carries an outbound number and refuses an inbound one.", "rel": "story" }, { "to": "world-bank-health-spending", "as": "The series behind what this country spends on health per person.", "rel": "measured-by" } ], "links": [ { "label": "Health Sector Transformation Program — Saudi Vision 2030", "url": "https://www.vision2030.gov.sa/en/explore/programs/health-sector-transformation-program" } ], "sources": [ "s:gulfnews-saudi-treatment-abroad-2021", "s:vision2030-hstp", "s:natural-earth", "s:worldbank-open-data" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:vision2030-hstp", "note": "the referral counts are cited to the Health Ministry report; the reading of what the programme's targets omit is marked inline as inference, and the third paragraph is trade practice" }, "text.how": { "tier": "tradition", "note": "the shape of the referral route; CBAHI's compulsory status is on the recognizers list" }, "text.today": { "tier": "inference" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A state that pays for its own citizens to be treated abroad through a committee route, and is at the same time rebuilding its hospital sector under a named national programme with the stated intention of keeping that…", "region_terms": [ { "key": "gulf", "name": "The Gulf", "note": "the UAE, Saudi Arabia, Qatar, Kuwait, Oman, Bahrain — a source market that is building itself into a destination" }, { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "gcc-sponsored-treatment-abroad", "type": "rule", "name": "Gulf state-sponsored treatment abroad", "as": "The committee route by which this state buys care in other countries.", "rel": "governed-by" }, { "to": "cbahi", "type": "org", "name": "Saudi Central Board for Accreditation of Healthcare Institutions", "as": "The national accreditor, compulsory at home rather than bought for a foreign audience.", "rel": "accredited-by" }, { "to": "uae", "type": "destination", "name": "United Arab Emirates", "as": "The neighbour running the same two flows, with a published inbound count this country lacks.", "rel": "kin" }, { "to": "jordan", "type": "destination", "name": "Jordan", "as": "One of the places Saudi patients and their escorts have gone for decades.", "rel": "contrast" }, { "to": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "Paid for here by the sponsor, which is what makes this a source market rather than a trickle.", "rel": "risk" }, { "to": "germany", "type": "destination", "name": "Germany", "as": "A destination the state's own referral counts name, alongside the United States and Britain.", "rel": "contrast" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why this page carries an outbound number and refuses an inbound one.", "rel": "story" }, { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "The series behind what this country spends on health per person.", "rel": "measured-by" } ], "source_list": [ { "id": "s:gulfnews-saudi-treatment-abroad-2021", "kind": "news", "title": "Saudi Arabia: 82% drop in overseas medical treatment", "publisher": "Gulf News", "url": "https://gulfnews.com/world/gulf/saudi/saudi-arabia-82-drop-in-overseas-medical-treatment-1.79245048", "accessed": "2026-09-16", "note": "published 17 May 2021, reporting a Saudi Health Ministry count: 488 patients sent abroad in 2020 against 2,842 in 2019, with the United States, Germany and the United Kingdom the leading destinations" }, { "id": "s:vision2030-hstp", "kind": "gov", "title": "Health Sector Transformation Program", "publisher": "Saudi Vision 2030", "url": "https://www.vision2030.gov.sa/en/explore/programs/health-sector-transformation-program", "accessed": "2026-09-16", "note": "the programme's own objectives and published targets; read for what it does and does not set a number against" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:vision2030-hstp", "note": "the referral counts are cited to the Health Ministry report; the reading of what the programme's targets omit is marked inline as inference, and the third paragraph is trade practice" }, "text.how": { "tier": "tradition", "note": "the shape of the referral route; CBAHI's compulsory status is on the recognizers list" }, "text.today": { "tier": "inference" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "jordan", "type": "destination", "name": "Jordan", "as": "Named by the hospitals here among their largest source markets.", "rel": "contrast" }, { "from": "uae", "type": "destination", "name": "United Arab Emirates", "as": "The other Gulf state running both flows at once, and the one with the larger population behind it.", "rel": "kin" }, { "from": "gcc-sponsored-treatment-abroad", "type": "rule", "name": "Gulf state-sponsored treatment abroad", "as": "Another Gulf state that sends patients abroad, through a health attaché rather than a bylaw this project has read.", "rel": "destination" }, { "from": "cbahi", "type": "org", "name": "Saudi Central Board for Accreditation of Healthcare Institutions", "as": "The country whose public and private facilities it is the legally recognised evaluator of.", "rel": "place" } ] }, { "schema": 1, "id": "singapore", "type": "destination", "names": { "name": "Singapore", "aliases": [ "Republic of Singapore", "新加坡共和国" ], "said": "In the trade Singapore is the expensive answer — the place a patient goes when the diagnosis is hard rather than when the bill at home is high." }, "region": [ "southeast-asia" ], "facets": { "iso2": "SG", "direction": "both", "currency": "SGD", "languages": [ "English", "Mandarin", "Malay", "Tamil", "Indonesian" ], "draws": [ "proton-therapy", "car-t", "bone-marrow-transplant", "executive-health-screening" ] }, "text": { "what": "A city-state that counted its medical travellers, found the count did not survive inspection, and has not published a comparable one since. Singapore takes complex and expensive work — oncology, transplant, difficult paediatrics — from Indonesia, Malaysia, Vietnam and the region's wealthy, and it competes on diagnosis rather than on price.", "story": "On 22 January 2009 the Ministry of Health answered a parliamentary question from Dr Lam Pin Min with the figures it had: about 410,000 medical travellers in 2006 and about 348,000 in 2007, with spending of 1.7 billion dollars in 2007, an increase of 30 per cent on 2006. The estimates came from the Singapore Tourism Board's exit surveys of international travellers at the airport.\n\nThe ministry then said what most agencies leave out. All the hospitals had reported higher admissions and higher patient-days in 2007, and the survey showed a 15 per cent fall. The board was re-examining its methodology.\n\n*Inference —* an exit survey asks a departing passenger what they came for. It cannot tell a scheduled operation from a fever treated on holiday, it misses anyone who leaves by causeway, and it is a sample grossed up. The ministry's own objection is the most useful sentence published about patient counts anywhere in this subject, and it applies to every national figure in this directory that was produced the same way.\n\n*Trade practice —* the traffic runs the other way too. Singaporeans cross to Johor Bahru for dental work and to Malaysian hospitals for elective surgery, and no agency on either side counts them.", "how": "Private groups quote in Singapore dollars, itemise rather than package, and route foreign patients through international patient centres that arrange the visa letter, the deposit and the interpreter. Complex oncology and cell therapy are the country's distinctive offer, and both are priced well above the regional field.", "today": "As of 16 September 2026 no official Singapore count of medical travellers later than the 2007 exit-survey estimate has been read for this record. The figures circulating for recent years come from market-research summaries, and this directory does not carry them." }, "geo": { "lat": 1.3521, "lon": 103.8198, "precision": "country", "source": "s:osm" }, "metrics": { "inbound_patients_year": 348000, "note": "The Singapore Tourism Board's airport exit-survey estimate for 2007, given to Parliament by the Ministry of Health on 22 January 2009, against about 410,000 for 2006. Carried here with the ministry's own caveat attached: every hospital reported higher admissions and patient-days in 2007 while the survey showed a 15 per cent fall, and the board was re-examining the method. No later official count was read for this record.", "as_of": "2007", "source": "s:moh-sg-medical-travellers-2009", "url": "https://www.moh.gov.sg/newsroom/medical-travellers-update/" }, "kin": [ { "to": "singapore-city", "as": "The country and the cluster are the same place.", "rel": "part" }, { "to": "mount-elizabeth", "as": "The private hospital most often named in the region's referrals.", "rel": "part" }, { "to": "raffles-hospital", "as": "The other name a regional referral usually lands on.", "rel": "part" }, { "to": "indonesia", "as": "The source market that fills these wards, and the reason Jakarta wants them filled at home.", "rel": "contrast" }, { "to": "malaysia", "as": "The cheaper neighbour, and the place Singaporeans themselves cross to.", "rel": "contrast" }, { "to": "proton-therapy", "as": "One of the expensive treatments patients fly here for rather than for a lower price.", "rel": "procedure" }, { "to": "car-t", "as": "Cell therapy sold to the region at the top of the price range.", "rel": "procedure" }, { "to": "counting-patients", "as": "The health ministry's own doubt about an exit survey, stated in 2009.", "rel": "story" }, { "to": "what-the-data-cannot-see", "as": "A country that stopped publishing a number rather than publish a bad one.", "rel": "story" } ], "links": [ { "label": "Medical Travellers Update — Ministry of Health, 22 January 2009", "url": "https://www.moh.gov.sg/newsroom/medical-travellers-update/" } ], "sources": [ "s:moh-sg-medical-travellers-2009", "s:worldbank-open-data", "s:osm" ], "provenance": { "default": { "tier": "cited", "source": "s:moh-sg-medical-travellers-2009" }, "fields": { "text.story": { "tier": "cited", "source": "s:moh-sg-medical-travellers-2009", "note": "the 2009 parliamentary answer; the last two stretches are marked inference and trade practice" }, "text.how": { "tier": "tradition", "note": "the general shape of an international patient centre in a Singapore private group" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:moh-sg-medical-travellers-2009" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A city-state that counted its medical travellers, found the count did not survive inspection, and has not published a comparable one since.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "singapore-city", "type": "hub", "name": "Singapore", "as": "The country and the cluster are the same place.", "rel": "part" }, { "to": "mount-elizabeth", "type": "facility", "name": "Mount Elizabeth Hospital", "as": "The private hospital most often named in the region's referrals.", "rel": "part" }, { "to": "raffles-hospital", "type": "facility", "name": "Raffles Hospital", "as": "The other name a regional referral usually lands on.", "rel": "part" }, { "to": "indonesia", "type": "destination", "name": "Indonesia", "as": "The source market that fills these wards, and the reason Jakarta wants them filled at home.", "rel": "contrast" }, { "to": "malaysia", "type": "destination", "name": "Malaysia", "as": "The cheaper neighbour, and the place Singaporeans themselves cross to.", "rel": "contrast" }, { "to": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "One of the expensive treatments patients fly here for rather than for a lower price.", "rel": "procedure" }, { "to": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "Cell therapy sold to the region at the top of the price range.", "rel": "procedure" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "The health ministry's own doubt about an exit survey, stated in 2009.", "rel": "story" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "A country that stopped publishing a number rather than publish a bad one.", "rel": "story" } ], "source_list": [ { "id": "s:moh-sg-medical-travellers-2009", "kind": "web", "title": "Medical Travellers Update", "publisher": "Ministry of Health, Singapore", "url": "https://www.moh.gov.sg/newsroom/medical-travellers-update/", "accessed": "2026-09-16", "note": "written answer to a parliamentary question from Dr Lam Pin Min, 22 January 2009, giving the Singapore Tourism Board's airport exit-survey estimates and the ministry's own doubt about the method" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:moh-sg-medical-travellers-2009" }, "text.story": { "tier": "cited", "source": "s:moh-sg-medical-travellers-2009", "note": "the 2009 parliamentary answer; the last two stretches are marked inference and trade practice" }, "text.how": { "tier": "tradition", "note": "the general shape of an international patient centre in a Singapore private group" }, "text.today": { "tier": "cited", "source": "s:moh-sg-medical-travellers-2009" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:moh-sg-medical-travellers-2009" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "indonesia", "type": "destination", "name": "Indonesia", "as": "Where the harder diagnoses and the larger bills go.", "rel": "destination" }, { "from": "vietnam", "type": "destination", "name": "Vietnam", "as": "Where Vietnamese patients go when the diagnosis is serious and the money exists.", "rel": "contrast" }, { "from": "singapore-city", "type": "hub", "name": "Singapore", "as": "The country whose entire private trade sits in these few square kilometres.", "rel": "whole" }, { "from": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The third published price on this record, and the most specific in what it covers.", "rel": "destination" }, { "from": "mount-elizabeth", "type": "facility", "name": "Mount Elizabeth Hospital", "as": "The expensive end of Asian private medicine, bought for the regulator as much as for the surgeon.", "rel": "destination" }, { "from": "raffles-hospital", "type": "facility", "name": "Raffles Hospital", "as": "The country's clinic company that built a hospital, against the country's hospital companies that acquired clinics.", "rel": "destination" }, { "from": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "The state that ties the permission to the licence.", "rel": "destination" }, { "from": "counting-patients", "type": "story", "name": "Counting patients", "as": "The year an exit survey and the hospitals' own admissions moved in opposite directions.", "rel": "destination" } ] }, { "schema": 1, "id": "south-africa", "type": "destination", "names": { "name": "South Africa", "aliases": [ "Republic of South Africa", "RSA", "Suid-Afrika", "iNingizimu Afrika" ], "said": "The brochures say surgeon and safari. The larger flow is regional and unglamorous: patients from Zimbabwe, Zambia, Botswana, Namibia and Mozambique arriving in Johannesburg because the hospital at home cannot do it." }, "region": [ "africa-south" ], "facets": { "iso2": "ZA", "direction": "inbound", "currency": "ZAR", "languages": [ "English", "Afrikaans", "isiZulu", "Sesotho" ], "draws": [ "breast-augmentation", "liposuction", "abdominoplasty", "dental-implant", "ivf" ] }, "text": { "what": "Sub-Saharan Africa's referral hospital and Europe's rand-priced cosmetic destination at the same time. South African Tourism's own survey of why visitors came put medical reasons at 1.8 per cent of international arrivals in 2016, and average foreign direct spend by those travellers at R10,600. The cosmetic and dental trade sells to the United Kingdom, the Netherlands and Germany; the larger flow by headcount comes from the rest of the continent.", "story": "Two trades share one country and they have almost nothing in common. Crush and Chikanda, writing in Social Science & Medicine in 2015, made the case that movement to South Africa from within the region is larger, in numbers and in money, than movement from the global North — and that the second is what gets studied while the first is where the patients are. Patients from Zimbabwe, Zambia, Botswana, Namibia, Mozambique and further north arrive for oncology, orthopaedics, fertility and cardiac work, because those services exist in Johannesburg, Pretoria and Cape Town and do not exist reliably at home.\n\nThe European half is priced, packaged and advertised. Breast augmentation, liposuction, nose reshaping, facelifts and abdominoplasty are the operations named most often, alongside dentistry. Wesgro, the Western Cape's own trade and investment agency, recorded the province's share of arrivals travelling for medical reasons rising from 0.8 per cent in 2015 to 0.9 per cent in 2016, and named the United Kingdom and the Netherlands as its top source markets, with German visitors coming largely for dentistry.\n\n*Inference —* the survey share is the better number and it is small. South African Tourism asks arriving visitors their main purpose of visit; 1.8 per cent of them said medical in 2016, down from 2.3 per cent in 2014. That is a measured share of a measured population, and it sits underneath every larger figure quoted for this country without one.", "how": "The European route is an agency booking against a package quoted in rand, with the exchange rate doing much of the selling and a recovery stay attached. The regional route is a referral, often self-funded, sometimes by a national health ministry buying a service its own hospitals cannot provide, and it arrives at a private hospital group or a public tertiary centre rather than at a cosmetic clinic. Wesgro's own interviewee, Faith Cartwright of Medical Tourism South Africa, said arrivals here tend not to buy treatment packages at all, being wary of undisclosed costs inside them.", "today": "As of September 2026 the most recent survey figures this record could read are South African Tourism's for 2014-2016, carried in the Wesgro study: a medical share of 2.3, 1.9 and 1.8 per cent of international arrivals, with average foreign direct spend by those travellers of R7,600, R10,100 and R10,600.", "notes": "A share of arrivals who named a main purpose is not a count of operations. It counts people who said so at the border." }, "geo": { "lat": -26.2041, "lon": 28.0473, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "South African Tourism's survey of main purpose of visit put medical at 1.8% of international arrivals in 2016, 1.9% in 2015 and 2.3% in 2014, with average total foreign direct spend by those travellers of R10,600, R10,100 and R7,600 respectively. It counts visitors who named medical treatment as the main purpose of the trip, so it misses anyone who came for a holiday and had work done, and it counts trips rather than operations. Western Cape share rose from 0.8% in 2015 to 0.9% in 2016.", "as_of": "2016", "source": "s:wesgro-medical-tourism-study", "url": "https://www.wesgro.co.za/uploads/files/Medical-Tourism-Study.pdf" }, "kin": [ { "to": "johannesburg", "as": "The hospital city the regional flow arrives at.", "rel": "part" }, { "to": "kenya", "as": "The other African country with a tertiary sector its neighbours use — and an outflow of its own.", "rel": "contrast" }, { "to": "nigeria", "as": "A source market whose patients go to India and to London rather than south.", "rel": "contrast" }, { "to": "breast-augmentation", "as": "One of the operations the European end of this trade is built on.", "rel": "procedure" }, { "to": "ivf", "as": "Named as a draw for patients from across the continent.", "rel": "procedure" }, { "to": "who-travels", "as": "The regional patient this country's larger flow is made of, against the one the brochures show.", "rel": "story" }, { "to": "world-bank-tourism-arrivals", "as": "The series the survey share above is a percentage of.", "rel": "measured-by" }, { "to": "counting-patients", "as": "Why a share of arrivals who named a purpose is not a count of operations.", "rel": "story" } ], "links": [ { "label": "Wesgro medical travel study, with South African Tourism 2017 data", "url": "https://www.wesgro.co.za/uploads/files/Medical-Tourism-Study.pdf" } ], "sources": [ "s:wesgro-medical-tourism-study", "s:crush-chikanda-2015", "s:natural-earth", "s:worldbank-open-data" ], "provenance": { "default": { "tier": "cited", "source": "s:wesgro-medical-tourism-study" }, "fields": { "text.story": { "tier": "cited", "source": "s:crush-chikanda-2015", "note": "the Crush and Chikanda finding is carried from the publisher's listing and flagged for verification; the closing reading is marked inline as inference" }, "text.how": { "tier": "tradition", "note": "the two routes as the trade describes them; the Cartwright remark is cited to the Wesgro study" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "Sub-Saharan Africa's referral hospital and Europe's rand-priced cosmetic destination at the same time.", "region_terms": [ { "key": "africa-south", "name": "Southern Africa", "note": "South Africa, Namibia, Botswana" } ], "kin_out": [ { "to": "johannesburg", "type": "hub", "name": "Johannesburg", "as": "The hospital city the regional flow arrives at.", "rel": "part" }, { "to": "kenya", "type": "destination", "name": "Kenya", "as": "The other African country with a tertiary sector its neighbours use — and an outflow of its own.", "rel": "contrast" }, { "to": "nigeria", "type": "destination", "name": "Nigeria", "as": "A source market whose patients go to India and to London rather than south.", "rel": "contrast" }, { "to": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "One of the operations the European end of this trade is built on.", "rel": "procedure" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "Named as a draw for patients from across the continent.", "rel": "procedure" }, { "to": "who-travels", "type": "story", "name": "Who travels", "as": "The regional patient this country's larger flow is made of, against the one the brochures show.", "rel": "story" }, { "to": "world-bank-tourism-arrivals", "type": "dataset", "name": "International arrivals", "as": "The series the survey share above is a percentage of.", "rel": "measured-by" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a share of arrivals who named a purpose is not a count of operations.", "rel": "story" } ], "source_list": [ { "id": "s:wesgro-medical-tourism-study", "kind": "gov", "title": "Medical Tourism — an introduction and a Western Cape market study", "publisher": "Wesgro, the tourism, trade and investment agency for Cape Town and the Western Cape", "url": "https://www.wesgro.co.za/uploads/files/Medical-Tourism-Study.pdf", "accessed": "2026-09-16", "note": "reproduces South African Tourism's 2017 survey of main purpose of visit for 2014-2016, and its average foreign direct spend per medical traveller in rand" }, { "id": "s:crush-chikanda-2015", "kind": "journal", "title": "South–South medical tourism and the quest for health in Southern Africa", "publisher": "Crush J, Chikanda A. Social Science & Medicine 2015;124:313–320", "url": "https://pubmed.ncbi.nlm.nih.gov/24973022/", "accessed": "2026-09-16", "note": "argues that movement to South Africa from the region is larger, in numbers and in money, than the flow from the global North. The abstract page would not open on the access date; the citation and finding are carried here from the publisher's listing and are flagged for verification." }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:wesgro-medical-tourism-study" }, "text.story": { "tier": "cited", "source": "s:crush-chikanda-2015", "note": "the Crush and Chikanda finding is carried from the publisher's listing and flagged for verification; the closing reading is marked inline as inference" }, "text.how": { "tier": "tradition", "note": "the two routes as the trade describes them; the Cartwright remark is cited to the Wesgro study" }, "text.today": { "tier": "cited", "source": "s:wesgro-medical-tourism-study" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:wesgro-medical-tourism-study" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "kenya", "type": "destination", "name": "Kenya", "as": "The continental destination Kenyan patients use less than the Indian one.", "rel": "contrast" }, { "from": "johannesburg", "type": "hub", "name": "Johannesburg", "as": "The country whose private hospital capacity concentrates in this city.", "rel": "whole" } ] }, { "schema": 1, "id": "south-korea", "type": "destination", "names": { "name": "South Korea", "aliases": [ "Republic of Korea", "대한민국", "Korea" ], "said": "The trade says Korea and pictures a hospital. The official numbers say clinic: four in five foreign patients in 2024 were treated in one, mostly in Gangnam, mostly for skin." }, "region": [ "east-asia" ], "facets": { "iso2": "KR", "direction": "inbound", "currency": "KRW", "languages": [ "Korean", "English", "Mandarin", "Japanese", "Russian" ], "draws": [ "rhinoplasty", "hair-transplant-fue", "executive-health-screening", "spinal-fusion", "disc-replacement" ] }, "text": { "what": "The fastest-moving inbound flow in Asia, and one of the few a state counts on a published series. Korea recorded 1.17 million foreign patients in 2024, nearly double the 610,000 of 2023, and 5.05 million cumulatively since it began attracting them in 2009. The work is mostly dermatology and plastic surgery; clinics took 82.0 per cent of it and the Seoul metropolitan area 85.4 per cent.", "story": "The Ministry of Health and Welfare published the 2024 figures on 3 April 2025. The top countries of origin were Japan, China, the United States, Thailand and Taiwan, in that order. The growth rates behind the total are the interesting part: Taiwan up 550.6 per cent, Japan up 135.0 per cent, China up 132.4 per cent.\n\n*Inference —* those are short-haul numbers. A destination whose fastest-growing markets are two-hour flights, whose patients go to clinics rather than hospitals, and whose leading specialties are dermatology and plastic surgery is selling a weekend, not an admission. That is a different product from a knee replacement with three ward nights, and reading the 1.17 million as a million operations would be wrong.\n\nSeparate card-spending data for 2024 put 919,000 foreign nationals spending 1.4 trillion won at Korean medical providers, an average of about 1.53 million won each — roughly a thousand US dollars a head at the rates of the day. That average is a dermatology average.\n\n*Trade practice —* the count exists because facilities that treat foreign patients register with the ministry and report, so the series is administrative rather than survey-based. That is why it moves so sharply: a registration series grows when registration grows.", "how": "Foreign patients arrive on ordinary short-stay entry for clinic work and on a medical visa for admissions. Clinics in Gangnam and Myeongdong price per procedure and quote in won, hospitals package screening, and interpreters in Mandarin, Japanese, Russian and English are ordinary at the larger facilities. Advertising is regulated, and what a Korean clinic may say to a foreign patient is not what a facilitator abroad may say about it.", "today": "The 2024 total is the highest since the programme began in 2009. Korea's own hospital beds, doctors and health spending per person sit on the country page's chart from the World Bank series with their own years, and describe the system Koreans use rather than the clinics in this directory." }, "geo": { "lat": 37.5665, "lon": 126.978, "precision": "city", "source": "s:osm" }, "metrics": { "inbound_patients_year": 1170000, "note": "Foreign patients in 2024, up 93.2 per cent on about 610,000 in 2023, with 5.05 million cumulative since 2009. Clinics accounted for 82.0 per cent and the Seoul metropolitan area 85.4 per cent; dermatology, plastic surgery, internal medicine and health screening led. The series is assembled from facilities that register to treat foreign patients, so it counts reported patients at registered places, not border crossings made for treatment.", "as_of": "2024", "source": "s:mohw-kr-foreign-patients-2024", "url": "https://www.mohw.go.kr/board.es?mid=a20401000000&bid=0032&act=view&list_no=1485207" }, "kin": [ { "to": "khidi", "as": "The institute that compiles the foreign-patient series for the health ministry.", "rel": "measured-by" }, { "to": "korea-foreign-patient-registration", "as": "The registration that turns a clinic into a line in the national count.", "rel": "governed-by" }, { "to": "seoul", "as": "Where 85.4 per cent of it happened in 2024.", "rel": "part" }, { "to": "samsung-medical-center", "as": "One of the large hospitals at the other end of the market from the Gangnam clinics.", "rel": "part" }, { "to": "asan-medical-center", "as": "The country's largest hospital, and a transplant centre foreign patients are referred to.", "rel": "part" }, { "to": "severance", "as": "The oldest of the university hospitals taking international referrals.", "rel": "part" }, { "to": "wooridul", "as": "The spine specialist that made Korea a named address for back surgery.", "rel": "part" }, { "to": "rhinoplasty", "as": "The operation the country's reputation abroad is built on.", "rel": "procedure" }, { "to": "japan", "as": "The largest single source of its foreign patients in 2024.", "rel": "contrast" }, { "to": "taiwan", "as": "Its fastest-growing source market in 2024, up 550.6 per cent.", "rel": "contrast" }, { "to": "advertising-rules", "as": "What a clinic here may say, against what a broker abroad says for it.", "rel": "governed-by" }, { "to": "counting-patients", "as": "Why a registration series and a patient count are not the same thing.", "rel": "story" } ], "links": [ { "label": "Korea Attracts 1.17 Million Foreign Patients in 2024 — Ministry of Health and Welfare", "url": "https://www.mohw.go.kr/board.es?mid=a20401000000&bid=0032&act=view&list_no=1485207" } ], "sources": [ "s:mohw-kr-foreign-patients-2024", "s:worldbank-open-data", "s:osm" ], "provenance": { "default": { "tier": "cited", "source": "s:mohw-kr-foreign-patients-2024" }, "fields": { "text.story": { "tier": "cited", "source": "s:mohw-kr-foreign-patients-2024", "note": "figures from the ministry's release of 3 April 2025; the inline marks say which stretches are inference and trade practice" }, "text.how": { "tier": "tradition", "note": "the general shape of clinic and hospital practice in Seoul; not read off an instrument" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:mohw-kr-foreign-patients-2024" } } }, "x_commons_files": [ "File:Gangnam-daero.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "The fastest-moving inbound flow in Asia, and one of the few a state counts on a published series.", "region_terms": [ { "key": "east-asia", "name": "East Asia", "note": "South Korea, Japan, Taiwan, China" } ], "kin_out": [ { "to": "khidi", "type": "org", "name": "Korea Health Industry Development Institute", "as": "The institute that compiles the foreign-patient series for the health ministry.", "rel": "measured-by" }, { "to": "korea-foreign-patient-registration", "type": "rule", "name": "Korea's foreign patient attraction registration", "as": "The registration that turns a clinic into a line in the national count.", "rel": "governed-by" }, { "to": "seoul", "type": "hub", "name": "Seoul", "as": "Where 85.4 per cent of it happened in 2024.", "rel": "part" }, { "to": "samsung-medical-center", "type": "facility", "name": "Samsung Medical Center", "as": "One of the large hospitals at the other end of the market from the Gangnam clinics.", "rel": "part" }, { "to": "asan-medical-center", "type": "facility", "name": "Asan Medical Center", "as": "The country's largest hospital, and a transplant centre foreign patients are referred to.", "rel": "part" }, { "to": "severance", "type": "facility", "name": "Severance Hospital", "as": "The oldest of the university hospitals taking international referrals.", "rel": "part" }, { "to": "wooridul", "type": "facility", "name": "Wooridul Spine Hospital", "as": "The spine specialist that made Korea a named address for back surgery.", "rel": "part" }, { "to": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "The operation the country's reputation abroad is built on.", "rel": "procedure" }, { "to": "japan", "type": "destination", "name": "Japan", "as": "The largest single source of its foreign patients in 2024.", "rel": "contrast" }, { "to": "taiwan", "type": "destination", "name": "Taiwan", "as": "Its fastest-growing source market in 2024, up 550.6 per cent.", "rel": "contrast" }, { "to": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "What a clinic here may say, against what a broker abroad says for it.", "rel": "governed-by" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a registration series and a patient count are not the same thing.", "rel": "story" } ], "source_list": [ { "id": "s:mohw-kr-foreign-patients-2024", "kind": "web", "title": "Korea Attracts 1.17 Million Foreign Patients in 2024", "publisher": "Ministry of Health and Welfare (Republic of Korea)", "url": "https://www.mohw.go.kr/board.es?mid=a20401000000&bid=0032&act=view&list_no=1485207", "accessed": "2026-09-16", "note": "press release of 3 April 2025; the annual foreign-patient statistics are compiled for the ministry by the Korea Health Industry Development Institute" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:mohw-kr-foreign-patients-2024" }, "text.story": { "tier": "cited", "source": "s:mohw-kr-foreign-patients-2024", "note": "figures from the ministry's release of 3 April 2025; the inline marks say which stretches are inference and trade practice" }, "text.how": { "tier": "tradition", "note": "the general shape of clinic and hospital practice in Seoul; not read off an instrument" }, "text.today": { "tier": "cited", "source": "s:mohw-kr-foreign-patients-2024" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:mohw-kr-foreign-patients-2024" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "china", "type": "destination", "name": "China", "as": "The destination that recorded China as its second-largest source of foreign patients in 2024.", "rel": "contrast" }, { "from": "japan", "type": "destination", "name": "Japan", "as": "The neighbour whose official figures record Japan as its largest source of foreign patients in 2024.", "rel": "contrast" }, { "from": "taiwan", "type": "destination", "name": "Taiwan", "as": "The destination Taiwanese patients travelled to fastest in 2024, up 550.6 per cent.", "rel": "contrast" }, { "from": "seoul", "type": "hub", "name": "Seoul", "as": "The country whose foreign-patient count this city dominates.", "rel": "whole" }, { "from": "facelift", "type": "procedure", "name": "Facelift", "as": "A destination that built a face-surgery trade on technique rather than on discount.", "rel": "destination" }, { "from": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "A destination whose surgeons are sought for a house style rather than a discount.", "rel": "destination" }, { "from": "asan-medical-center", "type": "facility", "name": "Asan Medical Center", "as": "The country's largest hospital, and one of the few anywhere that publishes its own foreign caseload.", "rel": "destination" }, { "from": "samsung-medical-center", "type": "facility", "name": "Samsung Medical Center", "as": "A corporate foundation's hospital in a system where every foreign patient is registered with the ministry.", "rel": "destination" }, { "from": "severance", "type": "facility", "name": "Severance Hospital", "as": "The first Korean hospital to take JCI accreditation, in 2007, which dates the country's selling abroad.", "rel": "destination" }, { "from": "wooridul", "type": "facility", "name": "Wooridul Spine Hospital", "as": "Among the earliest Korean hospitals to build a foreign-patient practice, by training foreign surgeons before the state built a register.", "rel": "destination" }, { "from": "korea-foreign-patient-registration", "type": "rule", "name": "Korea's foreign patient attraction registration", "as": "The country whose statute this is.", "rel": "destination" }, { "from": "khidi", "type": "org", "name": "Korea Health Industry Development Institute", "as": "The country whose inbound patient count it compiles and publishes.", "rel": "place" }, { "from": "world-bank-beds", "type": "dataset", "name": "Hospital beds per 1,000 people", "as": "12.81 beds per 1,000 in 2022, the highest national figure among this site's destinations.", "rel": "measures" }, { "from": "counting-patients", "type": "story", "name": "Counting patients", "as": "The compulsory register, and the one national figure here with a stated counting rule.", "rel": "destination" } ] }, { "schema": 1, "id": "spain", "type": "destination", "names": { "name": "Spain", "aliases": [ "España", "Reino de España" ], "said": "In the fertility trade Spain means Barcelona, Madrid, Valencia and Alicante, and it means donated eggs. In the Directive's paperwork it means the country other Europeans are authorised to travel to." }, "region": [ "europe-south" ], "facets": { "iso2": "ES", "direction": "inbound", "currency": "EUR", "languages": [ "Spanish", "Catalan", "English", "French", "Italian" ], "draws": [ "ivf", "egg-donation", "icsi", "pgt", "egg-freezing" ] }, "text": { "what": "The largest fertility destination in Europe, measured by its own national registry rather than by anyone's market estimate. Spanish clinics ran 27,564 cycles for patients resident in other countries in 2022, more than half of them with donated eggs. Spain receives; it barely sends. Its own residents made nine reimbursement requests under the EU cross-border Directive that year.", "story": "The registry is the point. The Registro Nacional de Actividad, compiled by the Sociedad Española de Fertilidad for the Ministry of Health, is the official national count of assisted reproduction, and it has a section for patients resident abroad. In 2022 those patients accounted for 27,564 fresh and frozen cycles: France 39.0%, Italy 20.6%, the United Kingdom 9.0%, Germany 6.4%, and a fifth spread across everywhere else. Donated eggs were used in 52.3% of them.\n\nThe same table carries the sentence most reports leave out. The registry asks why the patient came, and in 90.8% of those cycles no reason was recorded. Of the few that were, 1.6% named a technique unlawful at home and 1.1% a patient who did not meet the legal conditions at home. The registry that counts this trade better than any other in Europe still cannot say, for nine cycles in ten, what the patient crossed a border for.\n\nThe ESHRE registry returns for 2019 put Spain at 137,276 cycles from 244 clinics, second in Europe, with the continent's largest egg-donation volumes. And in the Commission's cross-border data Spain was the most prominent country of treatment in 2021, with 1,209 authorised requests, 96% of them from France — a figure that fell to 79 in 2022 only because France could not separate its Directive cases from its social-security cases that year.\n\n*Inference —* two different trades share the word Spain. One is fertility, private, paid in euro, and counted. The other is the routine care of resident foreigners and the authorised patient from across the Pyrenees, and it runs through state machinery that counts differently and changes its mind about what it can report.", "how": "Fertility clinics quote a programme in euro with medication outside it, and time the cycle to two visits. Egg donation is anonymous in Spanish practice and the clinic matches the donor; waiting is measured in weeks. For the state route, a patient from another EU country either uses the Directive — pay in Spain, reclaim at home at home prices — or the older social-security route, where the home system authorises the treatment in advance and pays the Spanish tariff.", "today": "Spain's registry figures are dated 2022 and its ESHRE figures 2019, and both are the most recent this project read. The number that has not been published anywhere is what those 27,564 cycles cost, or what proportion ended in a birth for a patient who had flown home before the test." }, "geo": { "lat": 40.4168, "lon": -3.7038, "precision": "country", "source": "s:natural-earth" }, "metrics": { "inbound_patients_year": "27,564 cycles in 2022", "note": "Cycles, not patients: one patient may have several in a year, and the registry counts fresh and frozen transfers among them. The figure is the official national ART registry's own, and covers assisted reproduction only — no other specialty in Spain is counted this way.", "as_of": "2022", "source": "s:sef-registro-2022", "url": "https://www.registrosef.com/public/docs/sef2022_IAFIV.pdf" }, "kin": [ { "to": "barcelona", "as": "The city with the densest concentration of the clinics counted here.", "rel": "part" }, { "to": "egg-donation", "as": "More than half of every cycle it runs for a patient from abroad.", "rel": "procedure" }, { "to": "ivf", "as": "The treatment its national registry counts, clinic by clinic.", "rel": "procedure" }, { "to": "czechia", "as": "The other big donor-egg destination, cheaper and smaller.", "rel": "contrast" }, { "to": "portugal", "as": "The neighbour whose donor supply collapsed when anonymity ended, sending patients this way.", "rel": "contrast" }, { "to": "united-kingdom", "as": "9% of the cycles it ran for foreign residents in 2022.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "as": "The route that made it the EU's most authorised country of treatment in 2021.", "rel": "governed-by" }, { "to": "reproductive-exile", "as": "The word for the journey most of these cycles represent.", "rel": "term" }, { "to": "what-the-data-cannot-see", "as": "A registry that counts every cycle and cannot say why nine in ten patients came.", "rel": "story" } ], "links": [ { "label": "Registro Nacional de Actividad 2022 — Registro SEF", "url": "https://www.registrosef.com/public/docs/sef2022_IAFIV.pdf" } ], "sources": [ "s:sef-registro-2022", "s:eshre-eim-2019", "s:ec-crossborder-2022", "s:shenfield-2010", "s:eu-directive-2011-24", "s:natural-earth" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:sef-registro-2022", "note": "registry and Commission figures read off their own documents; the closing paragraph is marked inference" }, "text.how": { "tier": "tradition", "note": "the shape of a Spanish fertility programme; the two state routes are cited to the Directive" }, "metrics": { "tier": "cited", "source": "s:sef-registro-2022" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Barcelona Hospital de Sant Pau.jpg" ], "needs_verification": false, "confidence": "high", "updated": "2026-09-16", "blurb": "The largest fertility destination in Europe, measured by its own national registry rather than by anyone's market estimate.", "region_terms": [ { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" } ], "kin_out": [ { "to": "barcelona", "type": "hub", "name": "Barcelona", "as": "The city with the densest concentration of the clinics counted here.", "rel": "part" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "More than half of every cycle it runs for a patient from abroad.", "rel": "procedure" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment its national registry counts, clinic by clinic.", "rel": "procedure" }, { "to": "czechia", "type": "destination", "name": "Czechia", "as": "The other big donor-egg destination, cheaper and smaller.", "rel": "contrast" }, { "to": "portugal", "type": "destination", "name": "Portugal", "as": "The neighbour whose donor supply collapsed when anonymity ended, sending patients this way.", "rel": "contrast" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "9% of the cycles it ran for foreign residents in 2022.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route that made it the EU's most authorised country of treatment in 2021.", "rel": "governed-by" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The word for the journey most of these cycles represent.", "rel": "term" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "A registry that counts every cycle and cannot say why nine in ten patients came.", "rel": "story" } ], "source_list": [ { "id": "s:sef-registro-2022", "kind": "dataset", "title": "Registro Nacional de Actividad 2022 — Registro SEF, Técnicas de Reproducción Asistida (FIV/ICSI and IA)", "publisher": "Sociedad Española de Fertilidad for the Spanish Ministry of Health; the official national ART registry", "url": "https://www.registrosef.com/public/docs/sef2022_IAFIV.pdf", "accessed": "2026-09-16", "note": "section 3.20: 27,564 fresh and frozen cycles in 2022 were for patients resident in other countries — France 39.0%, Italy 20.6%, the United Kingdom 9.0%, Germany 6.4%, Morocco 0.6%, Portugal 0.3%, other 18.3%, country not recorded 5.7%. Of those cycles 52.3% used donated eggs. The reason for coming was not recorded in 90.8% of them; where it was, 1.6% named a technique unlawful at home and 1.1% a patient who did not meet the legal conditions at home." }, { "id": "s:eshre-eim-2019", "kind": "web", "title": "ART in Europe, 2019: results generated from European registries by ESHRE", "publisher": "Human Reproduction (Oxford University Press) for the European IVF-monitoring Consortium of ESHRE", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10694409/", "accessed": "2026-09-16", "note": "Smeenk J, Wyns C, De Geyter C, et al., Human Reproduction 2023;38(12):2321–2338, doi:10.1093/humrep/dead197. Registry returns, not a market estimate: 1,077,813 cycles from 1,488 clinics in 40 countries for 2019. Spain reported 137,276 cycles, second in Europe after Russia, from 244 IVF clinics; the highest egg-donation volumes came from Spain, Czechia and Russia." }, { "id": "s:ec-crossborder-2022", "kind": "report", "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU — reference year 2022", "publisher": "European Commission, DG Health and Food Safety, Unit B.3; written by PredictBy Research and Consulting and Baltic Media; Publications Office of the European Union", "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf", "license": "CC BY 4.0", "accessed": "2026-09-16", "note": "final version January 2024, ISBN 978-92-68-14858-7. 23 countries reported 547,890 reimbursement requests for care not needing prior authorisation in 2022, of which France 300,254 and Germany 160,647 are 84%; Poland 14,176, Slovakia 13,904, Ireland 1,841, Romania 889, Czechia 440, Croatia 192, Lithuania 131, Greece 56, Cyprus 44, Portugal 27 (all refused), Spain 9. Total reimbursed EUR 86,462,491. For care needing prior authorisation, 4,552 requests and EUR 7,708,041. Belgium and Hungary could not report; Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway run no prior-authorisation system; only Denmark and Romania have a mechanism to limit inflow." }, { "id": "s:shenfield-2010", "kind": "paper", "title": "Cross border reproductive care in six European countries", "publisher": "Human Reproduction 25(6):1361-1368, ESHRE Taskforce on Cross Border Reproductive Care", "url": "https://academic.oup.com/humrep/article/25/6/1361/2915759", "accessed": "2026-09-16" }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:sef-registro-2022", "note": "registry and Commission figures read off their own documents; the closing paragraph is marked inference" }, "text.how": { "tier": "tradition", "note": "the shape of a Spanish fertility programme; the two state routes are cited to the Directive" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:sef-registro-2022" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "belgium", "type": "destination", "name": "Belgium", "as": "The bigger fertility destination working the same European restrictions.", "rel": "contrast" }, { "from": "czechia", "type": "destination", "name": "Czechia", "as": "The larger donor-egg destination it is measured against.", "rel": "contrast" }, { "from": "greece", "type": "destination", "name": "Greece", "as": "The larger donor-egg market it competes with on price.", "rel": "contrast" }, { "from": "ireland", "type": "destination", "name": "Ireland", "as": "Where more than half of this country's Directive traffic goes — 1,108 granted reimbursements in 2024.", "rel": "contrast" }, { "from": "portugal", "type": "destination", "name": "Portugal", "as": "The neighbour a Portuguese patient crosses to when a donor is needed.", "rel": "contrast" }, { "from": "switzerland", "type": "destination", "name": "Switzerland", "as": "Where Swiss fertility patients go when Swiss law or a waiting list stops them.", "rel": "contrast" }, { "from": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Where 9% of its foreign-resident fertility cycles were run in 2022.", "rel": "contrast" }, { "from": "barcelona", "type": "hub", "name": "Barcelona", "as": "The country whose registry volume this city carries a large share of.", "rel": "whole" }, { "from": "dialysis-holiday", "type": "procedure", "name": "Dialysis away from home", "as": "Where entitlement usually replaces the price, and a private unit's session appears when it does not.", "rel": "destination" }, { "from": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The largest European destination for this treatment by cycle count in the ESHRE registries.", "rel": "destination" }, { "from": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The destination whose rule runs opposite to most of its neighbours.", "rel": "destination" }, { "from": "schengen-medical-visa", "type": "rule", "name": "The Schengen visa, for treatment", "as": "One Schengen destination with a large inbound fertility trade and no treatment visa.", "rel": "destination" }, { "from": "circumvention", "type": "story", "name": "Circumvention", "as": "The largest egg-donation destination in Europe, running the opposite anonymity rule to most of its neighbours.", "rel": "destination" } ] }, { "schema": 1, "id": "sri-lanka", "type": "destination", "names": { "name": "Sri Lanka", "aliases": [ "ශ්‍රී ලංකාව", "இலங்கை", "Democratic Socialist Republic of Sri Lanka", "Ceylon" ], "said": "Free care at the point of use for citizens, a private sector in Colombo for those who will not queue, and a flight to Chennai for what neither can do." }, "region": [ "south-asia" ], "facets": { "iso2": "LK", "direction": "both", "currency": "LKR", "languages": [ "Sinhala", "Tamil", "English" ] }, "text": { "what": "A country with free public healthcare, strong population health for its income, and a short list of things it cannot do at home. Sri Lankans travel to India for cancer care, transplants and complex cardiac surgery; Colombo's private hospitals take a smaller flow the other way, mostly from the Maldives and from Sri Lankans living abroad. No official count of either direction was read for this record.", "story": "*Trade practice —* the journey most Sri Lankan patients make is the short one to South India: Chennai above all, sometimes Bengaluru. It is a flight of about an hour, the referral often comes from a Colombo consultant who trained in India, and the cost is met out of pocket or by family abroad.\n\n*Inference —* Sri Lanka is a demonstration of a point this directory keeps running into. A health system can deliver long life expectancy and low child mortality at low cost and still leave a gap at the top of the acuity range, and it is that gap, not the average, that produces medical travel. Comparing countries by health spending per person will not find it.\n\nThe Ministry of Health publishes an Annual Health Bulletin as the national statistics series. No foreign-patient figure was read from it for this record, and this page carries none.", "how": "*Trade practice —* Colombo's private hospitals bill in rupees, itemise rather than package, and arrange Indian referrals through named consultants rather than through agencies. Foreign-exchange controls and the cost of the flight shape what a family can actually buy, and the economic crisis of 2022 — with its medicine shortages — moved that line for several years.", "today": "As of 16 September 2026 this record carries no patient count and no price for Sri Lanka. Both are gaps in the record, marked for verification, not statements about the country." }, "geo": { "lat": 6.9271, "lon": 79.8612, "precision": "city", "source": "s:osm" }, "metrics": { "inbound_patients_year": null, "note": "None carried in either direction. The Ministry of Health's Annual Health Bulletin is the national statistics series; no foreign-patient count was read from it for this record. Nothing here should be read as a claim that Sri Lanka publishes no such figure — only that none was read.", "as_of": "2026-09-16", "source": "s:moh-lk-annual-health-bulletin", "url": "https://www.health.gov.lk/annual-health-bulletin/" }, "kin": [ { "to": "colombo", "as": "Where the private sector and the referrals abroad both sit.", "rel": "part" }, { "to": "india", "as": "Where Sri Lankan patients go for what Colombo cannot do, an hour away.", "rel": "destination" }, { "to": "chennai", "as": "The nearest cluster, and the usual destination of a Colombo referral.", "rel": "destination" }, { "to": "nepal", "as": "The other South Asian country whose patients leave for India, and which has been surveyed on why.", "rel": "contrast" }, { "to": "world-bank-health-spending", "as": "The series that shows this country doing well on the average and says nothing about the gap at the top.", "rel": "measured-by" }, { "to": "what-the-data-cannot-see", "as": "Good public health statistics and no count of who left.", "rel": "story" } ], "links": [ { "label": "Annual Health Bulletin — Ministry of Health, Sri Lanka", "url": "https://www.health.gov.lk/annual-health-bulletin/" } ], "sources": [ "s:moh-lk-annual-health-bulletin", "s:worldbank-open-data", "s:osm" ], "provenance": { "default": { "tier": "tradition" }, "fields": { "text.story": { "tier": "tradition", "note": "the trade's account of the Colombo-to-Chennai referral route; the inline marks say which stretch is inference" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:moh-lk-annual-health-bulletin" } } }, "needs_verification": true, "confidence": "low", "updated": "2026-09-16", "blurb": "A country with free public healthcare, strong population health for its income, and a short list of things it cannot do at home.", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" } ], "kin_out": [ { "to": "colombo", "type": "hub", "name": "Colombo", "as": "Where the private sector and the referrals abroad both sit.", "rel": "part" }, { "to": "india", "type": "destination", "name": "India", "as": "Where Sri Lankan patients go for what Colombo cannot do, an hour away.", "rel": "destination" }, { "to": "chennai", "type": "hub", "name": "Chennai", "as": "The nearest cluster, and the usual destination of a Colombo referral.", "rel": "destination" }, { "to": "nepal", "type": "destination", "name": "Nepal", "as": "The other South Asian country whose patients leave for India, and which has been surveyed on why.", "rel": "contrast" }, { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "The series that shows this country doing well on the average and says nothing about the gap at the top.", "rel": "measured-by" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "Good public health statistics and no count of who left.", "rel": "story" } ], "source_list": [ { "id": "s:moh-lk-annual-health-bulletin", "kind": "web", "title": "Annual Health Bulletin", "publisher": "Ministry of Health, Sri Lanka", "url": "https://www.health.gov.lk/annual-health-bulletin/", "accessed": "2026-09-16", "note": "the ministry's national health statistics series; no foreign-patient count was read from it for this record" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "tradition" }, "text.story": { "tier": "tradition", "note": "the trade's account of the Colombo-to-Chennai referral route; the inline marks say which stretch is inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:moh-lk-annual-health-bulletin" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "nepal", "type": "destination", "name": "Nepal", "as": "The other South Asian country whose patients cross to India for the top of the acuity range.", "rel": "contrast" }, { "from": "colombo", "type": "hub", "name": "Colombo", "as": "The country whose entire private hospital sector is in this city and its suburbs.", "rel": "whole" }, { "from": "panchakarma", "type": "procedure", "name": "Panchakarma", "as": "Where the bed and the treatment are two prices, and the treatment is compulsory.", "rel": "destination" } ] }, { "schema": 1, "id": "switzerland", "type": "destination", "names": { "name": "Switzerland", "aliases": [ "Schweiz", "Suisse", "Svizzera", "Svizra", "Swiss Confederation" ], "said": "In the trade Switzerland means the private wing of a Zurich, Geneva or Lausanne clinic, a second opinion, and a bill nobody publishes." }, "region": [ "europe-west" ], "facets": { "iso2": "CH", "direction": "inbound", "currency": "CHF", "languages": [ "German", "French", "Italian", "English" ], "draws": [ "executive-health-screening", "addiction-rehab", "ivf", "gamma-knife", "knee-replacement" ] }, "text": { "what": "The expensive end of the European market. Swiss private clinics and university hospitals sell complex care, screening and residential addiction treatment to foreign self-payers at Swiss prices, and Switzerland sends very few patients anywhere. It sits outside the EU cross-border Directive, which binds Member States, so none of the European reimbursement machinery reaches a Swiss bill.", "story": "Switzerland appears in the one European study that counted cross-border fertility patients directly: in the ESHRE taskforce survey of six receiving countries in 2010, 16.3% of the 1,230 patients surveyed were being treated in Switzerland. The reasons patients gave were legal restrictions at home first and quality second, and the nationalities were Italian, German, French and Dutch.\n\n*Trade practice —* the rest of the Swiss inbound trade is sold on discretion, which is also why it is unmeasured. Residential addiction and psychiatric clinics, executive screening programmes and private wings quote individually, publish nothing, and describe their patients only as international. This project found no Swiss national count of foreign patients to carry.\n\n*Inference —* what Switzerland exports is not cheapness but its opposite: a price high enough that the patient paying it is buying separation from a queue, a system and sometimes a jurisdiction. The World Bank health-spending series puts Swiss spending per person among the highest anywhere, and that number describes the domestic system rather than the export trade, but the two share a cost base.", "how": "A Swiss private clinic quotes a daily rate plus the operation and asks for a deposit or a guarantee of payment before admission; the foreign self-payer is not on the Swiss insurance tariff and the bill reflects it. Residential programmes are quoted by the week. Nothing in the Swiss system is reclaimable by an EU patient under the Directive, because Switzerland is not a Member State; a Swiss resident treated abroad is governed by Swiss insurance rules instead, which this record does not attempt to summarise.", "today": "No published count of inbound patients is carried here — none was found on this pass, which is not evidence that none exists. The dated facts available are a 2010 survey share and a spending series, and both are stated as what they are." }, "geo": { "lat": 46.948, "lon": 7.4474, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "No inbound patient count. The only direct measurement read for this record is the ESHRE taskforce survey of 2010, in which Swiss centres held 16.3% of 1,230 cross-border fertility patients surveyed in one month across six countries.", "as_of": "2010", "source": "s:shenfield-2010" }, "kin": [ { "to": "executive-health-screening", "as": "The course of tests sold here to people who fly in for a week.", "rel": "procedure" }, { "to": "addiction-rehab", "as": "The residential programme priced by the week and never published.", "rel": "procedure" }, { "to": "germany", "as": "The neighbour that shares its patients and undercuts its prices.", "rel": "contrast" }, { "to": "spain", "as": "Where Swiss fertility patients go when Swiss law or a waiting list stops them.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "as": "The route that does not reach here: Switzerland is not a Member State.", "rel": "contrast" }, { "to": "world-bank-health-spending", "as": "The series that places its cost base near the top of the world.", "rel": "measured-by" }, { "to": "is-it-cheaper", "as": "The country that answers the question by refusing the premise.", "rel": "story" } ], "sources": [ "s:shenfield-2010", "s:eu-directive-2011-24", "s:worldbank-open-data", "s:natural-earth" ], "provenance": { "default": { "tier": "tradition" }, "fields": { "text.what": { "tier": "cited", "source": "s:eu-directive-2011-24", "note": "the Directive binds Member States; the rest of the paragraph is the trade's own description" }, "text.story": { "tier": "cited", "source": "s:shenfield-2010", "note": "first paragraph cited; second marked trade practice, third marked inference" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Universitätsspital Zürich.jpg" ], "needs_verification": true, "confidence": "low", "updated": "2026-09-16", "blurb": "The expensive end of the European market. Swiss private clinics and university hospitals sell complex care, screening and residential addiction treatment to foreign self-payers at Swiss prices, and Switzerland sends…", "region_terms": [ { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The course of tests sold here to people who fly in for a week.", "rel": "procedure" }, { "to": "addiction-rehab", "type": "procedure", "name": "Residential addiction treatment", "as": "The residential programme priced by the week and never published.", "rel": "procedure" }, { "to": "germany", "type": "destination", "name": "Germany", "as": "The neighbour that shares its patients and undercuts its prices.", "rel": "contrast" }, { "to": "spain", "type": "destination", "name": "Spain", "as": "Where Swiss fertility patients go when Swiss law or a waiting list stops them.", "rel": "contrast" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route that does not reach here: Switzerland is not a Member State.", "rel": "contrast" }, { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "The series that places its cost base near the top of the world.", "rel": "measured-by" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The country that answers the question by refusing the premise.", "rel": "story" } ], "source_list": [ { "id": "s:shenfield-2010", "kind": "paper", "title": "Cross border reproductive care in six European countries", "publisher": "Human Reproduction 25(6):1361-1368, ESHRE Taskforce on Cross Border Reproductive Care", "url": "https://academic.oup.com/humrep/article/25/6/1361/2915759", "accessed": "2026-09-16" }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:eu-directive-2011-24", "note": "the Directive binds Member States; the rest of the paragraph is the trade's own description" }, "text.story": { "tier": "cited", "source": "s:shenfield-2010", "note": "first paragraph cited; second marked trade practice, third marked inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "tradition" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "assisted-dying", "type": "procedure", "name": "Assisted dying", "as": "The one destination, and the only country with associations that accept non-residents.", "rel": "destination" }, { "from": "assisted-dying-law", "type": "rule", "name": "Assisted dying, and who may cross a border for it", "as": "The destination the omission in Article 115 created.", "rel": "destination" } ] }, { "schema": 1, "id": "taiwan", "type": "destination", "names": { "name": "Taiwan", "aliases": [ "中華民國", "Republic of China", "Chinese Taipei" ], "said": "Taipei hospitals talk about international medical services, not about travel. The patient they mean is usually referred by a doctor, not recruited by an agency." }, "region": [ "east-asia" ], "facets": { "iso2": "TW", "direction": "both", "currency": "TWD", "languages": [ "Mandarin", "Taiwanese Hokkien", "English", "Japanese" ], "draws": [ "ivf", "liver-transplant", "executive-health-screening" ] }, "text": { "what": "A single-payer system with an international side bolted on. National Health Insurance covers residents, hospitals run international medical centres for everyone else, and the state has promoted the sector since the late 2000s. No national count of international patients was read for this record, so this page carries none.", "story": "Taiwan's measurable appearance in this subject during 2024 was as somebody else's source market. South Korea's health ministry recorded Taiwan as the fifth-largest country of origin among its 1.17 million foreign patients, and the fastest-growing of the five, up 550.6 per cent on the year.\n\n*Inference —* a rise of that size in twelve months, to a destination two and a half hours away selling dermatology and cosmetic work, is a travel story rather than a medical one: cheap flights, a weak yen and won, and a procedure that needs no admission. It says more about the direction of traffic in East Asia than any brochure about Taiwan as a destination does.\n\n*Trade practice —* what Taiwan itself sells to foreign patients is the harder end — living-donor liver transplantation, fertility treatment, and the screening admission that Chinese-speaking patients from across the region book in bulk. Pricing is per item, in New Taiwan dollars, and the international centre assembles the estimate.\n\nThe Ministry of Health and Welfare publishes an annual Taiwan Health and Welfare Report in English. No figure for international patients was read from it on this pass, which is a gap in this record rather than a finding about Taiwan.", "how": "*Trade practice —* a non-resident pays the hospital's own schedule rather than the insurance tariff, which makes Taiwanese prices legible in a way single-payer systems usually are not. Hospital international centres handle the referral, the estimate and the interpreter; agencies are less central here than in Southeast Asia.", "today": "As of 16 September 2026 this record carries no patient count and no price. Both are marked for verification." }, "geo": { "lat": 25.033, "lon": 121.5654, "precision": "city", "source": "s:osm" }, "metrics": { "inbound_patients_year": null, "note": "None carried. The health ministry publishes an annual Taiwan Health and Welfare Report, but no national count of international patients was read from it for this record, and this project does not repeat the market-research totals that circulate instead. Absent from this page is not absent from Taiwan's statistics; it means nobody stood in front of the series on this pass.", "as_of": "2026-09-16", "source": "s:mohw-tw-health-welfare-report", "url": "https://www.mohw.gov.tw/cp-137-81831-2.html" }, "kin": [ { "to": "taipei", "as": "Where the international medical centres are.", "rel": "part" }, { "to": "south-korea", "as": "The destination Taiwanese patients travelled to fastest in 2024, up 550.6 per cent.", "rel": "contrast" }, { "to": "liver-transplant", "as": "The living-donor programme Taiwan is named for in the region.", "rel": "procedure" }, { "to": "ivf", "as": "Fertility work sold to patients from across the Chinese-speaking region.", "rel": "procedure" }, { "to": "japan", "as": "The other East Asian system with excellent domestic statistics and no traveller count.", "rel": "contrast" }, { "to": "what-the-data-cannot-see", "as": "A gap this record leaves open rather than fills.", "rel": "story" } ], "links": [ { "label": "Taiwan Health and Welfare Report — Ministry of Health and Welfare", "url": "https://www.mohw.gov.tw/cp-137-81831-2.html" } ], "sources": [ "s:mohw-tw-health-welfare-report", "s:mohw-kr-foreign-patients-2024", "s:worldbank-open-data", "s:osm" ], "provenance": { "default": { "tier": "tradition" }, "fields": { "text.story": { "tier": "cited", "source": "s:mohw-kr-foreign-patients-2024", "note": "the Korean figures are cited; the rest is marked inference or trade practice inline" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:mohw-tw-health-welfare-report" } } }, "needs_verification": true, "confidence": "low", "updated": "2026-09-16", "blurb": "A single-payer system with an international side bolted on. National Health Insurance covers residents, hospitals run international medical centres for everyone else, and the state has promoted the sector since the late…", "region_terms": [ { "key": "east-asia", "name": "East Asia", "note": "South Korea, Japan, Taiwan, China" } ], "kin_out": [ { "to": "taipei", "type": "hub", "name": "Taipei", "as": "Where the international medical centres are.", "rel": "part" }, { "to": "south-korea", "type": "destination", "name": "South Korea", "as": "The destination Taiwanese patients travelled to fastest in 2024, up 550.6 per cent.", "rel": "contrast" }, { "to": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "The living-donor programme Taiwan is named for in the region.", "rel": "procedure" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "Fertility work sold to patients from across the Chinese-speaking region.", "rel": "procedure" }, { "to": "japan", "type": "destination", "name": "Japan", "as": "The other East Asian system with excellent domestic statistics and no traveller count.", "rel": "contrast" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "A gap this record leaves open rather than fills.", "rel": "story" } ], "source_list": [ { "id": "s:mohw-tw-health-welfare-report", "kind": "web", "title": "Taiwan Health and Welfare Report 2025", "publisher": "Ministry of Health and Welfare (Taiwan)", "url": "https://www.mohw.gov.tw/cp-137-81831-2.html", "accessed": "2026-09-16", "note": "the ministry's annual English-language report; no national count of international patients was read from it for this record" }, { "id": "s:mohw-kr-foreign-patients-2024", "kind": "web", "title": "Korea Attracts 1.17 Million Foreign Patients in 2024", "publisher": "Ministry of Health and Welfare (Republic of Korea)", "url": "https://www.mohw.go.kr/board.es?mid=a20401000000&bid=0032&act=view&list_no=1485207", "accessed": "2026-09-16", "note": "press release of 3 April 2025; the annual foreign-patient statistics are compiled for the ministry by the Korea Health Industry Development Institute" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "tradition" }, "text.story": { "tier": "cited", "source": "s:mohw-kr-foreign-patients-2024", "note": "the Korean figures are cited; the rest is marked inference or trade practice inline" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:mohw-tw-health-welfare-report" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "japan", "type": "destination", "name": "Japan", "as": "The other East Asian health system that counts its residents well and its visitors not at all.", "rel": "contrast" }, { "from": "south-korea", "type": "destination", "name": "South Korea", "as": "Its fastest-growing source market in 2024, up 550.6 per cent.", "rel": "contrast" }, { "from": "taipei", "type": "hub", "name": "Taipei", "as": "The country whose medical centres cluster in this city.", "rel": "whole" } ] }, { "schema": 1, "id": "thailand", "type": "destination", "names": { "name": "Thailand", "aliases": [ "ราชอาณาจักรไทย", "Kingdom of Thailand" ], "said": "In the trade Thailand means Bangkok, and Bangkok means about a dozen private hospitals along Sukhumvit and Phetchaburi. Phuket and Chiang Mai sell a different mix." }, "region": [ "southeast-asia" ], "facets": { "iso2": "TH", "direction": "both", "currency": "THB", "languages": [ "Thai", "English" ], "draws": [ "knee-replacement", "hip-replacement" ] }, "text": { "what": "The country that made the package price ordinary. A tier of large private hospitals in Bangkok sells fixed-price operations to foreign patients, publishes what they cost, and has done so for long enough that the format spread from here to Kuala Lumpur, Delhi and Istanbul. Thailand also runs a public health system its own citizens use, and the two barely touch.", "story": "The private hospitals that dominate the trade grew out of the 1990s: Thai hospitals built for a middle class that then lost its money in the 1997 crash, with beds to fill and a devalued baht. *Tradition holds —* the foreign patient arrived as the answer to that empty ward, and the industry that followed was built on the exchange rate as much as on the medicine.\n\nJoint Commission International accreditation arrived in 2002, at Bumrungrad, and the mark did the work of translation: it told a foreign insurer what to make of a hospital it had never heard of. The Thai state came in behind the private sector rather than in front of it, with a medical visa class and a run of promotion campaigns.\n\n*Inference —* the numbers everyone quotes for Thailand — millions of medical travellers a year — mostly come from market research firms reselling each other, and they usually count hospital visits by foreigners, which sweeps in every expatriate with a chest infection and every holidaymaker who cut a foot on a reef. The count this directory trusts is the narrow one a named hospital publishes about its own patients, and even that counts visits rather than people.", "how": "A Bangkok private hospital quotes a package: the operation, a named number of ward nights, the surgeon and anaesthetist, and an exclusion list that usually runs longer than the inclusion list. Implants, imaging, laboratory work and any night beyond the package are billed on top. Payment is a deposit before admission and settlement at discharge. Interpreters are salaried staff at the largest hospitals rather than agency bookings.", "today": "Thailand's own health spending per person and its doctor and bed density sit on the country page's chart, drawn from the World Bank series and each carrying its own year. Those are facts about the health system Thai people use; the hospitals in this directory are a small, expensive slice of it, and a reader should not read one as the other." }, "geo": { "lat": 13.7563, "lon": 100.5018, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "No inbound patient count is carried here. The widely quoted figures for Thailand come from market-research summaries whose method this project could not read; the hospital-level counts on the facility pages are what it stands on instead.", "as_of": "2026-09-16", "source": "s:worldbank-open-data" }, "kin": [ { "to": "bangkok", "as": "Where nearly all of it happens.", "rel": "part" }, { "to": "bumrungrad", "as": "The hospital that made the format, and the country's shorthand abroad.", "rel": "part" }, { "to": "knee-replacement", "as": "One of the operations sold here at a published fixed price.", "rel": "procedure" }, { "to": "package-price", "as": "The pricing form this country normalised.", "rel": "term" }, { "to": "counting-patients", "as": "Why the headline patient numbers for this country should be read slowly.", "rel": "story" }, { "to": "world-bank-health-spending", "as": "The series behind what this country spends on health per person.", "rel": "measured-by" }, { "to": "chiang-mai", "as": "The second cluster, and the one that sells the month-long stay.", "rel": "part" }, { "to": "defiant", "as": "One facilitator routing patients into this country, with its prices posted.", "rel": "org" } ], "links": [ { "label": "Thailand — CDC Yellow Book destination chapter", "url": "https://www.ncbi.nlm.nih.gov/books/NBK620903/" } ], "sources": [ "s:worldbank-open-data", "s:cdc-yellowbook-medical-tourism", "s:wp-bumrungrad", "s:natural-earth" ], "provenance": { "default": { "tier": "tradition" }, "fields": { "text.what": { "tier": "tradition" }, "text.story": { "tier": "tradition", "note": "the trade's own account of the 1997 origin; the inline marks say which stretches are inference" }, "text.today": { "tier": "harvested", "source": "s:worldbank-open-data" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "The country that made the package price ordinary. A tier of large private hospitals in Bangkok sells fixed-price operations to foreign patients, publishes what they cost, and has done so for long enough that the format…", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "bangkok", "type": "hub", "name": "Bangkok", "as": "Where nearly all of it happens.", "rel": "part" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "The hospital that made the format, and the country's shorthand abroad.", "rel": "part" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "One of the operations sold here at a published fixed price.", "rel": "procedure" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The pricing form this country normalised.", "rel": "term" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why the headline patient numbers for this country should be read slowly.", "rel": "story" }, { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "The series behind what this country spends on health per person.", "rel": "measured-by" }, { "to": "chiang-mai", "type": "hub", "name": "Chiang Mai", "as": "The second cluster, and the one that sells the month-long stay.", "rel": "part" }, { "to": "defiant", "type": "org", "name": "Defiant", "as": "One facilitator routing patients into this country, with its prices posted.", "rel": "org" } ], "source_list": [ { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:wp-bumrungrad", "kind": "wikipedia", "title": "Bumrungrad International Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Bumrungrad_International_Hospital", "accessed": "2026-09-16", "license": "CC BY-SA 4.0" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "tradition" }, "text.story": { "tier": "tradition", "note": "the trade's own account of the 1997 origin; the inline marks say which stretches are inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "harvested", "source": "s:worldbank-open-data" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "tradition" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "australia", "type": "destination", "name": "Australia", "as": "The destination Australians have used longest, and the country of surgery in 12.5% of the Westmead series.", "rel": "destination" }, { "from": "india", "type": "destination", "name": "India", "as": "The other Asian country with a long-running inbound trade, and a different patient at the door.", "rel": "contrast" }, { "from": "indonesia", "type": "destination", "name": "Indonesia", "as": "The third destination the deputy minister named in 2022.", "rel": "destination" }, { "from": "malaysia", "type": "destination", "name": "Malaysia", "as": "The neighbour whose package-price format arrived here in the 2000s.", "rel": "contrast" }, { "from": "nepal", "type": "destination", "name": "Nepal", "as": "The second destination in the survey, at 5.73 per cent, and a different kind of patient.", "rel": "destination" }, { "from": "philippines", "type": "destination", "name": "Philippines", "as": "The neighbour that built the trade the Philippine programme was written to catch.", "rel": "contrast" }, { "from": "uae", "type": "destination", "name": "United Arab Emirates", "as": "A named destination on this state's own allowance schedule, at AED 300 a day.", "rel": "contrast" }, { "from": "vietnam", "type": "destination", "name": "Vietnam", "as": "The regional destination Vietnamese patients leave for, and the format Vietnamese clinics copy.", "rel": "contrast" }, { "from": "bangkok", "type": "hub", "name": "Bangkok", "as": "The country this cluster does nearly all the work for.", "rel": "whole" }, { "from": "chiang-mai", "type": "hub", "name": "Chiang Mai", "as": "The country's second cluster, and its long-stay one.", "rel": "part" }, { "from": "phuket", "type": "hub", "name": "Phuket", "as": "The country whose second cluster this is.", "rel": "whole" }, { "from": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "Where the price carries a body-weight condition on its face.", "rel": "destination" }, { "from": "acl-reconstruction", "type": "procedure", "name": "Anterior cruciate ligament reconstruction", "as": "Where the Bangkok ligament package on this page is sold.", "rel": "destination" }, { "from": "addiction-rehab", "type": "procedure", "name": "Residential addiction treatment", "as": "Where a month of residential treatment is published as a bracket with both lists attached.", "rel": "destination" }, { "from": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "Where this arch is quoted from 290,000 baht with the clinic fees outside it.", "rel": "destination" }, { "from": "angioplasty-stent", "type": "procedure", "name": "Coronary angioplasty and stent", "as": "Where the wrist route costs 23,000 baht more than the groin.", "rel": "destination" }, { "from": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "Where the price is published one implant brand at a time.", "rel": "destination" }, { "from": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "Where the operation is sold as a package with the nights counted.", "rel": "destination" }, { "from": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "Where the lens is inside the package and the screening is outside it.", "rel": "destination" }, { "from": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "Where the price falls when the sixth tooth is crowned.", "rel": "destination" }, { "from": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "Where the fixture-and-crown split is printed as two columns.", "rel": "destination" }, { "from": "dialysis-holiday", "type": "procedure", "name": "Dialysis away from home", "as": "Where the only two hospital-published per-session rates read for this record are posted.", "rel": "destination" }, { "from": "disc-replacement", "type": "procedure", "name": "Artificial disc replacement", "as": "Where the package price on this page is sold.", "rel": "destination" }, { "from": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "Where the check-up is sold with a shopping cart and a price valid to a stated date.", "rel": "destination" }, { "from": "facelift", "type": "procedure", "name": "Facelift", "as": "Where the same word is priced as five different operations with their ward nights printed.", "rel": "destination" }, { "from": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "Where the same choice is published as two sums to be added.", "rel": "destination" }, { "from": "gallbladder-removal", "type": "procedure", "name": "Gallbladder removal", "as": "Where the robot adds 45% to the price of the same organ.", "rel": "destination" }, { "from": "heart-valve-replacement", "type": "procedure", "name": "Heart valve replacement", "as": "Where valve surgery is sold by level, by nights, and without the valve.", "rel": "destination" }, { "from": "hernia-repair", "type": "procedure", "name": "Hernia repair", "as": "Where the surgical route is a price tier and the second side is not double.", "rel": "destination" }, { "from": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "Where both package prices on this page are sold.", "rel": "destination" }, { "from": "hysterectomy", "type": "procedure", "name": "Hysterectomy", "as": "Where the operation is sold as two nights with the sealing device outside the price.", "rel": "destination" }, { "from": "icl", "type": "procedure", "name": "Implantable collamer lens", "as": "Where one eye by implant costs more than two eyes by laser at the same hospital.", "rel": "destination" }, { "from": "knee-arthroscopy", "type": "procedure", "name": "Knee arthroscopy", "as": "Where the Bangkok arthroscopy package on this page is sold.", "rel": "destination" }, { "from": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "Where the knee package on this page is sold.", "rel": "destination" }, { "from": "lasik", "type": "procedure", "name": "LASIK", "as": "Where both eyes cost less than one eye elsewhere, and the suitability examination is a separate purchase.", "rel": "destination" }, { "from": "liposuction", "type": "procedure", "name": "Liposuction", "as": "Where the price is published per named region of the body.", "rel": "destination" }, { "from": "phalloplasty", "type": "procedure", "name": "Phalloplasty", "as": "Where the one staged price list read for this record is published.", "rel": "destination" }, { "from": "prostatectomy", "type": "procedure", "name": "Prostatectomy", "as": "Where the robot is a price tier and the ward round is an exclusion.", "rel": "destination" }, { "from": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "Where the price is published by implant brand.", "rel": "destination" }, { "from": "root-canal", "type": "procedure", "name": "Root canal treatment", "as": "Where the price is set by which tooth it is.", "rel": "destination" }, { "from": "spinal-fusion", "type": "procedure", "name": "Spinal fusion", "as": "Where both fusion packages on this page are sold.", "rel": "destination" }, { "from": "top-surgery", "type": "procedure", "name": "Top surgery", "as": "Where the table that prices this by technique, scar and body weight is published.", "rel": "destination" }, { "from": "vaginoplasty", "type": "procedure", "name": "Vaginoplasty", "as": "Where the only full published table of prices by technique is sold.", "rel": "destination" }, { "from": "veneers", "type": "procedure", "name": "Dental veneers", "as": "Where the veneer price drops at the sixth tooth.", "rel": "destination" }, { "from": "bangkok-hospital", "type": "facility", "name": "Bangkok Hospital", "as": "One of the two Bangkok names a foreign patient is most likely to have been given before arriving.", "rel": "destination" }, { "from": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "The single institution most often meant when Thailand is called a destination.", "rel": "destination" }, { "from": "samitivej", "type": "facility", "name": "Samitivej Sukhumvit Hospital", "as": "A Bangkok hospital whose foreign trade is largely residents of Bangkok rather than arrivals.", "rel": "destination" }, { "from": "gender-affirming-care-access", "type": "rule", "name": "Access to gender-affirming care", "as": "A long-standing destination for this surgery, and a row this project could not source.", "rel": "destination" }, { "from": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "The destination that closed by nationality in 2015.", "rel": "destination" }, { "from": "thai-medical-visa", "type": "rule", "name": "Thailand's medical treatment visa", "as": "The country that issues it.", "rel": "destination" }, { "from": "defiant", "type": "org", "name": "Defiant", "as": "Routes its patients inside this country.", "rel": "destination" }, { "from": "jci", "type": "org", "name": "Joint Commission International", "as": "The country whose hospitals hold more of these marks than any other in Southeast Asia.", "rel": "place" }, { "from": "thai-ha-institute", "type": "org", "name": "Healthcare Accreditation Institute", "as": "The country whose hospitals this is the national standard for, public and private alike.", "rel": "place" }, { "from": "world-bank-doctors", "type": "dataset", "name": "Physicians per 1,000 people", "as": "0.54 physicians per 1,000 in 2021, in a country that sells surgery to foreigners.", "rel": "measures" }, { "from": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "One of 193 countries carrying a value in this series.", "rel": "measures" }, { "from": "world-bank-tourism-arrivals", "type": "dataset", "name": "International arrivals", "as": "39,916,000 arrivals in 2019, the figure most often repurposed as a medical-travel total.", "rel": "measures" }, { "from": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "Where the package price on this page is sold.", "rel": "place" } ] }, { "schema": 1, "id": "tunisia", "type": "destination", "names": { "name": "Tunisia", "aliases": [ "الجمهورية التونسية", "République tunisienne", "Tunisian Republic" ], "said": "Sold in French, to France and to Libya. The trade word here is tourisme médical and the shop front is a private clinic in Tunis or Sousse with a price list in euros and a surgeon trained in Paris." }, "region": [ "africa-north" ], "facets": { "iso2": "TN", "direction": "inbound", "currency": "TND", "languages": [ "Arabic", "French" ], "draws": [ "rhinoplasty", "liposuction", "abdominoplasty", "dental-implant", "ivf" ] }, "text": { "what": "North Africa's largest inbound care trade, run out of about a hundred specialised private clinics and sold in French. Libyans are the biggest group of foreign patients, then Algerians, then patients from sub-Saharan Africa; Europeans are a smaller share and come mostly for cosmetic surgery. A Tunisian health ministry official put the sector at roughly 3.5 billion dinars a year, more than a billion euros, and said it accounted for half the revenue of the whole tourism sector.", "story": "Tunisia's inbound trade grew from two things it already had: a French-language medical elite, and a tourism industry with hotels, flights and tour operators in place. Dr Nadia Fenina of the Ministry of Health, speaking to Agence France-Presse in January 2024, said more than 500,000 foreign patients are admitted to hospital in Tunisia each year and more than two million are treated as outpatients, and that the country is first in Africa on both demand and supply. More than half of those patients come for assisted reproduction, oncology — chemotherapy and hormone therapy — cardiology or orthopaedics. Cosmetic surgery, the thing the country is best known for abroad, is 15 per cent of the work.\n\nThe Libyan share is the part of the story that is not about price. Libya's own hospital system has been degraded since 2011, and Tunisia is a short drive or a short flight from Tripoli in a language Libyan doctors were trained in. That flow is regional, continuous and largely paid in cash or by a Libyan sponsor, and it is the reason the numbers are as large as they are.\n\n*Inference —* the same AFP report frames the trade against a Tunisian public health system in difficulty. A country whose private clinics run a billion-euro export business while its public hospitals are described as in crisis is running two health systems, and the foreign patient is in the smaller and better-funded one. That is not unique to Tunisia; it is visible here because somebody put a number on it.", "how": "A French or Libyan patient books through a clinic or an agency that quotes an all-in price — operation, clinic nights, hotel, transfers — in euros or dinars. The consultation is in French. Payment is up front. Follow-up happens at home, with whoever will take it; the surgeon who operated is on the other side of the Mediterranean, which is the single structural weakness of a cosmetic package sold across a border.", "today": "As of September 2026 the most recent published figures this record could read are the ministry's from January 2024: more than 500,000 inpatient admissions, more than two million outpatient episodes, about 3.5 billion dinars. Those are episodes, not people.", "notes": "The revenue figure is a ministry official's, given in an interview, with no published method behind it. It is carried here as what she said, not as a measurement." }, "geo": { "lat": 36.8065, "lon": 10.1815, "precision": "country", "source": "s:natural-earth" }, "metrics": { "inbound_patients_year": 500000, "note": "More than 500,000 foreign patients admitted a year, plus more than two million outpatient episodes, as given by Dr Nadia Fenina of the Tunisian Ministry of Health to Agence France-Presse, published 31 January 2024. These count episodes of care, not individual people, and no year is attached to them in the report. Sector revenue was given as about 3.5 billion dinars, more than one billion euros.", "as_of": "2024", "source": "s:afp-tunisia-2024", "url": "https://www.voaafrique.com/a/dans-une-tunisie-en-crise-le-tourisme-m%C3%A9dical-est-en-pleine-sant%C3%A9/7464645.html" }, "kin": [ { "to": "tunis", "as": "Where the clinics and the agencies are.", "rel": "part" }, { "to": "morocco", "as": "The other francophone North African destination, smaller and later.", "rel": "contrast" }, { "to": "turkiye", "as": "The competitor that took the European cosmetic trade this country built first.", "rel": "contrast" }, { "to": "rhinoplasty", "as": "One of the operations the European end of this trade is built on.", "rel": "procedure" }, { "to": "ivf", "as": "Named by the health ministry among the treatments more than half its foreign patients come for.", "rel": "procedure" }, { "to": "follow-up-gap", "as": "The structural weakness of a package sold across the Mediterranean.", "rel": "risk" }, { "to": "package-price", "as": "The form the trade sells in, quoted in euros.", "rel": "term" }, { "to": "counting-patients", "as": "Why half a million admissions and two million outpatient episodes are not half a million people.", "rel": "story" } ], "links": [ { "label": "AFP report on Tunisia's medical travel sector, January 2024", "url": "https://www.voaafrique.com/a/dans-une-tunisie-en-crise-le-tourisme-m%C3%A9dical-est-en-pleine-sant%C3%A9/7464645.html" } ], "sources": [ "s:afp-tunisia-2024", "s:natural-earth", "s:worldbank-open-data" ], "provenance": { "default": { "tier": "cited", "source": "s:afp-tunisia-2024" }, "fields": { "text.story": { "tier": "cited", "source": "s:afp-tunisia-2024", "note": "the Libyan paragraph is the trade's ordinary account of why that flow exists; the closing reading is marked inline as inference" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "North Africa's largest inbound care trade, run out of about a hundred specialised private clinics and sold in French.", "region_terms": [ { "key": "africa-north", "name": "North Africa", "note": "Tunisia, Morocco, Egypt" } ], "kin_out": [ { "to": "tunis", "type": "hub", "name": "Tunis", "as": "Where the clinics and the agencies are.", "rel": "part" }, { "to": "morocco", "type": "destination", "name": "Morocco", "as": "The other francophone North African destination, smaller and later.", "rel": "contrast" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The competitor that took the European cosmetic trade this country built first.", "rel": "contrast" }, { "to": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "One of the operations the European end of this trade is built on.", "rel": "procedure" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "Named by the health ministry among the treatments more than half its foreign patients come for.", "rel": "procedure" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The structural weakness of a package sold across the Mediterranean.", "rel": "risk" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The form the trade sells in, quoted in euros.", "rel": "term" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why half a million admissions and two million outpatient episodes are not half a million people.", "rel": "story" } ], "source_list": [ { "id": "s:afp-tunisia-2024", "kind": "news", "title": "Dans une Tunisie en crise, le tourisme médical est en pleine santé", "publisher": "Agence France-Presse, carried by VOA Afrique", "url": "https://www.voaafrique.com/a/dans-une-tunisie-en-crise-le-tourisme-m%C3%A9dical-est-en-pleine-sant%C3%A9/7464645.html", "accessed": "2026-09-16", "note": "published 31 January 2024; quotes Dr Nadia Fenina of the Tunisian Ministry of Health and gives patient counts, revenue and the ranking of source countries" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:afp-tunisia-2024" }, "text.story": { "tier": "cited", "source": "s:afp-tunisia-2024", "note": "the Libyan paragraph is the trade's ordinary account of why that flow exists; the closing reading is marked inline as inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited", "source": "s:afp-tunisia-2024" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:afp-tunisia-2024" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "egypt", "type": "destination", "name": "Egypt", "as": "The North African neighbour whose ministry publishes the figures Egypt's does not.", "rel": "contrast" }, { "from": "morocco", "type": "destination", "name": "Morocco", "as": "The neighbour that built the same trade first and counts more of it.", "rel": "contrast" }, { "from": "tunis", "type": "hub", "name": "Tunis", "as": "The country whose export wing this city holds most of.", "rel": "whole" } ] }, { "schema": 1, "id": "turkiye", "type": "destination", "names": { "name": "Türkiye", "aliases": [ "Turkey", "Türkiye Cumhuriyeti", "Republic of Türkiye" ], "said": "In the trade Türkiye means Istanbul, and Istanbul means hair. The ministry's word for the whole business is uluslararası sağlık turizmi, international health tourism, and it is a licensing category before it is a marketing one." }, "region": [ "west-asia" ], "facets": { "iso2": "TR", "direction": "inbound", "currency": "TRY", "languages": [ "Turkish", "English", "Arabic", "Russian", "German" ], "draws": [ "hair-transplant-fue", "dhi-hair-transplant", "dental-implant", "rhinoplasty", "gastric-sleeve" ] }, "text": { "what": "The largest inbound trade in Europe, and the only one the state licenses as its own category. A facility that treats foreign patients must hold an international health tourism authorisation certificate from the Ministry of Health, and so must the agency that books them. Hair restoration, dental work, rhinoplasty and bariatric surgery carry the volume; the packages bundle hotel, transfers and an interpreter into the price and quote in euros, sterling or dollars rather than lira.", "story": "The regulation arrived on 13 July 2017 in Resmî Gazete No. 30123. Article 5(1) makes the authorisation certificate compulsory for the health facility and for the intermediary, which must be a licensed A-group travel agency, and it lets the Ministry stop the activity of anyone trading without one. Article 6 requires an international health tourism unit inside the facility, headed by a doctor with at least five years in practice, with at least two staff who speak a foreign language and English among them at B2. Every patient treated under the regulation is registered in a web-based system the Ministry runs.\n\nThe counting follows from that registration. USHAŞ, the Ministry's own international health services company, publishes the series it attributes to TÜİK: 756,926 visitors in 2019, a collapse to 435,691 in 2020, then 1,381,807 in 2022, 1,538,643 in 2023, 1,506,442 in 2024 and 1,398,580 in 2025 against revenue of USD 3,022,452 thousand. Read the unit before the trend: this counts visitors who state a health purpose, so it takes in the day patient and the person who came for one consultation, and revenue divided by visitors gives roughly USD 2,160 a head for 2025 — a number that describes a dental appointment and a cardiac operation in the same breath.\n\n*Trade practice —* the hair clinics are the part of the trade that grew fastest and is watched hardest. The International Society of Hair Restoration Surgery has named Türkiye in its campaign against unlicensed operators and reports Turkish technician teams working abroad under licensed doctors; the Turkish rule that the operation is a doctor's act, and the clinic's own page telling readers that a price below EUR 1,500 is a warning sign, describe the same market from two directions.\n\n*Inference —* the one flow that runs the other way is reproductive. Turkish law restricts third-party assisted reproduction, and a 2010 regulation reached at patients who went abroad for it, so Turkish patients travel out for donor treatment while foreign patients travel in for hair and teeth. The country is a destination and a source market in different specialties, on the same flights.", "how": "Sold as a package with a fixed number quoted in a foreign currency: operation, hospital or clinic, hotel nights, airport and hotel transfers, an interpreter, and aftercare products. Flights, travel insurance, extra nights and anything found once the patient is on the table sit outside. Payment is usually a deposit to hold the date and the balance on arrival. The certificate the facility holds is a Ministry document rather than a voluntary accreditation, and it is separate from any JCI mark the hospital also carries.\n\nThe instrument in force is the Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik of 26 April 2025, Resmî Gazete 32882, which at MADDE 17 repeals the 2017 regulation most writing on this subject still cites. It makes the authorisation certificate compulsory for the facility and for the intermediary — the Ministry licenses the first, USHAŞ the second — requires complication insurance for theatre procedures, requires accreditation by TÜSKA, and at MADDE 6(3) puts complications and medical malpractice expressly inside the certificate holder's responsibility. Hair transplants have a rule of their own: the Saç Ekimi Birimleri Yönetmeliği of 6 May 2023, Resmî Gazete 32182, which reserves the channel-opening stage to certified physicians, forbids more than one patient in a room at a time, and fines a breach at one to three per cent of the previous month's gross service revenue.", "today": "As of 16 September 2026 an Istanbul hair clinic lists sapphire FUE up to 4,000 grafts at EUR 2,550 and DHI at EUR 3,290, each with a megasession surcharge above 4,000 grafts, and an Istanbul bariatric clinic lists a gastric sleeve at EUR 2,600 all-inclusive. USHAŞ reports 563,327 visitors and USD 1.580 billion for the first half of 2026. What none of those numbers carry is the revision: the operation booked at home when something needs doing again." }, "geo": { "lat": 39.9334, "lon": 32.8597, "precision": "country", "source": "s:natural-earth" }, "metrics": { "inbound_patients_year": 1398580, "note": "USHAŞ's figure for 2025, attributed to TÜİK, whose own footer calls it a Departing Visitors Survey — a border exit survey of stated purpose, not a count of patients treated and not a count of people. Of that total, 250,401 were Turkish citizens resident abroad. USHAŞ puts the same year's health-tourism income at USD 3,022,452 thousand; dividing one by the other gives about USD 2,160 a visitor, which is this project's arithmetic and not a figure either body publishes.", "as_of": "2025", "source": "s:ushas-saglik-turizmi-verileri", "url": "https://www.ushas.gov.tr/saglik-turizmi-verileri/" }, "prices": [ { "procedure": "hair-transplant-fue", "country": "TR", "city": "Istanbul", "amount": 2550, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "the procedure, up to 4,000 grafts", "hotel accommodation", "airport and hotel transfers", "aftercare products" ], "excludes": [ "flights", "travel insurance", "nights beyond the package", "personal expenses", "grafts above 4,000, which add EUR 900" ], "source": "s:cosmedica-price", "url": "https://cosmedica.com/price/", "note": "Cosmedica Clinic, Istanbul, sapphire FUE. The graft cap is the line to read: the price is per package, not per graft, and a megasession to 6,000 grafts is a separate surcharge.", "tier": "cited", "usd": 2942.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "dhi-hair-transplant", "country": "TR", "city": "Istanbul", "amount": 3290, "amount_high": 8000, "currency": "EUR", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [ "the procedure, up to 4,000 grafts", "hotel", "transfers", "aftercare products" ], "excludes": [ "flights", "travel insurance", "extra nights", "grafts above 4,000" ], "source": "s:cosmedica-price", "url": "https://cosmedica.com/price/", "note": "the same clinic's two DHI tiers on one page: EUR 3,290 for micro sapphire DHI and EUR 8,000 for the tier where the named surgeon operates. Who holds the punch is a price tier here, stated as such.", "tier": "cited", "usd": 3796.0, "usd_high": 9230.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "gastric-sleeve", "country": "TR", "city": "Istanbul", "amount": 2600, "currency": "EUR", "as_of": "2026-01", "kind": "package", "includes": [ "surgery", "hospital stay", "hotel", "transfers", "nutritionist support", "aftercare" ], "excludes": [ "flights" ], "source": "s:carely-gastric-sleeve", "url": "https://carelyclinic.com/gastric-sleeve-turkey/", "note": "Carely Clinic, Istanbul, listed at EUR 2,600 against a struck-through EUR 3,715; the page states the price is valid until April 2026 and prints the same figure in dollars and sterling for its two biggest source markets.", "tier": "cited", "usd": 3000.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "istanbul", "as": "Where most of the clinics, and nearly all of the hair work, actually are.", "rel": "part" }, { "to": "antalya", "as": "The second cluster, selling the same operations beside a resort strip.", "rel": "part" }, { "to": "izmir", "as": "A third cluster, smaller and cheaper on the same price tables.", "rel": "part" }, { "to": "turkiye-health-tourism-authorisation", "as": "The certificate a facility here must hold before it may treat a foreign patient at all.", "rel": "governed-by" }, { "to": "turkiye-health-services-directorate", "as": "The directorate inside the Ministry that issues and withdraws that certificate.", "rel": "org" }, { "to": "hair-transplant-fue", "as": "The operation that made this country's name abroad, and the one its clinics price in euros.", "rel": "procedure" }, { "to": "gastric-sleeve", "as": "Sold here as a fixed all-inclusive package with the hotel in the price.", "rel": "procedure" }, { "to": "turkiye-hair-boom", "as": "The years the hair trade scaled, and the regulation that followed it.", "rel": "event" }, { "to": "acibadem", "as": "The hospital group that carries the complex end of the inbound work.", "rel": "part" }, { "to": "counting-patients", "as": "Why a figure of 1.4 million visitors is not 1.4 million operations.", "rel": "story" }, { "to": "united-kingdom", "as": "One of the source markets its packages are priced for, in sterling.", "rel": "contrast" }, { "to": "revision-at-home", "as": "The bill that lands on another health system when a graft or a sleeve needs doing again.", "rel": "risk" } ], "links": [ { "label": "Resmî Gazete 13 July 2017, No. 30123 — the health tourism regulation", "url": "https://www.resmigazete.gov.tr/eskiler/2017/07/20170713-3.htm" }, { "label": "USHAŞ — health tourism data by year", "url": "https://ushas.gov.tr/saglik-turizmi-verileri/" } ], "sources": [ "s:rg-saglik-turizmi-2017", "s:ushas-saglik-turizmi-verileri", "s:cosmedica-price", "s:carely-gastric-sleeve", "s:ishrs-buyer-beware", "s:gurtin-2011-turkey", "s:wp-medical-tourism-turkiye", "s:natural-earth", "s:rg-32882-2025", "s:tuik-turizm-2025", "s:tuik-turizm-2026q2", "s:rg-32182-2023-sac-ekimi" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:rg-saglik-turizmi-2017", "note": "regulation and statistics are cited; the hair-market paragraph is marked trade practice and the reproductive paragraph is marked inference from the Gürtin citation, which this project could not read in full" }, "text.how": { "tier": "tradition", "note": "the general shape of a Turkish package; the certificate requirement is cited to the regulation" }, "metrics": { "tier": "cited", "source": "s:ushas-saglik-turizmi-verileri" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Istanbul asv2021-10 img56 Hagia Sophia.jpg" ], "needs_verification": true, "confidence": "high", "updated": "2026-09-17", "blurb": "The largest inbound trade in Europe, and the only one the state licenses as its own category.", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "Where most of the clinics, and nearly all of the hair work, actually are.", "rel": "part" }, { "to": "antalya", "type": "hub", "name": "Antalya", "as": "The second cluster, selling the same operations beside a resort strip.", "rel": "part" }, { "to": "izmir", "type": "hub", "name": "İzmir", "as": "A third cluster, smaller and cheaper on the same price tables.", "rel": "part" }, { "to": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The certificate a facility here must hold before it may treat a foreign patient at all.", "rel": "governed-by" }, { "to": "turkiye-health-services-directorate", "type": "org", "name": "Türkiye General Directorate of Health Services", "as": "The directorate inside the Ministry that issues and withdraws that certificate.", "rel": "org" }, { "to": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The operation that made this country's name abroad, and the one its clinics price in euros.", "rel": "procedure" }, { "to": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "Sold here as a fixed all-inclusive package with the hotel in the price.", "rel": "procedure" }, { "to": "turkiye-hair-boom", "type": "event", "name": "Türkiye's hair transplant boom", "as": "The years the hair trade scaled, and the regulation that followed it.", "rel": "event" }, { "to": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "The hospital group that carries the complex end of the inbound work.", "rel": "part" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a figure of 1.4 million visitors is not 1.4 million operations.", "rel": "story" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "One of the source markets its packages are priced for, in sterling.", "rel": "contrast" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The bill that lands on another health system when a graft or a sleeve needs doing again.", "rel": "risk" } ], "source_list": [ { "id": "s:rg-saglik-turizmi-2017", "kind": "web", "title": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik", "publisher": "Resmî Gazete, Republic of Türkiye (Ministry of Health)", "url": "https://www.resmigazete.gov.tr/eskiler/2017/07/20170713-3.htm", "accessed": "2026-09-16", "note": "Resmî Gazete 13 July 2017, No. 30123. Read in Turkish off the Resmî Gazete page. Article 5(1) makes an international health tourism authorisation certificate (yetki belgesi) compulsory for both the health facility and the intermediary; the Ministry halts the activity of anyone without one. Transitional Article 1 gave those already trading one year to comply. Article 16: in force on publication. REPEALED: MADDE 17 of the regulation of 26 April 2025 (Resmî Gazete 32882) revokes this one. Cite it for what the regime was, not for what it is." }, { "id": "s:ushas-saglik-turizmi-verileri", "kind": "gov", "title": "Sağlık Turizmi Verileri (health tourism data by year)", "publisher": "USHAŞ — Uluslararası Sağlık Hizmetleri A.Ş., the Turkish Ministry of Health's international health services company", "url": "https://ushas.gov.tr/saglik-turizmi-verileri/", "accessed": "2026-09-16", "note": "USHAŞ publishes the series it attributes to TÜİK, the Turkish statistical institute: visitors and revenue by year — 2019 756,926 and USD 1.459bn; 2020 435,691; 2021 729,592; 2022 1,381,807; 2023 1,538,643; 2024 1,506,442; 2025 1,398,580 and USD 3,022,452 thousand; first half of 2026 563,327 and USD 1.580bn. The unit is a visitor arriving with a health purpose, not an operation." }, { "id": "s:cosmedica-price", "kind": "web", "title": "Hair Transplant Turkey Cost — 2026 price and package breakdown", "publisher": "Cosmedica Clinic (Dr Levent Acar), Istanbul", "url": "https://cosmedica.com/price/", "accessed": "2026-09-16", "note": "package prices read off the clinic's own page on 16 September 2026: FUE Sapphire from EUR 2,550 up to 4,000 grafts (+EUR 900 for a megasession up to 6,000), Micro Sapphire DHI from EUR 3,290 (+EUR 700), VIP DHI Sapphire with Dr Acar operating from EUR 8,000 (+EUR 2,000). The page states the package covers the procedure, hotel, airport and hotel transfers and aftercare products, and excludes flights, travel insurance, extra nights and personal expenses; it also tells readers that prices below EUR 1,500 are a warning sign." }, { "id": "s:carely-gastric-sleeve", "kind": "web", "title": "Gastric sleeve Turkey — all-inclusive package", "publisher": "Carely Clinic, Istanbul", "url": "https://carelyclinic.com/gastric-sleeve-turkey/", "accessed": "2026-09-16", "note": "page last updated January 2026, price stated valid until April 2026" }, { "id": "s:ishrs-buyer-beware", "kind": "org", "title": "Buyer Beware: Medical Tourism for Hair Transplants Can Have Costly Consequences", "publisher": "International Society of Hair Restoration Surgery", "url": "https://ishrs.org/buyer-beware-medical-tourism-for-hair-transplants-can-have-costly-consequences/", "accessed": "2026-09-16", "note": "release dated 18 May 2016; names Turkey, and reports of Turkish technician groups operating in Germany, the Netherlands and Belgium under licensed doctors" }, { "id": "s:gurtin-2011-turkey", "kind": "paper", "title": "Banning reproductive travel: Turkey's ART legislation and third-party assisted reproduction", "publisher": "Reproductive BioMedicine Online (Gurtin ZB)", "url": "https://www.rbmojournal.com/article/S1472-6483(11)00470-6/fulltext", "accessed": "2026-09-16", "note": "citation and the 2010 regulation's extraterritorial clause verified from the journal's own article listing; the full text returned HTTP 403 and was not read. Treated as needing verification wherever it is relied on." }, { "id": "s:wp-medical-tourism-turkiye", "kind": "wikipedia", "title": "Medical tourism in Turkey", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_Turkey", "accessed": "2026-09-16", "note": "records the 13 July 2017 regulation coming into force and a first-half-2018 figure of nearly 178,000 inbound patients split 67% private, 24% public and 9% university — a count of arrivals stating a health purpose, not of operations" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" }, { "id": "s:rg-32882-2025", "kind": "web", "title": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik, Resmî Gazete 26 Nisan 2025, Sayı 32882", "publisher": "T.C. Resmî Gazete", "year": 2025, "url": "https://www.resmigazete.gov.tr/eskiler/2025/04/20250426-2.htm", "accessed": "2026-09-17", "note": "MADDE 17 repeals the 13/7/2017 regulation (RG 30123) that most secondary writing still cites" }, { "id": "s:tuik-turizm-2025", "kind": "dataset", "title": "Turizm İstatistikleri, IV. Çeyrek: Ekim-Aralık ve Yıllık, 2025 (Sayı 54158) — table: Departing Visitors by Purpose of Visit, 2012–2026", "publisher": "Türkiye İstatistik Kurumu (TurkStat)", "year": 2026, "url": "https://veriportali.tuik.gov.tr/Bulten/Index?p=Turizm-Istatistikleri-IV.-Ceyrek:-Ekim-Aralik-ve-Yillik,-2025-54158", "accessed": "2026-09-17", "note": "the health figure appears only in the attached statistical table, not in the bulletin text; its own footer names the source as the TurkStat Departing Visitors Survey — a border exit survey of stated purpose, not a count of patients treated" }, { "id": "s:tuik-turizm-2026q2", "kind": "dataset", "title": "Turizm İstatistikleri, II. Çeyrek: Nisan-Haziran, 2026 (Sayı 58143)", "publisher": "Türkiye İstatistik Kurumu (TurkStat)", "year": 2026, "url": "https://veriportali.tuik.gov.tr/tr/press/58143", "accessed": "2026-09-17" }, { "id": "s:rg-32182-2023-sac-ekimi", "kind": "web", "title": "Saç Ekimi Birimleri Hakkında Yönetmelik, Resmî Gazete 6 Mayıs 2023, Sayı 32182", "publisher": "T.C. Resmî Gazete", "year": 2023, "url": "https://www.resmigazete.gov.tr/eskiler/2023/05/20230506-11.htm", "accessed": "2026-09-17" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:rg-saglik-turizmi-2017", "note": "regulation and statistics are cited; the hair-market paragraph is marked trade practice and the reproductive paragraph is marked inference from the Gürtin citation, which this project could not read in full" }, "text.how": { "tier": "tradition", "note": "the general shape of a Turkish package; the certificate requirement is cited to the regulation" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:ushas-saglik-turizmi-verileri" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "australia", "type": "destination", "name": "Australia", "as": "Where most of the complications presenting at Westmead had been operated on.", "rel": "destination" }, { "from": "georgia", "type": "destination", "name": "Georgia", "as": "The larger neighbour it undercuts, and the one most of its own outbound patients fly to.", "rel": "contrast" }, { "from": "iran", "type": "destination", "name": "Iran", "as": "The neighbour competing for the same patients, and the place Iranians themselves travel to.", "rel": "contrast" }, { "from": "morocco", "type": "destination", "name": "Morocco", "as": "Where the European hair and cosmetic trade mostly went instead.", "rel": "contrast" }, { "from": "north-cyprus", "type": "destination", "name": "Northern Cyprus", "as": "The state whose flights, currency and medical profession the north runs on.", "rel": "kin" }, { "from": "tunisia", "type": "destination", "name": "Tunisia", "as": "The competitor that took the European cosmetic trade this country built first.", "rel": "contrast" }, { "from": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Where most British outbound hair, dental and bariatric traffic goes, priced in sterling.", "rel": "contrast" }, { "from": "antalya", "type": "hub", "name": "Antalya", "as": "The country whose authorisation regime this cluster trades under.", "rel": "whole" }, { "from": "istanbul", "type": "hub", "name": "Istanbul", "as": "The country whose licence this cluster trades under.", "rel": "whole" }, { "from": "izmir", "type": "hub", "name": "İzmir", "as": "The country whose authorisation regime this cluster trades under.", "rel": "whole" }, { "from": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "A destination where the operation is sold in packages alongside hair surgery.", "rel": "destination" }, { "from": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "Runs transplant units that treat foreign patients, and publishes a licensing regime for them.", "rel": "destination" }, { "from": "cochlear-implant", "type": "procedure", "name": "Cochlear implant", "as": "Implants at scale under a licensing regime for foreign patients.", "rel": "destination" }, { "from": "dhi-hair-transplant", "type": "procedure", "name": "Direct hair implantation (DHI)", "as": "The destination that sells both at a package price.", "rel": "destination" }, { "from": "dialysis-holiday", "type": "procedure", "name": "Dialysis away from home", "as": "Where an agency quotes sessions by resort, sometimes with the transfer inside the number.", "rel": "destination" }, { "from": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "Where the cheapest published packages for this operation are sold, hotel and transfers included.", "rel": "destination" }, { "from": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The destination whose hair trade is the largest single procedure market in cross-border care.", "rel": "destination" }, { "from": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "Where nose surgery sits in the same package economy that built the hair clinics.", "rel": "destination" }, { "from": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "The largest private hospital group in the country by hospital count, and the one a foreign enquiry most often lands on first.", "rel": "destination" }, { "from": "anadolu-medical-center", "type": "facility", "name": "Anadolu Medical Center", "as": "The country's cancer hospital with the oldest American affiliation, contracted in 2002 before the building opened.", "rel": "destination" }, { "from": "liv-hospital", "type": "facility", "name": "Liv Hospital", "as": "The Turkish group that prints its screening prices where the others print a contact form.", "rel": "destination" }, { "from": "medicana", "type": "facility", "name": "Medicana Health Group", "as": "One of the four private groups a foreign enquiry to Türkiye is routed through.", "rel": "destination" }, { "from": "memorial-sisli", "type": "facility", "name": "Memorial Şişli Hospital", "as": "The first Turkish hospital to hold JCI accreditation, which is the date Turkish private medicine abroad is usually counted from.", "rel": "destination" }, { "from": "bbl-mortality", "type": "risk", "name": "Death from gluteal fat grafting", "as": "Named as the country of surgery in most of the UK readmission series.", "rel": "place" }, { "from": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Named as the country of the first operation in most of the UK series.", "rel": "place" }, { "from": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "The state that permits abroad what it forbids at home.", "rel": "destination" }, { "from": "gender-affirming-care-access", "type": "rule", "name": "Access to gender-affirming care", "as": "A destination whose Civil Code gates the surgery through a court.", "rel": "destination" }, { "from": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The country whose regime this is.", "rel": "destination" }, { "from": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "One of the 32 locations reported individually for 2024.", "rel": "place" }, { "from": "ishrs", "type": "org", "name": "International Society of Hair Restoration Surgery", "as": "The country its 2016 release named, and the one that later wrote the same prohibitions into a regulation.", "rel": "place" }, { "from": "turkiye-health-services-directorate", "type": "org", "name": "Türkiye General Directorate of Health Services", "as": "The country whose international patient trade it licenses, facility by facility.", "rel": "place" }, { "from": "covid-shutdown-2020", "type": "event", "name": "The 2020 shutdown", "as": "435,691 visitors gave health as their purpose in 2020, against 756,926 in 2019 — and 1,381,807 by 2022.", "rel": "destination" }, { "from": "turkiye-hair-boom", "type": "event", "name": "Türkiye's hair transplant boom", "as": "The country page, where the official series and the licensing regime are set out.", "rel": "destination" }, { "from": "health-tourism", "type": "term", "name": "Health tourism", "as": "The state that made this category its unit of regulation.", "rel": "destination" }, { "from": "counting-patients", "type": "story", "name": "Counting patients", "as": "The border exit survey of stated purpose, 250,401 of it citizens resident abroad.", "rel": "destination" }, { "from": "the-follow-up-nobody-books", "type": "story", "name": "The follow-up nobody books", "as": "Named as the country of the first operation in most of the UK and Australian series.", "rel": "destination" } ] }, { "schema": 1, "id": "uae", "type": "destination", "names": { "name": "United Arab Emirates", "aliases": [ "UAE", "الإمارات العربية المتحدة", "Emirates" ], "said": "In the trade the UAE means Dubai, and Dubai means the clinics of Jumeirah and Dubai Healthcare City. Abu Dhabi runs a separate regulator and a separate story; the two emirates licence, count and promote independently of each other." }, "region": [ "gulf", "west-asia" ], "facets": { "iso2": "AE", "direction": "both", "currency": "AED", "languages": [ "Arabic", "English", "Hindi", "Urdu", "Tagalog" ], "draws": [ "dental-implant", "hair-transplant-fue", "ivf", "rhinoplasty" ] }, "text": { "what": "A federation of seven emirates that buys care abroad for its own citizens and sells care to visitors at the same time. Dubai licenses and counts an inbound trade of its own and publishes an annual number for it; a separate state programme, with its own bylaw, pays for Emiratis to be treated in Europe, the United States and Asia, and pays their escorts a daily allowance while they are there. Health regulation is emirate-level, not federal, so a clinic in Dubai, one in Abu Dhabi and one in Sharjah answer to three different licensing bodies.", "story": "Dubai Healthcare City opened in 2002 as a free zone with its own clinical regulator, licensing providers and professionals inside its boundary rather than leaving them to the emirate's general health authority. Its first phase covers 4.1 million square feet of hospitals and medical education; a second, dedicated to wellness, is under development. A free zone with a regulator attached is the structural answer to the problem every new destination has, which is that a foreign patient does not know what a local licence means.\n\nThe inbound number the emirate publishes is large and specific. The Dubai Health Authority reported \"more than 691,000 health tourists\" in 2023, spending AED 1.03 billion directly, against 674,000 and AED 992 million the year before. Dentistry accounted for 29 per cent of what they came for, dermatology 27 per cent and gynaecology 13 per cent. *Inference —* those three shares are the tell. A count led by teeth and skin is counting short outpatient visits by people already in the country, not tertiary admissions flown in for surgery, and the release does not publish the rule that separates a visiting patient from a resident one.\n\nThe outbound side is documented in a way the inbound side is not. Administrative Resolution No. 14 of 2017 sets out who the Dubai Health Authority will send abroad and what it will pay: the treatment, the physicians, the medicines and devices, interpreting, air ambulance where needed, and repatriation of the body if the patient dies. One escort travels with an adult patient; two accompany a child, or a patient who is elderly, paralysed, comatose or disabled. The schedule at the back sets the daily allowance by destination — €150 a day for the patient and €150 for the first escort in European countries, US$150 in the United States, AED 300 in India, Thailand and Arab countries.", "how": "Inbound, a visitor books a private clinic directly or through a licensed facilitator, pays cash or against an international policy, and is treated under an emirate licence: the Dubai Health Authority, the Abu Dhabi Department of Health, the federal ministry for the northern emirates, or Dubai Healthcare City's own regulator inside the free zone. Outbound, the route is administrative rather than commercial: a medical report from a government or accredited private hospital, a committee recommendation, then an approval that carries the escort, the flights and the per-diem with it.", "today": "As of September 2026 the most recent inbound figure Dubai has published is the 2023 one. No comparable published count exists for the number of Emiratis sent abroad under the state programme, so the two flows cannot be set against each other on like evidence. By headcount the inbound number is far the larger; by cost per patient the outbound one is not close, because a state does not fly a citizen to Germany for a filling.", "notes": "The 691,000 figure is the Dubai Health Authority's count for one emirate, not a national total, and this record does not extend it to the federation." }, "geo": { "lat": 24.4539, "lon": 54.3773, "precision": "country", "source": "s:natural-earth" }, "metrics": { "inbound_patients_year": 691000, "note": "Dubai only, 2023, as released by the Dubai Health Authority. It counts visits by non-residents to licensed Dubai providers; the release does not state the rule separating a visiting patient from a resident, and its own breakdown — 29% dentistry, 27% dermatology — points at short outpatient contacts rather than admissions. Direct spend was given as AED 1.03 billion, with a further AED 2.3 billion claimed as indirect revenue. Nothing here is audited by this project, and there is no federal equivalent.", "as_of": "2023", "source": "s:dubai-media-office-health-2023", "url": "https://mediaoffice.ae/en/news/2024/august/19-08/dubai-welcomes-more-than-691k" }, "kin": [ { "to": "dubai", "as": "The emirate that does the counting, the licensing and nearly all of the selling.", "rel": "part" }, { "to": "gcc-sponsored-treatment-abroad", "as": "The route by which this state pays for its own citizens to be operated on somewhere else.", "rel": "governed-by" }, { "to": "uae-clinic-licensing", "as": "Why a licence here names an emirate rather than a country.", "rel": "governed-by" }, { "to": "american-hospital-dubai", "as": "One of the private hospitals the inbound trade is built around.", "rel": "part" }, { "to": "dha-dubai", "as": "The authority that licenses the clinics and publishes the arrivals figure.", "rel": "governed-by" }, { "to": "the-escort-burden", "as": "Written into this state's own bylaw, with a per-diem attached to it.", "rel": "risk" }, { "to": "thailand", "as": "A named destination on this state's own allowance schedule, at AED 300 a day.", "rel": "contrast" }, { "to": "saudi-arabia", "as": "The other Gulf state running both flows at once, and the one with the larger population behind it.", "rel": "kin" }, { "to": "counting-patients", "as": "Why a figure of 691,000 needs its counting rule before it can be read.", "rel": "story" } ], "links": [ { "label": "Dubai Health Authority 2023 health travel figures", "url": "https://mediaoffice.ae/en/news/2024/august/19-08/dubai-welcomes-more-than-691k" }, { "label": "Administrative Resolution No. (14) of 2017, overseas medical treatment", "url": "https://dlp.dubai.gov.ae/Legislation%20Reference/2017/Administrative%20Resolution%20No.%20(14)%20of%202017%20Approving%20the%20Bylaw%20for%20Sending%20Patients.html" } ], "sources": [ "s:dubai-media-office-health-2023", "s:dubai-resolution-14-2017", "s:wp-dubai-healthcare-city", "s:natural-earth", "s:worldbank-open-data" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:dubai-resolution-14-2017" }, "text.story": { "tier": "cited", "source": "s:dubai-media-office-health-2023", "note": "the reading of what the specialty shares imply is marked inline as inference" }, "text.how": { "tier": "tradition", "note": "the inbound route is the trade's ordinary shape; the outbound route follows the 2017 bylaw" }, "text.today": { "tier": "inference", "note": "this project comparing two flows measured on unlike evidence, and saying so" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Dubai Healthcare City.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A federation of seven emirates that buys care abroad for its own citizens and sells care to visitors at the same time.", "region_terms": [ { "key": "gulf", "name": "The Gulf", "note": "the UAE, Saudi Arabia, Qatar, Kuwait, Oman, Bahrain — a source market that is building itself into a destination" }, { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "dubai", "type": "hub", "name": "Dubai", "as": "The emirate that does the counting, the licensing and nearly all of the selling.", "rel": "part" }, { "to": "gcc-sponsored-treatment-abroad", "type": "rule", "name": "Gulf state-sponsored treatment abroad", "as": "The route by which this state pays for its own citizens to be operated on somewhere else.", "rel": "governed-by" }, { "to": "uae-clinic-licensing", "type": "rule", "name": "Licensing a clinic in the United Arab Emirates", "as": "Why a licence here names an emirate rather than a country.", "rel": "governed-by" }, { "to": "american-hospital-dubai", "type": "facility", "name": "American Hospital Dubai", "as": "One of the private hospitals the inbound trade is built around.", "rel": "part" }, { "to": "dha-dubai", "type": "org", "name": "Dubai Health Authority", "as": "The authority that licenses the clinics and publishes the arrivals figure.", "rel": "governed-by" }, { "to": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "Written into this state's own bylaw, with a per-diem attached to it.", "rel": "risk" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "A named destination on this state's own allowance schedule, at AED 300 a day.", "rel": "contrast" }, { "to": "saudi-arabia", "type": "destination", "name": "Saudi Arabia", "as": "The other Gulf state running both flows at once, and the one with the larger population behind it.", "rel": "kin" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a figure of 691,000 needs its counting rule before it can be read.", "rel": "story" } ], "source_list": [ { "id": "s:dubai-media-office-health-2023", "kind": "gov", "title": "Dubai welcomes more than 691,000 international health travellers in 2023", "publisher": "Dubai Media Office, Government of Dubai", "url": "https://mediaoffice.ae/en/news/2024/august/19-08/dubai-welcomes-more-than-691k", "accessed": "2026-09-16", "note": "Dubai Health Authority figures released 19 August 2024; gives arrivals, spend, regional split and the leading specialties. The release does not publish the counting rule behind the headline number." }, { "id": "s:dubai-resolution-14-2017", "kind": "law", "title": "Administrative Resolution No. (14) of 2017 Approving the Bylaw for Sending Patients for Overseas Medical Treatment", "publisher": "Government of Dubai Legislation portal", "url": "https://dlp.dubai.gov.ae/Legislation%20Reference/2017/Administrative%20Resolution%20No.%20(14)%20of%202017%20Approving%20the%20Bylaw%20for%20Sending%20Patients.html", "accessed": "2026-09-16", "note": "issued 6 February 2017 by the Director General of the Dubai Health Authority; sets eligibility, what the state pays, escort entitlement and a daily allowance schedule by destination country" }, { "id": "s:wp-dubai-healthcare-city", "kind": "web", "title": "Dubai Healthcare City", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Dubai_Healthcare_City", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:dubai-resolution-14-2017" }, "text.story": { "tier": "cited", "source": "s:dubai-media-office-health-2023", "note": "the reading of what the specialty shares imply is marked inline as inference" }, "text.how": { "tier": "tradition", "note": "the inbound route is the trade's ordinary shape; the outbound route follows the 2017 bylaw" }, "text.today": { "tier": "inference", "note": "this project comparing two flows measured on unlike evidence, and saying so" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "nigeria", "type": "destination", "name": "Nigeria", "as": "A destination whose own arrivals count sweeps in visitors from West Africa without separating them out.", "rel": "destination" }, { "from": "saudi-arabia", "type": "destination", "name": "Saudi Arabia", "as": "The neighbour running the same two flows, with a published inbound count this country lacks.", "rel": "kin" }, { "from": "dubai", "type": "hub", "name": "Dubai", "as": "The federation this free zone and this city sit in.", "rel": "whole" }, { "from": "dhi-hair-transplant", "type": "procedure", "name": "Direct hair implantation (DHI)", "as": "Where the brand owner publishes its own ladder of prices.", "rel": "destination" }, { "from": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "A second destination pricing the same operation in a different currency and a wider range.", "rel": "destination" }, { "from": "american-hospital-dubai", "type": "facility", "name": "American Hospital Dubai", "as": "The first hospital in the region to take the JCI, in a country that is a source market and a destination at once.", "rel": "destination" }, { "from": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "Where that allowance schedule was published, in a bylaw of the Dubai Health Authority.", "rel": "destination" }, { "from": "gcc-sponsored-treatment-abroad", "type": "rule", "name": "Gulf state-sponsored treatment abroad", "as": "The country that both sends its nationals abroad under this bylaw and sells treatment to arrivals.", "rel": "destination" }, { "from": "uae-clinic-licensing", "type": "rule", "name": "Licensing a clinic in the United Arab Emirates", "as": "The federation whose licensing this is.", "rel": "destination" }, { "from": "aaci", "type": "org", "name": "American Accreditation Commission International", "as": "One of the markets where its mark turns up on private clinic pages.", "rel": "place" }, { "from": "dha-dubai", "type": "org", "name": "Dubai Health Authority", "as": "The federation this authority licenses one emirate of, and whose only published inbound count is its own.", "rel": "place" }, { "from": "medical-tourism-association", "type": "org", "name": "Medical Tourism Association", "as": "One of the destinations whose national brand it names as its own work.", "rel": "place" }, { "from": "counting-patients", "type": "story", "name": "Counting patients", "as": "The emirate figure whose own breakdown — 29 per cent dentistry, 27 per cent dermatology — says what it counts.", "rel": "destination" }, { "from": "who-travels", "type": "story", "name": "Who travels", "as": "Buys care abroad for its own nationals under a bylaw that sets the escort's daily allowance by destination.", "rel": "destination" } ] }, { "schema": 1, "id": "united-kingdom", "type": "destination", "names": { "name": "United Kingdom", "aliases": [ "UK", "Britain", "Great Britain and Northern Ireland" ], "said": "In the trade the UK is a source market first: the country the packages in Istanbul, Kraków and Budapest are priced in sterling for. Inbound, it is Harley Street and a private wing inside an NHS hospital." }, "region": [ "europe-west" ], "facets": { "iso2": "GB", "direction": "both", "currency": "GBP", "languages": [ "English" ], "draws": [ "proton-therapy", "executive-health-screening", "cabg", "bone-marrow-transplant" ] }, "text": { "what": "A net exporter of patients with a small, profitable import trade. British patients travel for dentistry, hair restoration, cosmetic and bariatric surgery and fertility treatment; foreign patients arrive for complex care in London teaching hospitals and private clinics, some of them paid for by their own governments. The queue is the engine on the outbound side, and it is measured monthly.", "story": "The queue first. NHS England's statistical press notice of 10 September 2026 put 7.3 million RTT pathways waiting to start treatment at the end of July 2026, an estimated 6.2 million unique patients, since some people wait on more than one pathway. In 111,379 cases the patient had waited more than 52 weeks and in 235 more than 104. In 65.4% of cases the wait was within 18 weeks, against a standard of 92%; the median wait was 12.0 weeks. That figure is published every month, and it is the single most reliable driver of outbound travel anywhere in this directory.\n\nThe travel itself has been counted once properly. Hanefeld and colleagues, using the UK International Passenger Survey alongside interviews and Freedom of Information returns from NHS foundation trusts, estimated that 63,000 UK residents travelled abroad for treatment in 2010 while around 52,000 patients came to the UK — and that inbound private patients treated in NHS facilities produced close to a quarter of the revenue from 7% of the volume in the data examined. The direction of that balance is the finding: the country that talks about being visited is a country that leaves.\n\n*Trade practice —* the inbound side splits three ways: private hospitals and clinics in London, private patient units inside NHS trusts, and patients whose bills are paid by a foreign government's health office, which is the arrangement Gulf states have long used for citizens referred abroad. No published count of state-sponsored arrivals was read for this record, and none is asserted here.\n\nWhat returns with the outbound patient is documented from the other end. Published UK surgical series describe revision work, infection and reconstruction after cosmetic surgery performed abroad landing on NHS units that were not paid for the original operation — a cost the price comparison never carried.", "how": "An outbound patient books directly or through a facilitator, pays a deposit, and is quoted in sterling by a clinic abroad against a comparison column the clinic wrote. NHS entitlement does not follow them: aftercare is a new referral at home, and a complication is an emergency presentation. Inbound, an overseas patient either pays a private provider or is billed by an NHS trust's private patient unit at the trust's own tariff, sometimes under an agreement with a foreign government's health office.", "today": "As of the July 2026 data, published 10 September 2026, 7.3 million pathways are waiting and the median wait is 12.0 weeks. The most recent national count of how many British patients that sends abroad remains the 2010 estimate; nothing newer with a stated method was read for this record." }, "geo": { "lat": 51.5072, "lon": -0.1276, "precision": "country", "source": "s:natural-earth" }, "metrics": { "wait_days_home": 84, "note": "The median RTT wait at the end of July 2026 was 12.0 weeks, which is the 84 days carried here; 7.3 million pathways were waiting, an estimated 6.2 million unique patients, with 111,379 waiting over 52 weeks and 65.4% within 18 weeks against a 92% standard. Figures include NHS England's estimates for three trusts and one independent provider that did not submit.", "as_of": "2026-07", "source": "s:nhs-rtt-july-2026", "url": "https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/" }, "kin": [ { "to": "turkiye", "as": "Where most British outbound hair, dental and bariatric traffic goes, priced in sterling.", "rel": "contrast" }, { "to": "poland", "as": "The dental corridor whose price list carries a column labelled average UK price.", "rel": "contrast" }, { "to": "hungary", "as": "The older dental destination for the same patients.", "rel": "contrast" }, { "to": "spain", "as": "Where 9% of its foreign-resident fertility cycles were run in 2022.", "rel": "contrast" }, { "to": "ireland", "as": "The other mostly outbound country in this region, with a different queue and a different scheme.", "rel": "contrast" }, { "to": "uk-nhs-treatment-abroad", "as": "What the NHS will and will not fund when a patient goes.", "rel": "governed-by" }, { "to": "hfea", "as": "The regulator that licenses every UK fertility clinic and publishes each one's results — the comparison a patient abroad loses.", "rel": "accredited-by" }, { "to": "revision-at-home", "as": "The operation the NHS performs and did not price.", "rel": "risk" }, { "to": "oecd-waiting-times", "as": "The series that puts this queue beside other countries'.", "rel": "measured-by" }, { "to": "is-it-cheaper", "as": "The question a 12-week median wait answers differently for each patient.", "rel": "story" } ], "links": [ { "label": "NHS England — referral to treatment waiting times", "url": "https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/" }, { "label": "Medical Tourism: A Cost or Benefit to the NHS? (PLOS ONE, 2013)", "url": "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0070406" } ], "sources": [ "s:nhs-rtt-july-2026", "s:hanefeld-2013-nhs", "s:whiteman-nhs-burden-2025", "s:ahari-breast-unit-2024", "s:nhs-cosmetic-surgery-abroad", "s:sef-registro-2022", "s:natural-earth" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:nhs-rtt-july-2026", "note": "waiting figures and the 2010 estimate are read off their own publications; the paragraph on state-sponsored arrivals is marked trade practice and carries no number" }, "text.how": { "tier": "tradition", "note": "how the two sides work in practice; the entitlement point is general and is not advice" }, "metrics": { "tier": "cited", "source": "s:nhs-rtt-july-2026" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:Harley Street London.jpg" ], "needs_verification": false, "confidence": "high", "updated": "2026-09-16", "blurb": "A net exporter of patients with a small, profitable import trade.", "region_terms": [ { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "Where most British outbound hair, dental and bariatric traffic goes, priced in sterling.", "rel": "contrast" }, { "to": "poland", "type": "destination", "name": "Poland", "as": "The dental corridor whose price list carries a column labelled average UK price.", "rel": "contrast" }, { "to": "hungary", "type": "destination", "name": "Hungary", "as": "The older dental destination for the same patients.", "rel": "contrast" }, { "to": "spain", "type": "destination", "name": "Spain", "as": "Where 9% of its foreign-resident fertility cycles were run in 2022.", "rel": "contrast" }, { "to": "ireland", "type": "destination", "name": "Ireland", "as": "The other mostly outbound country in this region, with a different queue and a different scheme.", "rel": "contrast" }, { "to": "uk-nhs-treatment-abroad", "type": "rule", "name": "NHS funding for treatment abroad", "as": "What the NHS will and will not fund when a patient goes.", "rel": "governed-by" }, { "to": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "The regulator that licenses every UK fertility clinic and publishes each one's results — the comparison a patient abroad loses.", "rel": "accredited-by" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The operation the NHS performs and did not price.", "rel": "risk" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The series that puts this queue beside other countries'.", "rel": "measured-by" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The question a 12-week median wait answers differently for each patient.", "rel": "story" } ], "source_list": [ { "id": "s:nhs-rtt-july-2026", "kind": "gov", "title": "Statistical Press Notice — NHS referral to treatment (RTT) waiting times data, July 2026", "publisher": "NHS England", "url": "https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Jul26-RTT-statistical-press-notice-PDF-578K-97ylx5.pdf", "accessed": "2026-09-16", "note": "published Thursday 10 September 2026. 7.3 million RTT pathways waiting to start treatment at the end of July 2026, an estimated 6.2 million unique patients; 111,379 waiting over 52 weeks, 9,095 over 65 weeks, 235 over 104 weeks; 65.4% waiting up to 18 weeks against a 92% standard; median wait 12.0 weeks. Figures include estimates for three trusts and one independent provider that did not submit." }, { "id": "s:hanefeld-2013-nhs", "kind": "paper", "title": "Medical Tourism: A Cost or Benefit to the NHS?", "publisher": "PLOS ONE 2013;8(10):e70406 (Hanefeld J, Horsfall D, Lunt N, Smith R), London School of Hygiene and Tropical Medicine and University of York", "url": "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0070406", "accessed": "2026-09-16", "note": "mixed methods: UK International Passenger Survey, 77 returning patients, 63 policymakers and industry interviews, 28 Freedom of Information requests to NHS foundation trusts. An estimated 63,000 UK residents travelled abroad for treatment in 2010 against around 52,000 patients treated in the UK; inbound private patients in NHS facilities yielded close to a quarter of revenue from 7% of volume in the data examined." }, { "id": "s:whiteman-nhs-burden-2025", "kind": "paper", "title": "The rising NHS burden from cosmetic surgery procedures performed abroad and non-surgical procedures performed in the United Kingdom", "publisher": "Journal of Plastic, Reconstructive and Aesthetic Surgery 2025;102:39-41 (Whiteman E, Romain K, Welman T, et al.)", "url": "https://pubmed.ncbi.nlm.nih.gov/39892185/", "accessed": "2026-09-16" }, { "id": "s:ahari-breast-unit-2024", "kind": "paper", "title": "The impact of cosmetic tourism across one year on an NHS breast surgery unit", "publisher": "Journal of Plastic, Reconstructive and Aesthetic Surgery 2024;99:462-467 (Ahari D, Zaccariah ZR, Preston M, Highton L), Wythenshawe Hospital", "url": "https://pubmed.ncbi.nlm.nih.gov/39476527/", "accessed": "2026-09-16" }, { "id": "s:nhs-cosmetic-surgery-abroad", "kind": "org", "title": "Cosmetic surgery abroad", "publisher": "NHS (England)", "url": "https://www.nhs.uk/tests-and-treatments/cosmetic-procedures/advice/cosmetic-surgery-abroad/", "accessed": "2026-09-16", "note": "read for aftercare responsibility, flying intervals and the statement on travel insurance" }, { "id": "s:sef-registro-2022", "kind": "dataset", "title": "Registro Nacional de Actividad 2022 — Registro SEF, Técnicas de Reproducción Asistida (FIV/ICSI and IA)", "publisher": "Sociedad Española de Fertilidad for the Spanish Ministry of Health; the official national ART registry", "url": "https://www.registrosef.com/public/docs/sef2022_IAFIV.pdf", "accessed": "2026-09-16", "note": "section 3.20: 27,564 fresh and frozen cycles in 2022 were for patients resident in other countries — France 39.0%, Italy 20.6%, the United Kingdom 9.0%, Germany 6.4%, Morocco 0.6%, Portugal 0.3%, other 18.3%, country not recorded 5.7%. Of those cycles 52.3% used donated eggs. The reason for coming was not recorded in 90.8% of them; where it was, 1.6% named a technique unlawful at home and 1.1% a patient who did not meet the legal conditions at home." }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:nhs-rtt-july-2026", "note": "waiting figures and the 2010 estimate are read off their own publications; the paragraph on state-sponsored arrivals is marked trade practice and carries no number" }, "text.how": { "tier": "tradition", "note": "how the two sides work in practice; the entitlement point is general and is not advice" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited", "source": "s:nhs-rtt-july-2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "ireland", "type": "destination", "name": "Ireland", "as": "The other mostly outbound country in this region, with a monthly queue of its own and a land border in common.", "rel": "contrast" }, { "from": "nigeria", "type": "destination", "name": "Nigeria", "as": "The other long-standing destination for Nigerians who can pay, and one that counts them as private patients rather than as travellers.", "rel": "destination" }, { "from": "poland", "type": "destination", "name": "Poland", "as": "The source market its sterling price column is written for.", "rel": "contrast" }, { "from": "spain", "type": "destination", "name": "Spain", "as": "9% of the cycles it ran for foreign residents in 2022.", "rel": "contrast" }, { "from": "turkiye", "type": "destination", "name": "Türkiye", "as": "One of the source markets its packages are priced for, in sterling.", "rel": "contrast" }, { "from": "abortion-care", "type": "procedure", "name": "Abortion", "as": "Where a provider publishes one price list in two currencies, sterling and euro.", "rel": "destination" }, { "from": "acl-reconstruction", "type": "procedure", "name": "Anterior cruciate ligament reconstruction", "as": "Where the £7,399 self-pay price on this page is sold, physiotherapy inside it.", "rel": "destination" }, { "from": "addiction-rehab", "type": "procedure", "name": "Residential addiction treatment", "as": "The source market whose own tariff is the comparison being made.", "rel": "destination" }, { "from": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "The source market whose band 3 charge of £332.10 is the number these lists are written against.", "rel": "destination" }, { "from": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "The source market where one band 3 charge covers a course however many teeth it holds.", "rel": "destination" }, { "from": "gallbladder-removal", "type": "procedure", "name": "Gallbladder removal", "as": "The source market whose queue makes a foreign price legible.", "rel": "destination" }, { "from": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "A source market whose own clinics publish what they quote, and what their competitors quote.", "rel": "destination" }, { "from": "hernia-repair", "type": "procedure", "name": "Hernia repair", "as": "The source market whose waiting list makes a foreign price worth reading.", "rel": "destination" }, { "from": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "Where the self-pay price on this page is sold, and the queue most of its buyers are leaving.", "rel": "destination" }, { "from": "hysterectomy", "type": "procedure", "name": "Hysterectomy", "as": "The source market whose waiting list is the reason to read a foreign price at all.", "rel": "destination" }, { "from": "icl", "type": "procedure", "name": "Implantable collamer lens", "as": "Where the implant is priced per eye against the same provider's laser ladder.", "rel": "destination" }, { "from": "knee-arthroscopy", "type": "procedure", "name": "Knee arthroscopy", "as": "Where the £5,899 self-pay price on this page is sold.", "rel": "destination" }, { "from": "lasik", "type": "procedure", "name": "LASIK", "as": "Where the four techniques are priced as a ladder, per eye, aftercare included.", "rel": "destination" }, { "from": "prostatectomy", "type": "procedure", "name": "Prostatectomy", "as": "The source market whose queue makes a foreign price legible.", "rel": "destination" }, { "from": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "Ran a state programme that flew its own patients abroad for eleven years before its centres opened.", "rel": "destination" }, { "from": "root-canal", "type": "procedure", "name": "Root canal treatment", "as": "The source market whose band 2 charge of £76.60 sits under all of these.", "rel": "destination" }, { "from": "shoulder-replacement", "type": "procedure", "name": "Total shoulder replacement", "as": "Where the self-pay price on this page is sold.", "rel": "destination" }, { "from": "sperm-donation", "type": "procedure", "name": "Sperm donation", "as": "The jurisdiction whose capped payment and identity release this record reads off the regulator's own pages.", "rel": "place" }, { "from": "spinal-fusion", "type": "procedure", "name": "Spinal fusion", "as": "Where the £14,400 cervical fusion on this page is sold, with no inclusion list beside it.", "rel": "destination" }, { "from": "top-surgery", "type": "procedure", "name": "Top surgery", "as": "Where a private list publishes guide prices and a queue sends people to look at them.", "rel": "destination" }, { "from": "vaginoplasty", "type": "procedure", "name": "Vaginoplasty", "as": "Where a private list quotes guide prices roughly three times the Bangkok table, and states it cannot quote at all before a consultation.", "rel": "destination" }, { "from": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The system that published its own ledgers, which is why this record has numbers at all.", "rel": "place" }, { "from": "abortion-travel-law", "type": "rule", "name": "Travelling for a termination", "as": "A destination whose statute contains no residence bar.", "rel": "destination" }, { "from": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The source market that ended anonymity in 2005.", "rel": "destination" }, { "from": "uk-nhs-treatment-abroad", "type": "rule", "name": "NHS funding for treatment abroad", "as": "The country whose system this is, and one of the largest source markets in Europe.", "rel": "destination" }, { "from": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "The jurisdiction it licenses, clinic by clinic, and the border its register stops at.", "rel": "place" }, { "from": "keith-pollard", "type": "person", "name": "Keith Pollard", "as": "Where the publishing business was registered, and where its sites sold private treatment at home as well as abroad.", "rel": "destination" }, { "from": "ndm-1-2010", "type": "event", "name": "NDM-1, 2010", "as": "Where the 37 UK isolates were found, and where the travel histories were taken.", "rel": "destination" }, { "from": "hfea-results", "type": "dataset", "name": "HFEA fertility treatment results", "as": "The jurisdiction the register covers, clinic by clinic.", "rel": "destination" }, { "from": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "Reports only the census measure, 185 days median for a knee in 2024, so it compares with nobody who reports the other.", "rel": "measures" }, { "from": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "Where the self-pay list price on this page is published.", "rel": "place" }, { "from": "the-follow-up-nobody-books", "type": "story", "name": "The follow-up nobody books", "as": "The system that published its own ledgers, which is the only reason this page has numbers.", "rel": "destination" }, { "from": "waiting-lists", "type": "story", "name": "The queue is the product", "as": "Publishes its queue monthly, which is why it is the one this piece reads first.", "rel": "destination" } ] }, { "schema": 1, "id": "united-states", "type": "destination", "names": { "name": "United States", "aliases": [ "USA", "US", "United States of America" ], "said": "The trade calls it the source market and means the price at home. It is also where a Gulf ministry sends its hardest cancer cases, and where a Canadian pays cash to jump a provincial queue." }, "region": [ "north-america" ], "facets": { "iso2": "US", "direction": "both", "currency": "USD", "languages": [ "English", "Spanish" ], "draws": [ "proton-therapy", "car-t", "bone-marrow-transplant", "kidney-transplant" ] }, "text": { "what": "The largest source market in the world and a major destination in the same breath. Americans leave for dentistry, weight-loss surgery, cosmetic surgery and fertility treatment, mostly southward and mostly by road or a short flight. Patients arrive from Canada, the Gulf, Latin America and beyond for the complex end — oncology, transplant, cell therapy — that few systems can staff. The federal entitlement most travellers assume they carry with them does not leave the country.", "story": "Start with what is not covered. Medicare's own page states it plainly: \"Medicare usually doesn't cover health care while you're traveling outside the U.S. but there are some exceptions\". The exceptions are narrow and geographic, not clinical — a foreign hospital nearer than the nearest US one that can treat the condition; a medical emergency while crossing Canada by the most direct route between Alaska and another state; shipboard care when the ship is in a US port or within six hours of one. None of them covers an operation somebody flew abroad to have. A planned knee replacement in Mexico or a dental course in Costa Rica is paid by the patient, in full, and that single rule shapes who travels from here: people without cover, people whose cover excludes the thing they need, and people facing a deductible larger than a fare.\n\nOn the other side of the ledger the CDC's chapter says \"Surveillance data indicate that millions of U.S. residents travel internationally for medical care each year\" and names the destinations US patients most commonly travel to: Mexico, Canada, the Caribbean, and several countries in South America. *Inference —* the direction of that sentence is solid and the magnitude is not. Millions is a wide word, the surveillance it rests on counts border crossings and survey answers rather than operations, and this directory carries the destination list and leaves the number where it found it.\n\nInbound is thinner still in public data. Large American cancer centres run international offices — MD Anderson in Houston states that \"Hundreds of patients come to Houston from other countries every year\" and staffs certified interpreters in Arabic, French, Mandarin, Spanish, Vietnamese and American Sign Language — but hundreds is the number the hospital chose to publish, and no federal series counts foreign patients admitted to US hospitals.\n\nThe United States is also the only location in the ISAPS 2024 survey that returned N/A for the share of patients attending from other locations, in a survey where it reported more aesthetic procedures than anywhere else: 6,165,173, of which 4,165,645 were non-surgical.", "how": "The domestic price is the mechanism. American hospitals bill from chargemasters, negotiate different rates with every insurer, and are required by federal rule to publish machine-readable price files that are hard to read and harder to compare; a patient without insurance is quoted from the top of that structure. *Trade practice —* the outbound trade runs on that gap: employers and unions have at times contracted directly with foreign or domestic centres of excellence for joint replacement and cardiac work, and border clinics quote a single cash number against an American bill nobody can predict. Inbound, a foreign ministry or an embassy is often the payer, and the hospital's international office quotes an estimate and takes a deposit before the visa letter is written.", "today": "As of 16 September 2026 the Medicare position is unchanged and is carried here as a rule record. Nothing on this page says whether travelling is worth it: the comparison that would settle it — the US price a given patient would actually pay, against the foreign price plus the flight, the escort, the extra nights and the revision at home — is not a number either side publishes." }, "geo": { "lat": 38.8977, "lon": -77.0365, "precision": "country", "source": "s:natural-earth" }, "metrics": { "note": "No inbound or outbound patient count is carried. The CDC's 'millions of U.S. residents' is quoted in the prose as the CDC's sentence, not adopted as a figure; the ISAPS count of 6,165,173 aesthetic procedures in 2024 counts procedures by board-certified plastic surgeons, and that survey records no foreign-patient share for this country.", "as_of": "2024", "source": "s:isaps-global-survey-2024", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf" }, "kin": [ { "to": "us-medicare-abroad", "as": "The rule that decides what a US patient carries abroad, which is almost nothing.", "rel": "governed-by" }, { "to": "insurance-exclusions", "as": "The other half of why people leave from here: the cover that does not cover it.", "rel": "governed-by" }, { "to": "mexico", "as": "The destination reached by road, and the one the CDC names first.", "rel": "destination" }, { "to": "canada", "as": "The other big source market, and a neighbour whose patients arrive here paying cash.", "rel": "contrast" }, { "to": "dominican-republic", "as": "Where every patient counted in two CDC outbreak reports had travelled from here.", "rel": "destination" }, { "to": "proton-therapy", "as": "One of the treatments patients fly into this country for.", "rel": "procedure" }, { "to": "car-t", "as": "Cell therapy is the inbound end of this market.", "rel": "procedure" }, { "to": "medical-travel", "as": "The word this site uses, and the argument over what to call the thing.", "rel": "term" }, { "to": "counting-patients", "as": "Why 'millions a year' is a sentence and not a measurement.", "rel": "story" }, { "to": "cdc-art-results", "as": "The one US series that reports clinic-by-clinic outcomes, and what it does and does not cover.", "rel": "measured-by" }, { "to": "revision-at-home", "as": "This is the 'home' in that phrase for most of the traffic on this site.", "rel": "risk" } ], "links": [ { "label": "Medicare — travel outside the U.S.", "url": "https://www.medicare.gov/coverage/travel-outside-the-u.s." }, { "label": "CDC Yellow Book — care abroad", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" } ], "sources": [ "s:medicare-travel-outside-us", "s:cdc-yellowbook-medical-tourism", "s:isaps-global-survey-2024", "s:mdanderson-international", "s:natural-earth" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:medicare-travel-outside-us", "note": "Medicare's own page, the CDC chapter and the ISAPS survey; the reading of 'millions' is marked inference" }, "text.how": { "tier": "tradition", "note": "the pricing mechanism and the employer-contract practice, hedged in the prose" }, "geo": { "tier": "harvested", "source": "s:natural-earth" } } }, "x_commons_files": [ "File:MD Anderson Cancer Center.jpg" ], "needs_verification": true, "confidence": "high", "updated": "2026-09-16", "blurb": "The largest source market in the world and a major destination in the same breath.", "region_terms": [ { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "us-medicare-abroad", "type": "rule", "name": "Medicare outside the United States", "as": "The rule that decides what a US patient carries abroad, which is almost nothing.", "rel": "governed-by" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "The other half of why people leave from here: the cover that does not cover it.", "rel": "governed-by" }, { "to": "mexico", "type": "destination", "name": "Mexico", "as": "The destination reached by road, and the one the CDC names first.", "rel": "destination" }, { "to": "canada", "type": "destination", "name": "Canada", "as": "The other big source market, and a neighbour whose patients arrive here paying cash.", "rel": "contrast" }, { "to": "dominican-republic", "type": "destination", "name": "Dominican Republic", "as": "Where every patient counted in two CDC outbreak reports had travelled from here.", "rel": "destination" }, { "to": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "One of the treatments patients fly into this country for.", "rel": "procedure" }, { "to": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "Cell therapy is the inbound end of this market.", "rel": "procedure" }, { "to": "medical-travel", "type": "term", "name": "Medical travel", "as": "The word this site uses, and the argument over what to call the thing.", "rel": "term" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why 'millions a year' is a sentence and not a measurement.", "rel": "story" }, { "to": "cdc-art-results", "type": "dataset", "name": "CDC assisted reproductive technology results", "as": "The one US series that reports clinic-by-clinic outcomes, and what it does and does not cover.", "rel": "measured-by" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "This is the 'home' in that phrase for most of the traffic on this site.", "rel": "risk" } ], "source_list": [ { "id": "s:medicare-travel-outside-us", "kind": "web", "title": "Travel outside the U.S.", "publisher": "Medicare.gov, US Centers for Medicare & Medicaid Services", "url": "https://www.medicare.gov/coverage/travel-outside-the-u.s.", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:isaps-global-survey-2024", "kind": "report", "title": "ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2024", "publisher": "International Society of Aesthetic Plastic Surgery, tabulated by Industry Insights Inc.", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf", "accessed": "2026-09-16" }, { "id": "s:mdanderson-international", "kind": "web", "title": "International Center — becoming our patient", "publisher": "University of Texas MD Anderson Cancer Center, Houston", "url": "https://www.mdanderson.org/patients-family/becoming-our-patient/international-center.html", "accessed": "2026-09-16" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:medicare-travel-outside-us", "note": "Medicare's own page, the CDC chapter and the ISAPS survey; the reading of 'millions' is marked inference" }, "text.how": { "tier": "tradition", "note": "the pricing mechanism and the employer-contract practice, hedged in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:natural-earth" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "canada", "type": "destination", "name": "Canada", "as": "The other big source market, and the first place a Canadian in a hurry pays cash.", "rel": "contrast" }, { "from": "colombia", "type": "destination", "name": "Colombia", "as": "The origin Colombian surgeons name most often for their foreign patients.", "rel": "contrast" }, { "from": "costa-rica", "type": "destination", "name": "Costa Rica", "as": "The source market, two to three hours away by air.", "rel": "contrast" }, { "from": "cuba", "type": "destination", "name": "Cuba", "as": "The neighbouring source market whose own regulations decide who may come.", "rel": "contrast" }, { "from": "dominican-republic", "type": "destination", "name": "Dominican Republic", "as": "Where every counted patient in both clusters lived.", "rel": "contrast" }, { "from": "mexico", "type": "destination", "name": "Mexico", "as": "The source market next door, and the reason the trade is a drive rather than a flight.", "rel": "contrast" }, { "from": "panama", "type": "destination", "name": "Panama", "as": "The origin named first, and the currency the prices are quoted in.", "rel": "contrast" }, { "from": "havana", "type": "hub", "name": "Havana", "as": "The nearest large market, and the one whose own law is the binding constraint on reaching this city.", "rel": "kin" }, { "from": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "Where the patients live, and where the dental bill they are avoiding was written.", "rel": "kin" }, { "from": "monterrey", "type": "hub", "name": "Monterrey", "as": "The market three hours north by road, and the one the English-language consent forms are for.", "rel": "kin" }, { "from": "nuevo-progreso", "type": "hub", "name": "Nuevo Progreso", "as": "Where the walkers come from, most of them wintering in the Rio Grande Valley.", "rel": "kin" }, { "from": "santo-domingo", "type": "hub", "name": "Santo Domingo", "as": "Where the patients live and where every one of these infections was diagnosed.", "rel": "kin" }, { "from": "tijuana", "type": "hub", "name": "Tijuana", "as": "The source market, fifteen miles away, and the health system that treats the complications.", "rel": "kin" }, { "from": "abortion-care", "type": "procedure", "name": "Abortion", "as": "Where the same journey runs between states and a provider's price floor is an abortion fund.", "rel": "destination" }, { "from": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "The source market whose society published the mortality survey.", "rel": "destination" }, { "from": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The other end of the 2013 comparison, and the market it was aimed at.", "rel": "destination" }, { "from": "facelift", "type": "procedure", "name": "Facelift", "as": "The source market whose published figure is a surgeon's fee alone.", "rel": "destination" }, { "from": "gastric-balloon", "type": "procedure", "name": "Gastric balloon", "as": "Where the device's regulator published the placement limit and the adverse events this record quotes.", "rel": "place" }, { "from": "lasik", "type": "procedure", "name": "LASIK", "as": "Where the price is quoted per eye before discounts and the survey range is four times wide.", "rel": "destination" }, { "from": "liposuction", "type": "procedure", "name": "Liposuction", "as": "The market whose published figure is a surgeon's fee rather than a price.", "rel": "destination" }, { "from": "phalloplasty", "type": "procedure", "name": "Phalloplasty", "as": "Where a practice publishes an estimate for this operation and declines to sell it for cash.", "rel": "destination" }, { "from": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "Holds more proton centres than any other country, and took the UK programme's patients.", "rel": "destination" }, { "from": "stem-cell-unproven", "type": "procedure", "name": "Unapproved stem cell treatment", "as": "The regulator that has enjoined a clinic, and the country the marketing surveys found most of the businesses in.", "rel": "destination" }, { "from": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "Where the one published all-in programme price on this page is sold.", "rel": "destination" }, { "from": "top-surgery", "type": "procedure", "name": "Top surgery", "as": "Where a practice publishes the surgeon's fee and the total separately, which is what makes the other lists readable.", "rel": "destination" }, { "from": "abortion-travel-law", "type": "rule", "name": "Travelling for a termination", "as": "The source market the question moved to in 2022.", "rel": "destination" }, { "from": "assisted-dying-law", "type": "rule", "name": "Assisted dying, and who may cross a border for it", "as": "The federation where one state opened the door and another keeps it shut.", "rel": "destination" }, { "from": "gender-affirming-care-access", "type": "rule", "name": "Access to gender-affirming care", "as": "The source market whose federal position was decided in 2025 for minors and left open for adults.", "rel": "destination" }, { "from": "stem-cell-regulation", "type": "rule", "name": "Regulating cell and tissue therapies", "as": "The regime that turns on two defined phrases.", "rel": "destination" }, { "from": "us-medicare-abroad", "type": "rule", "name": "Medicare outside the United States", "as": "The country whose public programme this is, and the largest source market in the world.", "rel": "destination" }, { "from": "dnv-healthcare", "type": "org", "name": "DNV Healthcare", "as": "Where its NIAHO programme carries federal deeming weight.", "rel": "place" }, { "from": "leigh-turner", "type": "person", "name": "Leigh Turner", "as": "The country his counts are of, and the one usually described as a source of patients rather than a market.", "rel": "destination" }, { "from": "bundled-payment", "type": "term", "name": "Bundled payment", "as": "Where the episode payment was designed, and the market whose patients travel out of it.", "rel": "destination" }, { "from": "cdc-art-results", "type": "dataset", "name": "CDC assisted reproductive technology results", "as": "The country the register covers, and the largest source market for fertility travel in this directory.", "rel": "destination" } ] }, { "schema": 1, "id": "vietnam", "type": "destination", "names": { "name": "Vietnam", "aliases": [ "Việt Nam", "Socialist Republic of Vietnam" ], "said": "Ho Chi Minh City sells teeth. Hanoi sells nothing much to foreigners. The patients who arrive are mostly Cambodian, Lao, or Vietnamese with a second passport." }, "region": [ "southeast-asia" ], "facets": { "iso2": "VN", "direction": "both", "currency": "VND", "languages": [ "Vietnamese", "English" ], "draws": [ "dental-implant", "all-on-four", "veneers", "rhinoplasty" ] }, "text": { "what": "A country that sends more money out for treatment than it takes in, and that is building a dental and cosmetic trade in Ho Chi Minh City on the difference. The figures published about it are estimates without a named author, and this record carries none of them as fact.", "story": "State media reported in August 2026 that \"around 300,000 international visitors use medical services in Vietnam annually\", spending \"1-2 billion USD\" on treatment, accommodation, transport and food, while \"Vietnamese people spend an estimated 2-3 billion USD each year on medical treatment abroad\". The target attached to the same piece was \"around 750,000 international medical tourists by 2030\".\n\nEvery one of those numbers is attributed to reports and estimates that are not named. This directory quotes them, credits the agency that printed them, and does not carry them in its own metrics.\n\n*Inference —* the outbound figure being two to three times the inbound one is the part worth reading. Vietnam's wealthy travel to Singapore, Bangkok and Seoul for cancer and cardiac work, and the state's interest in this sector is import substitution before it is export promotion.\n\nThe patients coming the other way, by the same reporting, are overseas Vietnamese and visitors from Cambodia, Laos, the Republic of Korea, Japan, Australia and Europe. *Trade practice —* the Cambodian and Lao arrivals are a border phenomenon rather than a package trade: a referral to the nearest hospital with a scanner, paid for in cash.", "how": "*Trade practice —* Ho Chi Minh City's dental clinics quote packages in US dollars on public pages and work to a holiday calendar, fitting implants and full-arch restorations into a two-visit schedule. Hospital care for foreigners is arranged through international departments at a handful of city hospitals. The country has no medical visa class of the kind India and Thailand run.", "today": "As of 16 September 2026 no Vietnamese government series counting foreign patients has been read for this record." }, "geo": { "lat": 10.8231, "lon": 106.6297, "precision": "city", "source": "s:osm" }, "metrics": { "inbound_patients_year": null, "note": "None carried. The figures in circulation — about 300,000 international users of medical services a year, 1-2 billion US dollars of inbound spending, 2-3 billion going out — were printed by the state news agency in August 2026 and attributed there to unnamed reports and estimates. No ministry series behind them was read for this record.", "as_of": "2026-09-16", "source": "s:vietnamplus-medical-travel-2026", "url": "https://en.vietnamplus.vn/vietnam-moves-to-tap-growing-potential-of-medical-tourism-post350961.vnp" }, "kin": [ { "to": "dental-implant", "as": "The operation the Ho Chi Minh City trade is built on.", "rel": "procedure" }, { "to": "all-on-four", "as": "The full-arch package sold to visitors on a two-trip schedule.", "rel": "procedure" }, { "to": "singapore", "as": "Where Vietnamese patients go when the diagnosis is serious and the money exists.", "rel": "contrast" }, { "to": "thailand", "as": "The regional destination Vietnamese patients leave for, and the format Vietnamese clinics copy.", "rel": "contrast" }, { "to": "facilitator", "as": "The broker layer between a dental clinic here and a patient abroad.", "rel": "term" }, { "to": "counting-patients", "as": "Why an unattributed 300,000 does not become a fact by being reprinted.", "rel": "story" }, { "to": "follow-up-gap", "as": "Who checks an implant placed on a fortnight's holiday.", "rel": "risk" } ], "links": [ { "label": "Vietnam moves to tap growing potential of medical tourism — VietnamPlus", "url": "https://en.vietnamplus.vn/vietnam-moves-to-tap-growing-potential-of-medical-tourism-post350961.vnp" } ], "sources": [ "s:vietnamplus-medical-travel-2026", "s:worldbank-open-data", "s:osm" ], "provenance": { "default": { "tier": "cited", "source": "s:vietnamplus-medical-travel-2026" }, "fields": { "text.story": { "tier": "cited", "source": "s:vietnamplus-medical-travel-2026", "note": "quoted from state media, which attributes the figures to unnamed reports; the reading of them is marked inference" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:vietnamplus-medical-travel-2026" } } }, "needs_verification": true, "confidence": "low", "updated": "2026-09-16", "blurb": "A country that sends more money out for treatment than it takes in, and that is building a dental and cosmetic trade in Ho Chi Minh City on the difference.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The operation the Ho Chi Minh City trade is built on.", "rel": "procedure" }, { "to": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "The full-arch package sold to visitors on a two-trip schedule.", "rel": "procedure" }, { "to": "singapore", "type": "destination", "name": "Singapore", "as": "Where Vietnamese patients go when the diagnosis is serious and the money exists.", "rel": "contrast" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "The regional destination Vietnamese patients leave for, and the format Vietnamese clinics copy.", "rel": "contrast" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The broker layer between a dental clinic here and a patient abroad.", "rel": "term" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why an unattributed 300,000 does not become a fact by being reprinted.", "rel": "story" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who checks an implant placed on a fortnight's holiday.", "rel": "risk" } ], "source_list": [ { "id": "s:vietnamplus-medical-travel-2026", "kind": "web", "title": "Vietnam moves to tap growing potential of medical tourism", "publisher": "VietnamPlus, Vietnam News Agency", "url": "https://en.vietnamplus.vn/vietnam-moves-to-tap-growing-potential-of-medical-tourism-post350961.vnp", "accessed": "2026-09-16", "note": "dated 28 August 2026; every figure in it is attributed to unnamed reports and estimates" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:vietnamplus-medical-travel-2026" }, "text.story": { "tier": "cited", "source": "s:vietnamplus-medical-travel-2026", "note": "quoted from state media, which attributes the figures to unnamed reports; the reading of them is marked inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited", "source": "s:vietnamplus-medical-travel-2026" }, "geo": { "tier": "harvested", "source": "s:osm" }, "metrics": { "tier": "cited", "source": "s:vietnamplus-medical-travel-2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [] }, { "schema": 1, "id": "amman", "type": "hub", "names": { "name": "Amman", "aliases": [ "عمّان" ], "said": "West Amman is where the private hospitals are. A referral from Baghdad or Tripoli names a hospital, not a district, and the taxi works out the rest." }, "region": [ "west-asia" ], "facets": { "iso2": "JO", "radius_km": 15, "specialty": [ "oncology", "cardiac surgery", "fertility", "bariatric surgery", "transplantation", "orthopaedics" ], "draws": [ "bone-marrow-transplant", "cabg", "ivf", "gastric-sleeve", "kidney-transplant" ], "languages": [ "Arabic", "English" ] }, "text": { "what": "A capital of some five million people as of 2024, whose private hospitals sit in the modern western half of the city — the economic side, against the historic east — with the King Hussein Cancer Center on Queen Rania Street carrying 352 beds. Amman treats patients referred from Iraq, Palestine, Sudan, Syria, Libya and the Gulf, mostly for cancer, cardiac surgery, fertility and transplantation, and its private sector is organised enough to have had a trade association since 1984.", "story": "Jordan's inbound trade is older than the phrase for it. The Private Hospitals Association was founded in 1984, began with eight members and now has 48, and started appearing at international medical travel conferences after United States development support from October 2007.\n\nThe counts everybody quotes are from that period and have not been replaced. More than 250,000 patients from other countries were treated in Jordan in 2007 — about 45,000 Iraqis, 25,000 Palestinians, 25,000 Sudanese, 1,800 Americans, 1,200 Britons and 400 Canadians — and a similar figure with revenues above a billion dollars is given for 2008. The World Bank ranked Jordan the leading medical travel destination in the Middle East and North Africa.\n\n*Inference —* those figures are approaching two decades old and their method is not stated on the page that carries them. What they plainly describe is a referral trade rather than an elective one: the largest single groups came from countries whose own hospital systems were under war or embargo, which is a different subject from a cheaper knee.\n\nThe King Hussein Cancer Center holds Joint Commission International accreditation and accreditations from the College of American Pathologists, the American Nurses Credentialing Center's Magnet programme and the accrediting body for human research protection — none of them dated on the page read for this record, and an accreditation without its year cannot be read as current.", "how": "*Trade practice —* the Amman route is a referral rather than a web enquiry. A physician or a ministry in the sending country names the hospital, the hospital issues an invitation letter for the visa, and a family travels with the patient — often several, since the escort is part of the arrangement rather than an extra. Payment is state-funded for some sending countries, and cash or charitable for others.", "today": "As of 16 September 2026 no current inbound patient count for Jordan could be read for this record; the figures carried above are 2007 and 2008 and are labelled as such.", "notes": "Fifteen kilometres from the city point covers both halves of the city and the university hospitals to the north-west." }, "geo": { "lat": 31.9497, "lon": 35.9328, "precision": "city", "source": "s:wp-amman" }, "address": { "city": "Amman", "country": "JO" }, "kin": [ { "to": "jordan", "as": "The country this cluster is effectively the whole of.", "rel": "whole" }, { "to": "king-hussein-cancer-center", "as": "The hospital the city is named for abroad, on Queen Rania Street.", "rel": "part" }, { "to": "bone-marrow-transplant", "as": "The kind of work a regional referral centre is built to take.", "rel": "procedure" }, { "to": "cabg", "as": "Among the operations the 2007 and 2008 referral counts were made of.", "rel": "procedure" }, { "to": "the-escort-burden", "as": "Here the companion is part of the arrangement, and often several people rather than one.", "rel": "risk" }, { "to": "the-visa", "as": "The invitation letter the hospital issues is the step that makes the journey possible.", "rel": "step" }, { "to": "jci", "as": "The accreditor whose mark this city's flagship hospital carries, undated on the page read.", "rel": "accredited-by" }, { "to": "counting-patients", "as": "Why two-decade-old arrival figures keep getting repeated as current.", "rel": "story" }, { "to": "dubai", "as": "The Gulf destination that grew after this one and competes for the same referrals.", "rel": "contrast" } ], "links": [ { "label": "King Hussein Cancer Center", "url": "https://en.wikipedia.org/wiki/King_Hussein_Cancer_Center" } ], "sources": [ "s:wp-amman", "s:wp-khcc", "s:wp-pha-jordan", "s:wp-health-in-jordan", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:wp-health-in-jordan", "note": "the third paragraph is this project reasoning about what the counts describe" }, "text.how": { "tier": "tradition", "note": "the shape of a referral route into a regional centre" }, "geo": { "tier": "cited", "source": "s:wp-amman" }, "facets.radius_km": { "tier": "inference" } } }, "x_commons_files": [ "File:Amman skyline West Amman.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A capital of some five million people as of 2024, whose private hospitals sit in the modern western half of the city — the economic side, against the historic east — with the King Hussein Cancer Center on Queen Rania…", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "jordan", "type": "destination", "name": "Jordan", "as": "The country this cluster is effectively the whole of.", "rel": "whole" }, { "to": "king-hussein-cancer-center", "type": "facility", "name": "King Hussein Cancer Center", "as": "The hospital the city is named for abroad, on Queen Rania Street.", "rel": "part" }, { "to": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "The kind of work a regional referral centre is built to take.", "rel": "procedure" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "Among the operations the 2007 and 2008 referral counts were made of.", "rel": "procedure" }, { "to": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "Here the companion is part of the arrangement, and often several people rather than one.", "rel": "risk" }, { "to": "the-visa", "type": "pathway", "name": "The visa", "as": "The invitation letter the hospital issues is the step that makes the journey possible.", "rel": "step" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The accreditor whose mark this city's flagship hospital carries, undated on the page read.", "rel": "accredited-by" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why two-decade-old arrival figures keep getting repeated as current.", "rel": "story" }, { "to": "dubai", "type": "hub", "name": "Dubai", "as": "The Gulf destination that grew after this one and competes for the same referrals.", "rel": "contrast" } ], "source_list": [ { "id": "s:wp-amman", "kind": "wikipedia", "title": "Amman", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Amman", "accessed": "2026-09-16", "note": "coordinates, population five million as of 2024; West Amman named as the modern economic centre against the historic east" }, { "id": "s:wp-khcc", "kind": "wikipedia", "title": "King Hussein Cancer Center", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/King_Hussein_Cancer_Center", "accessed": "2026-09-16", "note": "Queen Rania Street, Amman; 352 beds; JCI accreditation, College of American Pathologists, ANCC Magnet and AAHRPP, none of them dated on the page; coordinates 32.0045, 35.8750" }, { "id": "s:wp-pha-jordan", "kind": "web", "title": "Private Hospitals Association (Jordan)", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Private_Hospitals_Association_(Jordan)", "accessed": "2026-09-16" }, { "id": "s:wp-health-in-jordan", "kind": "wikipedia", "title": "Health in Jordan", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Health_in_Jordan", "accessed": "2026-09-16", "note": "carries the 2007 and 2008 inbound patient counts of roughly 250,000 and the World Bank's regional ranking; the counts are nearly two decades old and their method is not stated on the page" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:wp-health-in-jordan", "note": "the third paragraph is this project reasoning about what the counts describe" }, "text.how": { "tier": "tradition", "note": "the shape of a referral route into a regional centre" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited", "source": "s:wp-amman" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "jordan", "type": "destination", "name": "Jordan", "as": "Where the private hospital ring is, and where nearly all of it happens.", "rel": "part" }, { "from": "king-hussein-cancer-center", "type": "facility", "name": "King Hussein Cancer Center", "as": "The institution the Amman cluster is built around, on Queen Rania Street.", "rel": "place" }, { "from": "who-travels", "type": "story", "name": "Who travels", "as": "Where the regional flow lands, and why it went there rather than to Delhi: the staff and the patient share a language.", "rel": "hub" } ] }, { "schema": 1, "id": "antalya", "type": "hub", "names": { "name": "Antalya", "aliases": [ "Antalya clinic-and-hotel belt" ], "said": "In the trade Antalya means the package: the clinic and the hotel quoted on one invoice, often by a travel agency rather than a hospital." }, "region": [ "west-asia" ], "facets": { "iso2": "TR", "radius_km": 25, "specialty": [ "hair restoration", "dentistry", "cosmetic surgery", "bariatric surgery", "ophthalmology", "thermal and spa" ], "draws": [ "hair-transplant-fue", "all-on-four", "dental-implant", "rhinoplasty", "gastric-sleeve", "lasik" ], "languages": [ "Turkish", "Russian", "German", "English", "Arabic" ] }, "text": { "what": "A Turkish Mediterranean city of 2,722,103 people in its metropolitan area, whose private clinics sit in the central Muratpaşa district and along the hotel strip at Lara, a short transfer from an airport that in 2020 carried more international passengers than Istanbul's two airports did. Antalya took more than 16.5 million foreign visitors in 2023. The health trade sells into that arrival machine: a resort room doubles as convalescence, and the invoice is frequently written by a licensed travel agency rather than by the hospital.", "story": "The agency on the invoice is not an accident of commerce; it is written into the law. The Turkish regulation of 13 July 2017 defines an international health tourism intermediary as a group A travel agency holding an operating certificate under Law 1618 of 14 September 1972, and requires both that agency and the treating facility to hold a Ministry authorisation certificate before either may trade with foreign patients. A country that ran a package-holiday industry first regulated surgery through it.\n\nThe state had been promoting the city for years before that. A 2012 catalogue published by the Antalya Promotion and Tourism Development company with BAKA, the West Mediterranean Development Agency, records that the Ministry of Health set up a Health Tourism Coordinating Unit in 2010, brought in promotion incentives in 2011, and ran an international patient assistance telephone line in English, German, Russian and Arabic. Its photographic credits name Dünya Göz Hospital, Aspendos Hospital and Akdeniz University Hospital.\n\nThat catalogue is a sales document, and it reads like one — it instructs a reader with a long queue at home and an expensive health system to buy a ticket. This directory carries it as evidence of what a development agency was selling in 2012, not as a description of care.\n\n*Inference —* Antalya's pitch differs from Istanbul's in one structural way. Istanbul sells a procedure to somebody who came for the procedure. Antalya sells a procedure attached to a stay that already had a reason, which lengthens the convalescence on the ground and shortens nothing about the follow-up at home.", "how": "*Trade practice —* the Antalya package is quoted per person and covers the transfer, the hotel nights, the operation and a companion's bed. The clinic day sits inside a longer stay, so a dental course of two or three visits fits a fortnight and a hair transplant leaves a week of sun to avoid. Deposits hold the date. What falls outside the quote is what falls outside everywhere: imaging, laboratory work, a complication, a night past the package, and the flight change if the surgeon says wait.", "today": "As of 16 September 2026 the 2017 regulation is the operative instrument, and the two documents that matter for a facility here are its health facility licence and its international health tourism authorisation certificate. No inbound patient count for the city is carried on this record.", "notes": "OpenStreetMap is queried 25 km around the city point, which reaches Konyaaltı in the west, Kepez in the north and the Lara hotel strip in the east." }, "geo": { "lat": 36.8869, "lon": 30.7033, "precision": "city", "source": "s:wp-antalya" }, "address": { "city": "Antalya", "country": "TR" }, "kin": [ { "to": "turkiye", "as": "The country whose authorisation regime this cluster trades under.", "rel": "whole" }, { "to": "istanbul", "as": "The other Turkish cluster: the same procedures, sold against a business district instead of a beach.", "rel": "contrast" }, { "to": "turkiye-health-tourism-authorisation", "as": "The certificate both the clinic and its agency must hold here.", "rel": "governed-by" }, { "to": "facilitator", "as": "In this city the facilitator is a licensed travel agency, and the law says so.", "rel": "term" }, { "to": "hair-transplant-fue", "as": "Sold here as a week that includes the hotel.", "rel": "procedure" }, { "to": "all-on-four", "as": "A dental course that fits the length of a resort stay.", "rel": "procedure" }, { "to": "gastric-sleeve", "as": "Sold here with the convalescence written into the hotel nights.", "rel": "procedure" }, { "to": "flying-after-surgery", "as": "The clot risk that decides whether the return flight on the package is the return flight taken.", "rel": "risk" }, { "to": "package-price", "as": "The form this city invented for holidays and now sells surgery in.", "rel": "term" }, { "to": "reading-the-exclusions", "as": "The step that matters most where a hotel, a transfer and an operation share one invoice.", "rel": "step" } ], "links": [ { "label": "Medical Tourism in Antalya — BAKA, 2012", "url": "https://baka.gov.tr/assets/upload/dosyalar/medical-tourism-in-antalya.pdf" } ], "sources": [ "s:wp-antalya", "s:baka-antalya-2012", "s:rg-saglik-turizmi-2017", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "tradition", "note": "the shape of a clinic-and-hotel package; no single page states it" }, "geo": { "tier": "cited", "source": "s:wp-antalya" }, "facets.radius_km": { "tier": "inference", "note": "25 km from the city point reaches Konyaaltı, Kepez and Lara" } } }, "x_commons_files": [ "File:Antalya Lara Beach hotels.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "A Turkish Mediterranean city of 2,722,103 people in its metropolitan area, whose private clinics sit in the central Muratpaşa district and along the hotel strip at Lara, a short transfer from an airport that in 2020…", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The country whose authorisation regime this cluster trades under.", "rel": "whole" }, { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "The other Turkish cluster: the same procedures, sold against a business district instead of a beach.", "rel": "contrast" }, { "to": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The certificate both the clinic and its agency must hold here.", "rel": "governed-by" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "In this city the facilitator is a licensed travel agency, and the law says so.", "rel": "term" }, { "to": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "Sold here as a week that includes the hotel.", "rel": "procedure" }, { "to": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "A dental course that fits the length of a resort stay.", "rel": "procedure" }, { "to": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "Sold here with the convalescence written into the hotel nights.", "rel": "procedure" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The clot risk that decides whether the return flight on the package is the return flight taken.", "rel": "risk" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The form this city invented for holidays and now sells surgery in.", "rel": "term" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step that matters most where a hotel, a transfer and an operation share one invoice.", "rel": "step" } ], "source_list": [ { "id": "s:wp-antalya", "kind": "wikipedia", "title": "Antalya", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Antalya", "accessed": "2026-09-16", "note": "coordinates, metropolitan population 2,722,103 (2024), Muratpaşa, Konyaaltı and Kepez districts, Lara beach, 16.5 million foreign visitors in 2023" }, { "id": "s:baka-antalya-2012", "kind": "web", "title": "Medical Tourism in Antalya", "publisher": "Antalya Promotion and Tourism Development Inc. and BAKA West Mediterranean Development Agency", "url": "https://baka.gov.tr/assets/upload/dosyalar/medical-tourism-in-antalya.pdf", "accessed": "2026-09-16", "note": "23-page promotional catalogue, BAKA Yayın No. 2012/75, ISBN 978-605-87282-9-5, 2012. Read page by page. A state development agency's sales document, and carried here as one: it states the Ministry of Health set up a Health Tourism Coordinating Unit in 2010, brought promotion incentives in 2011, and runs an International Patient Assistance line in English, German, Russian and Arabic. Photographic credits name Dünya Göz Hospital, Aspendos Hospital and Akdeniz University Hospital." }, { "id": "s:rg-saglik-turizmi-2017", "kind": "web", "title": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik", "publisher": "Resmî Gazete, Republic of Türkiye (Ministry of Health)", "url": "https://www.resmigazete.gov.tr/eskiler/2017/07/20170713-3.htm", "accessed": "2026-09-16", "note": "Resmî Gazete 13 July 2017, No. 30123. Read in Turkish off the Resmî Gazete page. Article 5(1) makes an international health tourism authorisation certificate (yetki belgesi) compulsory for both the health facility and the intermediary; the Ministry halts the activity of anyone without one. Transitional Article 1 gave those already trading one year to comply. Article 16: in force on publication. REPEALED: MADDE 17 of the regulation of 26 April 2025 (Resmî Gazete 32882) revokes this one. Cite it for what the regime was, not for what it is." }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "the shape of a clinic-and-hotel package; no single page states it" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited", "source": "s:wp-antalya" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "turkiye", "type": "destination", "name": "Türkiye", "as": "The second cluster, selling the same operations beside a resort strip.", "rel": "part" }, { "from": "istanbul", "type": "hub", "name": "Istanbul", "as": "The other Turkish cluster, selling the same procedures against a beach rather than a business district.", "rel": "contrast" }, { "from": "izmir", "type": "hub", "name": "İzmir", "as": "The other Turkish coast, selling the same procedures with the hotel written in.", "rel": "contrast" } ] }, { "schema": 1, "id": "bangkok", "type": "hub", "names": { "name": "Bangkok", "aliases": [ "กรุงเทพมหานคร", "Krung Thep", "Krung Thep Maha Nakhon" ], "said": "Krung Thep. In the trade Bangkok means two streets rather than a city: Sukhumvit, where Bumrungrad stands on Soi 3 and Samitivej on Soi 49, and New Phetchaburi, where Bangkok Hospital fills Soi Soonvijai." }, "region": [ "southeast-asia" ], "facets": { "iso2": "TH", "radius_km": 25, "specialty": [ "orthopaedics", "cardiology", "health screening", "fertility", "gender-affirming surgery", "dentistry", "oncology" ], "draws": [ "knee-replacement", "hip-replacement", "executive-health-screening", "dental-implant", "ivf", "vaginoplasty" ], "languages": [ "Thai", "English", "Arabic", "Japanese", "Mandarin" ] }, "text": { "what": "The private-hospital quarter of Bangkok runs along two corridors about four kilometres apart. Sukhumvit carries Bumrungrad at 33 Soi 3 in Watthana and Samitivej at 133 Soi 49 in Khlong Tan Nuea; New Phetchaburi carries Bangkok Hospital at 2 Soi Phetchaburi 47, the lane the taxis still call Soi Soonvijai, in Bang Kapi, Huai Khwang. Add the university hospitals — Siriraj across the river, Chulalongkorn at Rama IV — and the dental and cosmetic shopfronts strung between them, and the cluster is the densest concentration of fixed-price surgery sold to foreigners anywhere in Asia.", "story": "The corridor grew outward from Sukhumvit, where the embassies, the serviced apartments and the Arabic-speaking quarter around Soi 3 already were. Bumrungrad opened there in 1980 and took Joint Commission International accreditation in 2002; Samitivej settled on Soi 49 in the Thonglor end, where about 40 per cent of its patients were reported to be non-Thai as of 2009. Bangkok Hospital, opened on 26 February 1972, sits off New Phetchaburi with 488 inpatient beds and grew into the hub of a listed hospital group rather than a single building.\n\n*Trade practice —* the corridors also explain the shape of the day. A patient staying in a Sukhumvit hotel can reach three hospitals, two dental groups and a laboratory without leaving the Skytrain, and the hospitals price and market against each other at that walking distance. Soi Soonvijai is the exception: the Bangkok Hospital campus is a compound of its own, reached by taxi, and its scale is the argument it makes.\n\n*Inference —* the second-order effect is a marketplace rather than a destination. Because a dozen hospitals quote against each other in the same few square kilometres, the package price with its inclusion and exclusion list became the local unit of account, and the exclusion list became the place a reader has to look.", "how": "A Bangkok inquiry is answered by an international patient department, in English, Arabic, Japanese or Mandarin at the largest hospitals, with a quoted package naming the operation, the surgeon, the anaesthetist, a fixed number of ward nights and a list of what is billed on top. The implant, the imaging, the laboratory work and every night past the package are the usual exclusions. A deposit is taken before admission and the balance settled at discharge.", "today": "As of 16 September 2026 the harvest point for this hub sits between the Sukhumvit and New Phetchaburi corridors, with a 25-kilometre radius that reaches Siriraj and Chulalongkorn to the west and the Praram 9 and Vejthani hospitals to the east. Bumrungrad's published knee package and the prices beside it are read on the procedure pages, each with its own date.", "notes": "This is a description of a district. Nothing here is advice about treatment or about where to have it." }, "geo": { "lat": 13.744, "lon": 100.569, "precision": "city", "source": "s:osm-nominatim" }, "address": { "city": "Bangkok", "area": "Watthana and Huai Khwang", "country": "TH" }, "kin": [ { "to": "bumrungrad", "as": "The hospital on Sukhumvit Soi 3 that the cluster is usually named for.", "rel": "part" }, { "to": "bangkok-hospital", "as": "The Soi Soonvijai campus off New Phetchaburi, the other pole of the cluster.", "rel": "part" }, { "to": "samitivej", "as": "The Soi 49 hospital at the Thonglor end of the Sukhumvit corridor.", "rel": "part" }, { "to": "thailand", "as": "The country this cluster does nearly all the work for.", "rel": "whole" }, { "to": "knee-replacement", "as": "Sold here at a published fixed price, implant billed separately.", "rel": "procedure" }, { "to": "hip-replacement", "as": "The other joint on the same package pages.", "rel": "procedure" }, { "to": "executive-health-screening", "as": "The day-long screening package that fills the quiet end of these hospitals' order books.", "rel": "procedure" }, { "to": "vaginoplasty", "as": "Bangkok surgeons took this work early, and the city is still where much of it is quoted.", "rel": "procedure" }, { "to": "package-price", "as": "The unit of account a dozen hospitals within a few kilometres quote each other in.", "rel": "term" }, { "to": "phuket", "as": "The island cluster that sells a different mix to a different arrival.", "rel": "contrast" }, { "to": "osm-facilities", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 25 kilometres of this point.", "rel": "measured-by" }, { "to": "chiang-mai", "as": "Six hundred kilometres north, selling the long stay rather than the operation.", "rel": "contrast" } ], "links": [ { "label": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/" }, { "label": "Bangkok Hospital", "url": "https://www.bangkokhospital.com/" } ], "sources": [ "s:osm-nominatim", "s:wp-bumrungrad", "s:wp-bangkok-hospital", "s:wp-samitivej", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "streets and house numbers read off OpenStreetMap address tags and the hospitals' Wikipedia entries" }, "text.story": { "tier": "tradition", "note": "the trade's account of why the two corridors formed; the inline marks say which stretches are inference" }, "text.how": { "tier": "tradition", "note": "the standard shape of an international patient department in this city" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "the midpoint between the Sukhumvit and New Phetchaburi anchors, not a point anybody published" } } }, "x_commons_files": [ "File:Bumrungrad International Hospital.jpg", "File:Sukhumvit Road Bangkok.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "The private-hospital quarter of Bangkok runs along two corridors about four kilometres apart.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "The hospital on Sukhumvit Soi 3 that the cluster is usually named for.", "rel": "part" }, { "to": "bangkok-hospital", "type": "facility", "name": "Bangkok Hospital", "as": "The Soi Soonvijai campus off New Phetchaburi, the other pole of the cluster.", "rel": "part" }, { "to": "samitivej", "type": "facility", "name": "Samitivej Sukhumvit Hospital", "as": "The Soi 49 hospital at the Thonglor end of the Sukhumvit corridor.", "rel": "part" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "The country this cluster does nearly all the work for.", "rel": "whole" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "Sold here at a published fixed price, implant billed separately.", "rel": "procedure" }, { "to": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "The other joint on the same package pages.", "rel": "procedure" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The day-long screening package that fills the quiet end of these hospitals' order books.", "rel": "procedure" }, { "to": "vaginoplasty", "type": "procedure", "name": "Vaginoplasty", "as": "Bangkok surgeons took this work early, and the city is still where much of it is quoted.", "rel": "procedure" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The unit of account a dozen hospitals within a few kilometres quote each other in.", "rel": "term" }, { "to": "phuket", "type": "hub", "name": "Phuket", "as": "The island cluster that sells a different mix to a different arrival.", "rel": "contrast" }, { "to": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 25 kilometres of this point.", "rel": "measured-by" }, { "to": "chiang-mai", "type": "hub", "name": "Chiang Mai", "as": "Six hundred kilometres north, selling the long stay rather than the operation.", "rel": "contrast" } ], "source_list": [ { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." }, { "id": "s:wp-bumrungrad", "kind": "wikipedia", "title": "Bumrungrad International Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Bumrungrad_International_Hospital", "accessed": "2026-09-16", "license": "CC BY-SA 4.0" }, { "id": "s:wp-bangkok-hospital", "kind": "wikipedia", "title": "Bangkok Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Bangkok_Hospital", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-samitivej", "kind": "wikipedia", "title": "Samitivej Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Samitivej_Hospital", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "streets and house numbers read off OpenStreetMap address tags and the hospitals' Wikipedia entries" }, "text.story": { "tier": "tradition", "note": "the trade's account of why the two corridors formed; the inline marks say which stretches are inference" }, "text.how": { "tier": "tradition", "note": "the standard shape of an international patient department in this city" }, "text.today": { "tier": "cited" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "the midpoint between the Sukhumvit and New Phetchaburi anchors, not a point anybody published" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "thailand", "type": "destination", "name": "Thailand", "as": "Where nearly all of it happens.", "rel": "part" }, { "from": "chiang-mai", "type": "hub", "name": "Chiang Mai", "as": "Where the complex cases and the flagship private hospitals are, six hundred kilometres south.", "rel": "contrast" }, { "from": "phuket", "type": "hub", "name": "Phuket", "as": "The capital cluster that sells the complex work this island refers upward to.", "rel": "contrast" }, { "from": "singapore-city", "type": "hub", "name": "Singapore", "as": "The other, and the one that made the published package price ordinary.", "rel": "contrast" }, { "from": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The hub whose hospitals sell screening as the first purchase.", "rel": "place" }, { "from": "icl", "type": "procedure", "name": "Implantable collamer lens", "as": "The city whose hospital eye centres sell both halves of this choice from one list.", "rel": "place" }, { "from": "lasik", "type": "procedure", "name": "LASIK", "as": "The city whose hospital eye centres sell refractive surgery as a package.", "rel": "place" }, { "from": "phalloplasty", "type": "procedure", "name": "Phalloplasty", "as": "The city holding that hospital and the surgeons whose flap techniques are on their pages without prices.", "rel": "hub" }, { "from": "vaginoplasty", "type": "procedure", "name": "Vaginoplasty", "as": "The city holding the hospital that publishes those prices, and two long-established clinics that publish none.", "rel": "hub" }, { "from": "bangkok-hospital", "type": "facility", "name": "Bangkok Hospital", "as": "The hospital at the eastern end of the Bangkok cluster, off New Phetchaburi rather than Sukhumvit.", "rel": "place" }, { "from": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "The hospital the Bangkok cluster is usually named for.", "rel": "place" }, { "from": "samitivej", "type": "facility", "name": "Samitivej Sukhumvit Hospital", "as": "The Sukhumvit end of the Bangkok cluster, four soi east of Bumrungrad.", "rel": "place" }, { "from": "thai-medical-visa", "type": "rule", "name": "Thailand's medical treatment visa", "as": "Where nearly every holder is treated.", "rel": "hub" }, { "from": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "521 rows inside 25 km of the hub's point, against Bengaluru's 2,548 inside the same radius.", "rel": "measures" } ] }, { "schema": 1, "id": "barcelona", "type": "hub", "names": { "name": "Barcelona", "aliases": [ "Barna" ], "said": "Fertility clinics here say programme and cite a donor pool; patients arriving from countries with donor registers say Spain and mean anonymity." }, "region": [ "europe-south" ], "facets": { "iso2": "ES", "radius_km": 15, "specialty": [ "fertility", "reproductive medicine", "oncology", "orthopaedics", "cosmetic surgery" ], "draws": [ "ivf", "egg-donation", "icsi", "egg-freezing", "pgt" ], "languages": [ "Catalan", "Spanish", "English", "French", "Italian" ] }, "text": { "what": "A city of 1,686,208 people in ten districts, with the private fertility clinics that draw foreign patients spread through Eixample and Sarrià-Sant Gervasi, and the large teaching hospitals — the Clínic in Eixample, Sant Pau above it, Vall d'Hebron on the northern edge — holding the complex work. Barcelona's export is reproductive medicine, and the country it sits in reports more treatment cycles than any European state except Russia.", "story": "The figure to stand on is a registry return. The European IVF-monitoring Consortium of ESHRE, reporting 2019, recorded 137,276 cycles in Spain from 244 IVF clinics — second in Europe behind Russia's 161,166, out of 1,077,813 cycles collected from 40 countries — and named Spain first among the countries reporting the highest egg-donation volumes.\n\n*Inference —* those are national figures, and Barcelona is one of two Spanish cities that carry most of them. What the national ranking does say, plainly, is that the volume is not generated by Spanish residents alone: it is bought by patients flying in, which is the definition of the trade this directory describes.\n\n*Trade practice —* what they fly for is supply and a rule. Spanish clinics advertise a matched donor within weeks rather than a wait of years, and donation here is anonymous — which is the attraction for some patients and the objection for others, since a child born of it cannot later identify the donor. The instrument that settles that, and its date, belongs on the donor anonymity record rather than here.\n\nAn insured EU patient has a reimbursement route under Directive 2011/24/EU at the home tariff. For fertility treatment that route is narrow, because a treatment a home system does not fund at all is not reimbursed by it.", "how": "*Trade practice —* the Barcelona programme starts remotely: records and hormone results sent ahead, a video consultation, a quoted programme price in euros. The donor is matched by the clinic and never met. The patient is in the city for the transfer and for a few days around it, and for the retrieval where her own eggs are used. Medication, freezing, storage and the second attempt are quoted separately, and the second attempt is the line that moves a budget most.", "today": "As of 16 September 2026 this record carries no price row for Barcelona: the clinic programme prices read for this batch were quoted without a date on the page, and a price without its date is not a price.", "notes": "Fifteen kilometres from the city point covers all ten districts and reaches Vall d'Hebron and the Besòs edge." }, "geo": { "lat": 41.3833, "lon": 2.1833, "precision": "city", "source": "s:wp-barcelona" }, "address": { "city": "Barcelona", "area": "Catalonia", "country": "ES" }, "kin": [ { "to": "spain", "as": "The country whose registry volume this city carries a large share of.", "rel": "whole" }, { "to": "egg-donation", "as": "The treatment this city is flown to for, and the one Spain reports the most of in Europe.", "rel": "procedure" }, { "to": "ivf", "as": "The cycle every programme quoted here is built around.", "rel": "procedure" }, { "to": "egg-freezing", "as": "The other reason a patient books a retrieval here rather than at home.", "rel": "procedure" }, { "to": "prague", "as": "The other European donation centre, reporting the next largest volumes.", "rel": "contrast" }, { "to": "donor-anonymity-law", "as": "The rule that brings some patients here and keeps others away.", "rel": "governed-by" }, { "to": "reproductive-exile", "as": "The word for the journey most of this city's fertility traffic is making.", "rel": "term" }, { "to": "eshre", "as": "The society whose registry return is the count this record stands on.", "rel": "measured-by" }, { "to": "eu-directive-2011-24", "as": "A reimbursement route that is narrow here, because a home system that funds nothing reimburses nothing.", "rel": "governed-by" }, { "to": "counting-patients", "as": "Why a national cycle count is not a count of people who travelled.", "rel": "story" } ], "links": [ { "label": "ART in Europe, 2019 (ESHRE EIM)", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10694409/" } ], "sources": [ "s:wp-barcelona", "s:eshre-eim-2019", "s:eu-directive-2011-24", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:wp-barcelona", "note": "the district names and population are cited; which hospitals sit in which district is general knowledge of the city and not read off a page for this record" }, "text.story": { "tier": "cited", "source": "s:eshre-eim-2019", "note": "paragraphs two and three are marked inline as inference and trade practice" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "cited", "source": "s:wp-barcelona" }, "facets.radius_km": { "tier": "inference" } } }, "x_commons_files": [ "File:Hospital de Sant Pau Barcelona.jpg", "File:Eixample Barcelona aerial.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A city of 1,686,208 people in ten districts, with the private fertility clinics that draw foreign patients spread through Eixample and Sarrià-Sant Gervasi, and the large teaching hospitals — the Clínic in Eixample, Sant…", "region_terms": [ { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" } ], "kin_out": [ { "to": "spain", "type": "destination", "name": "Spain", "as": "The country whose registry volume this city carries a large share of.", "rel": "whole" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The treatment this city is flown to for, and the one Spain reports the most of in Europe.", "rel": "procedure" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The cycle every programme quoted here is built around.", "rel": "procedure" }, { "to": "egg-freezing", "type": "procedure", "name": "Egg freezing", "as": "The other reason a patient books a retrieval here rather than at home.", "rel": "procedure" }, { "to": "prague", "type": "hub", "name": "Prague", "as": "The other European donation centre, reporting the next largest volumes.", "rel": "contrast" }, { "to": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The rule that brings some patients here and keeps others away.", "rel": "governed-by" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The word for the journey most of this city's fertility traffic is making.", "rel": "term" }, { "to": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "The society whose registry return is the count this record stands on.", "rel": "measured-by" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "A reimbursement route that is narrow here, because a home system that funds nothing reimburses nothing.", "rel": "governed-by" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a national cycle count is not a count of people who travelled.", "rel": "story" } ], "source_list": [ { "id": "s:wp-barcelona", "kind": "wikipedia", "title": "Barcelona", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Barcelona", "accessed": "2026-09-16", "note": "coordinates, population 1,686,208 (2024), the ten districts including Eixample, Ciutat Vella, Gràcia and Sarrià-Sant Gervasi; describes the city as the main biotech hub in Spain" }, { "id": "s:eshre-eim-2019", "kind": "web", "title": "ART in Europe, 2019: results generated from European registries by ESHRE", "publisher": "Human Reproduction (Oxford University Press) for the European IVF-monitoring Consortium of ESHRE", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10694409/", "accessed": "2026-09-16", "note": "Smeenk J, Wyns C, De Geyter C, et al., Human Reproduction 2023;38(12):2321–2338, doi:10.1093/humrep/dead197. Registry returns, not a market estimate: 1,077,813 cycles from 1,488 clinics in 40 countries for 2019. Spain reported 137,276 cycles, second in Europe after Russia, from 244 IVF clinics; the highest egg-donation volumes came from Spain, Czechia and Russia." }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:wp-barcelona", "note": "the district names and population are cited; which hospitals sit in which district is general knowledge of the city and not read off a page for this record" }, "text.story": { "tier": "cited", "source": "s:eshre-eim-2019", "note": "paragraphs two and three are marked inline as inference and trade practice" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited", "source": "s:wp-barcelona" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "spain", "type": "destination", "name": "Spain", "as": "The city with the densest concentration of the clinics counted here.", "rel": "part" }, { "from": "prague", "type": "hub", "name": "Prague", "as": "The other European donation centre, reporting larger volumes still.", "rel": "contrast" } ] }, { "schema": 1, "id": "bengaluru", "type": "hub", "names": { "name": "Bengaluru", "aliases": [ "ಬೆಂಗಳೂರು", "Bangalore" ], "said": "Ben-ga-loo-roo. The heart work is not in the city: it is twenty kilometres down Hosur Road at Bommasandra, past the electronics parks, and the taxi fare there is part of the quote nobody quotes." }, "region": [ "south-asia" ], "facets": { "iso2": "IN", "radius_km": 25, "specialty": [ "cardiac surgery", "transplant", "oncology", "orthopaedics", "neurosurgery" ], "draws": [ "cabg", "heart-valve-replacement", "angioplasty-stent", "knee-replacement", "bone-marrow-transplant" ], "languages": [ "Kannada", "English", "Hindi", "Tamil" ] }, "text": { "what": "Two poles, about twenty kilometres apart. Narayana Health City stands on Hosur Road at Bommasandra, on the far southern edge of the city beyond the Electronics City corridor, where Devi Prasad Shetty put a 280-bed cardiac hospital in 2000 and then a campus around it. The older pole is central: Manipal Hospital on HAL Old Airport Road at Kodihalli, with the private hospitals and diagnostic chains of Indiranagar and Richmond Town around it. Whitefield, twelve kilometres east of the centre, is the third and newest.", "story": "Devi Prasad Shetty founded Narayana Hrudayalaya in 2000 with an initial 280-bed cardiac facility; the group as of 2025 runs 24 hospitals and seven heart centres and reported revenue of ₹5,483 crore. It opened Health City Cayman Islands in 2014 — an Indian hospital group building a hospital in the Caribbean to sell to Americans, which is the export of a format rather than of a service.\n\n*Trade practice —* Bengaluru's argument in the trade has always been volume rather than location. A cardiac programme doing several thousand operations a year on a campus at the edge of the city prices differently from a tower in a capital, and the city's surgeons have said so in public for twenty years.\n\n*Inference —* the geography is what the harvest has to solve. Bommasandra and Old Airport Road are twenty kilometres apart with almost nothing clinical between them, so a point set on either misses the other. This record splits the difference and takes a 25-kilometre radius, which also catches Whitefield.", "how": "An estimate against a room category and a projected stay, as everywhere in India, with an international desk handling the visa invitation and the interpreter. What is different here is the distance: the hospital at Bommasandra is an hour from the airport on a good day and further from the hotels, and the companion's accommodation is a separate arrangement rather than a floor upstairs.", "today": "As of 16 September 2026 the harvest point for this hub sits between Bommasandra and Old Airport Road, with a 25-kilometre radius reaching both and Whitefield beyond. No Bengaluru price has been read off a page into this directory yet.", "notes": "A description of two hospital districts and the road between them. Not advice about cardiac surgery." }, "geo": { "lat": 12.885, "lon": 77.672, "precision": "city", "source": "s:osm-nominatim" }, "address": { "city": "Bengaluru", "area": "Karnataka", "country": "IN" }, "kin": [ { "to": "narayana-health", "as": "The Hosur Road campus at Bommasandra the southern pole is built on.", "rel": "part" }, { "to": "devi-shetty", "as": "The cardiac surgeon who put a 280-bed heart hospital at the edge of this city in 2000.", "rel": "person" }, { "to": "india", "as": "The country whose highest-volume cardiac programmes sit here.", "rel": "whole" }, { "to": "cabg", "as": "The operation the southern campus was built to do at volume.", "rel": "procedure" }, { "to": "heart-valve-replacement", "as": "The other half of the cardiac list this city is known for.", "rel": "procedure" }, { "to": "knee-replacement", "as": "Sold on an estimate in the central hospitals rather than as a package.", "rel": "procedure" }, { "to": "india-e-medical-visa", "as": "The entry route foreign patients arrive on.", "rel": "governed-by" }, { "to": "chennai", "as": "The neighbouring cardiac cluster, older and closer to its airport.", "rel": "contrast" }, { "to": "the-companion", "as": "Twenty kilometres from the city means the relative needs housing, not a chair.", "rel": "step" }, { "to": "osm-facilities", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 25 kilometres of this point.", "rel": "measured-by" } ], "links": [ { "label": "Narayana Health", "url": "https://www.narayanahealth.org/" } ], "sources": [ "s:osm-nominatim", "s:wp-narayana-health", "s:wp-medical-tourism-india", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "Bommasandra and Old Airport Road located from OpenStreetMap address tags" }, "text.story": { "tier": "cited", "source": "s:wp-narayana-health", "note": "the founding, the group figures and the Cayman hospital are cited; the inline marks say which stretches are inference and trade practice" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "the midpoint between the Bommasandra and Old Airport Road poles, not a point anybody published" } } }, "x_commons_files": [ "File:Narayana Health City Bangalore.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "Two poles, about twenty kilometres apart. Narayana Health City stands on Hosur Road at Bommasandra, on the far southern edge of the city beyond the Electronics City corridor, where Devi Prasad Shetty put a 280-bed…", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" } ], "kin_out": [ { "to": "narayana-health", "type": "facility", "name": "Narayana Health", "as": "The Hosur Road campus at Bommasandra the southern pole is built on.", "rel": "part" }, { "to": "devi-shetty", "type": "person", "name": "Devi Prasad Shetty", "as": "The cardiac surgeon who put a 280-bed heart hospital at the edge of this city in 2000.", "rel": "person" }, { "to": "india", "type": "destination", "name": "India", "as": "The country whose highest-volume cardiac programmes sit here.", "rel": "whole" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The operation the southern campus was built to do at volume.", "rel": "procedure" }, { "to": "heart-valve-replacement", "type": "procedure", "name": "Heart valve replacement", "as": "The other half of the cardiac list this city is known for.", "rel": "procedure" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "Sold on an estimate in the central hospitals rather than as a package.", "rel": "procedure" }, { "to": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The entry route foreign patients arrive on.", "rel": "governed-by" }, { "to": "chennai", "type": "hub", "name": "Chennai", "as": "The neighbouring cardiac cluster, older and closer to its airport.", "rel": "contrast" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "Twenty kilometres from the city means the relative needs housing, not a chair.", "rel": "step" }, { "to": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 25 kilometres of this point.", "rel": "measured-by" } ], "source_list": [ { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." }, { "id": "s:wp-narayana-health", "kind": "wikipedia", "title": "Narayana Health", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Narayana_Health", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-medical-tourism-india", "kind": "wikipedia", "title": "Medical tourism in India", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_India", "license": "CC BY-SA 4.0", "accessed": "2026-09-16", "note": "carries city-share and market-size figures sourced to newspapers and market-research summaries; this project reads it for the claims and their attributions, not as a count." }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "Bommasandra and Old Airport Road located from OpenStreetMap address tags" }, "text.story": { "tier": "cited", "source": "s:wp-narayana-health", "note": "the founding, the group figures and the Cayman hospital are cited; the inline marks say which stretches are inference and trade practice" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "the midpoint between the Bommasandra and Old Airport Road poles, not a point anybody published" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "india", "type": "destination", "name": "India", "as": "Where the volume-surgery model was built and costed.", "rel": "part" }, { "from": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The city outside which the cheap-bypass argument was built.", "rel": "place" }, { "from": "narayana-health", "type": "facility", "name": "Narayana Health", "as": "The city its first hospital was built outside, at Bommasandra on the Hosur road.", "rel": "place" }, { "from": "devi-shetty", "type": "person", "name": "Devi Prasad Shetty", "as": "Where the first hospital was built, on the southern edge of the city.", "rel": "hub" }, { "from": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The largest harvest on this site at 2,548 rows, and a lesson in reading map coverage as medical density.", "rel": "measures" } ] }, { "schema": 1, "id": "bogota", "type": "hub", "names": { "name": "Bogotá", "aliases": [ "Bogota", "Santafé de Bogotá", "Distrito Capital" ], "said": "Bo-go-TAH. At 2,640 metres it is the third-highest capital in the world, which is a clinical fact before it is a geographical one." }, "region": [ "south-america" ], "facets": { "iso2": "CO", "radius_km": 25, "specialty": [ "cardiology", "oncology", "transplant", "neurosurgery", "ophthalmology", "orthopaedics" ], "draws": [ "cabg", "angioplasty-stent", "heart-valve-replacement", "kidney-transplant", "bone-marrow-transplant", "gamma-knife", "cataract-surgery" ], "languages": [ "Spanish", "English" ] }, "text": { "what": "Colombia's capital and largest city, the country's medical as well as political centre, sitting at 2,640 metres on the Bogotá savanna. Its export trade is complex hospital work — cardiac, oncological, transplant and neurosurgical — sold mostly to patients from elsewhere in Colombia, from the Caribbean and from Central America, rather than to North Americans on a package.", "story": "Fundación Santa Fe de Bogotá publishes the clearest accreditation record of any institution in this batch: not a logo but a timeline. Its own page gives six Joint Commission International cycles — first accreditation in 2010, then reaccreditation in 2013, 2016, 2019, 2022 and 2025. That is fifteen unbroken years on a three-year cycle, each renewal named and dated.\n\n*Inference —* the timeline is worth more than the mark. An accreditation badge tells a reader that a hospital passed an inspection at some unstated moment; a published cycle list tells them when, how often, and whether anything lapsed. The Cancún hospital in this same batch prints its expiry dates and they have passed; the Bogotá one prints its renewal dates and they have not. Both are being more forthcoming than a hospital that prints a logo alone.\n\nBogotá's altitude is the other thing that distinguishes it. At 2,640 metres the arterial oxygen a patient arrives with is lower than at sea level, and a cardiac or respiratory case flying in from the coast is being asked to acclimatise before being operated on. No page in this project's sources quantifies that, and this record does not.", "how": "Patients arrive by air at El Dorado and are admitted rather than accommodated: this is inpatient medicine. Colombian private hospitals bill per case and negotiate with foreign insurers where one exists. A non-resident coming for treatment whose stay is expected to run beyond ninety days needs a Colombian health visa, which is applied for through the Cancillería.", "today": "As of 16 September 2026 Fundación Santa Fe de Bogotá states six Joint Commission International cycles, the most recent in 2025." }, "geo": { "lat": 4.7111, "lon": -74.0722, "precision": "city", "source": "s:wp-bogota" }, "address": { "city": "Bogotá", "area": "Distrito Capital", "country": "CO" }, "tags": [ { "tag": "outcomes-published", "source": "s:fsfb-jci", "tier": "cited", "note": "the hospital publishes its accreditation cycle by cycle with dates, which is not the same as clinical outcomes but is more than a logo", "url": "https://fundacionsantafedebogota.com/publicaciones/certificacion-joint-comission-international-jci" } ], "kin": [ { "to": "colombia", "as": "The country whose complex hospital work concentrates here rather than in Medellín.", "rel": "destination" }, { "to": "fundacion-santa-fe", "as": "The hospital whose six dated accreditation cycles this record reads.", "rel": "place" }, { "to": "medellin", "as": "The other Colombian hub — cosmetic and dental where this one is cardiac and oncological.", "rel": "contrast" }, { "to": "jci", "as": "Accredited the city's flagship hospital in 2010 and has renewed it five times since.", "rel": "accredited-by" }, { "to": "cabg", "as": "The kind of work that brings a patient to Bogotá rather than to a coast.", "rel": "performs" }, { "to": "kidney-transplant", "as": "Transplant medicine is part of what the city's hospitals sell across borders, and it is the part with the sharpest rules.", "rel": "performs" }, { "to": "declaration-of-istanbul-group", "as": "The framework that governs whether a foreign patient may be transplanted at all.", "rel": "governed-by" }, { "to": "the-accreditation-question", "as": "A dated six-cycle timeline is the most useful answer this batch found to it.", "rel": "story" }, { "to": "the-visa", "as": "Colombia asks for a health visa where the stay runs past ninety days.", "rel": "step" } ], "links": [ { "label": "Fundación Santa Fe de Bogotá — JCI accreditation timeline", "url": "https://fundacionsantafedebogota.com/publicaciones/certificacion-joint-comission-international-jci" } ], "sources": [ "s:wp-bogota", "s:fsfb-jci", "s:lasamericas-visa" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:fsfb-jci", "note": "the cycle list is the hospital's own page, read 16 September 2026; the second paragraph is marked as this project's reasoning and the third states what it cannot source" }, "text.how": { "tier": "tradition", "source": "s:lasamericas-visa", "note": "the ninety-day health visa threshold is cited; the rest is the general shape of an inpatient referral trade" } } }, "x_commons_files": [ "File:Bogota skyline.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "Colombia's capital and largest city, the country's medical as well as political centre, sitting at 2,640 metres on the Bogotá savanna.", "region_terms": [ { "key": "south-america", "name": "South America", "note": "Colombia, Brazil, Argentina, Chile, Peru" } ], "kin_out": [ { "to": "colombia", "type": "destination", "name": "Colombia", "as": "The country whose complex hospital work concentrates here rather than in Medellín.", "rel": "destination" }, { "to": "fundacion-santa-fe", "type": "facility", "name": "Fundación Santa Fe de Bogotá", "as": "The hospital whose six dated accreditation cycles this record reads.", "rel": "place" }, { "to": "medellin", "type": "hub", "name": "Medellín", "as": "The other Colombian hub — cosmetic and dental where this one is cardiac and oncological.", "rel": "contrast" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "Accredited the city's flagship hospital in 2010 and has renewed it five times since.", "rel": "accredited-by" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The kind of work that brings a patient to Bogotá rather than to a coast.", "rel": "performs" }, { "to": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "Transplant medicine is part of what the city's hospitals sell across borders, and it is the part with the sharpest rules.", "rel": "performs" }, { "to": "declaration-of-istanbul-group", "type": "org", "name": "Declaration of Istanbul Custodian Group", "as": "The framework that governs whether a foreign patient may be transplanted at all.", "rel": "governed-by" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "A dated six-cycle timeline is the most useful answer this batch found to it.", "rel": "story" }, { "to": "the-visa", "type": "pathway", "name": "The visa", "as": "Colombia asks for a health visa where the stay runs past ninety days.", "rel": "step" } ], "source_list": [ { "id": "s:wp-bogota", "kind": "web", "title": "Bogotá", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Bogot%C3%A1", "accessed": "2026-09-16" }, { "id": "s:fsfb-jci", "kind": "web", "title": "Certificación Joint Comission International (JCI)", "publisher": "Fundación Santa Fe de Bogotá", "url": "https://fundacionsantafedebogota.com/publicaciones/certificacion-joint-comission-international-jci", "accessed": "2026-09-16", "note": "the hospital's own accreditation timeline: first cycle 2010, then 2013, 2016, 2019, 2022 and 2025" }, { "id": "s:lasamericas-visa", "kind": "web", "title": "Visa Médica en Colombia", "publisher": "Clínica Las Américas Auna, Medellín", "url": "https://www.lasamericas.com.co/oficina-internacional/paso-a-paso/visa-medica-en-colombia", "accessed": "2026-09-16", "note": "states that a non-resident foreigner coming for treatment, and any companion, needs a Colombian health visa where the stay is expected to exceed 90 days, and points at the Cancillería de Colombia" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:fsfb-jci", "note": "the cycle list is the hospital's own page, read 16 September 2026; the second paragraph is marked as this project's reasoning and the third states what it cannot source" }, "text.how": { "tier": "tradition", "source": "s:lasamericas-visa", "note": "the ninety-day health visa threshold is cited; the rest is the general shape of an inpatient referral trade" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [ { "key": "outcomes-published", "label": "Publishes outcomes", "icon": "📊", "group": "clinical", "evidence": "a registry submission, an annual clinical report, or a national outcome dataset naming the unit", "source": "s:fsfb-jci", "note": "the hospital publishes its accreditation cycle by cycle with dates, which is not the same as clinical outcomes but is more than a logo", "tier": "cited", "url": "https://fundacionsantafedebogota.com/publicaciones/certificacion-joint-comission-international-jci" } ], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "colombia", "type": "destination", "name": "Colombia", "as": "The capital cluster, where the teaching hospitals and complex cases sit.", "rel": "part" }, { "from": "medellin", "type": "hub", "name": "Medellín", "as": "The other Colombian hub — cardiac and oncological where this one is cosmetic.", "rel": "contrast" }, { "from": "fundacion-santa-fe", "type": "facility", "name": "Fundación Santa Fe de Bogotá", "as": "The academic hospital the Bogotá cluster is anchored on, in the north of the city on Calle 119.", "rel": "place" } ] }, { "schema": 1, "id": "budapest", "type": "hub", "names": { "name": "Budapest", "aliases": [ "Buda and Pest" ], "said": "Dental clinics advertise a district number — V, VI, XIII — because a Hungarian address is read that way, and because the inner Pest districts are the short walk from a hotel." }, "region": [ "europe-central" ], "facets": { "iso2": "HU", "radius_km": 15, "specialty": [ "dentistry", "oral surgery", "fertility", "cosmetic surgery", "thermal and spa" ], "draws": [ "dental-implant", "all-on-four", "dental-crown", "veneers", "full-mouth-restoration", "ivf" ], "languages": [ "Hungarian", "German", "English" ] }, "text": { "what": "A capital of 1,685,209 people split by the Danube into hilly Buda and flat Pest, administered in 23 districts written in Roman numerals. The dental surgeries that foreign patients use cluster in inner Pest — District V, Belváros-Lipótváros, District VI, Terézváros, along Andrássy Avenue, and District XIII — inside a walk or two tram stops of the hotels. Budapest is also a spa city: it carries more than 100 medicinal geothermal springs and Ottoman-built baths at Rudas and Király still in use five centuries on.", "story": "Hungarian cross-border dentistry began on the Austrian frontier rather than here. Under Goulash Communism, German and Austrian visitors started seeing Hungarian dentists; the border towns took the day-trip traffic, and prices settled at a third to a half of Vienna's. Budapest is the version of that trade with an international airport attached, which changes who can reach it and how long they stay.\n\n*Trade practice —* the capital's clinics therefore sell a different unit from the border towns. A Sopron surgery sells a morning. A Budapest clinic sells a course: two visits some months apart, with a temporary bridge in between, because implants need to integrate before anything is loaded onto them.\n\nFor a patient insured in another EU or EEA state there is a reimbursement route as well as a price. Directive 2011/24/EU on patients' rights in cross-border healthcare gives an entitlement to be reimbursed at the home tariff for care that would have been covered at home, which for dentistry is usually a fraction of the bill and for some treatments requires prior authorisation.\n\n*Inference —* the directive matters less to this city's trade than the price does. A patient paying a third of the Vienna price out of pocket is not waiting on a reimbursement form, and the clinics quote as though nobody is.", "how": "*Trade practice —* the Budapest course starts with a panoramic radiograph and a written plan, sometimes made from images sent ahead. Extractions, bone graft where needed and implant placement happen on the first visit; the crowns or the bridge go on three to six months later. Clinics quote per implant and per crown rather than per mouth, and the difference between a quote and a final bill is usually the graft, the extractions and the number of units. Hotel nights are sold alongside by the larger clinics.", "today": "As of 16 September 2026 this record carries no price row for Budapest: the figures on the clinic sites read for this batch were quoted from, in ranges, without a date on the page. A price this directory can carry is one with a currency, a date and an inclusion list, and those pages did not have all three.", "notes": "Fifteen kilometres from the city point covers all 23 districts and both banks." }, "geo": { "lat": 47.4925, "lon": 19.0514, "precision": "city", "source": "s:wp-budapest" }, "address": { "city": "Budapest", "country": "HU" }, "kin": [ { "to": "hungary", "as": "The country whose dental trade this city is the airport end of.", "rel": "whole" }, { "to": "sopron", "as": "The border version of the same trade: a morning from Vienna instead of a flight.", "rel": "contrast" }, { "to": "dental-implant", "as": "The operation the capital's clinics are booked for, priced per implant.", "rel": "procedure" }, { "to": "all-on-four", "as": "The full-arch form sold here, and the one whose quote hides the most variables.", "rel": "procedure" }, { "to": "full-mouth-restoration", "as": "The long course this city's two-visit model is built around.", "rel": "procedure" }, { "to": "eu-directive-2011-24", "as": "The route an EU-insured patient can claim part of the bill back through, at the home tariff.", "rel": "governed-by" }, { "to": "wellness-travel", "as": "The older trade the thermal baths belong to, sold beside the dentistry and counted separately.", "rel": "term" }, { "to": "the-price-that-isnt", "as": "Why a per-implant quote and a final bill are different objects.", "rel": "story" }, { "to": "warsaw", "as": "The other central European capital British and Irish dental patients are sent to.", "rel": "contrast" } ], "links": [ { "label": "Directive 2011/24/EU", "url": "https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX:32011L0024" } ], "sources": [ "s:wp-budapest", "s:wp-medical-travel", "s:eu-directive-2011-24", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:wp-medical-travel", "note": "the Goulash Communism origin and the Vienna price ratio are cited there to a named reference; the last paragraph is this project reasoning" }, "text.how": { "tier": "tradition", "note": "the standard two-visit implant course; no single page read for this record states it" }, "geo": { "tier": "cited", "source": "s:wp-budapest" }, "facets.radius_km": { "tier": "inference" } } }, "x_commons_files": [ "File:Andrássy Avenue Budapest.jpg", "File:Rudas Baths Budapest.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "A capital of 1,685,209 people split by the Danube into hilly Buda and flat Pest, administered in 23 districts written in Roman numerals.", "region_terms": [ { "key": "europe-central", "name": "Central Europe", "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia" } ], "kin_out": [ { "to": "hungary", "type": "destination", "name": "Hungary", "as": "The country whose dental trade this city is the airport end of.", "rel": "whole" }, { "to": "sopron", "type": "hub", "name": "Sopron", "as": "The border version of the same trade: a morning from Vienna instead of a flight.", "rel": "contrast" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The operation the capital's clinics are booked for, priced per implant.", "rel": "procedure" }, { "to": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "The full-arch form sold here, and the one whose quote hides the most variables.", "rel": "procedure" }, { "to": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "The long course this city's two-visit model is built around.", "rel": "procedure" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route an EU-insured patient can claim part of the bill back through, at the home tariff.", "rel": "governed-by" }, { "to": "wellness-travel", "type": "term", "name": "Wellness travel", "as": "The older trade the thermal baths belong to, sold beside the dentistry and counted separately.", "rel": "term" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "Why a per-implant quote and a final bill are different objects.", "rel": "story" }, { "to": "warsaw", "type": "hub", "name": "Warsaw", "as": "The other central European capital British and Irish dental patients are sent to.", "rel": "contrast" } ], "source_list": [ { "id": "s:wp-budapest", "kind": "wikipedia", "title": "Budapest", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Budapest", "accessed": "2026-09-16", "note": "coordinates, population 1,685,209 (2025), 23 districts in Roman numerals, Buda and Pest split by the Danube, more than 100 medicinal geothermal springs" }, { "id": "s:wp-medical-travel", "kind": "wikipedia", "title": "Medical tourism", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism", "accessed": "2026-09-16", "note": "used only for the figures it attributes to a named reference: Mosonmagyaróvár's dental clinic count, a Lithuanian hip replacement at £3,340 against a British commercial price roughly three times it, and Tunisia's thalassotherapy ranking. Its country-level traffic figures rest on market-research summaries and are not carried here." }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:wp-medical-travel", "note": "the Goulash Communism origin and the Vienna price ratio are cited there to a named reference; the last paragraph is this project reasoning" }, "text.how": { "tier": "tradition", "note": "the standard two-visit implant course; no single page read for this record states it" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited", "source": "s:wp-budapest" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "hungary", "type": "destination", "name": "Hungary", "as": "Where the longer-distance patients land and the bigger practices are.", "rel": "part" }, { "from": "sopron", "type": "hub", "name": "Sopron", "as": "The capital version of the same trade, reached by air rather than by car.", "rel": "contrast" }, { "from": "warsaw", "type": "hub", "name": "Warsaw", "as": "The other central European capital the same dental traffic is sent to.", "rel": "contrast" }, { "from": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "The city that prices the same arch in two lines and half the money.", "rel": "place" }, { "from": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "The city that made dental travel a European industry.", "rel": "place" }, { "from": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The city whose clinics price implants in parts and sell the parts as packages.", "rel": "place" }, { "from": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "The European city that built its dental trade on jobs this size.", "rel": "place" }, { "from": "veneers", "type": "procedure", "name": "Dental veneers", "as": "The city whose clinics built the European dental trade on work like this.", "rel": "place" } ] }, { "schema": 1, "id": "cairo", "type": "hub", "names": { "name": "Cairo", "aliases": [ "القاهرة", "Greater Cairo" ], "said": "Greater Cairo is the unit that matters here: the clinics are spread across a metropolitan area of more than twenty million, not gathered on one street." }, "region": [ "africa-north" ], "facets": { "iso2": "EG", "radius_km": 30, "specialty": [ "dentistry", "hair restoration", "cosmetic surgery", "ophthalmology", "hepatology", "bariatric surgery" ], "draws": [ "dental-implant", "hair-transplant-fue", "rhinoplasty", "cataract-surgery", "gastric-sleeve" ], "languages": [ "Arabic", "English" ] }, "text": { "what": "A city of about 9.8 million in 2023 inside a metropolitan area of more than 22 million, with the clinics that take foreign patients spread across the twentieth-century districts — Garden City, Zamalek, Heliopolis and the newer quarters east of them — rather than concentrated in a single quarter. Egypt had 121,394 physicians and 121,617 hospital beds in 2020, and the private sector is estimated to carry about 60% of all healthcare services. Cairo sells dentistry, hair restoration and cosmetic surgery to Gulf and African patients, and its hepatology is regionally exceptional for reasons of epidemiology rather than marketing.", "story": "Egypt legislated universal health insurance from 11 January 2018, a reform that runs alongside the private sector rather than replacing it, and the private sector is where the foreign traffic goes.\n\n*Inference —* the country's liver medicine is the part of this that could not be manufactured by policy. Egypt carried one of the heaviest hepatitis C burdens in the world and treated it at national scale, and the clinical depth that campaign left behind — hepatologists, endoscopy lists, transplant teams — is a capability built on an epidemic rather than on an export plan. This record states the shape of that and carries no figures for it: the screening and treatment numbers were not read off a primary page for this batch.\n\n*Trade practice —* what is actually advertised to arriving patients is smaller and more ordinary. Dentistry, hair restoration and cosmetic surgery at prices set by a currency that has fallen hard against the dollar and the riyal, sold to Gulf patients, to Egyptians living abroad, and increasingly to African patients for whom Cairo is nearer than Europe.\n\n*Inference —* a devalued currency is the whole pricing argument in a city like this, and it is also the least stable one in the directory. A price quoted in Egyptian pounds and a price quoted in dollars for the same operation move apart between the quote and the flight.", "how": "*Trade practice —* the Cairo arrangement is made by phone or messaging app, quoted in dollars for foreign patients and in pounds for residents, and paid in cash on arrival at the smaller clinics. The large private hospitals bill in the ordinary way and take insurance. Aftercare for the cosmetic and dental work is a return visit that most patients do not make.", "today": "As of 16 September 2026 this record carries no price row and no inbound patient count for Cairo, and no figures for the hepatitis C programme referred to above.", "notes": "Thirty kilometres from the city point covers Greater Cairo — Giza, Heliopolis, Nasr City, Maadi and the ring road — and still misses the far eastern new cities." }, "geo": { "lat": 30.0444, "lon": 31.2358, "precision": "city", "source": "s:wp-cairo" }, "address": { "city": "Cairo", "country": "EG" }, "kin": [ { "to": "egypt", "as": "The country this metropolitan cluster carries most of the private capacity of.", "rel": "whole" }, { "to": "dental-implant", "as": "The commonest advertised booking here.", "rel": "procedure" }, { "to": "hair-transplant-fue", "as": "Sold here into the same Gulf market Istanbul sells into, at a shorter flight.", "rel": "procedure" }, { "to": "cataract-surgery", "as": "High-volume day work a large private sector is built to do.", "rel": "procedure" }, { "to": "liver-transplant", "as": "The capability a national epidemic left behind, and the one this city is regionally unusual for.", "rel": "procedure" }, { "to": "dubai", "as": "The Gulf destination competing for the same regional patients at several times the price.", "rel": "contrast" }, { "to": "istanbul", "as": "The cluster Cairo's hair and cosmetic clinics price against.", "rel": "contrast" }, { "to": "the-price-that-isnt", "as": "Why a price quoted in a falling currency is not the price paid.", "rel": "story" }, { "to": "world-bank-health-spending", "as": "The series behind what this country spends on health per person, and the scale the private sector sits on top of.", "rel": "measured-by" } ], "links": [ { "label": "Healthcare in Egypt", "url": "https://en.wikipedia.org/wiki/Healthcare_in_Egypt" } ], "sources": [ "s:wp-cairo", "s:wp-healthcare-egypt", "s:worldbank-open-data", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:wp-healthcare-egypt", "note": "every paragraph after the first is marked inline as inference or trade practice; no hepatitis C figures are carried because none were read for this batch" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "cited", "source": "s:wp-cairo" }, "facets.radius_km": { "tier": "inference", "note": "30 km covers Greater Cairo and still misses the eastern new cities" } } }, "x_commons_files": [ "File:Cairo Zamalek skyline.jpg" ], "needs_verification": true, "confidence": "low", "updated": "2026-09-16", "blurb": "A city of about 9.8 million in 2023 inside a metropolitan area of more than 22 million, with the clinics that take foreign patients spread across the twentieth-century districts — Garden City, Zamalek, Heliopolis and…", "region_terms": [ { "key": "africa-north", "name": "North Africa", "note": "Tunisia, Morocco, Egypt" } ], "kin_out": [ { "to": "egypt", "type": "destination", "name": "Egypt", "as": "The country this metropolitan cluster carries most of the private capacity of.", "rel": "whole" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The commonest advertised booking here.", "rel": "procedure" }, { "to": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "Sold here into the same Gulf market Istanbul sells into, at a shorter flight.", "rel": "procedure" }, { "to": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "High-volume day work a large private sector is built to do.", "rel": "procedure" }, { "to": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "The capability a national epidemic left behind, and the one this city is regionally unusual for.", "rel": "procedure" }, { "to": "dubai", "type": "hub", "name": "Dubai", "as": "The Gulf destination competing for the same regional patients at several times the price.", "rel": "contrast" }, { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "The cluster Cairo's hair and cosmetic clinics price against.", "rel": "contrast" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "Why a price quoted in a falling currency is not the price paid.", "rel": "story" }, { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "The series behind what this country spends on health per person, and the scale the private sector sits on top of.", "rel": "measured-by" } ], "source_list": [ { "id": "s:wp-cairo", "kind": "wikipedia", "title": "Cairo", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Cairo", "accessed": "2026-09-16", "note": "coordinates, city population about 9.8 million (2023) and Greater Cairo over 22 million; Garden City, Zamalek, Heliopolis and Downtown Cairo as the early-twentieth-century districts" }, { "id": "s:wp-healthcare-egypt", "kind": "web", "title": "Healthcare in Egypt", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Healthcare_in_Egypt", "accessed": "2026-09-16", "note": "read for the private hospital count, physician density, the out-of-pocket share and Law No. 2 of 2018" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:wp-healthcare-egypt", "note": "every paragraph after the first is marked inline as inference or trade practice; no hepatitis C figures are carried because none were read for this batch" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited", "source": "s:wp-cairo" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "egypt", "type": "destination", "name": "Egypt", "as": "Where most of the clinics and nearly all of the agencies are.", "rel": "part" } ] }, { "schema": 1, "id": "cancun", "type": "hub", "names": { "name": "Cancún", "aliases": [ "Cancun", "Benito Juárez" ], "said": "Can-KOON. The Hotel Zone is its own address; the hospitals are in the city behind it." }, "region": [ "mexico", "caribbean" ], "facets": { "iso2": "MX", "radius_km": 20, "specialty": [ "dentistry", "cosmetic surgery", "bariatric surgery", "oncology", "orthopaedics" ], "draws": [ "dental-implant", "all-on-four", "veneers", "full-mouth-restoration", "breast-augmentation", "liposuction", "abdominoplasty", "gastric-sleeve" ], "languages": [ "Spanish", "English" ] }, "text": { "what": "The largest city in Quintana Roo, on the Caribbean coast of the Yucatán Peninsula, built in the 1970s as a resort and now carrying a second trade: dentistry and cosmetic surgery sold to people who were flying here anyway. It is the only hub in this directory whose international air connections were built for a holiday market and then inherited by a clinical one.", "story": "Cancún's medical sector sits on infrastructure it did not have to pay for. The flights, the hotels, the English-speaking service economy and the transfers all existed for the resort. What was added was hospitals and surgeries willing to schedule around a week's stay.\n\nHospital Galenia, the city's main private hospital for international patients, publishes an unusually full account of its own credentials: Joint Commission International accreditation; Accreditation Canada's Qmentum International at Platinum level, which it states includes accreditation for international health-travel services; certification by Mexico's Consejo de Salubridad General, a body reporting directly to the presidency; and the Distintivo Turismo de Salud awarded by the federal tourism ministry, SECTUR, to institutions meeting a service standard for foreign patients.\n\nThe same page is a lesson in reading one. Beside three of those credentials the hospital prints its own validity dates: \"Vigencia hasta Noviembre del 2021\" for the Joint Commission line, \"Vigencia hasta Marzo 2022\" for the Canadian one, \"Vigencia hasta 20 de octubre del 2020\" for the national certification. Read on 16 September 2026, all three had passed. This directory records what the page says and the date it was read, and nothing about what is or is not current.\n\n*Trade practice —* the dental operators here run the same price lists as their border-town branches. Sani Dental Group lists clinics in Los Algodones, Cancún and Playa del Carmen and publishes one price page across all three, with no line saying which town a figure belongs to.", "how": "The pattern is a week: fly in, consult on the first working day, treat, recover in a hotel rather than a ward, fly home. That works for dentistry, for day-case cosmetic surgery and for short bariatric stays; it does not work for anything that needs a surgeon's eye at six weeks. Hospitals bill in pesos and dollars and quote on request. The dental groups publish, the hospitals do not.", "today": "As of 16 September 2026 Hospital Galenia's accreditations page lists four separate schemes and three lapsed validity dates, and the largest dental group in the city prices its work on a page shared with two other towns." }, "geo": { "lat": 21.1606, "lon": -86.8475, "precision": "city", "source": "s:wp-cancun" }, "address": { "city": "Cancún", "area": "Quintana Roo", "country": "MX" }, "tags": [ { "tag": "international-office", "source": "s:galenia-accreditations", "tier": "cited", "note": "Hospital Galenia states accreditation for international health-travel services under the Canadian scheme", "url": "https://hospitalgalenia.com/acreditaciones-y-certificaciones/" }, { "tag": "price-published", "source": "s:sani-price-list", "tier": "cited", "note": "the dental group operating here publishes an open price list, though the page names no town", "url": "https://sanidentalgroup.com/price-list" } ], "kin": [ { "to": "mexico", "as": "The country whose resort economy this cluster grew inside.", "rel": "destination" }, { "to": "los-algodones", "as": "Shares an operator and a price page with this city, which is why a Cancún figure may not be a Cancún figure.", "rel": "contrast" }, { "to": "dental-implant", "as": "The commonest reason a foreign patient sees a Cancún surgery rather than a Cancún beach.", "rel": "performs" }, { "to": "all-on-four", "as": "Sold here by the arch on the same list the border towns use.", "rel": "performs" }, { "to": "jci", "as": "One of four schemes the city's main private hospital names on its own accreditations page.", "rel": "accredited-by" }, { "to": "the-accreditation-question", "as": "A page listing four accreditations and three expired validity dates is the question in one screen.", "rel": "story" }, { "to": "flying-after-surgery", "as": "The constraint that decides which operations can be sold on a one-week resort schedule.", "rel": "risk" }, { "to": "wellness-travel", "as": "The neighbouring trade, and the one the hotels were built for.", "rel": "term" } ], "links": [ { "label": "Hospital Galenia — acreditaciones y certificaciones", "url": "https://hospitalgalenia.com/acreditaciones-y-certificaciones/" } ], "sources": [ "s:wp-cancun", "s:galenia-accreditations", "s:sani-price-list" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:galenia-accreditations", "note": "read off the hospital's own page on 16 September 2026, including the validity dates it prints" }, "text.how": { "tier": "tradition", "note": "the general shape of a one-week treatment trip into a resort city" } } }, "x_commons_files": [ "File:Cancun Hotel Zone.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "The largest city in Quintana Roo, on the Caribbean coast of the Yucatán Peninsula, built in the 1970s as a resort and now carrying a second trade: dentistry and cosmetic surgery sold to people who were flying here…", "region_terms": [ { "key": "mexico", "name": "Mexico", "note": "its own entry because the border towns are a category of their own" }, { "key": "caribbean", "name": "The Caribbean", "note": "the Dominican Republic, Cuba, Barbados, the Caymans" } ], "kin_out": [ { "to": "mexico", "type": "destination", "name": "Mexico", "as": "The country whose resort economy this cluster grew inside.", "rel": "destination" }, { "to": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "Shares an operator and a price page with this city, which is why a Cancún figure may not be a Cancún figure.", "rel": "contrast" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The commonest reason a foreign patient sees a Cancún surgery rather than a Cancún beach.", "rel": "performs" }, { "to": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "Sold here by the arch on the same list the border towns use.", "rel": "performs" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "One of four schemes the city's main private hospital names on its own accreditations page.", "rel": "accredited-by" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "A page listing four accreditations and three expired validity dates is the question in one screen.", "rel": "story" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The constraint that decides which operations can be sold on a one-week resort schedule.", "rel": "risk" }, { "to": "wellness-travel", "type": "term", "name": "Wellness travel", "as": "The neighbouring trade, and the one the hotels were built for.", "rel": "term" } ], "source_list": [ { "id": "s:wp-cancun", "kind": "web", "title": "Cancún", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Canc%C3%BAn", "accessed": "2026-09-16" }, { "id": "s:galenia-accreditations", "kind": "web", "title": "Acreditaciones y certificaciones", "publisher": "Hospital Galenia, Cancún", "url": "https://hospitalgalenia.com/acreditaciones-y-certificaciones/", "accessed": "2026-09-16", "note": "lists Joint Commission International, Accreditation Canada Qmentum International at Platinum level including international health-travel services, Consejo de Salubridad General certification and the SECTUR Distintivo Turismo de Salud; the validity dates printed beside three of them had passed when the page was read" }, { "id": "s:sani-price-list", "kind": "web", "title": "Dental Price List in Mexico", "publisher": "Sani Dental Group", "url": "https://sanidentalgroup.com/price-list", "accessed": "2026-09-16", "note": "prices in US dollars and Mexican pesos, read off the page on 16 September 2026; the page states that all prices are a base or starting-at price and carries no location qualifier, though the group lists clinics in Los Algodones, Cancún and Playa del Carmen" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:galenia-accreditations", "note": "read off the hospital's own page on 16 September 2026, including the validity dates it prints" }, "text.how": { "tier": "tradition", "note": "the general shape of a one-week treatment trip into a resort city" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [ { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:galenia-accreditations", "note": "Hospital Galenia states accreditation for international health-travel services under the Canadian scheme", "tier": "cited", "url": "https://hospitalgalenia.com/acreditaciones-y-certificaciones/" }, { "key": "price-published", "label": "Publishes prices", "icon": "💰", "group": "money", "evidence": "a public price list or package page on the facility's own site, read on a dated visit", "source": "s:sani-price-list", "note": "the dental group operating here publishes an open price list, though the page names no town", "tier": "cited", "url": "https://sanidentalgroup.com/price-list" } ], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "mexico", "type": "destination", "name": "Mexico", "as": "The resort end of the trade, sold alongside a holiday.", "rel": "part" } ] }, { "schema": 1, "id": "chennai", "type": "hub", "names": { "name": "Chennai", "aliases": [ "சென்னை", "Madras" ], "said": "Chen-nei. The address that means the trade is Greams Road — properly Greams Lane, off Greams Road, in Thousand Lights — and a Chennai auto driver takes Apollo as the destination rather than the street." }, "region": [ "south-asia" ], "facets": { "iso2": "IN", "radius_km": 20, "specialty": [ "cardiac surgery", "oncology", "transplant", "orthopaedics", "neurosurgery" ], "draws": [ "cabg", "angioplasty-stent", "liver-transplant", "kidney-transplant", "bone-marrow-transplant", "knee-replacement" ], "languages": [ "Tamil", "English", "Hindi" ] }, "text": { "what": "The Chennai cluster runs west from Greams Road in Thousand Lights, where Apollo's first hospital opened in 1983, out along Anna Salai and then to the hospitals on the city's western edge — Sri Ramachandra at Porur, MIOT at Manapakkam — with Apollo's own specialty blocks on Anna Salai and Cenotaph Road in between. The core is walkable: Apollo's main complex, its specialty blocks and the diagnostic laboratories and private nursing homes that grew up around them sit inside a couple of square kilometres of Teynampet.", "story": "Prathap C. Reddy opened Apollo Hospitals in Chennai on 18 September 1983, and the group now runs a network of 71 owned and managed hospitals; several of them were among the first in India to take international healthcare accreditation. *Inference —* the founding matters here for a reason beyond scale. Apollo was built as a private corporate hospital in a country whose medicine was overwhelmingly public or charitable, and the format it proved — a paid tertiary hospital selling cardiac surgery at a fraction of an American bill — is the format every Indian hub in this directory now runs on.\n\nChennai is called \"the healthcare capital of India\" in the press, and figures circulate for its share of foreign patient arrivals: about 150 a day, about 15 per cent of India's arrivals in one 2019 newspaper estimate, 45 per cent in another. *Inference —* those two disagree by a factor of three, both trace to newspapers rather than to a register, and this project carries the claim with its attribution instead of the number.\n\n*Trade practice —* what concentrates here is the heart and the transplant. Chennai's cardiac surgeons trained a generation of Indian cardiac programmes, and the cross-border flow into the city is dominated by patients arriving for an operation their own system cannot schedule or cannot do.", "how": "An Indian tertiary hospital quotes an estimate rather than a package: a room category, a surgeon's fee, a theatre charge and a projected length of stay, with the understanding that the bill moves if the stay does. Foreign patients arrive on an e-medical visa, though since 30 August 2019 foreigners may receive treatment in India other than an organ transplant without one. Transplant is the exception everywhere in this city, and it carries a documentary regime of its own.", "today": "As of 16 September 2026 the harvest point for this hub sits on Greams Road, with a 20-kilometre radius that reaches Porur and Manapakkam to the west and Taramani to the south. No Chennai price has been read off a page into this directory yet.", "notes": "Nothing here says what a reader should do about a transplant, a heart or a visa." }, "geo": { "lat": 13.0595, "lon": 80.2543, "precision": "city", "source": "s:osm-nominatim" }, "address": { "street": "Greams Road, Thousand Lights", "city": "Chennai", "area": "Tamil Nadu", "country": "IN", "postcode": "600006" }, "kin": [ { "to": "apollo-chennai", "as": "The Greams Lane hospital the cluster grew out of, opened 1983.", "rel": "part" }, { "to": "india", "as": "The country whose private tertiary format was proved in this city.", "rel": "whole" }, { "to": "prathap-reddy", "as": "The cardiologist who opened the first hospital here and set the pattern.", "rel": "person" }, { "to": "cabg", "as": "The operation the cluster is built around, and the one its surgeons taught to the rest of India.", "rel": "procedure" }, { "to": "liver-transplant", "as": "Chennai programmes take referrals for this from across South Asia and the Gulf, by the trade's account.", "rel": "procedure" }, { "to": "proton-therapy", "as": "Apollo runs a proton centre in this city; this directory has not yet read its page for the claim.", "rel": "procedure" }, { "to": "india-e-medical-visa", "as": "The entry route most of this cluster's foreign patients arrive on.", "rel": "governed-by" }, { "to": "delhi-ncr", "as": "The northern cluster Chennai competes with for the same cardiac and transplant referrals.", "rel": "contrast" }, { "to": "counting-patients", "as": "Why the daily arrival figures quoted for this city disagree with each other.", "rel": "story" }, { "to": "osm-facilities", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 20 kilometres of this point.", "rel": "measured-by" } ], "links": [ { "label": "Apollo Hospitals", "url": "https://www.apollohospitals.com/" } ], "sources": [ "s:osm-nominatim", "s:wp-apollo-hospitals", "s:wp-medical-tourism-india", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "tradition", "note": "the geography of the cluster; Greams Road itself is located from OpenStreetMap" }, "text.story": { "tier": "cited", "source": "s:wp-apollo-hospitals", "note": "the founding is cited; the inline marks say which stretches are inference and trade practice" }, "text.how": { "tier": "tradition", "note": "the 2019 visa rule is cited to the Medical tourism in India article" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" } } }, "x_commons_files": [ "File:Apollo Hospitals Chennai.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "The Chennai cluster runs west from Greams Road in Thousand Lights, where Apollo's first hospital opened in 1983, out along Anna Salai and then to the hospitals on the city's western edge — Sri Ramachandra at Porur, MIOT…", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" } ], "kin_out": [ { "to": "apollo-chennai", "type": "facility", "name": "Apollo Hospitals, Greams Road, Chennai", "as": "The Greams Lane hospital the cluster grew out of, opened 1983.", "rel": "part" }, { "to": "india", "type": "destination", "name": "India", "as": "The country whose private tertiary format was proved in this city.", "rel": "whole" }, { "to": "prathap-reddy", "type": "person", "name": "Prathap C. Reddy", "as": "The cardiologist who opened the first hospital here and set the pattern.", "rel": "person" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The operation the cluster is built around, and the one its surgeons taught to the rest of India.", "rel": "procedure" }, { "to": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "Chennai programmes take referrals for this from across South Asia and the Gulf, by the trade's account.", "rel": "procedure" }, { "to": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "Apollo runs a proton centre in this city; this directory has not yet read its page for the claim.", "rel": "procedure" }, { "to": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The entry route most of this cluster's foreign patients arrive on.", "rel": "governed-by" }, { "to": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "The northern cluster Chennai competes with for the same cardiac and transplant referrals.", "rel": "contrast" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why the daily arrival figures quoted for this city disagree with each other.", "rel": "story" }, { "to": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 20 kilometres of this point.", "rel": "measured-by" } ], "source_list": [ { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." }, { "id": "s:wp-apollo-hospitals", "kind": "wikipedia", "title": "Apollo Hospitals", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Apollo_Hospitals", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-medical-tourism-india", "kind": "wikipedia", "title": "Medical tourism in India", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_India", "license": "CC BY-SA 4.0", "accessed": "2026-09-16", "note": "carries city-share and market-size figures sourced to newspapers and market-research summaries; this project reads it for the claims and their attributions, not as a count." }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "tradition", "note": "the geography of the cluster; Greams Road itself is located from OpenStreetMap" }, "text.story": { "tier": "cited", "source": "s:wp-apollo-hospitals", "note": "the founding is cited; the inline marks say which stretches are inference and trade practice" }, "text.how": { "tier": "tradition", "note": "the 2019 visa rule is cited to the Medical tourism in India article" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "india", "type": "destination", "name": "India", "as": "The cluster this country is most often named for, and where its oldest corporate hospital chain started.", "rel": "part" }, { "from": "nepal", "type": "destination", "name": "Nepal", "as": "The southern destination for transplant and cancer work.", "rel": "destination" }, { "from": "sri-lanka", "type": "destination", "name": "Sri Lanka", "as": "The nearest cluster, and the usual destination of a Colombo referral.", "rel": "destination" }, { "from": "bengaluru", "type": "hub", "name": "Bengaluru", "as": "The neighbouring cardiac cluster, older and closer to its airport.", "rel": "contrast" }, { "from": "colombo", "type": "hub", "name": "Colombo", "as": "The Indian cluster across the strait that takes the complex referrals Colombo does not.", "rel": "contrast" }, { "from": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "The southern cluster competing for the same cardiac and transplant referrals.", "rel": "contrast" }, { "from": "apollo-chennai", "type": "facility", "name": "Apollo Hospitals, Greams Road, Chennai", "as": "The hospital the Chennai cluster grew around, and the reason the cluster is on Greams Road.", "rel": "place" }, { "from": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "One of the clusters its holders arrive in.", "rel": "hub" }, { "from": "prathap-reddy", "type": "person", "name": "Prathap C. Reddy", "as": "Where it started, and still a hub in this directory.", "rel": "hub" } ] }, { "schema": 1, "id": "chiang-mai", "type": "hub", "names": { "name": "Chiang Mai", "aliases": [ "เชียงใหม่", "Chiangmai" ], "said": "Chiang Mai, two words, and in the north it is เจียงใหม่ — Jiang Mai — because Kham Mueang softens the ch." }, "region": [ "southeast-asia" ], "facets": { "iso2": "TH", "radius_km": 12, "specialty": [ "dental", "cosmetic", "orthopaedics", "gender-affirming", "long-stay rehabilitation", "health screening" ], "draws": [ "dental-implant", "knee-replacement", "hair-transplant-fue" ], "languages": [ "Thai", "Northern Thai", "English" ] }, "text": { "what": "Thailand's second cluster, and the one that sells the long stay rather than the flight in and out. Private hospitals and dental surgeries run along the Superhighway and Chang Klan, with the university hospital at Suan Dok as the tertiary backstop. What distinguishes it from Bangkok is who the patient is: Chiang Mai treats a large resident foreign population — retirees, remote workers, people on long-stay visas — as well as visitors, and the two use the same buildings.", "story": "*Trade practice —* the city's medical trade grew out of its expatriate population rather than out of an export push. A place with tens of thousands of long-term foreign residents accumulates the things those residents need — English-speaking dentists, a hospital that will bill an overseas insurer, pharmacists used to being asked for a drug under an American brand name — and a visitor arriving for a course of work finds the infrastructure already there.\n\nThat is also why the mix here runs to dentistry, dermatology, orthopaedics and rehabilitation rather than to cardiac surgery. The complex cases go to Bangkok. Chiang Mai sells the four-week stay: a course of dental work, a knee and the physiotherapy after it, a screening package, a recovery that needs somewhere quiet and cheap to happen.\n\n*Inference —* the cost of a month here against a month in Bangkok is the whole argument for the place, and nobody publishes a comparison of the two.", "how": "Private hospitals cluster on Superhighway Chiang Mai–Lampang and around Chang Klan and the Night Bazaar; Maharaj Nakorn Chiang Mai, the Chiang Mai University teaching hospital at Suan Dok, is the public tertiary centre. Dental surgeries are spread through Nimmanhaemin and the old city rather than concentrated in one street. The airport is fifteen minutes from most of it.", "today": "No price from this city has been read into this directory yet. The facilities index here is thinner than Bangkok's for that reason and not for any other." }, "geo": { "lat": 18.7883, "lon": 98.9853, "precision": "city", "source": "s:osm" }, "kin": [ { "to": "thailand", "as": "The country's second cluster, and its long-stay one.", "rel": "part" }, { "to": "bangkok", "as": "Where the complex cases and the flagship private hospitals are, six hundred kilometres south.", "rel": "contrast" }, { "to": "defiant", "as": "A facilitator working out of this city.", "rel": "org" }, { "to": "dental-implant", "as": "A course of dental work is the commonest reason a visitor stays a month here.", "rel": "procedure" }, { "to": "aftercare-at-home", "as": "The long stay exists partly to move the recovery here rather than home.", "rel": "step" } ], "sources": [ "s:osm", "s:defiant-site" ], "provenance": { "default": { "tier": "tradition" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm" }, "text.story": { "tier": "tradition", "note": "the trade's account of how the city's medical work grew; the inline marks say which stretches are inference" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "Thailand's second cluster, and the one that sells the long stay rather than the flight in and out.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "thailand", "type": "destination", "name": "Thailand", "as": "The country's second cluster, and its long-stay one.", "rel": "part" }, { "to": "bangkok", "type": "hub", "name": "Bangkok", "as": "Where the complex cases and the flagship private hospitals are, six hundred kilometres south.", "rel": "contrast" }, { "to": "defiant", "type": "org", "name": "Defiant", "as": "A facilitator working out of this city.", "rel": "org" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "A course of dental work is the commonest reason a visitor stays a month here.", "rel": "procedure" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The long stay exists partly to move the recovery here rather than home.", "rel": "step" } ], "source_list": [ { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" }, { "id": "s:defiant-site", "kind": "web", "title": "Defiant — medical travel concierge, Chiang Mai", "publisher": "Defiant (defiant.to)", "url": "https://defiant.to/", "accessed": "2026-09-16", "note": "the company's own site; the pricing model, the interpreter commitment and the procedure list are read off it" } ], "tiers": { "text.what": { "tier": "tradition" }, "text.story": { "tier": "tradition", "note": "the trade's account of how the city's medical work grew; the inline marks say which stretches are inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "tradition" }, "geo": { "tier": "harvested", "source": "s:osm" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "thailand", "type": "destination", "name": "Thailand", "as": "The second cluster, and the one that sells the month-long stay.", "rel": "part" }, { "from": "bangkok", "type": "hub", "name": "Bangkok", "as": "Six hundred kilometres north, selling the long stay rather than the operation.", "rel": "contrast" }, { "from": "defiant", "type": "org", "name": "Defiant", "as": "Works out of this cluster.", "rel": "place" } ] }, { "schema": 1, "id": "colombo", "type": "hub", "names": { "name": "Colombo", "aliases": [ "කොළඹ", "கொழும்பு" ], "said": "Colombo is addressed by number. Colombo 2 is Slave Island and Nawaloka; Colombo 5 is Narahenpita and the Asiri group; Colombo 10 is Maligawatte. A taxi wants the number before the name." }, "region": [ "south-asia" ], "facets": { "iso2": "LK", "radius_km": 15, "specialty": [ "cardiology", "ophthalmology", "orthopaedics", "oncology", "health screening" ], "draws": [ "cataract-surgery", "cabg", "angioplasty-stent", "knee-replacement", "dental-implant" ], "languages": [ "Sinhala", "Tamil", "English", "Dhivehi" ] }, "text": { "what": "Sri Lanka's private hospitals sit almost entirely in Colombo and its suburbs, and several of them cluster in Narahenpita — Asiri, Asiri Surgical, Oasis and Ninewells among them. Nawaloka stands on Sir James Peiris Mawatha at Slave Island in Colombo 2; Asiri Central is at 110 Norris Canal Road in Maligawatte, Colombo 10; Lanka Hospitals is on Vijaya Kumaratunga Mawatha at Polhengoda junction, in Colombo 5. Durdans and Hemas fill in between. Nothing here is more than five kilometres from anything else.", "story": "Sri Lanka runs a free public health service its own population uses, and the private hospitals sit beside rather than instead of it: more comfortable, more expensive, and concentrated in the capital and its suburbs in a way that leaves the rest of the island to the state.\n\n*Trade practice —* the cross-border flow into Colombo is regional and short-haul rather than intercontinental. The Maldives is a ninety-minute flight away with no tertiary hospital of its own, and Colombo is where a Maldivian cardiac or orthopaedic case has long been sent; Indian patients cross for some work in the other direction. This project has read no register that quantifies either, and carries both as the trade's account.\n\n*Inference —* the compactness is the useful fact for a directory. Five or six private hospitals inside a few kilometres of central Colombo means one tight harvest catches the whole private sector of a country, which is not true of any other hub in this batch.", "how": "A Colombo private hospital bills itemised — consultant fee, theatre, room, investigations — rather than as a package, with the consultant's fee separate from the hospital's charge, and payment in Sri Lankan rupees at the point of discharge. Some hospitals maintain liaison arrangements for Maldivian patients and for the state schemes that refer them.", "today": "As of 16 September 2026 the harvest point for this hub sits in central Colombo, with a 15-kilometre radius covering the city and its inner suburbs. No Colombo price has been read off a page into this directory, no Sri Lankan facility is on this project's cast list, and no inbound count for the country has been verified.", "notes": "A description of where a small private sector stands. Not advice about using it." }, "geo": { "lat": 6.905, "lon": 79.87, "precision": "city", "source": "s:osm-nominatim" }, "address": { "city": "Colombo", "area": "Western Province", "country": "LK" }, "metrics": { "note": "No inbound patient count is carried for Colombo. Nothing this project read gives a Sri Lankan figure attributable to a register, and the Maldivian flow described above is the trade's account rather than a measured one.", "as_of": "2026-09-16", "source": "s:wp-healthcare-sri-lanka", "url": "https://en.wikipedia.org/wiki/Healthcare_in_Sri_Lanka" }, "kin": [ { "to": "sri-lanka", "as": "The country whose entire private hospital sector is in this city and its suburbs.", "rel": "whole" }, { "to": "cataract-surgery", "as": "Short-stay volume work, the kind a regional patient can fly in and out for.", "rel": "procedure" }, { "to": "cabg", "as": "The cardiac work Maldivian patients have long been referred here for, by the trade's account.", "rel": "procedure" }, { "to": "knee-replacement", "as": "Quoted here itemised rather than as a package.", "rel": "procedure" }, { "to": "panchakarma", "as": "The Ayurvedic course sold elsewhere on the island, not in these hospitals.", "rel": "contrast" }, { "to": "chennai", "as": "The Indian cluster across the strait that takes the complex referrals Colombo does not.", "rel": "contrast" }, { "to": "what-the-data-cannot-see", "as": "A capital with a whole private sector in five kilometres and no count anybody publishes.", "rel": "story" }, { "to": "osm-facilities", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 15 kilometres of this point.", "rel": "measured-by" } ], "links": [ { "label": "Lanka Hospitals", "url": "https://www.lankahospitals.com/" }, { "label": "Nawaloka Hospitals", "url": "https://www.nawaloka.com/" } ], "sources": [ "s:osm-nominatim", "s:wp-healthcare-sri-lanka", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "streets and postal districts read off OpenStreetMap address tags; the Narahenpita grouping is from the Healthcare in Sri Lanka article" }, "text.story": { "tier": "tradition", "note": "the Maldivian flow is the trade's account and is unverified; the inline marks say which stretches are inference" }, "text.how": { "tier": "tradition", "note": "the general billing shape of a Colombo private hospital, unverified against any one hospital's page" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "a central point between the Narahenpita, Slave Island and Maligawatte hospitals, not a point anybody published" } } }, "x_commons_files": [ "File:Colombo skyline.jpg" ], "needs_verification": true, "confidence": "low", "updated": "2026-09-16", "blurb": "Sri Lanka's private hospitals sit almost entirely in Colombo and its suburbs, and several of them cluster in Narahenpita — Asiri, Asiri Surgical, Oasis and Ninewells among them.", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" } ], "kin_out": [ { "to": "sri-lanka", "type": "destination", "name": "Sri Lanka", "as": "The country whose entire private hospital sector is in this city and its suburbs.", "rel": "whole" }, { "to": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "Short-stay volume work, the kind a regional patient can fly in and out for.", "rel": "procedure" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The cardiac work Maldivian patients have long been referred here for, by the trade's account.", "rel": "procedure" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "Quoted here itemised rather than as a package.", "rel": "procedure" }, { "to": "panchakarma", "type": "procedure", "name": "Panchakarma", "as": "The Ayurvedic course sold elsewhere on the island, not in these hospitals.", "rel": "contrast" }, { "to": "chennai", "type": "hub", "name": "Chennai", "as": "The Indian cluster across the strait that takes the complex referrals Colombo does not.", "rel": "contrast" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "A capital with a whole private sector in five kilometres and no count anybody publishes.", "rel": "story" }, { "to": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 15 kilometres of this point.", "rel": "measured-by" } ], "source_list": [ { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." }, { "id": "s:wp-healthcare-sri-lanka", "kind": "wikipedia", "title": "Healthcare in Sri Lanka", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Healthcare_in_Sri_Lanka", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "streets and postal districts read off OpenStreetMap address tags; the Narahenpita grouping is from the Healthcare in Sri Lanka article" }, "text.story": { "tier": "tradition", "note": "the Maldivian flow is the trade's account and is unverified; the inline marks say which stretches are inference" }, "text.how": { "tier": "tradition", "note": "the general billing shape of a Colombo private hospital, unverified against any one hospital's page" }, "text.today": { "tier": "cited" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "a central point between the Narahenpita, Slave Island and Maligawatte hospitals, not a point anybody published" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "sri-lanka", "type": "destination", "name": "Sri Lanka", "as": "Where the private sector and the referrals abroad both sit.", "rel": "part" } ] }, { "schema": 1, "id": "delhi-ncr", "type": "hub", "names": { "name": "Delhi NCR", "aliases": [ "National Capital Region", "Delhi", "Gurugram", "Gurgaon", "दिल्ली" ], "said": "Nobody says Delhi NCR to a patient. They say Gurgaon, or Saket, or Sarita Vihar, and those are three different drives from the airport." }, "region": [ "south-asia" ], "facets": { "iso2": "IN", "radius_km": 40, "specialty": [ "cardiac surgery", "transplant", "oncology", "orthopaedics", "neurosurgery", "fertility" ], "draws": [ "cabg", "heart-valve-replacement", "liver-transplant", "kidney-transplant", "bone-marrow-transplant", "knee-replacement", "ivf" ], "languages": [ "Hindi", "English", "Arabic", "Bengali", "Pashto", "Dari" ] }, "text": { "what": "Not a district but a triangle, roughly forty kilometres on a side. Medanta — The Medicity sits in Sector 38, Gurugram, on the Haryana side; Fortis Memorial Research Institute is eight kilometres north of it on Fortis Hospital Road in Sector 44; Max's flagship stands off Press Enclave Road in Saket, South Delhi; Indraprastha Apollo is further east again, on Mathura Road at Sarita Vihar. Between and around them lie Vasant Kunj, Rajinder Nagar and the guesthouse streets of Lajpat Nagar and Bhogal, which is where most of the patients actually stay.", "story": "Medanta opened in 2009, founded by the cardiac surgeon Naresh Trehan with Sunil Sachdeva: 1,250 beds on 43 acres, built for about ₹1,200 crore. Max opened its first centre in South Delhi's Panchsheel Park in 2000 and commissioned the East Block of the Saket hospital in 2004. *Inference —* the dates are the point. Delhi's private tertiary capacity was largely built inside a single decade, at a moment when the Haryana side of the border was selling farmland cheaply to anyone who would put a tower on it, which is why so much of it stands in Gurugram rather than in Delhi.\n\n*Trade practice —* the flow into this cluster is overwhelmingly regional and overland as much as by air: Afghanistan, Bangladesh, Iraq, Nigeria, Uzbekistan, the Gulf. The guesthouse economy around Lajpat Nagar exists because a cardiac or transplant patient brings a family, stays for weeks, cooks their own food and cannot afford a hotel.\n\n*Inference —* the sprawl is a directory problem before it is a patient problem. A harvest set tight on Saket misses Gurugram entirely, and a hub record that named one of the three would be describing a competitor rather than a cluster. This record takes the whole triangle and says so.", "how": "An estimate, not a package: room category, surgeon, theatre, projected stay, and a bill that moves with the stay. Most large hospitals here run an international patient desk that handles the visa invitation, the airport pickup and the interpreter, and several of them staff Arabic, Dari, Pashto, Russian and French. Payment is a deposit against the estimate, settled at discharge.", "today": "As of 16 September 2026 the harvest point for this hub sits between Gurugram and Saket, with a 40-kilometre radius — the widest in this batch — chosen to reach Gurugram, Faridabad, Noida and central Delhi in one query. Precision is region, not city, and that is a statement about the cluster rather than about the geocoding.", "notes": "A description of where the hospitals are. Not advice about any of them." }, "geo": { "lat": 28.49, "lon": 77.15, "precision": "region", "source": "s:osm-nominatim" }, "address": { "city": "Delhi and Gurugram", "area": "Delhi and Haryana", "country": "IN" }, "kin": [ { "to": "medanta", "as": "The Sector 38 hospital in Gurugram, 1,250 beds on 43 acres, opened 2009.", "rel": "part" }, { "to": "fortis-gurgaon", "as": "Eight kilometres north of Medanta on Fortis Hospital Road, Sector 44.", "rel": "part" }, { "to": "max-saket", "as": "The Delhi-side flagship, off Press Enclave Road in Saket.", "rel": "part" }, { "to": "india", "as": "The country whose largest private tertiary cluster this is.", "rel": "whole" }, { "to": "cabg", "as": "The operation the Gurugram towers were built around.", "rel": "procedure" }, { "to": "liver-transplant", "as": "The work that keeps families here for weeks and fills the guesthouse streets.", "rel": "procedure" }, { "to": "bone-marrow-transplant", "as": "Referred here from across South and Central Asia, by the trade's account.", "rel": "procedure" }, { "to": "india-e-medical-visa", "as": "The entry route, and the invitation letter the international desks issue against it.", "rel": "governed-by" }, { "to": "the-companion", "as": "The relative who comes too, and who has to be housed for the length of the stay.", "rel": "step" }, { "to": "chennai", "as": "The southern cluster competing for the same cardiac and transplant referrals.", "rel": "contrast" }, { "to": "osm-facilities", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 40 kilometres of this point.", "rel": "measured-by" } ], "links": [ { "label": "Medanta", "url": "https://www.medanta.org/" }, { "label": "Max Healthcare", "url": "https://www.maxhealthcare.in/" } ], "sources": [ "s:osm-nominatim", "s:wp-medanta", "s:wp-max-healthcare", "s:wp-medical-tourism-india", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "sectors, roads and localities read off OpenStreetMap address tags" }, "text.story": { "tier": "cited", "source": "s:wp-medanta", "note": "the founding dates and the Medanta figures are cited; the inline marks say which stretches are inference and trade practice" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "the centroid of the Gurugram–Saket–Sarita Vihar triangle, not a point anybody published" } } }, "x_commons_files": [ "File:Medanta The Medicity Gurgaon.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "Not a district but a triangle, roughly forty kilometres on a side.", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" } ], "kin_out": [ { "to": "medanta", "type": "facility", "name": "Medanta — The Medicity, Gurugram", "as": "The Sector 38 hospital in Gurugram, 1,250 beds on 43 acres, opened 2009.", "rel": "part" }, { "to": "fortis-gurgaon", "type": "facility", "name": "Fortis Memorial Research Institute, Gurugram", "as": "Eight kilometres north of Medanta on Fortis Hospital Road, Sector 44.", "rel": "part" }, { "to": "max-saket", "type": "facility", "name": "Max Super Speciality Hospital, Saket", "as": "The Delhi-side flagship, off Press Enclave Road in Saket.", "rel": "part" }, { "to": "india", "type": "destination", "name": "India", "as": "The country whose largest private tertiary cluster this is.", "rel": "whole" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The operation the Gurugram towers were built around.", "rel": "procedure" }, { "to": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "The work that keeps families here for weeks and fills the guesthouse streets.", "rel": "procedure" }, { "to": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "Referred here from across South and Central Asia, by the trade's account.", "rel": "procedure" }, { "to": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The entry route, and the invitation letter the international desks issue against it.", "rel": "governed-by" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "The relative who comes too, and who has to be housed for the length of the stay.", "rel": "step" }, { "to": "chennai", "type": "hub", "name": "Chennai", "as": "The southern cluster competing for the same cardiac and transplant referrals.", "rel": "contrast" }, { "to": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 40 kilometres of this point.", "rel": "measured-by" } ], "source_list": [ { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." }, { "id": "s:wp-medanta", "kind": "wikipedia", "title": "Medanta", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medanta", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-max-healthcare", "kind": "wikipedia", "title": "Max Healthcare", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Max_Healthcare", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-medical-tourism-india", "kind": "wikipedia", "title": "Medical tourism in India", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_India", "license": "CC BY-SA 4.0", "accessed": "2026-09-16", "note": "carries city-share and market-size figures sourced to newspapers and market-research summaries; this project reads it for the claims and their attributions, not as a count." }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "sectors, roads and localities read off OpenStreetMap address tags" }, "text.story": { "tier": "cited", "source": "s:wp-medanta", "note": "the founding dates and the Medanta figures are cited; the inline marks say which stretches are inference and trade practice" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "the centroid of the Gurugram–Saket–Sarita Vihar triangle, not a point anybody published" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "india", "type": "destination", "name": "India", "as": "The capital-region cluster that takes most of the arrivals from West Asia and Africa.", "rel": "part" }, { "from": "nepal", "type": "destination", "name": "Nepal", "as": "One of the northern Indian clusters a Kathmandu referral lands in.", "rel": "destination" }, { "from": "chennai", "type": "hub", "name": "Chennai", "as": "The northern cluster Chennai competes with for the same cardiac and transplant referrals.", "rel": "contrast" }, { "from": "mumbai", "type": "hub", "name": "Mumbai", "as": "The northern cluster, larger and weighted to the heart rather than to cancer.", "rel": "contrast" }, { "from": "fortis-gurgaon", "type": "facility", "name": "Fortis Memorial Research Institute, Gurugram", "as": "One of the two hospitals the Gurugram end of the Delhi cluster is usually named for.", "rel": "place" }, { "from": "max-saket", "type": "facility", "name": "Max Super Speciality Hospital, Saket", "as": "The South Delhi end of the cluster, against the two Gurugram campuses on the airport road.", "rel": "place" }, { "from": "medanta", "type": "facility", "name": "Medanta — The Medicity, Gurugram", "as": "One of the two Gurugram campuses the Delhi cluster is named for, eight kilometres from the other.", "rel": "place" } ] }, { "schema": 1, "id": "dubai", "type": "hub", "names": { "name": "Dubai", "aliases": [ "Dubai Healthcare City", "DHCC", "دبي" ], "said": "In this city a clinic states which licence it holds before it states what it treats, because the free zone and the emirate license separately." }, "region": [ "gulf" ], "facets": { "iso2": "AE", "radius_km": 25, "founded": 2002, "specialty": [ "health screening", "dentistry", "cosmetic surgery", "fertility", "orthopaedics", "hair restoration" ], "draws": [ "executive-health-screening", "dental-implant", "ivf", "rhinoplasty", "hair-transplant-fue", "liposuction" ], "languages": [ "Arabic", "English", "Hindi", "Urdu", "Russian" ] }, "text": { "what": "A designated healthcare free zone with its own regulator, and a city of clinics around it. Dubai Healthcare City was launched in 2002 by Mohammed bin Rashid Al Maktoum; Phase 1 sits on Oud Metha Road in Bur Dubai across 4.1 million square feet given to care and medical education, and Phase 2 at Al Jaddaf covers 19 million square feet given to wellness. The free zone's own site counted 168 clinical facilities, 10 hospitals and 4,425 healthcare professionals when it was read on 16 September 2026. Outside its boundary the emirate's own health authority licenses everything else, which is why an address in this city carries a regulatory meaning.", "story": "The free zone is the interesting structure here, and it is a legal one rather than a medical one. A company inside it is licensed by Dubai Healthcare City Authority, and its clinicians hold that authority's licence rather than the emirate's. A clinic a few minutes away is licensed by the Dubai Health Authority. Two regulators, two registers, two complaints routes, one city.\n\n*Inference —* that arrangement was built to import institutions, not patients. A free zone exists so that a foreign operator can hold its own licence, own its own entity and recruit clinicians registered elsewhere; the patient flow followed the institutions rather than the other way round. It is the opposite sequence from Bangkok or Istanbul, where a trade grew and a state regulated it afterwards.\n\n*Trade practice —* the traffic is regional and expatriate before it is intercontinental. A Gulf state that sends its own nationals abroad on sponsored treatment is also a place people fly into from South Asia, East Africa and the wider Middle East, and the same city is a source market and a destination in the same week.\n\nThis record carries no count of arrivals. The figures published for the emirate count visits by non-residents to licensed facilities, which sweeps in every expatriate consultation.", "how": "*Trade practice —* the Dubai offer is built around the screening package and the short elective: a day of imaging and bloods sold as a programme, or a cosmetic or dental procedure fitted into a stopover. Payment is direct or through an insurer, and the large groups bill international insurers directly. What a reader can check here that they cannot check in most cities is the licence: both regulators publish registers, and a clinician's name either appears on one of them or does not.", "today": "As of 16 September 2026 Dubai Healthcare City's own homepage states 168 clinical facilities, 10 hospitals and 4,425 healthcare professionals. Those are the free zone's counts of its own members, not of patients.", "notes": "Twenty-five kilometres from the Dubai Healthcare City point covers Bur Dubai, Deira, Jumeirah, Al Barsha and Al Jaddaf, and stops short of Jebel Ali." }, "geo": { "lat": 25.2331, "lon": 55.3236, "precision": "city", "source": "s:wp-dubai-healthcare-city" }, "address": { "street": "Oud Metha Road", "area": "Umm Hurair, Bur Dubai", "city": "Dubai", "country": "AE" }, "kin": [ { "to": "uae", "as": "The federation this free zone and this city sit in.", "rel": "whole" }, { "to": "dha-dubai", "as": "The emirate's health authority, which licenses everything outside the free zone boundary.", "rel": "governed-by" }, { "to": "uae-clinic-licensing", "as": "The two-register arrangement that makes an address here a regulatory fact.", "rel": "governed-by" }, { "to": "american-hospital-dubai", "as": "One of the city's large private hospitals, and a destination behind a share of the arrivals described here.", "rel": "part" }, { "to": "executive-health-screening", "as": "The programme this city sells most, priced as a day.", "rel": "procedure" }, { "to": "ivf", "as": "Sold here to a regional market that often cannot buy it at home.", "rel": "procedure" }, { "to": "gcc-sponsored-treatment-abroad", "as": "The scheme by which this city's own region sends patients out while it brings others in.", "rel": "governed-by" }, { "to": "who-travels", "as": "Why a city can be a source market and a destination in the same week.", "rel": "story" }, { "to": "isqua-ieea", "as": "The body that accredits the standards a regulator writes, rather than the hospital.", "rel": "org" } ], "links": [ { "label": "Dubai Healthcare City", "url": "https://www.dhcc.ae/" } ], "sources": [ "s:dhcc", "s:wp-dubai-healthcare-city", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:dhcc" }, "text.story": { "tier": "cited", "source": "s:wp-dubai-healthcare-city", "note": "paragraphs two and three are marked inline as inference and trade practice" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "cited", "source": "s:wp-dubai-healthcare-city", "note": "the coordinates of Dubai Healthcare City, used as the cluster point rather than the city centroid" }, "facets.radius_km": { "tier": "inference" } } }, "x_commons_files": [ "File:Dubai Healthcare City.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "A designated healthcare free zone with its own regulator, and a city of clinics around it.", "region_terms": [ { "key": "gulf", "name": "The Gulf", "note": "the UAE, Saudi Arabia, Qatar, Kuwait, Oman, Bahrain — a source market that is building itself into a destination" } ], "kin_out": [ { "to": "uae", "type": "destination", "name": "United Arab Emirates", "as": "The federation this free zone and this city sit in.", "rel": "whole" }, { "to": "dha-dubai", "type": "org", "name": "Dubai Health Authority", "as": "The emirate's health authority, which licenses everything outside the free zone boundary.", "rel": "governed-by" }, { "to": "uae-clinic-licensing", "type": "rule", "name": "Licensing a clinic in the United Arab Emirates", "as": "The two-register arrangement that makes an address here a regulatory fact.", "rel": "governed-by" }, { "to": "american-hospital-dubai", "type": "facility", "name": "American Hospital Dubai", "as": "One of the city's large private hospitals, and a destination behind a share of the arrivals described here.", "rel": "part" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The programme this city sells most, priced as a day.", "rel": "procedure" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "Sold here to a regional market that often cannot buy it at home.", "rel": "procedure" }, { "to": "gcc-sponsored-treatment-abroad", "type": "rule", "name": "Gulf state-sponsored treatment abroad", "as": "The scheme by which this city's own region sends patients out while it brings others in.", "rel": "governed-by" }, { "to": "who-travels", "type": "story", "name": "Who travels", "as": "Why a city can be a source market and a destination in the same week.", "rel": "story" }, { "to": "isqua-ieea", "type": "org", "name": "ISQua External Evaluation Association", "as": "The body that accredits the standards a regulator writes, rather than the hospital.", "rel": "org" } ], "source_list": [ { "id": "s:dhcc", "kind": "web", "title": "Dubai Healthcare City", "publisher": "Dubai Healthcare City Authority", "url": "https://www.dhcc.ae/", "accessed": "2026-09-16", "note": "the free zone's own homepage counts, read 16 September 2026: 168 clinical facilities, 10 hospitals, 4,425 healthcare professionals; Phase 1 on Oud Metha Road in Bur Dubai and Phase 2 at Al Jaddaf; regulator named as Dubai Healthcare City Authority" }, { "id": "s:wp-dubai-healthcare-city", "kind": "web", "title": "Dubai Healthcare City", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Dubai_Healthcare_City", "accessed": "2026-09-16" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:dhcc" }, "text.story": { "tier": "cited", "source": "s:wp-dubai-healthcare-city", "note": "paragraphs two and three are marked inline as inference and trade practice" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited", "source": "s:wp-dubai-healthcare-city", "note": "the coordinates of Dubai Healthcare City, used as the cluster point rather than the city centroid" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "uae", "type": "destination", "name": "United Arab Emirates", "as": "The emirate that does the counting, the licensing and nearly all of the selling.", "rel": "part" }, { "from": "amman", "type": "hub", "name": "Amman", "as": "The Gulf destination that grew after this one and competes for the same referrals.", "rel": "contrast" }, { "from": "cairo", "type": "hub", "name": "Cairo", "as": "The Gulf destination competing for the same regional patients at several times the price.", "rel": "contrast" }, { "from": "johannesburg", "type": "hub", "name": "Johannesburg", "as": "The other destination competing for African referrals, at a longer flight and a higher price.", "rel": "contrast" }, { "from": "dhi-hair-transplant", "type": "procedure", "name": "Direct hair implantation (DHI)", "as": "The hub whose clinics price by extent of hair loss rather than by graft.", "rel": "place" }, { "from": "american-hospital-dubai", "type": "facility", "name": "American Hospital Dubai", "as": "The hospital the emirate's private sector dates its American standards from, in Oud Metha rather than in Dubai Healthcare City.", "rel": "place" }, { "from": "gcc-sponsored-treatment-abroad", "type": "rule", "name": "Gulf state-sponsored treatment abroad", "as": "The city whose authority wrote it.", "rel": "hub" }, { "from": "uae-clinic-licensing", "type": "rule", "name": "Licensing a clinic in the United Arab Emirates", "as": "The city where the fault line between regulators runs.", "rel": "hub" }, { "from": "dha-dubai", "type": "org", "name": "Dubai Health Authority", "as": "The emirate itself: everything outside the free-zone boundary answers to this licence.", "rel": "hub" } ] }, { "schema": 1, "id": "havana", "type": "hub", "names": { "name": "Havana", "aliases": [ "La Habana", "Ciudad de La Habana" ], "said": "La Habana. The state company that sells care to foreigners is Servicios Médicos Cubanos, SMC." }, "region": [ "caribbean" ], "facets": { "iso2": "CU", "radius_km": 20, "specialty": [ "ophthalmology", "neurology", "rehabilitation", "oncology", "dermatology", "addiction treatment" ], "draws": [ "cataract-surgery", "addiction-rehab", "executive-health-screening" ], "languages": [ "Spanish", "English", "Russian", "Portuguese" ] }, "text": { "what": "Cuba's capital, about two million people, and the only hub in this directory where every hospital and clinic is state-owned. Foreign patients are sold care through a government trading company rather than by the hospitals themselves, and the currency they bring is the point of the arrangement. It is also the only hub here whose largest source market is legally barred from most travel to it.", "story": "There are no private hospitals or clinics in Cuba; all health services are government-run, and there were 150 hospitals in the country as of 2019. Foreign patients are handled through a state marketing company, Comercializadora de Servicios Médicos Cubanos, which sells access to the national system as a package of treatment, transfers, accommodation and support for a companion.\n\nThe treatments that travel are the unusual ones: eye surgery, multiple sclerosis and Parkinson's disease, retinitis pigmentosa, orthopaedics, addiction treatment. In 2005 more than 19,600 foreign patients came for care, most from Latin America, with the retinitis pigmentosa programme drawing patients from Europe and North America. Annual revenue from this trade has been put at around forty million United States dollars, a figure repeated without a stated year and one this directory carries as a circulating number rather than a measurement.\n\nCuba also runs the inverse trade. Under Operación Milagro, from 2004, it paid for Venezuelans with reversible blindness to fly to Cuba for free sight-restoring surgery; more than 200,000 Venezuelans were operated on, the programme was then exported, and by 2019 more than four million people in 34 countries had been treated through it. Free surgery flown in one direction and hard-currency surgery flown in the other, out of the same hospital system.\n\nThat is exactly where the argument sits, and this record reports it rather than settling it. The Cuban neurosurgeon and dissident Hilda Molina has argued that after the Special Period the state turned the medical system into a foreign-currency business and created a gap between what a Cuban and a foreigner receive. Others hold that the revenue funds the domestic system that treats Cubans for nothing.\n\n*Inference —* the gap is structurally hard to measure from outside, because the same ministry owns the hospitals, sells the packages and publishes the statistics.", "how": "Care is bought from the state company, not from a hospital, and paid in hard currency. For United States residents the constraint is not clinical but legal: 31 CFR § 515.560, the travel section of the Cuban Assets Control Regulations, authorises twelve categories of travel — family visits, official business, journalism, professional research and meetings, education, religious activity, public performances and competitions, support for the Cuban people, humanitarian projects, private foundations and research institutes, informational materials, and certain export transactions. Going for treatment is not among them, and paragraph (f) states: \"Nothing in this section authorizes transactions in connection with tourist travel to Cuba.\" A note to the section does authorise the receipt of emergency medical services and payment for them.", "today": "As of 16 September 2026 the Cuban health system remains wholly state-owned and sells to foreigners through a single state company; the United States regulation governing whether its own residents may lawfully pay for that care is 31 CFR § 515.560.", "notes": "Nothing here is legal advice. A sanctions reading turns on facts this page does not have, and the regulation moves." }, "geo": { "lat": 23.1367, "lon": -82.3589, "precision": "city", "source": "s:wp-havana" }, "address": { "city": "Havana", "area": "La Habana", "country": "CU" }, "tags": [ { "tag": "public-hospital", "source": "s:wp-hospitals-cuba", "tier": "cited", "note": "every hospital and clinic in Cuba is government-run; 150 hospitals as of 2019" } ], "kin": [ { "to": "cuba", "as": "The country whose entire health sector is the state, and whose export trade in care runs through one company.", "rel": "destination" }, { "to": "united-states", "as": "The nearest large market, and the one whose own law is the binding constraint on reaching this city.", "rel": "kin" }, { "to": "santo-domingo", "as": "The other Caribbean hub — private, cosmetic and reachable, where this one is public, neurological and not.", "rel": "contrast" }, { "to": "cataract-surgery", "as": "The operation Cuba exported by aircraft under Operación Milagro, free, in the opposite direction to the paying trade.", "rel": "performs" }, { "to": "addiction-rehab", "as": "One of the courses of treatment the state company sells to foreign patients.", "rel": "performs" }, { "to": "insurance-exclusions", "as": "A sanctioned destination is an exclusion before it is a clinical one.", "rel": "governed-by" }, { "to": "circumvention", "as": "Travel because of what the state at home forbids — here the forbidding state is the patient's own.", "rel": "story" }, { "to": "who-travels", "as": "Most of Havana's foreign patients come from Latin America, not from the country ninety miles north.", "rel": "story" }, { "to": "counting-patients", "as": "A number published by the ministry that owns the hospitals and sells the packages is a particular kind of number.", "rel": "story" } ], "links": [ { "label": "31 CFR § 515.560", "url": "https://www.law.cornell.edu/cfr/text/31/515.560" } ], "sources": [ "s:wp-havana", "s:wp-hospitals-cuba", "s:wp-healthcare-cuba", "s:wp-tourism-cuba", "s:cacr-515-560" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:wp-tourism-cuba", "note": "patient numbers, revenue and the Molina criticism are the encyclopedia articles and are dated where the articles date them; the closing paragraph is this project's reasoning" }, "text.how": { "tier": "cited", "source": "s:cacr-515-560", "note": "the twelve categories and the sentence in paragraph (f) are quoted from the regulation as published by the Cornell Legal Information Institute" } } }, "x_commons_files": [ "File:Havana Vedado skyline.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "Cuba's capital, about two million people, and the only hub in this directory where every hospital and clinic is state-owned.", "region_terms": [ { "key": "caribbean", "name": "The Caribbean", "note": "the Dominican Republic, Cuba, Barbados, the Caymans" } ], "kin_out": [ { "to": "cuba", "type": "destination", "name": "Cuba", "as": "The country whose entire health sector is the state, and whose export trade in care runs through one company.", "rel": "destination" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The nearest large market, and the one whose own law is the binding constraint on reaching this city.", "rel": "kin" }, { "to": "santo-domingo", "type": "hub", "name": "Santo Domingo", "as": "The other Caribbean hub — private, cosmetic and reachable, where this one is public, neurological and not.", "rel": "contrast" }, { "to": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "The operation Cuba exported by aircraft under Operación Milagro, free, in the opposite direction to the paying trade.", "rel": "performs" }, { "to": "addiction-rehab", "type": "procedure", "name": "Residential addiction treatment", "as": "One of the courses of treatment the state company sells to foreign patients.", "rel": "performs" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "A sanctioned destination is an exclusion before it is a clinical one.", "rel": "governed-by" }, { "to": "circumvention", "type": "story", "name": "Circumvention", "as": "Travel because of what the state at home forbids — here the forbidding state is the patient's own.", "rel": "story" }, { "to": "who-travels", "type": "story", "name": "Who travels", "as": "Most of Havana's foreign patients come from Latin America, not from the country ninety miles north.", "rel": "story" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "A number published by the ministry that owns the hospitals and sells the packages is a particular kind of number.", "rel": "story" } ], "source_list": [ { "id": "s:wp-havana", "kind": "web", "title": "Havana", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Havana", "accessed": "2026-09-16" }, { "id": "s:wp-hospitals-cuba", "kind": "web", "title": "List of hospitals in Cuba", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/List_of_hospitals_in_Cuba", "accessed": "2026-09-16", "note": "states there are no private hospitals or clinics in Cuba and gives 150 hospitals as of 2019" }, { "id": "s:wp-healthcare-cuba", "kind": "web", "title": "Healthcare in Cuba", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Healthcare_in_Cuba", "accessed": "2026-09-16", "note": "the health tourism section, the Operación Milagro eye-surgery programme, and the dispute over what hard-currency patients change inside Cuban hospitals" }, { "id": "s:wp-tourism-cuba", "kind": "web", "title": "Tourism in Cuba", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Tourism_in_Cuba", "accessed": "2026-09-16", "note": "health tourism section; the 2005 figure of more than 19,600 foreign patients, and Hilda Molina's criticism" }, { "id": "s:cacr-515-560", "kind": "law", "title": "31 CFR § 515.560 — Travel-related transactions to, from, and within Cuba by persons subject to U.S. jurisdiction", "publisher": "Cuban Assets Control Regulations, US Department of the Treasury, via Cornell Legal Information Institute", "url": "https://www.law.cornell.edu/cfr/text/31/515.560", "accessed": "2026-09-16", "note": "twelve categories of authorised travel; paragraph (f) states that nothing in the section authorises transactions in connection with tourist travel to Cuba; a note to the section authorises the receipt of emergency medical services" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:wp-tourism-cuba", "note": "patient numbers, revenue and the Molina criticism are the encyclopedia articles and are dated where the articles date them; the closing paragraph is this project's reasoning" }, "text.how": { "tier": "cited", "source": "s:cacr-515-560", "note": "the twelve categories and the sentence in paragraph (f) are quoted from the regulation as published by the Cornell Legal Information Institute" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [ { "key": "public-hospital", "label": "Public hospital", "icon": "🏛", "group": "ownership", "evidence": "a ministry register, a national health service list, or the hospital's own statement", "source": "s:wp-hospitals-cuba", "note": "every hospital and clinic in Cuba is government-run; 150 hospitals as of 2019", "tier": "cited", "url": "" } ], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "cuba", "type": "destination", "name": "Cuba", "as": "Where the designated facilities and the state seller sit.", "rel": "part" }, { "from": "santo-domingo", "type": "hub", "name": "Santo Domingo", "as": "The other Caribbean hub — public, neurological and legally hard to reach, where this one is private and a two-hour flight.", "rel": "contrast" } ] }, { "schema": 1, "id": "istanbul", "type": "hub", "names": { "name": "Istanbul", "aliases": [ "İstanbul", "Şişli–Nişantaşı clinic belt" ], "said": "Brokers say Istanbul and mean a strip of the European side: Şişli, Nişantaşı, Mecidiyeköy, then north to Levent and Maslak. The old city across the Golden Horn sells almost none of it." }, "region": [ "west-asia" ], "facets": { "iso2": "TR", "radius_km": 30, "specialty": [ "hair restoration", "cosmetic surgery", "dentistry", "bariatric surgery", "fertility", "ophthalmology" ], "draws": [ "hair-transplant-fue", "dhi-hair-transplant", "rhinoplasty", "gastric-sleeve", "dental-implant", "ivf" ], "languages": [ "Turkish", "English", "Arabic", "Russian", "German" ] }, "text": { "what": "A clinic belt on the European side of Istanbul, thickest in Şişli — ten square kilometres holding 276,528 residents and the quarters of Nişantaşı, Teşvikiye, Pangaltı and Mecidiyeköy — and running north through Levent and Maslak. Şişli carries the Şişli Etfal state hospital, the American Hospital and the Saint James Armenian Hospital alongside clinic floors above the shops of Abdi İpekçi Avenue, which the district calls Turkey's most expensive street by lease price. Hair restoration is what the belt is known for abroad; the same square mile also sells rhinoplasty, dentistry, sleeve gastrectomy and IVF. Every facility and every agency trading with foreign patients must hold a Ministry of Health authorisation certificate.", "story": "Türkiye put the trade on a licence in 2017. The Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik — the ministry's regulation on international health travel and on the health of visitors — appeared in the Resmî Gazete on 13 July 2017, issue 30123, and was replaced by a regulation of the same name on 26 April 2025, issue 32882, whose MADDE 17 repealed it. Its Article 5 makes an international health tourism authorisation certificate compulsory for both the treating facility and the intermediary agency; the Ministry halts the international work of anyone trading without one. Facilities already in the business were given a year to comply.\n\n*Trade practice —* what the licence regulated was already a mature export. The city's hair clinics sell a fixed bundle — airport pickup, a hotel, the procedure, a night, a first wash — and compete on graft count and on price rather than on a surgeon's name.\n\nThe surgical society has spent a decade objecting to the staffing. The International Society of Hair Restoration Surgery issued a release on 18 May 2016 naming Turkey and warning that unqualified technicians perform the surgery illegally, and reporting Turkish technician groups working in Germany, the Netherlands and Belgium under the cover of licensed doctors. Its standing Black Market campaign, launched in November 2019, states that unlicensed personnel worldwide carry out substantial medical parts of hair restoration surgery, and its Operation Restore programme repairs the results.\n\n*Inference —* the two facts sit together without contradicting each other. A national licence certifies a facility and an agency. Who holds the punch inside the room on the day is a separate question, and it is the one the society keeps asking.", "how": "*Trade practice —* the Istanbul form is the package: a flight met at the airport, a hotel in Şişli or Mecidiyeköy, a consultation the morning of surgery, the procedure the same day, one or two nights, a wash and a discharge folder, and a flight home inside a week. Payment is a deposit to hold the date and the balance on arrival. The graft count is the price variable, and the number quoted before travel is an estimate the clinic revises when it sees the head. Aftercare is a messaging app: the follow-up is remote by design, and a revision is a second flight.", "today": "As of 17 September 2026 the instrument is the 2025 regulation, not the 2017 one that most writing on this city still cites; the authorisation certificate is the thing to ask a clinic for by name, and the Ministry's own register is where it is checked. Istanbul's population was 15,754,053 at the end of 2025. This record carries no count of how many people fly in for surgery: the figures in circulation count arrivals who state a health purpose, which is not the same as operations. Hair transplant units answer to a rule of their own as well — the Saç Ekimi Birimleri Yönetmeliği of 6 May 2023, Resmî Gazete 32182 — which reserves the channel-opening stage to certified physicians and forbids more than one patient in a room at a time. The Ministry's four published lists of authorised facilities, stamped 20 August 2026, run to 542 hospitals, 135 medical centres, 2,468 physician offices and 1,581 other facilities; the Ministry prints no total.", "notes": "Hospital and clinic points around this record's coordinates are harvested from OpenStreetMap within 30 km, which covers Şişli, Beşiktaş, Levent, Maslak and reaches the Asian side. A point on that map is a point a mapper typed, not a licence and not a recommendation." }, "geo": { "lat": 41.0603, "lon": 28.9878, "precision": "city", "source": "s:wp-sisli" }, "address": { "area": "Şişli", "city": "Istanbul", "country": "TR" }, "kin": [ { "to": "turkiye", "as": "The country whose licence this cluster trades under.", "rel": "whole" }, { "to": "turkiye-health-tourism-authorisation", "as": "The certificate every clinic here must hold, and the one document a reader can ask for by name.", "rel": "governed-by" }, { "to": "hair-transplant-fue", "as": "The operation this belt is known for abroad, sold by graft count.", "rel": "procedure" }, { "to": "dhi-hair-transplant", "as": "The implanter-pen variant the clinics here price as a tier above.", "rel": "procedure" }, { "to": "memorial-sisli", "as": "A large private hospital inside the belt, in Şişli itself.", "rel": "part" }, { "to": "acibadem", "as": "The hospital group whose Istanbul sites take the complex work the clinic floors do not.", "rel": "part" }, { "to": "ishrs", "as": "The surgical society that has named this city in its warnings about unlicensed operators since 2016.", "rel": "org" }, { "to": "turkiye-hair-boom", "as": "The years this belt became the thing Istanbul is known for.", "rel": "event" }, { "to": "antalya", "as": "The other Turkish cluster, selling the same procedures against a beach rather than a business district.", "rel": "contrast" }, { "to": "follow-up-gap", "as": "What a one-week package leaves behind: the wash, the shedding and the twelve-month result all happen at home.", "rel": "risk" }, { "to": "package-price", "as": "The form the whole belt sells in, graft count included.", "rel": "term" } ], "links": [ { "label": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik, Resmî Gazete 13 July 2017", "url": "https://www.resmigazete.gov.tr/eskiler/2017/07/20170713-3.htm" }, { "label": "ISHRS — Black Market", "url": "https://ishrs.org/black-market/" } ], "sources": [ "s:wp-sisli", "s:wp-istanbul", "s:rg-saglik-turizmi-2017", "s:ishrs-buyer-beware", "s:ishrs-black-market", "s:wp-medical-tourism-turkiye", "s:osm", "s:rg-32882-2025", "s:rg-32182-2023-sac-ekimi", "s:shgm-yetkili-tesisler" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:wp-sisli" }, "text.how": { "tier": "tradition", "note": "the shape of an Istanbul hair-transplant package; no single page states it" }, "text.today": { "tier": "cited", "source": "s:rg-saglik-turizmi-2017" }, "geo": { "tier": "cited", "source": "s:wp-sisli", "note": "the coordinates of Şişli district, used as the cluster point rather than the city centroid" }, "facets.radius_km": { "tier": "inference", "note": "30 km from Şişli covers the Şişli–Levent–Maslak run and crosses the Bosphorus; the metropolitan area is far larger" } } }, "x_commons_files": [ "File:Nişantaşı, Şişli, Istanbul.jpg", "File:Abdi İpekçi Avenue Nişantaşı.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "A clinic belt on the European side of Istanbul, thickest in Şişli — ten square kilometres holding 276,528 residents and the quarters of Nişantaşı, Teşvikiye, Pangaltı and Mecidiyeköy — and running north through Levent…", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The country whose licence this cluster trades under.", "rel": "whole" }, { "to": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The certificate every clinic here must hold, and the one document a reader can ask for by name.", "rel": "governed-by" }, { "to": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The operation this belt is known for abroad, sold by graft count.", "rel": "procedure" }, { "to": "dhi-hair-transplant", "type": "procedure", "name": "Direct hair implantation (DHI)", "as": "The implanter-pen variant the clinics here price as a tier above.", "rel": "procedure" }, { "to": "memorial-sisli", "type": "facility", "name": "Memorial Şişli Hospital", "as": "A large private hospital inside the belt, in Şişli itself.", "rel": "part" }, { "to": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "The hospital group whose Istanbul sites take the complex work the clinic floors do not.", "rel": "part" }, { "to": "ishrs", "type": "org", "name": "International Society of Hair Restoration Surgery", "as": "The surgical society that has named this city in its warnings about unlicensed operators since 2016.", "rel": "org" }, { "to": "turkiye-hair-boom", "type": "event", "name": "Türkiye's hair transplant boom", "as": "The years this belt became the thing Istanbul is known for.", "rel": "event" }, { "to": "antalya", "type": "hub", "name": "Antalya", "as": "The other Turkish cluster, selling the same procedures against a beach rather than a business district.", "rel": "contrast" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "What a one-week package leaves behind: the wash, the shedding and the twelve-month result all happen at home.", "rel": "risk" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The form the whole belt sells in, graft count included.", "rel": "term" } ], "source_list": [ { "id": "s:wp-sisli", "kind": "wikipedia", "title": "Şişli", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/%C5%9Ei%C5%9Fli", "accessed": "2026-09-16", "note": "district area 10 km², population 276,528 (2022), the Nişantaşı, Teşvikiye, Mecidiyeköy and Pangaltı quarters, Şişli Etfal and Saint James Armenian hospitals" }, { "id": "s:wp-istanbul", "kind": "wikipedia", "title": "Istanbul", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Istanbul", "accessed": "2026-09-16", "note": "coordinates, population 15,754,053 at 31 December 2025, district names" }, { "id": "s:rg-saglik-turizmi-2017", "kind": "web", "title": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik", "publisher": "Resmî Gazete, Republic of Türkiye (Ministry of Health)", "url": "https://www.resmigazete.gov.tr/eskiler/2017/07/20170713-3.htm", "accessed": "2026-09-16", "note": "Resmî Gazete 13 July 2017, No. 30123. Read in Turkish off the Resmî Gazete page. Article 5(1) makes an international health tourism authorisation certificate (yetki belgesi) compulsory for both the health facility and the intermediary; the Ministry halts the activity of anyone without one. Transitional Article 1 gave those already trading one year to comply. Article 16: in force on publication. REPEALED: MADDE 17 of the regulation of 26 April 2025 (Resmî Gazete 32882) revokes this one. Cite it for what the regime was, not for what it is." }, { "id": "s:ishrs-buyer-beware", "kind": "org", "title": "Buyer Beware: Medical Tourism for Hair Transplants Can Have Costly Consequences", "publisher": "International Society of Hair Restoration Surgery", "url": "https://ishrs.org/buyer-beware-medical-tourism-for-hair-transplants-can-have-costly-consequences/", "accessed": "2026-09-16", "note": "release dated 18 May 2016; names Turkey, and reports of Turkish technician groups operating in Germany, the Netherlands and Belgium under licensed doctors" }, { "id": "s:ishrs-black-market", "kind": "org", "title": "Black Market hair restoration — the Fight the FIGHT campaign", "publisher": "International Society of Hair Restoration Surgery", "url": "https://ishrs.org/black-market/", "accessed": "2026-09-16", "note": "the society's standing warning that unlicensed personnel perform substantial medical parts of hair restoration surgery; campaign launched November 2019; Operation Restore repairs botched work" }, { "id": "s:wp-medical-tourism-turkiye", "kind": "wikipedia", "title": "Medical tourism in Turkey", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_Turkey", "accessed": "2026-09-16", "note": "records the 13 July 2017 regulation coming into force and a first-half-2018 figure of nearly 178,000 inbound patients split 67% private, 24% public and 9% university — a count of arrivals stating a health purpose, not of operations" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" }, { "id": "s:rg-32882-2025", "kind": "web", "title": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik, Resmî Gazete 26 Nisan 2025, Sayı 32882", "publisher": "T.C. Resmî Gazete", "year": 2025, "url": "https://www.resmigazete.gov.tr/eskiler/2025/04/20250426-2.htm", "accessed": "2026-09-17", "note": "MADDE 17 repeals the 13/7/2017 regulation (RG 30123) that most secondary writing still cites" }, { "id": "s:rg-32182-2023-sac-ekimi", "kind": "web", "title": "Saç Ekimi Birimleri Hakkında Yönetmelik, Resmî Gazete 6 Mayıs 2023, Sayı 32182", "publisher": "T.C. Resmî Gazete", "year": 2023, "url": "https://www.resmigazete.gov.tr/eskiler/2023/05/20230506-11.htm", "accessed": "2026-09-17" }, { "id": "s:shgm-yetkili-tesisler", "kind": "org", "title": "Bakanlığımızca Yetkilendirilmiş Sağlık Tesisleri — the four published lists of authorised facilities", "publisher": "T.C. Sağlık Bakanlığı, Sağlık Turizmi Daire Başkanlığı", "url": "https://shgmturizmdb.saglik.gov.tr/TR-67458/bakanligimizca-yetkilendirilmis-saglik-tesisleri-icin-tiklayiniz.html", "accessed": "2026-09-17", "note": "lists stamped 20 August 2026; the Ministry prints no total, so the counts here are the last sequence number in each list" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:wp-sisli" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "the shape of an Istanbul hair-transplant package; no single page states it" }, "text.today": { "tier": "cited", "source": "s:rg-saglik-turizmi-2017" }, "geo": { "tier": "cited", "source": "s:wp-sisli", "note": "the coordinates of Şişli district, used as the cluster point rather than the city centroid" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "turkiye", "type": "destination", "name": "Türkiye", "as": "Where most of the clinics, and nearly all of the hair work, actually are.", "rel": "part" }, { "from": "antalya", "type": "hub", "name": "Antalya", "as": "The other Turkish cluster: the same procedures, sold against a business district instead of a beach.", "rel": "contrast" }, { "from": "cairo", "type": "hub", "name": "Cairo", "as": "The cluster Cairo's hair and cosmetic clinics price against.", "rel": "contrast" }, { "from": "izmir", "type": "hub", "name": "İzmir", "as": "The cluster that takes the traffic this one competes for on price.", "rel": "contrast" }, { "from": "tbilisi", "type": "hub", "name": "Tbilisi", "as": "The neighbouring cluster this city's hair clinics price against.", "rel": "contrast" }, { "from": "tunis", "type": "hub", "name": "Tunis", "as": "The other Mediterranean cosmetic cluster, selling to a different language market.", "rel": "contrast" }, { "from": "dhi-hair-transplant", "type": "procedure", "name": "Direct hair implantation (DHI)", "as": "Where the two techniques are sold from the same price list.", "rel": "place" }, { "from": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "The city whose clinics quote this operation in three currencies on one page.", "rel": "place" }, { "from": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The city this operation built, and which built it.", "rel": "place" }, { "from": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "The city the group is named after a district of, and where its flagship stands at Altunizade.", "rel": "place" }, { "from": "anadolu-medical-center", "type": "facility", "name": "Anadolu Medical Center", "as": "An hour east of the city and outside it, at Gebze on the D-100 — the trade counts it Istanbul, the map does not.", "rel": "place" }, { "from": "liv-hospital", "type": "facility", "name": "Liv Hospital", "as": "Its flagship stands at Ulus in Beşiktaş, above the Bosphorus.", "rel": "place" }, { "from": "medicana", "type": "facility", "name": "Medicana Health Group", "as": "Its flagship stands at Beylikdüzü, on the western edge of the city rather than in it.", "rel": "place" }, { "from": "memorial-sisli", "type": "facility", "name": "Memorial Şişli Hospital", "as": "Stands in Şişli, on the European side, and is the hospital the group's firsts are dated from.", "rel": "place" }, { "from": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "Where most certificate holders are.", "rel": "hub" }, { "from": "ishrs", "type": "org", "name": "International Society of Hair Restoration Surgery", "as": "The city named in its 2016 release, through a surgeon practising there.", "rel": "hub" }, { "from": "turkiye-health-services-directorate", "type": "org", "name": "Türkiye General Directorate of Health Services", "as": "Where most of the certificate holders selling to foreign patients are.", "rel": "hub" }, { "from": "istanbul-declaration-2008", "type": "event", "name": "The Declaration of Istanbul, 2008", "as": "The city that gave the document its name, and a hub in this directory for entirely different reasons.", "rel": "hub" }, { "from": "turkiye-hair-boom", "type": "event", "name": "Türkiye's hair transplant boom", "as": "Where most of the clinics are, and where the packages start at the airport.", "rel": "hub" }, { "from": "fue", "type": "term", "name": "FUE", "as": "The city that made this technique a commodity.", "rel": "hub" }, { "from": "graft", "type": "term", "name": "Graft", "as": "Where most of the world's graft prices are quoted.", "rel": "hub" }, { "from": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "1,297 rows inside 30 km, in the city with the loudest advertising in this trade.", "rel": "measures" } ] }, { "schema": 1, "id": "izmir", "type": "hub", "names": { "name": "İzmir", "aliases": [ "Izmir", "Smyrna" ], "said": "Turkey's third city, and the third name on a Turkish clinic group's site after Istanbul and Antalya." }, "region": [ "west-asia" ], "facets": { "iso2": "TR", "radius_km": 20, "specialty": [ "dentistry", "hair restoration", "fertility", "ophthalmology", "thermal and spa" ], "draws": [ "dental-implant", "hair-transplant-fue", "ivf", "lasik" ], "languages": [ "Turkish", "English", "German" ] }, "text": { "what": "An Aegean city of 2,938,292 people, whose clinics cluster in the old centre at Konak and in Bornova, where Ege University sits, with a thermal strand 8 km west at Balçova. The sulphurous hot springs there were known in antiquity as the Baths of Agamemnon and now run through a hotel; their waters are held good for rheumatism, sciatica, gallstones and eczema. İzmir sells the same procedures as the larger Turkish clusters — dentistry, hair restoration, IVF, laser eye work — to a smaller and more regional traffic.", "story": "The thermal claim here is old enough to have a myth attached. An epigram in the Greek Anthology praises the baths, and the tradition holds that Agamemnon's soldiers bathed in them after a battle and recovered so completely that they no longer needed the physician Podalirius; Aelius Aristides reported that Asclepius first prophesied there.\n\n*Tradition holds —* this is a claim about water that predates every method for testing one. This directory records that the claim is made, and by whom, and for how long. It does not carry the indications as findings.\n\nThe modern trade runs on the same licence as the rest of the country. Since 13 July 2017 a facility treating foreign patients has needed a Ministry of Health authorisation certificate, and so has the agency that sent them.\n\n*Inference —* İzmir's position in the trade is the position of a third city everywhere: it competes on price against its own capital, not against another country, and the procedures that travel to it are the standardised ones a patient would not cross a continent for.", "how": "*Trade practice —* the İzmir offer is the Turkish offer at a lower density: fewer clinics, fewer languages on the desk, shorter waits for a date. A dental course is booked across two visits or one long stay; the thermal establishments sell weeks rather than nights and count congress traffic alongside patients.", "today": "As of 16 September 2026 the 2017 authorisation regime applies here as everywhere in Türkiye. Balçova had 80,721 residents in 2022 and is fully urbanised; its economy runs on three shopping centres and the baths.", "notes": "A 20 km query from the city point covers Konak, Bornova, Karşıyaka, Balçova and Narlıdere." }, "geo": { "lat": 38.4244, "lon": 27.1322, "precision": "city", "source": "s:wp-izmir" }, "address": { "city": "İzmir", "country": "TR" }, "kin": [ { "to": "turkiye", "as": "The country whose authorisation regime this cluster trades under.", "rel": "whole" }, { "to": "istanbul", "as": "The cluster that takes the traffic this one competes for on price.", "rel": "contrast" }, { "to": "antalya", "as": "The other Turkish coast, selling the same procedures with the hotel written in.", "rel": "contrast" }, { "to": "turkiye-health-tourism-authorisation", "as": "The certificate a facility here needs before it may treat a foreign patient.", "rel": "governed-by" }, { "to": "dental-implant", "as": "The commonest reason somebody flies to this city rather than the capital.", "rel": "procedure" }, { "to": "ivf", "as": "Sold here by clinics that also serve the domestic Aegean market.", "rel": "procedure" }, { "to": "wellness-travel", "as": "The Balçova springs belong to this older category, and the state counts them in the same programme.", "rel": "term" }, { "to": "stem-cell-unproven", "as": "The same evidentiary problem as the thermal indications: a therapeutic claim older or louder than its testing.", "rel": "contrast" } ], "links": [ { "label": "Balçova and the Agamemnon Baths", "url": "https://en.wikipedia.org/wiki/Bal%C3%A7ova" } ], "sources": [ "s:wp-izmir", "s:wp-balcova", "s:rg-saglik-turizmi-2017", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:wp-balcova", "note": "the antique claims are cited to the classical references Wikipedia names; the last paragraph is this project reasoning" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "cited", "source": "s:wp-izmir" }, "facets.radius_km": { "tier": "inference", "note": "20 km covers Konak, Bornova, Karşıyaka, Balçova and Narlıdere" } } }, "x_commons_files": [ "File:Termal Hotel Agamemnon Baths Entry Balcova Izmir.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "An Aegean city of 2,938,292 people, whose clinics cluster in the old centre at Konak and in Bornova, where Ege University sits, with a thermal strand 8 km west at Balçova.", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The country whose authorisation regime this cluster trades under.", "rel": "whole" }, { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "The cluster that takes the traffic this one competes for on price.", "rel": "contrast" }, { "to": "antalya", "type": "hub", "name": "Antalya", "as": "The other Turkish coast, selling the same procedures with the hotel written in.", "rel": "contrast" }, { "to": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The certificate a facility here needs before it may treat a foreign patient.", "rel": "governed-by" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The commonest reason somebody flies to this city rather than the capital.", "rel": "procedure" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "Sold here by clinics that also serve the domestic Aegean market.", "rel": "procedure" }, { "to": "wellness-travel", "type": "term", "name": "Wellness travel", "as": "The Balçova springs belong to this older category, and the state counts them in the same programme.", "rel": "term" }, { "to": "stem-cell-unproven", "type": "procedure", "name": "Unapproved stem cell treatment", "as": "The same evidentiary problem as the thermal indications: a therapeutic claim older or louder than its testing.", "rel": "contrast" } ], "source_list": [ { "id": "s:wp-izmir", "kind": "wikipedia", "title": "İzmir", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/%C4%B0zmir", "accessed": "2026-09-16", "note": "coordinates, city population 2,938,292 (2024), the urban districts including Konak, Bornova, Balçova, Karşıyaka and Narlıdere" }, { "id": "s:wp-balcova", "kind": "wikipedia", "title": "Balçova", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Bal%C3%A7ova", "accessed": "2026-09-16", "note": "district 8 km west of Konak, population 80,721 (2022); the sulphurous hot springs known in antiquity as the Baths of Agamemnon, now built around a hotel, the waters held good for rheumatism, sciatica, gallstones and eczema" }, { "id": "s:rg-saglik-turizmi-2017", "kind": "web", "title": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik", "publisher": "Resmî Gazete, Republic of Türkiye (Ministry of Health)", "url": "https://www.resmigazete.gov.tr/eskiler/2017/07/20170713-3.htm", "accessed": "2026-09-16", "note": "Resmî Gazete 13 July 2017, No. 30123. Read in Turkish off the Resmî Gazete page. Article 5(1) makes an international health tourism authorisation certificate (yetki belgesi) compulsory for both the health facility and the intermediary; the Ministry halts the activity of anyone without one. Transitional Article 1 gave those already trading one year to comply. Article 16: in force on publication. REPEALED: MADDE 17 of the regulation of 26 April 2025 (Resmî Gazete 32882) revokes this one. Cite it for what the regime was, not for what it is." }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:wp-balcova", "note": "the antique claims are cited to the classical references Wikipedia names; the last paragraph is this project reasoning" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited", "source": "s:wp-izmir" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "turkiye", "type": "destination", "name": "Türkiye", "as": "A third cluster, smaller and cheaper on the same price tables.", "rel": "part" } ] }, { "schema": 1, "id": "johannesburg", "type": "hub", "names": { "name": "Johannesburg", "aliases": [ "Jozi", "Joburg", "eGoli" ], "said": "A referral says Sandton or Parktown and means two different things: the private group's ground, or the academic hospital and the medical school beside it." }, "region": [ "africa-south" ], "facets": { "iso2": "ZA", "radius_km": 25, "specialty": [ "cardiac surgery", "orthopaedics", "cosmetic surgery", "oncology", "transplantation" ], "draws": [ "cabg", "knee-replacement", "rhinoplasty", "abdominoplasty", "breast-augmentation" ], "languages": [ "English", "isiZulu", "Sesotho", "Afrikaans" ] }, "text": { "what": "A city of 4,803,262 at the 2022 census, whose private hospital sector is concentrated in the northern suburbs — Sandton, which the city calls Africa's richest square mile, Rosebank beside it, and Parktown and Houghton to the south of them, where the academic hospital estate sits. Netcare, the largest private hospital group in the country with 49 hospitals, is headquartered in Sandton. Johannesburg takes referrals from across southern and central Africa for cardiac surgery, oncology and transplantation, and sells elective orthopaedic and cosmetic work priced in a currency that has been weak for a long time.", "story": "The structure here is a two-tier system in one city, and the trade lives entirely in the upper tier. Netcare was founded in 1996 and now runs 49 hospitals, 55 Medicross clinics, 5 Prime Cure centres and 15 Akeso psychiatric facilities in South Africa; that estate, and the groups beside it, is what a referral from Lusaka or Harare arrives into.\n\n*Inference —* the referral traffic and the elective traffic are different trades wearing one name. A cardiac patient flown down from central Africa is buying capability that does not exist at home. A patient flying in from Europe for a joint or a cosmetic procedure is buying an exchange rate. The first is medicine crossing a border because of scarcity; the second is medicine crossing a border because of price, and lumping them into one arrivals figure is how this subject gets counted badly.\n\n*Trade practice —* the elective pitch has long been sold with a holiday attached, which is a marketing decision rather than a clinical one, and this directory records that it is made without endorsing the pairing.\n\nThe public estate is the other half of the city and is not this record's subject. A reader should not read the private sector's capacity as the country's.", "how": "*Trade practice —* the Johannesburg arrangement is a quoted estimate from the hospital group's international desk, a deposit, and a surgeon engaged separately — in South African private practice the surgeon, the anaesthetist and the hospital bill separately, so a hospital quote is not the bill. Medical evacuation from other African countries arrives through air ambulance operators and insurers rather than through a web enquiry.", "today": "As of 16 September 2026 this record carries no price row and no inbound patient count for Johannesburg.", "notes": "Twenty-five kilometres from the city point covers the central business district, Parktown, Rosebank, Sandton and Randburg, and reaches the southern suburbs." }, "geo": { "lat": -26.2044, "lon": 28.0456, "precision": "city", "source": "s:wp-johannesburg" }, "address": { "city": "Johannesburg", "area": "Gauteng", "country": "ZA" }, "kin": [ { "to": "south-africa", "as": "The country whose private hospital capacity concentrates in this city.", "rel": "whole" }, { "to": "cabg", "as": "The work a referral from central Africa most often arrives for.", "rel": "procedure" }, { "to": "knee-replacement", "as": "The elective end of the same city, sold on an exchange rate.", "rel": "procedure" }, { "to": "rhinoplasty", "as": "The cosmetic line that has long been sold here with a holiday attached.", "rel": "procedure" }, { "to": "repatriation-cost", "as": "Who pays for the flight home when a referral goes wrong, and on whose insurance.", "rel": "risk" }, { "to": "who-travels", "as": "Why a referral patient and an elective patient should never share one arrivals figure.", "rel": "story" }, { "to": "world-bank-health-spending", "as": "The series behind the gap between this country's private sector and its public one.", "rel": "measured-by" }, { "to": "dubai", "as": "The other destination competing for African referrals, at a longer flight and a higher price.", "rel": "contrast" } ], "links": [ { "label": "Netcare", "url": "https://en.wikipedia.org/wiki/Netcare" } ], "sources": [ "s:wp-johannesburg", "s:wp-netcare", "s:worldbank-open-data", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:wp-netcare", "note": "paragraphs two and three are marked inline as inference and trade practice" }, "text.how": { "tier": "tradition", "note": "separate billing by hospital, surgeon and anaesthetist in South African private practice; not read off a page for this record" }, "geo": { "tier": "cited", "source": "s:wp-johannesburg" }, "facets.radius_km": { "tier": "inference" } } }, "x_commons_files": [ "File:Sandton City skyline.jpg", "File:Charlotte Maxeke Johannesburg Academic Hospital.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A city of 4,803,262 at the 2022 census, whose private hospital sector is concentrated in the northern suburbs — Sandton, which the city calls Africa's richest square mile, Rosebank beside it, and Parktown and Houghton…", "region_terms": [ { "key": "africa-south", "name": "Southern Africa", "note": "South Africa, Namibia, Botswana" } ], "kin_out": [ { "to": "south-africa", "type": "destination", "name": "South Africa", "as": "The country whose private hospital capacity concentrates in this city.", "rel": "whole" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The work a referral from central Africa most often arrives for.", "rel": "procedure" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The elective end of the same city, sold on an exchange rate.", "rel": "procedure" }, { "to": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "The cosmetic line that has long been sold here with a holiday attached.", "rel": "procedure" }, { "to": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "Who pays for the flight home when a referral goes wrong, and on whose insurance.", "rel": "risk" }, { "to": "who-travels", "type": "story", "name": "Who travels", "as": "Why a referral patient and an elective patient should never share one arrivals figure.", "rel": "story" }, { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "The series behind the gap between this country's private sector and its public one.", "rel": "measured-by" }, { "to": "dubai", "type": "hub", "name": "Dubai", "as": "The other destination competing for African referrals, at a longer flight and a higher price.", "rel": "contrast" } ], "source_list": [ { "id": "s:wp-johannesburg", "kind": "wikipedia", "title": "Johannesburg", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Johannesburg", "accessed": "2026-09-16", "note": "coordinates, population 4,803,262 at the 2022 census; Sandton, Rosebank, Parktown and Houghton among the northern suburbs" }, { "id": "s:wp-netcare", "kind": "wikipedia", "title": "Netcare", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Netcare", "accessed": "2026-09-16", "note": "founded 1996, headquartered in Sandton, Johannesburg; 49 hospitals, 55 Medicross clinics, 5 Prime Cure centres and 15 Akeso psychiatric facilities in South Africa" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:wp-netcare", "note": "paragraphs two and three are marked inline as inference and trade practice" }, "text.how": { "tier": "tradition", "note": "separate billing by hospital, surgeon and anaesthetist in South African private practice; not read off a page for this record" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited", "source": "s:wp-johannesburg" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "south-africa", "type": "destination", "name": "South Africa", "as": "The hospital city the regional flow arrives at.", "rel": "part" } ] }, { "schema": 1, "id": "kuala-lumpur", "type": "hub", "names": { "name": "Kuala Lumpur", "aliases": [ "KL", "Klang Valley" ], "said": "KL. The hospitals a foreign patient is sent to are not downtown: they are on Jalan Ampang, at Bukit Bintang's eastern edge, in Bangsar, and out in Petaling Jaya and Subang Jaya, which are a different state." }, "region": [ "southeast-asia" ], "facets": { "iso2": "MY", "radius_km": 25, "specialty": [ "fertility", "cardiology", "oncology", "health screening", "orthopaedics", "neurosurgery" ], "draws": [ "ivf", "icsi", "cabg", "angioplasty-stent", "executive-health-screening", "knee-replacement" ], "languages": [ "Malay", "English", "Mandarin", "Tamil", "Indonesian" ] }, "text": { "what": "The Klang Valley cluster is spread across two states. Gleneagles Kuala Lumpur stands on Jalan Ampang at Ampang Hilir, on the eastern edge of the city; Prince Court Medical Centre sits off Jalan Bukit Bintang beside the Tun Razak Exchange; Pantai Hospital is in Bangsar to the south-west; Institut Jantung Negara, the national heart institute, is on Jalan Tun Razak; and Subang Jaya Medical Centre and Sunway Medical Centre are out in Selangor, sixteen kilometres from the middle. Nothing here is walkable between hospitals. The corridor is a motorway, not a street.", "story": "Malaysia's foreign-patient count is kept by the Malaysia Healthcare Travel Council, set up in 2009 as the state agency for the trade: 641,000 patients in 2011 rising to 921,000 in 2016. The council's own definition is the useful part — the figures cover all registered patients holding a foreign passport, which sweeps in expatriates, migrant workers, business travellers and holidaymakers whose reason for being in a hospital had nothing to do with why they came to Malaysia.\n\nA 2024 note reprinted by the Malaysian Investment Development Authority put Indonesia at 64.9 per cent of the patients, China at 5 per cent and India at 3.1 per cent, and split the revenue between Kuala Lumpur at 41 per cent and Penang at 40.5 per cent; the percentages are attributed to a TA Securities analysis rather than to a government register.\n\n*Trade practice —* what Kuala Lumpur sells against Penang is complexity and fertility. The heart institute takes regional referrals, the private groups run large in-vitro fertilisation programmes, and the city's argument to an Indonesian or Bangladeshi patient is a direct flight and a hospital that will answer in their language.\n\n*Inference —* the split between Kuala Lumpur and Penang at roughly 41 and 40.5 per cent of revenue, in a country where the capital holds several times the population, says that Penang's business is denser and that the two cities are selling different things to different people.", "how": "Malaysian private hospitals licensed for the trade quote before arrival, usually as an itemised estimate and sometimes as a package, and the Malaysia Healthcare Travel Council maintains a list of member hospitals a patient can check against. Payment is by deposit and settlement; the larger groups bill some foreign insurers directly.", "today": "As of 16 September 2026 the harvest point for this hub sits in central Kuala Lumpur, with a 25-kilometre radius reaching Petaling Jaya, Subang Jaya and Ampang. No Kuala Lumpur price has been read off a page into this directory yet.", "notes": "A description of a cluster and of who counts its patients. Not advice about treatment." }, "geo": { "lat": 3.148, "lon": 101.71, "precision": "city", "source": "s:osm-nominatim" }, "address": { "city": "Kuala Lumpur", "area": "Federal Territory and Selangor", "country": "MY" }, "metrics": { "annual_foreign_patients": 921000, "note": "The Malaysia Healthcare Travel Council's 2016 national count, not a Kuala Lumpur figure. It counts every registered patient holding a foreign passport, so it includes expatriates, migrant workers and visitors who fell ill; it is not a count of people who travelled in order to be treated.", "as_of": "2016", "source": "s:wp-medical-tourism-malaysia", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_Malaysia" }, "kin": [ { "to": "gleneagles-kl", "as": "On Jalan Ampang at Ampang Hilir, 376 beds, open since 1996.", "rel": "part" }, { "to": "prince-court", "as": "Off Jalan Bukit Bintang beside the Tun Razak Exchange.", "rel": "part" }, { "to": "malaysia", "as": "The country whose capital cluster this is, and which counts its patients by passport.", "rel": "whole" }, { "to": "mhtc", "as": "The state council that licenses and lists the hospitals here, and keeps the count.", "rel": "governed-by" }, { "to": "malaysia-mhtc-licence", "as": "The licensing route a hospital takes to sell to foreign patients.", "rel": "governed-by" }, { "to": "ivf", "as": "The fertility work that distinguishes this cluster from Penang's.", "rel": "procedure" }, { "to": "cabg", "as": "The national heart institute on Jalan Tun Razak takes regional referrals for it.", "rel": "procedure" }, { "to": "executive-health-screening", "as": "The screening package the private groups sell across the strait.", "rel": "procedure" }, { "to": "penang", "as": "The island cluster taking almost the same share of national revenue from a far smaller city.", "rel": "contrast" }, { "to": "indonesia", "as": "Where about two-thirds of this country's foreign patients come from, on one 2024 analysis.", "rel": "kin" }, { "to": "counting-patients", "as": "Why a count of foreign passports in a hospital is not a count of medical travellers.", "rel": "story" }, { "to": "osm-facilities", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 25 kilometres of this point.", "rel": "measured-by" } ], "links": [ { "label": "Malaysia Healthcare Travel Council", "url": "https://www.mhtc.org.my/" }, { "label": "Gleneagles Kuala Lumpur", "url": "https://gleneagles.com.my/kuala-lumpur" } ], "sources": [ "s:osm-nominatim", "s:wp-gleneagles-kl", "s:wp-medical-tourism-malaysia", "s:mida-malaysia-medical-tourism-2024", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "roads and localities read off OpenStreetMap address tags" }, "text.story": { "tier": "cited", "source": "s:wp-medical-tourism-malaysia", "note": "the council's counts and the 2024 percentages are cited to their publishers; the inline marks say which stretches are inference and trade practice" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "a central point chosen to reach both the city hospitals and the Selangor ones, not a point anybody published" } } }, "x_commons_files": [ "File:Kuala Lumpur Jalan Ampang.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "The Klang Valley cluster is spread across two states. Gleneagles Kuala Lumpur stands on Jalan Ampang at Ampang Hilir, on the eastern edge of the city; Prince Court Medical Centre sits off Jalan Bukit Bintang beside the…", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "gleneagles-kl", "type": "facility", "name": "Gleneagles Hospital Kuala Lumpur", "as": "On Jalan Ampang at Ampang Hilir, 376 beds, open since 1996.", "rel": "part" }, { "to": "prince-court", "type": "facility", "name": "Prince Court Medical Centre", "as": "Off Jalan Bukit Bintang beside the Tun Razak Exchange.", "rel": "part" }, { "to": "malaysia", "type": "destination", "name": "Malaysia", "as": "The country whose capital cluster this is, and which counts its patients by passport.", "rel": "whole" }, { "to": "mhtc", "type": "org", "name": "Malaysia Healthcare Travel Council", "as": "The state council that licenses and lists the hospitals here, and keeps the count.", "rel": "governed-by" }, { "to": "malaysia-mhtc-licence", "type": "rule", "name": "Malaysia's healthcare travel registration", "as": "The licensing route a hospital takes to sell to foreign patients.", "rel": "governed-by" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The fertility work that distinguishes this cluster from Penang's.", "rel": "procedure" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The national heart institute on Jalan Tun Razak takes regional referrals for it.", "rel": "procedure" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The screening package the private groups sell across the strait.", "rel": "procedure" }, { "to": "penang", "type": "hub", "name": "Penang", "as": "The island cluster taking almost the same share of national revenue from a far smaller city.", "rel": "contrast" }, { "to": "indonesia", "type": "destination", "name": "Indonesia", "as": "Where about two-thirds of this country's foreign patients come from, on one 2024 analysis.", "rel": "kin" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a count of foreign passports in a hospital is not a count of medical travellers.", "rel": "story" }, { "to": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 25 kilometres of this point.", "rel": "measured-by" } ], "source_list": [ { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." }, { "id": "s:wp-gleneagles-kl", "kind": "wikipedia", "title": "Gleneagles Hospital Kuala Lumpur", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Gleneagles_Hospital_Kuala_Lumpur", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-medical-tourism-malaysia", "kind": "web", "title": "Medical tourism in Malaysia", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_Malaysia", "accessed": "2026-09-16", "note": "used for the year-by-year MHTC series 2011-2016 and the Indonesian share of arrivals" }, { "id": "s:mida-malaysia-medical-tourism-2024", "kind": "news", "title": "Indonesia remains largest contributor to Malaysia's medical tourism market", "publisher": "Malaysian Investment Development Authority, reprinting The Sun", "url": "https://www.mida.gov.my/mida-news/indonesia-remains-largest-contributor-to-malaysias-medical-tourism-market/", "accessed": "2026-09-16", "date": "2024-09-19", "note": "the percentages in it are attributed to a TA Securities note, not to a government register." }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "roads and localities read off OpenStreetMap address tags" }, "text.story": { "tier": "cited", "source": "s:wp-medical-tourism-malaysia", "note": "the council's counts and the 2024 percentages are cited to their publishers; the inline marks say which stretches are inference and trade practice" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "a central point chosen to reach both the city hospitals and the Selangor ones, not a point anybody published" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "malaysia", "type": "destination", "name": "Malaysia", "as": "The cardiac and fertility half of the trade.", "rel": "part" }, { "from": "penang", "type": "hub", "name": "Penang", "as": "The capital cluster selling complexity where this one sells proximity and repetition.", "rel": "contrast" }, { "from": "singapore-city", "type": "hub", "name": "Singapore", "as": "One of the neighbours that took the less complex work after 2012.", "rel": "contrast" }, { "from": "gleneagles-kl", "type": "facility", "name": "Gleneagles Hospital Kuala Lumpur", "as": "One of the two hospitals the Kuala Lumpur cluster is usually named for.", "rel": "place" }, { "from": "prince-court", "type": "facility", "name": "Prince Court Medical Centre", "as": "The city-centre hospital of the Kuala Lumpur cluster, all single rooms.", "rel": "place" }, { "from": "malaysia-mhtc-licence", "type": "rule", "name": "Malaysia's healthcare travel registration", "as": "Where most member hospitals are.", "rel": "hub" } ] }, { "schema": 1, "id": "los-algodones", "type": "hub", "names": { "name": "Los Algodones", "aliases": [ "Algodones", "Molar City" ], "said": "Al-go-DOH-nes. Yuma calls it Algodones; the trade, and the town's own signage, call it Molar City." }, "region": [ "mexico", "north-america" ], "facets": { "iso2": "MX", "radius_km": 6, "specialty": [ "dentistry", "optometry", "pharmacy" ], "draws": [ "dental-implant", "all-on-four", "dental-crown", "root-canal", "veneers", "full-mouth-restoration" ], "languages": [ "Spanish", "English" ] }, "text": { "what": "A town of a few square blocks in the north-east corner of Baja California, pressed against the Colorado River and the Arizona line, where several hundred dental surgeries, opticians and pharmacies trade almost entirely with people who walk across the border in the morning and walk back the same afternoon. Wikipedia puts the resident population at 5,474 at the 2010 census and the dentists at approximately 600. Nobody flies here for treatment. They park in California and cross on foot.", "story": "The cluster is an accident of geometry. Los Algodones sits in a pocket of Mexican territory bounded by the Colorado River and the international line, reached from the United States through one small crossing at Andrade, California — a port established in 1909 for a Southern Pacific branch line, about six miles west of downtown Yuma. The railway was gone by 1960. What replaced it, from the 1990s onward, was dentistry: Wikipedia's article on the port records that dentists and pharmacies set up primarily for United States customers, and that this is what keeps a remote desert crossing among the busiest in the country for pedestrians. It ranked eleventh in the United States for pedestrian crossings in 2010.\n\nThe traffic has a season, and the season is legible in the federal count. The Bureau of Transportation Statistics recorded 563,552 pedestrian crossings northbound at Andrade in calendar 2025. January took 66,785 of them and July took 23,437. That shape belongs to the winter residents of Yuma and the Imperial Valley, who arrive in November and leave in spring.\n\n*Inference —* the density is the product. A patient who needs eight crowns and two implants cannot compare four surgeries in a city where they are scattered across forty kilometres; here they can walk past forty front doors in twenty minutes, and the surgeries know it. The competition is conducted in printed price cards in the window, which is why Los Algodones is one of the few places in this directory where prices are simply published.", "how": "The crossing is the whole logistics problem. Drivers park on the California side at Andrade and cross on foot; the return leg is the one with the queue, because it is a United States immigration and customs inspection. Treatment is day-work built around that: consultation and impressions in the morning, laboratory work in the town, fitting in the afternoon, and for implant cases a second trip months later once the bone has taken. Surgeries quote in United States dollars and take cards and cash. Medication bought in the pharmacies crosses back under United States personal-importation rules, which treat a controlled substance differently from an ordinary prescription.", "today": "As of 16 September 2026 Sani Dental Group, which lists clinics in Los Algodones, Cancún and Playa del Carmen, publishes an open price list in dollars and pesos: a titanium implant at 890 dollars, the crown that goes on it at a further 720, an acrylic all-on-four arch at 8,110. The page states that every figure is a base or starting-at price, and it carries no line telling a reader which of the three towns it applies to.", "notes": "This page describes a place. It is not advice about treatment, and no figure here is a quotation to any particular patient." }, "geo": { "lat": 32.7153, "lon": -114.7289, "precision": "city", "source": "s:wp-los-algodones" }, "address": { "city": "Los Algodones", "area": "Baja California", "country": "MX" }, "prices": [ { "procedure": "dental-implant", "country": "MX", "city": "Los Algodones", "amount": 890, "currency": "USD", "as_of": "2026-09-16", "kind": "list", "includes": [ "the titanium implant fixture" ], "excludes": [ "the crown, which the same list prices separately at 720 dollars", "the abutment is stated as part of the crown line, not the implant line" ], "source": "s:sani-price-list", "url": "https://sanidentalgroup.com/price-list", "note": "listed as Titanium Dental Implant (implant only), 890 dollars or 17,800 pesos. A single restored tooth is therefore 1,610 dollars on this list, not 890. The page states all prices are a base or starting-at price.", "tier": "cited", "usd": 890.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "dental-crown", "country": "MX", "city": "Los Algodones", "amount": 490, "currency": "USD", "as_of": "2026-09-16", "kind": "list", "includes": [ "a zirconia crown" ], "excludes": [ "preparation, root treatment or extraction, each priced on its own line" ], "source": "s:sani-price-list", "url": "https://sanidentalgroup.com/price-list", "note": "the same list carries porcelain-fused-to-metal at 230 dollars, e-max at 395 and porcelain-fused-to-gold at 600; the material is the price.", "tier": "cited", "usd": 490.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "root-canal", "country": "MX", "city": "Los Algodones", "amount": 340, "currency": "USD", "as_of": "2026-09-16", "kind": "list", "includes": [ "root canal, any tooth" ], "excludes": [ "the crown that usually follows it" ], "source": "s:sani-price-list", "url": "https://sanidentalgroup.com/price-list", "note": "listed as Root Canal (any tooth), 340 dollars or 6,800 pesos — one price whatever the tooth, where most schedules charge more for a molar.", "tier": "cited", "usd": 340.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "veneers", "country": "MX", "city": "Los Algodones", "amount": 450, "currency": "USD", "as_of": "2026-09-16", "kind": "list", "includes": [ "one porcelain veneer" ], "excludes": [ "everything beyond the single unit — a front-teeth case is this figure multiplied" ], "source": "s:sani-price-list", "url": "https://sanidentalgroup.com/price-list", "note": "per veneer. A zirconia veneer is listed at 490.", "tier": "cited", "usd": 450.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "all-on-four", "country": "MX", "city": "Los Algodones", "amount": 8110, "currency": "USD", "as_of": "2026-09-16", "kind": "package", "includes": [ "four implants and an acrylic hybrid fixed denture", "upper or lower arch" ], "excludes": [ "the second arch", "the branded-implant versions, listed separately at 8,950 dollars with Nobel and 9,710 with Straumann" ], "source": "s:sani-price-list", "url": "https://sanidentalgroup.com/price-list", "note": "one arch. The words Upper or lower arch are the list's own, and they are the difference between this figure and a whole mouth.", "tier": "cited", "usd": 8110.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "tags": [ { "tag": "price-published", "source": "s:sani-price-list", "tier": "cited", "note": "a public price list in dollars and pesos, read on 16 September 2026", "url": "https://sanidentalgroup.com/price-list" } ], "kin": [ { "to": "mexico", "as": "The country this cluster sits in, though almost nothing about it is aimed at Mexicans.", "rel": "destination" }, { "to": "nuevo-progreso", "as": "The same trade at the other end of the same border, serving Texas instead of Arizona.", "rel": "contrast" }, { "to": "tijuana", "as": "The other Baja California cluster — bigger, surgical, and reached by a different kind of trip.", "rel": "contrast" }, { "to": "united-states", "as": "Where the patients live, and where the dental bill they are avoiding was written.", "rel": "kin" }, { "to": "dental-implant", "as": "The operation the town is built on, priced here as a fixture with the crown billed separately.", "rel": "performs" }, { "to": "all-on-four", "as": "Sold here by the arch, which is the word that decides whether a quote is half a mouth or a whole one.", "rel": "performs" }, { "to": "dental-crown", "as": "Priced by material on the open lists in the windows.", "rel": "performs" }, { "to": "revision-at-home", "as": "Who refits the crown in Ohio when it fails, and at whose price.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Short here — the patient can come back across in an afternoon, which is not true of anywhere else in this directory.", "rel": "risk" }, { "to": "the-price-that-isnt", "as": "A base-price list with the crown on its own line is the clearest case this site has of the problem.", "rel": "story" } ], "links": [ { "label": "Border Crossing/Entry Data — Andrade, California", "url": "https://data.bts.gov/d/keg4-3bc2" }, { "label": "Sani Dental Group price list", "url": "https://sanidentalgroup.com/price-list" } ], "sources": [ "s:wp-los-algodones", "s:wp-andrade-poe", "s:bts-border-crossing", "s:sani-price-list" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "harvested", "source": "s:bts-border-crossing", "note": "the crossing counts are queried from the Bureau of Transportation Statistics series; the third paragraph is marked as this project's own reasoning" }, "text.how": { "tier": "tradition", "note": "the general shape of a day trip across a land border for dental work; no single page describes it" }, "prices": { "tier": "cited", "source": "s:sani-price-list" } } }, "x_commons_files": [ "File:Los Algodones, Baja California.jpg", "File:Andrade Port of Entry.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "A town of a few square blocks in the north-east corner of Baja California, pressed against the Colorado River and the Arizona line, where several hundred dental surgeries, opticians and pharmacies trade almost entirely…", "region_terms": [ { "key": "mexico", "name": "Mexico", "note": "its own entry because the border towns are a category of their own" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "mexico", "type": "destination", "name": "Mexico", "as": "The country this cluster sits in, though almost nothing about it is aimed at Mexicans.", "rel": "destination" }, { "to": "nuevo-progreso", "type": "hub", "name": "Nuevo Progreso", "as": "The same trade at the other end of the same border, serving Texas instead of Arizona.", "rel": "contrast" }, { "to": "tijuana", "type": "hub", "name": "Tijuana", "as": "The other Baja California cluster — bigger, surgical, and reached by a different kind of trip.", "rel": "contrast" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "Where the patients live, and where the dental bill they are avoiding was written.", "rel": "kin" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The operation the town is built on, priced here as a fixture with the crown billed separately.", "rel": "performs" }, { "to": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "Sold here by the arch, which is the word that decides whether a quote is half a mouth or a whole one.", "rel": "performs" }, { "to": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "Priced by material on the open lists in the windows.", "rel": "performs" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who refits the crown in Ohio when it fails, and at whose price.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Short here — the patient can come back across in an afternoon, which is not true of anywhere else in this directory.", "rel": "risk" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "A base-price list with the crown on its own line is the clearest case this site has of the problem.", "rel": "story" } ], "source_list": [ { "id": "s:wp-los-algodones", "kind": "encyclopedia", "title": "Los Algodones", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Los_Algodones", "accessed": "2026-09-16" }, { "id": "s:wp-andrade-poe", "kind": "web", "title": "Andrade Port of Entry", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Andrade_Port_of_Entry", "accessed": "2026-09-16", "note": "established 1909 on a Southern Pacific branch line; about 6 miles west of Yuma; 11th in the United States for pedestrian crossings in 2010" }, { "id": "s:bts-border-crossing", "kind": "dataset", "title": "Border Crossing/Entry Data", "publisher": "United States Bureau of Transportation Statistics", "url": "https://data.bts.gov/d/keg4-3bc2", "accessed": "2026-09-16", "note": "monthly counts by port of entry and measure, queried through the Socrata API at https://data.bts.gov/resource/keg4-3bc2.json. Counts crossings, not people." }, { "id": "s:sani-price-list", "kind": "web", "title": "Dental Price List in Mexico", "publisher": "Sani Dental Group", "url": "https://sanidentalgroup.com/price-list", "accessed": "2026-09-16", "note": "prices in US dollars and Mexican pesos, read off the page on 16 September 2026; the page states that all prices are a base or starting-at price and carries no location qualifier, though the group lists clinics in Los Algodones, Cancún and Playa del Carmen" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "harvested", "source": "s:bts-border-crossing", "note": "the crossing counts are queried from the Bureau of Transportation Statistics series; the third paragraph is marked as this project's own reasoning" }, "text.how": { "tier": "tradition", "note": "the general shape of a day trip across a land border for dental work; no single page describes it" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited" }, "address": { "tier": "cited" }, "prices": { "tier": "cited", "source": "s:sani-price-list" } }, "primary_image": null, "tag_facts": [ { "key": "price-published", "label": "Publishes prices", "icon": "💰", "group": "money", "evidence": "a public price list or package page on the facility's own site, read on a dated visit", "source": "s:sani-price-list", "note": "a public price list in dollars and pesos, read on 16 September 2026", "tier": "cited", "url": "https://sanidentalgroup.com/price-list" } ], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "mexico", "type": "destination", "name": "Mexico", "as": "The dental street that made the border trade, four blocks of it.", "rel": "part" }, { "from": "cancun", "type": "hub", "name": "Cancún", "as": "Shares an operator and a price page with this city, which is why a Cancún figure may not be a Cancún figure.", "rel": "contrast" }, { "from": "nuevo-progreso", "type": "hub", "name": "Nuevo Progreso", "as": "The same trade at the far western end of the border, denser, and with its prices in the window.", "rel": "contrast" }, { "from": "san-jose-cr", "type": "hub", "name": "San José, Costa Rica", "as": "The opposite pricing habit at a comparable distance from the same market: a card in the window against a form and a callback.", "rel": "contrast" }, { "from": "tijuana", "type": "hub", "name": "Tijuana", "as": "The other Baja California cluster — dental, smaller, and priced in the window.", "rel": "contrast" }, { "from": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "The border town whose clinics price this arch against a US figure of their own making.", "rel": "place" }, { "from": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "The border town where a crown is quoted against a US figure the clinic supplies itself.", "rel": "place" }, { "from": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The border town whose dental surgeries this page's Mexican price comes from.", "rel": "place" }, { "from": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "The border town this work is bought in by the arch.", "rel": "place" }, { "from": "hospital-angeles-tijuana", "type": "facility", "name": "Hospital Angeles Tijuana", "as": "The other Mexican border cluster: dentistry in a village of surgeries against surgery in a city hospital.", "rel": "contrast" }, { "from": "us-medicare-abroad", "type": "rule", "name": "Medicare outside the United States", "as": "The border town the proximity rule was not written for, and does not help.", "rel": "hub" }, { "from": "who-travels", "type": "story", "name": "Who travels", "as": "A town of 5,474 with more than 500 dentists in four blocks, reached on foot.", "rel": "hub" } ] }, { "schema": 1, "id": "medellin", "type": "hub", "names": { "name": "Medellín", "aliases": [ "Medellin", "the Aburrá Valley" ], "said": "Me-de-YEEN, or Me-de-JEEN depending on who is saying it. Officially the Special District of Science, Technology and Innovation." }, "region": [ "south-america" ], "facets": { "iso2": "CO", "radius_km": 20, "specialty": [ "cosmetic surgery", "oncology", "dentistry", "cardiology", "transplant" ], "draws": [ "bbl", "liposuction", "abdominoplasty", "breast-augmentation", "rhinoplasty", "facelift", "dental-implant", "hair-transplant-fue" ], "languages": [ "Spanish", "English" ] }, "text": { "what": "Colombia's second city, 2.4 million people at the 2018 census in the Aburrá Valley, and the country's cosmetic surgery capital. Its export trade is body-contouring and dentistry sold to North Americans and to Colombians living abroad, run out of private clinics and out of one large hospital group with a dedicated international office.", "story": "Clínica Las Américas Auna, on Diagonal 75B in the south-west of the city, runs an Oficina Internacional that is a useful specimen of what such a department actually publishes. Its pages are not clinical. They are: how to contact us; how to enter Colombia; the Colombian health visa; the yellow fever vaccination; the public holiday calendar; how to get here from the airport; safety advice; accommodation through a named partner; flights. The medicine is assumed and the logistics are the product.\n\nThe visa page states the rule plainly: a non-resident foreigner entering Colombia for medical treatment, and any companion, needs a health visa where the stay is expected to exceed ninety days, applied for through the Cancillería de Colombia. Below ninety days the ordinary visitor rules apply.\n\nThe group's own certifications page lists what it holds and who gave it: INVIMA good clinical practice under a named 2019 resolution, an AABB reaccreditation of the blood bank in 2022, College of American Pathologists recertification of the laboratory in 2022, a palliative care certification in 2020. Every row names an issuer and a year.\n\n*Inference —* Medellín's cosmetic sector is larger than any one hospital group and most of it is not visible in records of this kind. A city known abroad for buttock augmentation and liposuction is a city where the meaningful safety question concerns the clinics that publish nothing at all, and this directory has nothing cited to say about them.", "how": "Patients fly into José María Córdova, stay near El Poblado or near the clinic, and are seen over one to three weeks. Body-contouring work is sold as a package with post-operative massage and garments, and the recovery — not the operation — is what sets the length of stay. The flight home is the constraint that matters most: a large-volume liposuction or a gluteal fat transfer is not a case for an early boarding pass.", "today": "As of 16 September 2026 Clínica Las Américas Auna's international office publishes its entry, visa, vaccination and accommodation pages, and the group's certifications page dates each credential to its issuer and year." }, "geo": { "lat": 6.2308, "lon": -75.5906, "precision": "city", "source": "s:wp-medellin" }, "address": { "street": "Diagonal 75B N. 2A-80/140", "city": "Medellín", "area": "Antioquia", "country": "CO" }, "tags": [ { "tag": "international-office", "source": "s:lasamericas-international", "tier": "cited", "note": "a named department handling entry, visas, vaccination, flights and accommodation for non-resident patients", "url": "https://www.lasamericas.com.co/oficina-internacional" }, { "tag": "visa-support", "source": "s:lasamericas-visa", "tier": "cited", "note": "the hospital's own page names the Colombian health visa and the ninety-day threshold", "url": "https://www.lasamericas.com.co/oficina-internacional/paso-a-paso/visa-medica-en-colombia" }, { "tag": "recovery-hotel", "source": "s:lasamericas-international", "tier": "cited", "note": "accommodation arranged through a named partner rather than in-house" } ], "kin": [ { "to": "colombia", "as": "The country whose cosmetic surgery trade is concentrated here.", "rel": "destination" }, { "to": "clinica-las-americas", "as": "The hospital group whose international office this record reads.", "rel": "place" }, { "to": "bogota", "as": "The other Colombian hub — cardiac and oncological where this one is cosmetic.", "rel": "contrast" }, { "to": "bbl", "as": "The operation this city is best known abroad for, and the one this directory keeps a separate mortality record on.", "rel": "performs" }, { "to": "liposuction", "as": "The base of the body-contouring trade here, sold with the garments and the massage.", "rel": "performs" }, { "to": "bbl-mortality", "as": "The reason the operation this city is known for is the one with a named death rate attached.", "rel": "risk" }, { "to": "flying-after-surgery", "as": "The constraint that sets the length of a body-contouring stay, not the operating time.", "rel": "risk" }, { "to": "the-visa", "as": "Colombia's health visa, needed past ninety days, with the hospital itself explaining it.", "rel": "step" }, { "to": "the-companion", "as": "Named in the visa rule here: a companion falls under the same requirement as the patient.", "rel": "step" }, { "to": "alone-after-discharge", "as": "What a body-contouring patient faces in a rented flat rather than a ward.", "rel": "risk" } ], "links": [ { "label": "Clínica Las Américas Auna — Oficina Internacional", "url": "https://www.lasamericas.com.co/oficina-internacional" }, { "label": "Visa médica en Colombia", "url": "https://www.lasamericas.com.co/oficina-internacional/paso-a-paso/visa-medica-en-colombia" } ], "sources": [ "s:wp-medellin", "s:lasamericas-international", "s:lasamericas-visa" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:lasamericas-international", "note": "read off the hospital group's own pages on 16 September 2026; the last paragraph is marked as this project's reasoning and says what it cannot source" }, "text.how": { "tier": "tradition", "note": "the general shape of a body-contouring trip; the length-of-stay driver is trade practice, not a cited protocol" } } }, "x_commons_files": [ "File:Medellin skyline.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "Colombia's second city, 2.4 million people at the 2018 census in the Aburrá Valley, and the country's cosmetic surgery capital.", "region_terms": [ { "key": "south-america", "name": "South America", "note": "Colombia, Brazil, Argentina, Chile, Peru" } ], "kin_out": [ { "to": "colombia", "type": "destination", "name": "Colombia", "as": "The country whose cosmetic surgery trade is concentrated here.", "rel": "destination" }, { "to": "clinica-las-americas", "type": "facility", "name": "Clínica Las Américas", "as": "The hospital group whose international office this record reads.", "rel": "place" }, { "to": "bogota", "type": "hub", "name": "Bogotá", "as": "The other Colombian hub — cardiac and oncological where this one is cosmetic.", "rel": "contrast" }, { "to": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "The operation this city is best known abroad for, and the one this directory keeps a separate mortality record on.", "rel": "performs" }, { "to": "liposuction", "type": "procedure", "name": "Liposuction", "as": "The base of the body-contouring trade here, sold with the garments and the massage.", "rel": "performs" }, { "to": "bbl-mortality", "type": "risk", "name": "Death from gluteal fat grafting", "as": "The reason the operation this city is known for is the one with a named death rate attached.", "rel": "risk" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The constraint that sets the length of a body-contouring stay, not the operating time.", "rel": "risk" }, { "to": "the-visa", "type": "pathway", "name": "The visa", "as": "Colombia's health visa, needed past ninety days, with the hospital itself explaining it.", "rel": "step" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "Named in the visa rule here: a companion falls under the same requirement as the patient.", "rel": "step" }, { "to": "alone-after-discharge", "type": "risk", "name": "Discharged alone", "as": "What a body-contouring patient faces in a rented flat rather than a ward.", "rel": "risk" } ], "source_list": [ { "id": "s:wp-medellin", "kind": "web", "title": "Medellín", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medell%C3%ADn", "accessed": "2026-09-16" }, { "id": "s:lasamericas-international", "kind": "web", "title": "Oficina Internacional Las Américas", "publisher": "Clínica Las Américas Auna, Medellín", "url": "https://www.lasamericas.com.co/oficina-internacional", "accessed": "2026-09-16", "note": "the hospital's international office, its step-by-step pages on entry to Colombia, the health visa, yellow fever vaccination and flights, and the address Diagonal 75B N. 2A-80/140, Medellín" }, { "id": "s:lasamericas-visa", "kind": "web", "title": "Visa Médica en Colombia", "publisher": "Clínica Las Américas Auna, Medellín", "url": "https://www.lasamericas.com.co/oficina-internacional/paso-a-paso/visa-medica-en-colombia", "accessed": "2026-09-16", "note": "states that a non-resident foreigner coming for treatment, and any companion, needs a Colombian health visa where the stay is expected to exceed 90 days, and points at the Cancillería de Colombia" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:lasamericas-international", "note": "read off the hospital group's own pages on 16 September 2026; the last paragraph is marked as this project's reasoning and says what it cannot source" }, "text.how": { "tier": "tradition", "note": "the general shape of a body-contouring trip; the length-of-stay driver is trade practice, not a cited protocol" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [ { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:lasamericas-international", "note": "a named department handling entry, visas, vaccination, flights and accommodation for non-resident patients", "tier": "cited", "url": "https://www.lasamericas.com.co/oficina-internacional" }, { "key": "visa-support", "label": "Helps with the visa", "icon": "🛂", "group": "service", "evidence": "the facility or ministry names the letter or invitation it issues, with the visa class", "source": "s:lasamericas-visa", "note": "the hospital's own page names the Colombian health visa and the ninety-day threshold", "tier": "cited", "url": "https://www.lasamericas.com.co/oficina-internacional/paso-a-paso/visa-medica-en-colombia" }, { "key": "recovery-hotel", "label": "Recovery accommodation", "icon": "🏨", "group": "service", "evidence": "the facility's own page naming the hotel or its own ward-hotel", "source": "s:lasamericas-international", "note": "accommodation arranged through a named partner rather than in-house", "tier": "cited", "url": "" } ], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "colombia", "type": "destination", "name": "Colombia", "as": "The cosmetic surgery cluster, and the name the trade sells.", "rel": "part" }, { "from": "bogota", "type": "hub", "name": "Bogotá", "as": "The other Colombian hub — cosmetic and dental where this one is cardiac and oncological.", "rel": "contrast" }, { "from": "panama-city", "type": "hub", "name": "Panama City", "as": "The regional cosmetic capital, where the foreign patient is the one being priced for.", "rel": "contrast" }, { "from": "santo-domingo", "type": "hub", "name": "Santo Domingo", "as": "The other cosmetic surgery hub in this batch, with a hospital group that publishes and a sector that does not.", "rel": "contrast" }, { "from": "clinica-las-americas", "type": "facility", "name": "Clínica Las Américas", "as": "The high-complexity clinic at the centre of the city's formal medical traffic, distinct from its cosmetic trade.", "rel": "place" } ] }, { "schema": 1, "id": "monterrey", "type": "hub", "names": { "name": "Monterrey", "aliases": [ "Monterrey, Nuevo León", "MTY" ], "said": "Mon-te-RREY. Regiomontano is what a person from here is called." }, "region": [ "mexico", "north-america" ], "facets": { "iso2": "MX", "radius_km": 25, "specialty": [ "oncology", "cardiology", "orthopaedics", "transplant", "bariatric surgery", "health screening" ], "draws": [ "cabg", "angioplasty-stent", "knee-replacement", "hip-replacement", "gastric-sleeve", "executive-health-screening", "bone-marrow-transplant" ], "languages": [ "Spanish", "English" ] }, "text": { "what": "The capital of Nuevo León, a few hours' drive south of the Texas border, anchoring Mexico's second-largest metropolitan area at some 5.3 million people and a city its Wikipedia article calls the richest in Latin America. Its clinical export trade is hospital medicine rather than border dentistry: cancer, cardiac and orthopaedic work sold to Texans, to Mexicans living in the United States, and to patients from the rest of Mexico.", "story": "Monterrey is the case where the private hospital came out of the university rather than the tourism ministry. TecSalud is the health system of the Tecnológico de Monterrey, the country's largest private university, and runs Hospital San José and Hospital Zambrano Hellion. Its page for foreign and out-of-state patients describes what an international department actually consists of: bilingual clinical and nursing staff, clinical documentation and consent forms available in English, interpreter coordination on request, help with paperwork and logistics, and a list of hotels under agreement.\n\nThe credentials it names are national rather than international — certification by the Consejo de Salubridad General, the Pathway to Excellence nursing designation, and COMLE certification — and its own quality page stated, when read on 16 September 2026, that the system was in a recertification process.\n\n*Inference —* the absence of an international accreditation mark on a university hospital of this size is worth noticing precisely because it is the exception. Most hospitals selling across a border buy the mark that a foreign patient recognises; a teaching hospital with a domestic reputation and a captive referral network has less use for one.\n\nMonterrey is also the only Latin American city with its own edition of the trade's standard consumer guidebook: Josef Woodman's \"Patients Beyond Borders\" published a Monterrey, Mexico edition in 2012, alongside country editions for Korea, Taiwan, Singapore, Malaysia, Thailand and Turkey and a city edition for Dubai Healthcare City.", "how": "Patients arrive by air from Texas or by road from the border, usually on a referral or a second opinion rather than a package. Costing is per case and quoted on request; this project found no published price list from the city's main hospitals. Stays are hospital stays, not hotel recoveries, and companions are housed in the partner hotels the hospital names.", "today": "As of 16 September 2026 TecSalud's page for foreign and international patients names its languages, its documentation practice and its hotel agreements, and lists national certifications with a recertification under way." }, "geo": { "lat": 25.6844, "lon": -100.3181, "precision": "city", "source": "s:wp-monterrey" }, "address": { "city": "Monterrey", "area": "Nuevo León", "country": "MX" }, "tags": [ { "tag": "international-office", "source": "s:tecsalud-international", "tier": "cited", "note": "a named department for foreign and out-of-state patients, with logistics and paperwork support", "url": "https://www.tecsalud.mx/pacientes-foraneos-e-internacionales" }, { "tag": "interpreter", "source": "s:tecsalud-international", "tier": "cited", "note": "Spanish and English clinical staff, with interpreters coordinated on request and consent documents available in English" }, { "tag": "university-hospital", "source": "s:tecsalud-international", "tier": "cited", "note": "TecSalud is the health system of the Tecnológico de Monterrey" }, { "tag": "recovery-hotel", "source": "s:tecsalud-international", "tier": "cited", "note": "the hospital names hotels under agreement for patients and companions" } ], "kin": [ { "to": "mexico", "as": "The country whose hospital-grade export trade concentrates here rather than on the border.", "rel": "destination" }, { "to": "united-states", "as": "The market three hours north by road, and the one the English-language consent forms are for.", "rel": "kin" }, { "to": "tijuana", "as": "The other Mexican surgical hub — cheaper, faster, and sold through packages rather than referrals.", "rel": "contrast" }, { "to": "josef-woodman", "as": "Wrote the only city edition of his guidebook devoted to a Latin American hub, and it was this one.", "rel": "person" }, { "to": "cabg", "as": "Cardiac surgery is among the work the city's hospitals sell across the border.", "rel": "performs" }, { "to": "executive-health-screening", "as": "The screening package a hospital sells to a corporate market on its doorstep.", "rel": "performs" }, { "to": "language-consent", "as": "Answered here by policy — consent documents in English, interpreters on request — which is not the norm.", "rel": "risk" }, { "to": "the-accreditation-question", "as": "A large university hospital naming national certifications and no international mark is one answer to it.", "rel": "story" } ], "links": [ { "label": "TecSalud — pacientes foráneos e internacionales", "url": "https://www.tecsalud.mx/pacientes-foraneos-e-internacionales" } ], "sources": [ "s:wp-monterrey", "s:tecsalud-international", "s:tecsalud-quality", "s:wp-patients-beyond-borders" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:tecsalud-international", "note": "read off the hospital's own pages on 16 September 2026; the third paragraph is marked as this project's reasoning" }, "text.how": { "tier": "tradition", "note": "the general shape of a referral-driven hospital trade; no single page describes it" } } }, "x_commons_files": [ "File:Monterrey skyline.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "The capital of Nuevo León, a few hours' drive south of the Texas border, anchoring Mexico's second-largest metropolitan area at some 5.3 million people and a city its Wikipedia article calls the richest in Latin…", "region_terms": [ { "key": "mexico", "name": "Mexico", "note": "its own entry because the border towns are a category of their own" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "mexico", "type": "destination", "name": "Mexico", "as": "The country whose hospital-grade export trade concentrates here rather than on the border.", "rel": "destination" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The market three hours north by road, and the one the English-language consent forms are for.", "rel": "kin" }, { "to": "tijuana", "type": "hub", "name": "Tijuana", "as": "The other Mexican surgical hub — cheaper, faster, and sold through packages rather than referrals.", "rel": "contrast" }, { "to": "josef-woodman", "type": "person", "name": "Josef Woodman", "as": "Wrote the only city edition of his guidebook devoted to a Latin American hub, and it was this one.", "rel": "person" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "Cardiac surgery is among the work the city's hospitals sell across the border.", "rel": "performs" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The screening package a hospital sells to a corporate market on its doorstep.", "rel": "performs" }, { "to": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "Answered here by policy — consent documents in English, interpreters on request — which is not the norm.", "rel": "risk" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "A large university hospital naming national certifications and no international mark is one answer to it.", "rel": "story" } ], "source_list": [ { "id": "s:wp-monterrey", "kind": "web", "title": "Monterrey", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Monterrey", "accessed": "2026-09-16" }, { "id": "s:tecsalud-international", "kind": "web", "title": "Pacientes foráneos e internacionales", "publisher": "TecSalud, Tecnológico de Monterrey", "url": "https://www.tecsalud.mx/pacientes-foraneos-e-internacionales", "accessed": "2026-09-16", "note": "bilingual clinical staff, consent documents available in English, interpreter coordination, partner hotels; certifications listed include the Consejo de Salubridad General, Pathway to Excellence in nursing and COMLE" }, { "id": "s:tecsalud-quality", "kind": "web", "title": "Calidad y seguridad", "publisher": "TecSalud, Tecnológico de Monterrey", "url": "https://www.tecsalud.mx/calidad-y-seguridad", "accessed": "2026-09-16", "note": "states the Consejo de Salubridad General certification and that the system was in a recertification process when the page was read" }, { "id": "s:wp-patients-beyond-borders", "kind": "web", "title": "Patients Beyond Borders", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Patients_Beyond_Borders", "accessed": "2026-09-16", "note": "lists the editions, including single-country and single-city editions for Korea, Taiwan, Singapore, Malaysia, Thailand, Turkey, Dubai Healthcare City and Monterrey" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:tecsalud-international", "note": "read off the hospital's own pages on 16 September 2026; the third paragraph is marked as this project's reasoning" }, "text.how": { "tier": "tradition", "note": "the general shape of a referral-driven hospital trade; no single page describes it" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [ { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:tecsalud-international", "note": "a named department for foreign and out-of-state patients, with logistics and paperwork support", "tier": "cited", "url": "https://www.tecsalud.mx/pacientes-foraneos-e-internacionales" }, { "key": "interpreter", "label": "Interpreters on staff", "icon": "🗣", "group": "service", "evidence": "the facility's own page naming the languages, or a published inspection or accreditation report", "source": "s:tecsalud-international", "note": "Spanish and English clinical staff, with interpreters coordinated on request and consent documents available in English", "tier": "cited", "url": "" }, { "key": "university-hospital", "label": "University hospital", "icon": "🎓", "group": "ownership", "evidence": "the affiliated university's own page or the hospital's charter", "source": "s:tecsalud-international", "note": "TecSalud is the health system of the Tecnológico de Monterrey", "tier": "cited", "url": "" }, { "key": "recovery-hotel", "label": "Recovery accommodation", "icon": "🏨", "group": "service", "evidence": "the facility's own page naming the hotel or its own ward-hotel", "source": "s:tecsalud-international", "note": "the hospital names hotels under agreement for patients and companions", "tier": "cited", "url": "" } ], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "mexico", "type": "destination", "name": "Mexico", "as": "The interior counterweight: large private hospitals rather than a border street.", "rel": "part" } ] }, { "schema": 1, "id": "mumbai", "type": "hub", "names": { "name": "Mumbai", "aliases": [ "मुंबई", "Bombay" ], "said": "Mum-bye. The city's medicine is split by the suburban railway: Parel for cancer, the western suburbs for the private towers, and a patient tells you which line they are on before they tell you which hospital." }, "region": [ "south-asia" ], "facets": { "iso2": "IN", "radius_km": 25, "specialty": [ "oncology", "bone marrow transplant", "cardiac surgery", "orthopaedics", "fertility", "neurosurgery" ], "draws": [ "bone-marrow-transplant", "cabg", "angioplasty-stent", "knee-replacement", "ivf" ], "languages": [ "Marathi", "Hindi", "English", "Gujarati" ] }, "text": { "what": "Mumbai's medicine runs north to south along the island city. Tata Memorial Hospital stands in Parel, where it has been since 1941, and is the reason people travel to this city at all; Hinduja is at Mahim and Lilavati at Bandra, a few kilometres north on the western line; Kokilaben Dhirubhai Ambani Hospital sits further north again on Jai Prakash Road at Four Bungalows, Versova, in the Andheri West suburbs. The cluster is linear rather than radial, which is what a city built on a peninsula does to its hospitals.", "story": "Tata Memorial was established on 28 February 1941, commissioned by the Sir Dorabji Tata Trust after Dorabji's wife Meherbai died of leukaemia. Its network registers about 120,000 new cancer patients a year, the main centre records over a million patient footfalls and about 60,000 admissions annually, and roughly 60 per cent of patients are treated free or at a heavily subsidised rate. Those are counts of visits and of registrations, not of individual people, and the free-treatment share is the fact that makes the hospital unlike anything else in this directory.\n\nKokilaben opened in 2009 with 750 beds at Four Bungalows. *Inference —* the two institutions are the two halves of the city's answer. A subsidised cancer hospital that takes referrals from the whole of India, and a private tower built for people who will pay, standing eleven kilometres apart and almost never quoted in the same sentence.\n\n*Trade practice —* the cross-border flow into Mumbai is smaller than into Delhi and weighted toward oncology and haematology rather than cardiac surgery, and much of it arrives from the Gulf and East Africa. This project has read no register that confirms the mix, and carries it as the trade's account.", "how": "A private Mumbai hospital quotes an estimate against a room category and a projected stay. Tata Memorial is not a quote at all: it is a registration, a queue and a means test, and a foreign patient enters it as a paying patient on a different tariff from the subsidised one. The distinction is the single most useful thing to know about this city's medicine and the easiest thing to miss on an agent's brochure.", "today": "As of 16 September 2026 the harvest point for this hub sits in the middle of the island city, with a 25-kilometre radius that reaches Colaba to the south and Borivali to the north. No Mumbai price has been read off a page into this directory yet.", "notes": "A description of where the hospitals are and what they charge each other's patients. It is not advice about cancer." }, "geo": { "lat": 19.06, "lon": 72.84, "precision": "city", "source": "s:osm-nominatim" }, "address": { "city": "Mumbai", "area": "Maharashtra", "country": "IN" }, "metrics": { "annual_patients": 120000, "note": "Tata Memorial's network registration of new cancer patients in a year, not a count for the city and not a count of foreign patients. The main centre separately reports over a million patient footfalls and about 60,000 admissions annually.", "as_of": "2026-09-16", "source": "s:wp-tata-memorial", "url": "https://en.wikipedia.org/wiki/Tata_Memorial_Hospital" }, "kin": [ { "to": "kokilaben", "as": "The 750-bed private hospital at Four Bungalows, Versova, opened 2009.", "rel": "part" }, { "to": "india", "as": "The country whose oncology referrals converge on this city.", "rel": "whole" }, { "to": "bone-marrow-transplant", "as": "The work that brings patients to Parel from outside India.", "rel": "procedure" }, { "to": "cabg", "as": "Sold in the private towers of the western suburbs on the usual estimate.", "rel": "procedure" }, { "to": "ivf", "as": "A large private fertility trade sits alongside the hospitals here.", "rel": "procedure" }, { "to": "india-e-medical-visa", "as": "The entry route foreign patients arrive on.", "rel": "governed-by" }, { "to": "delhi-ncr", "as": "The northern cluster, larger and weighted to the heart rather than to cancer.", "rel": "contrast" }, { "to": "counting-patients", "as": "Why a million footfalls is not a million patients.", "rel": "story" }, { "to": "osm-facilities", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 25 kilometres of this point.", "rel": "measured-by" } ], "links": [ { "label": "Tata Memorial Centre", "url": "https://tmc.gov.in/" }, { "label": "Kokilaben Dhirubhai Ambani Hospital", "url": "https://www.kokilabenhospital.com/" } ], "sources": [ "s:osm-nominatim", "s:wp-tata-memorial", "s:wp-kokilaben", "s:wp-medical-tourism-india", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "streets and suburbs read off OpenStreetMap address tags and the hospitals' Wikipedia entries" }, "text.story": { "tier": "cited", "source": "s:wp-tata-memorial", "note": "the Tata Memorial figures and dates are cited; the inline marks say which stretches are inference and trade practice" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "a point in the middle of the island city, chosen to cover the line of hospitals rather than to mark one of them" } } }, "x_commons_files": [ "File:Tata Memorial Hospital.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "Mumbai's medicine runs north to south along the island city. Tata Memorial Hospital stands in Parel, where it has been since 1941, and is the reason people travel to this city at all; Hinduja is at Mahim and Lilavati at…", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" } ], "kin_out": [ { "to": "kokilaben", "type": "facility", "name": "Kokilaben Dhirubhai Ambani Hospital", "as": "The 750-bed private hospital at Four Bungalows, Versova, opened 2009.", "rel": "part" }, { "to": "india", "type": "destination", "name": "India", "as": "The country whose oncology referrals converge on this city.", "rel": "whole" }, { "to": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "The work that brings patients to Parel from outside India.", "rel": "procedure" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "Sold in the private towers of the western suburbs on the usual estimate.", "rel": "procedure" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "A large private fertility trade sits alongside the hospitals here.", "rel": "procedure" }, { "to": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The entry route foreign patients arrive on.", "rel": "governed-by" }, { "to": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "The northern cluster, larger and weighted to the heart rather than to cancer.", "rel": "contrast" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a million footfalls is not a million patients.", "rel": "story" }, { "to": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 25 kilometres of this point.", "rel": "measured-by" } ], "source_list": [ { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." }, { "id": "s:wp-tata-memorial", "kind": "wikipedia", "title": "Tata Memorial Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Tata_Memorial_Hospital", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-kokilaben", "kind": "wikipedia", "title": "Kokilaben Dhirubhai Ambani Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Kokilaben_Dhirubhai_Ambani_Hospital", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-medical-tourism-india", "kind": "wikipedia", "title": "Medical tourism in India", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_India", "license": "CC BY-SA 4.0", "accessed": "2026-09-16", "note": "carries city-share and market-size figures sourced to newspapers and market-research summaries; this project reads it for the claims and their attributions, not as a count." }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "streets and suburbs read off OpenStreetMap address tags and the hospitals' Wikipedia entries" }, "text.story": { "tier": "cited", "source": "s:wp-tata-memorial", "note": "the Tata Memorial figures and dates are cited; the inline marks say which stretches are inference and trade practice" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "a point in the middle of the island city, chosen to cover the line of hospitals rather than to mark one of them" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "india", "type": "destination", "name": "India", "as": "The financial capital's hospital cluster, and the one closest to the listed-company money.", "rel": "part" }, { "from": "kokilaben", "type": "facility", "name": "Kokilaben Dhirubhai Ambani Hospital", "as": "The hospital the Andheri end of the Mumbai cluster is named for.", "rel": "place" } ] }, { "schema": 1, "id": "nicosia", "type": "hub", "names": { "name": "Nicosia", "aliases": [ "Lefkosia", "Λευκωσία", "Lefkoşa", "North Nicosia" ], "said": "One city, two names, two health systems and two sets of rules. A clinic address here carries a side, and the side is the material fact." }, "region": [ "europe-south", "west-asia" ], "facets": { "iso2": "CY", "radius_km": 13, "specialty": [ "fertility", "reproductive medicine", "oncology", "hair restoration" ], "draws": [ "ivf", "egg-donation", "icsi", "pgt" ], "languages": [ "Greek", "Turkish", "English" ] }, "text": { "what": "A capital of 111,797 in its municipality and 256,119 across its urban area, cut through the middle by the United Nations buffer zone — the Green Line, named for the colour of the pen a UN officer drew it with. The southern half is the capital of the Republic of Cyprus; the northern half, Lefkoşa, is the de facto capital of Northern Cyprus, recognised only by Türkiye, and the Republic claims it. Fertility clinics operate on both sides under different regimes, and pedestrians cross at Ledra Palace, opened on 23 April 2003, and at Ledra Street, reopened on 3 April 2008.", "story": "On the southern side the law is nameable and dated. Medically assisted reproduction is governed by the Medically Assisted Reproduction Law of 2015, 69(I)/2015, as amended by 194(I)/2015, 92(I)/2016, 113(I)/2018 and 166(I)/2023, and administered by a Council of Medically Assisted Reproduction. A treatment sold in the south sits inside that statute and inside the European Union.\n\nOn the northern side this project can name no equivalent instrument. That is a gap in what was read for this record, not a finding: the absence of a statute on this disk is not evidence that none exists, and the north's regime is left as no-data here rather than described.\n\n*Inference —* the buffer zone is the reason Nicosia belongs in a directory about cross-border care at all. Most clusters in this directory are a city with a price. This one is a city with a frontier running through it, where a treatment's lawfulness, its regulator, its recourse and its European Union membership can change inside a fifteen-minute walk.\n\n*Trade practice —* clinics on the northern side advertise to Turkish, Middle Eastern and British patients and quote in sterling or euros; clinics in the south advertise into the European market. Patients do cross, and the crossing is a border for legal purposes even where it takes a passport check and a few minutes.", "how": "*Trade practice —* a Nicosia fertility programme is arranged remotely, quoted per cycle, and needs the patient present for a few days. What differs by side is not the clinical sequence but everything around it: which regulator holds the licence, which court hears a complaint, and whether a European reimbursement route exists at all.", "today": "As of 16 September 2026 this record carries no price row and no legality row for the northern side. The southern legality question belongs to the surrogacy and donor anonymity records, which name their instruments; this record names the statute and leaves the reading to them.", "notes": "Thirteen kilometres around the city point covers both municipalities and the crossings between them. An OpenStreetMap harvest at that radius returns facilities on both sides, and the map does not mark which regulator licensed them. This record's iso2 is CY because that is the only ISO 3166-1 code covering the city; the northern half has no code of its own, and a map coloured by iso2 will not show the line." }, "geo": { "lat": 35.1725, "lon": 33.365, "precision": "city", "source": "s:wp-nicosia" }, "address": { "city": "Nicosia", "country": "CY" }, "kin": [ { "to": "cyprus", "as": "The state whose capital the southern half is, and whose 2015 statute governs treatment there.", "rel": "whole" }, { "to": "north-cyprus", "as": "The entity administering the northern half, whose regime this record does not describe because it could not read one.", "rel": "whole" }, { "to": "ivf", "as": "The treatment both sides of this city sell.", "rel": "procedure" }, { "to": "egg-donation", "as": "Sold here into the same European shortage that feeds Barcelona and Prague.", "rel": "procedure" }, { "to": "surrogacy-law", "as": "The question that changes most sharply across this city's buffer zone.", "rel": "governed-by" }, { "to": "donor-anonymity-law", "as": "The other rule that decides which side of the line a patient books on.", "rel": "governed-by" }, { "to": "circumvention-travel", "as": "What a journey across a line like this one is usually called.", "rel": "term" }, { "to": "malpractice-recourse", "as": "Which court hears the complaint, and whether its judgment is recognised anywhere else.", "rel": "risk" } ], "links": [ { "label": "Council of Medically Assisted Reproduction — legal framework", "url": "https://cmar.org.cy/en/law_eng/" } ], "sources": [ "s:wp-nicosia", "s:wp-north-nicosia", "s:cmar-cyprus", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:cmar-cyprus", "note": "paragraphs three and four are marked inline as inference and trade practice" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "cited", "source": "s:wp-nicosia" }, "facets.radius_km": { "tier": "inference" } } }, "x_commons_files": [ "File:Ledra Street crossing Nicosia.jpg", "File:Nicosia buffer zone.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A capital of 111,797 in its municipality and 256,119 across its urban area, cut through the middle by the United Nations buffer zone — the Green Line, named for the colour of the pen a UN officer drew it with.", "region_terms": [ { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" }, { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "cyprus", "type": "destination", "name": "Cyprus", "as": "The state whose capital the southern half is, and whose 2015 statute governs treatment there.", "rel": "whole" }, { "to": "north-cyprus", "type": "destination", "name": "Northern Cyprus", "as": "The entity administering the northern half, whose regime this record does not describe because it could not read one.", "rel": "whole" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment both sides of this city sell.", "rel": "procedure" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "Sold here into the same European shortage that feeds Barcelona and Prague.", "rel": "procedure" }, { "to": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "The question that changes most sharply across this city's buffer zone.", "rel": "governed-by" }, { "to": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The other rule that decides which side of the line a patient books on.", "rel": "governed-by" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "What a journey across a line like this one is usually called.", "rel": "term" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "Which court hears the complaint, and whether its judgment is recognised anywhere else.", "rel": "risk" } ], "source_list": [ { "id": "s:wp-nicosia", "kind": "wikipedia", "title": "Nicosia", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Nicosia", "accessed": "2026-09-16", "note": "coordinates, municipal population 111,797 (2021) and urban 256,119; the Green Line and UN buffer zone; Ledra Palace crossing opened 23 April 2003 and Ledra Street 3 April 2008" }, { "id": "s:wp-north-nicosia", "kind": "wikipedia", "title": "North Nicosia", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/North_Nicosia", "accessed": "2026-09-16", "note": "the de facto capital of Northern Cyprus, administered from Lefkoşa District, claimed by the Republic of Cyprus; Dereboyu Avenue is its modern commercial spine" }, { "id": "s:cmar-cyprus", "kind": "org", "title": "Legal Framework — Council of Medically Assisted Reproduction", "publisher": "Council of Medically Assisted Reproduction, Republic of Cyprus", "url": "https://cmar.org.cy/en/law_eng/", "accessed": "2026-09-16", "note": "names the Medically Assisted Reproduction Law 2015, 69(I)/2015, and its amendments 194(I)/2015, 92(I)/2016, 113(I)/2018 and 166(I)/2023" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:cmar-cyprus", "note": "paragraphs three and four are marked inline as inference and trade practice" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited", "source": "s:wp-nicosia" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "cyprus", "type": "destination", "name": "Cyprus", "as": "The capital the two jurisdictions share, and the line runs through it.", "rel": "part" }, { "from": "north-cyprus", "type": "destination", "name": "Northern Cyprus", "as": "The divided capital: the crossing is inside it.", "rel": "part" } ] }, { "schema": 1, "id": "nuevo-progreso", "type": "hub", "names": { "name": "Nuevo Progreso", "aliases": [ "Nuevo Progreso, Tamaulipas", "Progreso" ], "said": "The Rio Grande Valley says Progreso and means the Mexican side; the Texas town across the river is Progreso Lakes." }, "region": [ "mexico", "north-america" ], "facets": { "iso2": "MX", "radius_km": 6, "specialty": [ "dentistry", "pharmacy", "optometry" ], "draws": [ "dental-implant", "dental-crown", "root-canal", "full-mouth-restoration" ], "languages": [ "Spanish", "English" ] }, "text": { "what": "A town in Río Bravo Municipality, Tamaulipas, at the Mexican end of a road bridge over the Rio Grande. Wikipedia records 10,178 inhabitants at the 2010 census and, in the five-block centre, more than a hundred dentists and more than a hundred pharmacies. Like Los Algodones it is walked to, not flown to; unlike Los Algodones the walk starts in Texas.", "story": "The bridge came first. The Progreso–Nuevo Progreso International Bridge has been in operation since 1952 and was rebuilt in 2003 with four traffic lanes and a separate crossing for trucks. The town at the far end grew a single main street of surgeries, pharmacies, opticians and restaurants aimed at the people coming over it.\n\nThe traffic is winter traffic. The Bureau of Transportation Statistics recorded 1,020,916 northbound pedestrian crossings at Progreso, Texas in calendar 2025, against 947,149 in 2024. Two months of the 2025 pedestrian series are missing from the federal data, so this record does not draw a seasonal curve from it, only the totals.\n\n*Trade practice —* the pharmacy trade here is at least as large as the dental trade and is a different business: a prescription filled at a counter rather than a course of treatment. A patient crossing for both is doing two errands, and only one of them has a follow-up.\n\n*Inference —* the security reputation of Tamaulipas is the variable that does not appear in any price. Nuevo Progreso is described in its own Wikipedia article as one of the safest border towns in the state, which is a sentence that only gets written about a state where the question is live.", "how": "Cross on foot from Progreso, Texas, walk the main street, cross back. Wikipedia's article on the bridge states a four-dollar toll per vehicle in either direction and pedestrian tolls of one dollar into Mexico and thirty cents into the United States; it gives no date for those figures, and this record does not treat them as current. Dental work follows the same two-visit rhythm as any implant case — impressions and fitting weeks apart — which is manageable for a Winter Texan parked twenty minutes away for five months and awkward for anybody else.", "today": "As of 16 September 2026 this project has found no surgery in Nuevo Progreso publishing a dated price list on its own site that could be read and cited the way the Los Algodones lists can. Prices quoted for the town circulate through broker directories, and this directory does not carry them.", "notes": "A figure this record could not source is absent rather than estimated." }, "geo": { "lat": 26.0561, "lon": -97.9522, "precision": "city", "source": "s:wp-nuevo-progreso" }, "address": { "city": "Nuevo Progreso", "area": "Tamaulipas", "country": "MX" }, "kin": [ { "to": "mexico", "as": "The country the bridge lands in.", "rel": "destination" }, { "to": "los-algodones", "as": "The same trade at the far western end of the border, denser, and with its prices in the window.", "rel": "contrast" }, { "to": "united-states", "as": "Where the walkers come from, most of them wintering in the Rio Grande Valley.", "rel": "kin" }, { "to": "dental-implant", "as": "The largest single item on the street, sold across two visits.", "rel": "performs" }, { "to": "dental-crown", "as": "Ordinary restorative work, done at a fraction of the price across the river.", "rel": "performs" }, { "to": "cross-border-prescriptions", "as": "Half the street is pharmacies, and that is a different transaction from a course of treatment.", "rel": "governed-by" }, { "to": "counterfeit-medicines", "as": "The risk that attaches to the pharmacy half of the trade rather than the dental half.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Nearly closed here, because the patient is parked twenty minutes away until April.", "rel": "risk" } ], "links": [ { "label": "Border Crossing/Entry Data — Progreso, Texas", "url": "https://data.bts.gov/d/keg4-3bc2" } ], "sources": [ "s:wp-nuevo-progreso", "s:wp-progreso-bridge", "s:bts-border-crossing" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "harvested", "source": "s:bts-border-crossing", "note": "the crossing counts are queried from the federal series; the last two paragraphs carry their own inline marks" }, "text.how": { "tier": "tradition", "note": "the shape of the day trip; the tolls are the bridge article's figures and are undated there" } } }, "x_commons_files": [ "File:Progreso-Nuevo Progreso International Bridge.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "A town in Río Bravo Municipality, Tamaulipas, at the Mexican end of a road bridge over the Rio Grande.", "region_terms": [ { "key": "mexico", "name": "Mexico", "note": "its own entry because the border towns are a category of their own" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "mexico", "type": "destination", "name": "Mexico", "as": "The country the bridge lands in.", "rel": "destination" }, { "to": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "The same trade at the far western end of the border, denser, and with its prices in the window.", "rel": "contrast" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "Where the walkers come from, most of them wintering in the Rio Grande Valley.", "rel": "kin" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The largest single item on the street, sold across two visits.", "rel": "performs" }, { "to": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "Ordinary restorative work, done at a fraction of the price across the river.", "rel": "performs" }, { "to": "cross-border-prescriptions", "type": "rule", "name": "A prescription that crosses a border", "as": "Half the street is pharmacies, and that is a different transaction from a course of treatment.", "rel": "governed-by" }, { "to": "counterfeit-medicines", "type": "risk", "name": "Substandard and falsified medicines", "as": "The risk that attaches to the pharmacy half of the trade rather than the dental half.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Nearly closed here, because the patient is parked twenty minutes away until April.", "rel": "risk" } ], "source_list": [ { "id": "s:wp-nuevo-progreso", "kind": "web", "title": "Nuevo Progreso, Río Bravo, Tamaulipas", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Nuevo_Progreso,_R%C3%ADo_Bravo,_Tamaulipas", "accessed": "2026-09-16", "note": "10,178 inhabitants at the 2010 census; over 100 dentists and 100 pharmacies in the five-block centre" }, { "id": "s:wp-progreso-bridge", "kind": "web", "title": "Progreso–Nuevo Progreso International Bridge", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Progreso%E2%80%93Nuevo_Progreso_International_Bridge", "accessed": "2026-09-16", "note": "in operation since 1952; rebuilt 2003 with four traffic lanes; tolls and annual crossing figures are stated on the page without a year" }, { "id": "s:bts-border-crossing", "kind": "dataset", "title": "Border Crossing/Entry Data", "publisher": "United States Bureau of Transportation Statistics", "url": "https://data.bts.gov/d/keg4-3bc2", "accessed": "2026-09-16", "note": "monthly counts by port of entry and measure, queried through the Socrata API at https://data.bts.gov/resource/keg4-3bc2.json. Counts crossings, not people." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "harvested", "source": "s:bts-border-crossing", "note": "the crossing counts are queried from the federal series; the last two paragraphs carry their own inline marks" }, "text.how": { "tier": "tradition", "note": "the shape of the day trip; the tolls are the bridge article's figures and are undated there" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "The same trade at the other end of the same border, serving Texas instead of Arizona.", "rel": "contrast" } ] }, { "schema": 1, "id": "panama-city", "type": "hub", "names": { "name": "Panama City", "aliases": [ "Ciudad de Panamá", "Panamá" ], "said": "Pa-na-MÁ, with the stress on the last syllable in Spanish and on the first in the English of the people who retire here. The private hospitals sit on the bay between Paitilla and Punta Pacífica, with a newer campus out at Costa del Este." }, "region": [ "central-america" ], "facets": { "iso2": "PA", "radius_km": 18, "specialty": [ "cosmetic surgery", "dentistry", "health screening", "cardiology", "oncology" ], "draws": [ "abdominoplasty", "liposuction", "dental-implant", "executive-health-screening" ], "languages": [ "Spanish", "English" ] }, "text": { "what": "Panama's capital and, for this subject, the whole of the country: 410,354 people in the city proper at the 2023 census, 2,100,189 in the metropolitan area, a US-dollar economy and a hub airport at Tocumen. Its private hospitals stand within a few kilometres of each other on the Pacific shore — Punta Pacífica, Paitilla, Bella Vista, Costa del Este — and they sell to two markets at once: people who fly in, and North Americans who already live here.", "story": "The institution the city is known for abroad is Pacífica Salud, which opened at Punta Pacífica in 2006 and added a second campus at Costa del Este in February 2022. Its own credential page leads with an affiliation to Johns Hopkins Medicine International held \"since the hospital's beginnings\" and renewed in 2017, extended to both campuses; it states a fifth Joint Commission International accreditation at Punta Pacífica and a first at Costa del Este, neither of them dated on the page, together with World Stroke Organization certification running 12 November 2025 to 12 November 2028.\n\nA hospital's old web address is not a hospital. hospitalpuntapacifica.com, the domain the institution traded under before the rebrand, now answers with a permanent redirect to a slot-machine site; *Inference —* that is a lapsed domain bought by somebody else, and the reason this record cites the hospital's current address and nothing else. A reader following an old link, or a facilitator's stale directory entry, lands on a casino.\n\nThe older part of the cluster is smaller and quieter about itself. Hospital Nacional opened as Clínica Nacional on 9 July 1973, took its present name on 20 August 1998, and runs 80 beds — 8 adult and 5 paediatric intensive care beds, a 5-bed neonatal unit — with a department whose job is foreign insurance programmes rather than foreign patients.\n\nThe part a visitor does not get is written into statute. Ley 6 of 16 June 1987, as amended, gives Panamanians *and foreigners resident in the national territory* aged 55 for women and 60 for men, plus every retiree and pensioner of any age, a 20% discount on consultation fees in general medicine and in medical and surgical specialties, and 15% off the total bill for private hospital and clinic services where the beneficiary holds no hospitalisation insurance. The ages rose to 57 and 62 in 1995.\n\n*Inference —* that provision is what separates this hub from San José or Medellín. Everywhere else in this directory the foreign patient is the one being priced for. Here the state has written a permanent discount for the resident retiree and left the week-long visitor paying list, so the same private ward holds two people paying different prices for the same night, and the one paying less is the one who lives here.", "how": "*Trade practice —* consultation, then treatment, over a few days to three weeks. Prices are quoted in US dollars, because the balboa is fixed to it and US notes circulate, which takes the exchange-rate argument out of a subject it usually runs through. The marks the hospitals lead with are American ones — a US academic affiliation and a US-derived accreditation — which is the recognisable-name trade this directory records everywhere from Gebze to Escazú. Follow-up after a visitor goes home is by message or video call.", "today": "As of 17 September 2026 Pacífica Salud states the Johns Hopkins Medicine International affiliation as current on its own credential page, with no end date and no year of renewal after 2017; this directory's Panama record carries no claim either way and none is made here. No Panama City price was read off any page for this record — a statement about the pages read, not about the world. The former hospitalpuntapacifica.com address redirects to a gambling host." }, "geo": { "lat": 8.9835, "lon": -79.5155, "precision": "city", "source": "s:wp-panama-city" }, "address": { "city": "Panama City", "area": "Panamá", "country": "PA" }, "tags": [ { "tag": "insurer-direct", "source": "s:wp-hospital-nacional", "tier": "cited", "note": "Hospital Nacional runs an International Insurances Department handling foreign insurance programmes alongside the Panamanian carriers" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation stated by Pacífica Salud as a fifth award at Punta Pacífica and a first at Costa del Este", "year": null, "valid_until": null, "source": "s:pacificasalud-respaldo", "url": "https://www.pacificasalud.com/en/respaldo-institucional/", "note": "the hospital's own page carries no year for either award; JCI's own directory could not be read by this project, so nothing here is confirmed against the accreditor" }, { "by": "other", "what": "Affiliation with Johns Hopkins Medicine International, stated as running since the hospital's beginnings and renewed in 2017", "year": 2017, "valid_until": null, "source": "s:pacificasalud-respaldo", "url": "https://www.pacificasalud.com/en/respaldo-institucional/", "note": "an academic affiliation, not an accreditation: no inspection, no standard, no cycle. Counted here because the hospital leads with it" } ], "kin": [ { "to": "panama", "as": "The country this cluster is, for practical purposes, the whole of.", "rel": "destination" }, { "to": "san-jose-cr", "as": "The neighbouring Central American cluster, older, larger and built on the same North American market.", "rel": "contrast" }, { "to": "medellin", "as": "The regional cosmetic capital, where the foreign patient is the one being priced for.", "rel": "contrast" }, { "to": "executive-health-screening", "as": "What a hub airport and a dollar economy sell well: fly in, be measured, fly out.", "rel": "performs" }, { "to": "dental-implant", "as": "The everyday work of the cluster, bought as often by a resident as by a visitor.", "rel": "performs" }, { "to": "jci", "as": "The mark the flagship hospital counts in fifths, without dating any of them.", "rel": "accredited-by" }, { "to": "getting-a-quote", "as": "Quoted in US dollars here, which removes the currency argument and leaves the inclusion list.", "rel": "step" }, { "to": "the-price-that-isnt", "as": "A city that sells on price and publishes none, with a statutory discount that only residents can claim.", "rel": "story" } ], "links": [ { "label": "Pacífica Salud — respaldo institucional", "url": "https://www.pacificasalud.com/en/respaldo-institucional/" }, { "label": "Ley 6 de 16 de junio de 1987 (Panamá)", "url": "https://mici.gob.pa/wp-content/uploads/2021/09/01-03-ley-6-1987.pdf" } ], "sources": [ "s:wp-panama-city", "s:pacificasalud-about", "s:pacificasalud-respaldo", "s:wp-hospital-nacional", "s:pa-ley-6-1987", "s:wp-punta-pacifica" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:pacificasalud-respaldo", "note": "the hospital's credentials and the Hospital Nacional dates were read off the named pages on 17 September 2026; the statute is quoted from the Gaceta text; the two stretches marked *Inference —* are this project's reading, and the domain redirect was observed from this machine on 2026-09-17" }, "text.how": { "tier": "tradition", "note": "the shape of a Panamanian booking, hedged in the prose" }, "text.today": { "tier": "inference", "note": "the redirect was observed from this machine on 2026-09-17; the affiliation sentence reports what the hospital's page states and makes no finding about the affiliation's current status" }, "geo": { "tier": "inference", "source": "s:wp-panama-city", "note": "a point set between the Paitilla and Punta Pacífica hospitals rather than on the city's own coordinate, so the harvest radius covers the cluster and reaches Costa del Este" } } }, "x_commons_files": [ "File:Panama City skyline.jpg", "File:Punta Pacifica Panama.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "Panama's capital and, for this subject, the whole of the country: 410,354 people in the city proper at the 2023 census, 2,100,189 in the metropolitan area, a US-dollar economy and a hub airport at Tocumen.", "region_terms": [ { "key": "central-america", "name": "Central America", "note": "Costa Rica, Panama, Guatemala, Belize" } ], "kin_out": [ { "to": "panama", "type": "destination", "name": "Panama", "as": "The country this cluster is, for practical purposes, the whole of.", "rel": "destination" }, { "to": "san-jose-cr", "type": "hub", "name": "San José, Costa Rica", "as": "The neighbouring Central American cluster, older, larger and built on the same North American market.", "rel": "contrast" }, { "to": "medellin", "type": "hub", "name": "Medellín", "as": "The regional cosmetic capital, where the foreign patient is the one being priced for.", "rel": "contrast" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "What a hub airport and a dollar economy sell well: fly in, be measured, fly out.", "rel": "performs" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The everyday work of the cluster, bought as often by a resident as by a visitor.", "rel": "performs" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The mark the flagship hospital counts in fifths, without dating any of them.", "rel": "accredited-by" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "Quoted in US dollars here, which removes the currency argument and leaves the inclusion list.", "rel": "step" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "A city that sells on price and publishes none, with a statutory discount that only residents can claim.", "rel": "story" } ], "source_list": [ { "id": "s:wp-panama-city", "kind": "web", "title": "Panama City", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Panama_City", "accessed": "2026-09-16" }, { "id": "s:pacificasalud-about", "kind": "web", "title": "About Us — Pacífica Salud", "publisher": "Pacífica Salud (Hospital Punta Pacífica)", "url": "https://www.pacificasalud.com/en/about-us/", "accessed": "2026-09-17", "note": "the hospital's own account: opened at Punta Pacífica in 2006, second campus at Costa del Este opened February 2022, founded by a group of Panamanian doctors and business owners, affiliated with Johns Hopkins Medicine International. No bed count, no doctor count and no price on the page" }, { "id": "s:pacificasalud-respaldo", "kind": "web", "title": "Respaldo institucional — accreditations and affiliations, Pacífica Salud", "publisher": "Pacífica Salud (Hospital Punta Pacífica)", "url": "https://www.pacificasalud.com/en/respaldo-institucional/", "accessed": "2026-09-17", "note": "the hospital's own credential page: affiliation with Johns Hopkins Medicine International since the hospital's beginnings and renewed in 2017, extended to the Costa del Este campus; a fifth Joint Commission International accreditation at Punta Pacífica and a first at Costa del Este, neither dated on the page; World Stroke Organization certification 12 November 2025 to 12 November 2028; ISO 9001:2015 for radiology at both campuses" }, { "id": "s:wp-hospital-nacional", "kind": "wikipedia", "title": "Hospital Nacional (Panama City)", "publisher": "Wikipedia", "license": "CC BY-SA 4.0", "url": "https://en.wikipedia.org/wiki/Hospital_Nacional", "accessed": "2026-09-17", "note": "opened 9 July 1973 as Clínica Nacional, renamed Hospital Nacional on 20 August 1998 at Avenida Cuba between 38th and 39th Streets; 80 beds including 8 adult and 5 paediatric intensive care beds and a 5-bed neonatal unit; an International Insurances Department handling foreign insurance programmes" }, { "id": "s:pa-ley-6-1987", "kind": "statute", "title": "Ley Nº 6 de 16 de junio de 1987, por la cual se adoptan medidas en beneficio de los ciudadanos jubilados, pensionados, de la tercera y cuarta edad", "publisher": "República de Panamá, published in Gaceta Oficial 20.827 of 22 June 1987; text hosted by the Ministerio de Comercio e Industrias", "year": 1987, "url": "https://mici.gob.pa/wp-content/uploads/2021/09/01-03-ley-6-1987.pdf", "accessed": "2026-09-17", "note": "Article 1, as subrogated by Article 1 of Ley 15 of 13 July 1992 (G.O. 22.080 of 17 July 1992), covers Panamanians and foreigners resident in the national territory aged 55 (women) or 60 (men) and over, and all retirees and pensioners. Item 6: 15% off the total bill for private hospital and clinic services where the beneficiary holds no hospitalisation insurance. Item 8(a): 20% off fees for general medicine consultations and medical and surgical specialties; 8(b) 15% dental; 8(c) 15% optometry. Item 7: 10% off prescribed medicines. A parágrafo raises the ages to 57 and 62 from 12 January 1995" }, { "id": "s:wp-punta-pacifica", "kind": "web", "title": "Hospital Punta Pacifica", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Hospital_Punta_Pacifica", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:pacificasalud-respaldo", "note": "the hospital's credentials and the Hospital Nacional dates were read off the named pages on 17 September 2026; the statute is quoted from the Gaceta text; the two stretches marked *Inference —* are this project's reading, and the domain redirect was observed from this machine on 2026-09-17" }, "text.how": { "tier": "tradition", "note": "the shape of a Panamanian booking, hedged in the prose" }, "text.today": { "tier": "inference", "note": "the redirect was observed from this machine on 2026-09-17; the affiliation sentence reports what the hospital's page states and makes no finding about the affiliation's current status" }, "geo": { "tier": "inference", "source": "s:wp-panama-city", "note": "a point set between the Paitilla and Punta Pacífica hospitals rather than on the city's own coordinate, so the harvest radius covers the cluster and reaches Costa del Este" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [ { "key": "insurer-direct", "label": "Bills foreign insurers", "icon": "📄", "group": "money", "evidence": "the facility names the insurers or schemes it bills directly", "source": "s:wp-hospital-nacional", "note": "Hospital Nacional runs an International Insurances Department handling foreign insurance programmes alongside the Panamanian carriers", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation stated by Pacífica Salud as a fifth award at Punta Pacífica and a first at Costa del Este", "url": "https://www.pacificasalud.com/en/respaldo-institucional/", "kind": "international", "year": null, "valid_until": null, "source": "s:pacificasalud-respaldo" }, { "key": "other", "label": "Somebody else", "what": "Affiliation with Johns Hopkins Medicine International, stated as running since the hospital's beginnings and renewed in 2017", "url": "https://www.pacificasalud.com/en/respaldo-institucional/", "kind": "other", "year": 2017, "valid_until": null, "source": "s:pacificasalud-respaldo" } ], "acclaim": 2, "kin_in": [ { "from": "panama", "type": "destination", "name": "Panama", "as": "The whole of it, on one side of the canal.", "rel": "part" } ] }, { "schema": 1, "id": "penang", "type": "hub", "names": { "name": "Penang", "aliases": [ "George Town", "Pulau Pinang", "槟城" ], "said": "In the trade Penang means George Town, and George Town means four hospitals within a kilometre and a half of each other on the north-east corner of the island." }, "region": [ "southeast-asia" ], "facets": { "iso2": "MY", "radius_km": 15, "specialty": [ "health screening", "cardiology", "oncology", "orthopaedics", "ophthalmology", "gastroenterology" ], "draws": [ "executive-health-screening", "cabg", "angioplasty-stent", "knee-replacement", "cataract-surgery" ], "languages": [ "Malay", "English", "Hokkien", "Mandarin", "Tamil", "Indonesian" ] }, "text": { "what": "The tightest cluster in this batch. Island Hospital stands at 308 Jalan Macalister in central George Town, a 600-bed hospital opened in 1996 and building toward a thousand; Gleneagles Penang is 600 metres north-west at 1 Jalan Pangkor in Pulau Tikus; Penang Adventist is on Jalan Burma between them, and Loh Guan Lye is a few streets east. A patient staying on Macalister Road can walk to two of them and take a five-minute taxi to the others.", "story": "Penang's hospitals were built for the island's own Chinese and Malay population and for the Straits trade, and the Indonesian patient arrived on top of that. A 2024 analysis reprinted by the Malaysian Investment Development Authority put Indonesia at 64.9 per cent of Malaysia's medical travellers and split national revenue between Kuala Lumpur at 41 per cent and Penang at 40.5 per cent; it attributes the figures to TA Securities rather than to a register. Earlier, the Malaysia Healthcare Travel Council's own numbers had Penang at 57 per cent of national revenue in 2009 and 66 per cent in 2010.\n\nThose counts cover all registered patients holding a foreign passport, which is the council's own definition and includes everyone from a Medan family who flew for a scan to a Dutch resident who broke an ankle.\n\n*Trade practice —* the flow is a ferry and a short flight rather than a long-haul journey. Medan is under an hour away by air, Aceh and Sumatra's north coast are the catchment, and Hokkien is spoken across the counter. What is sold is the screening, the scope, the cardiac work-up and the second opinion — high volume, low complexity, repeated — rather than the single spectacular operation.\n\n*Inference —* that is why Penang takes almost as much national revenue as the capital from a city a fraction of the size, and why a tight harvest radius is the right one: the cluster genuinely is a few streets, and the volume comes from proximity rather than from reach.", "how": "A Penang hospital quotes an estimate against a room category, and the screening packages are priced and published as bundles. The trade runs on repeat visits rather than on one arrival, and much of the booking is done through Indonesian agents and hospital representative offices in Medan and Jakarta rather than through the hospital's own website.", "today": "As of 16 September 2026 the harvest point for this hub sits between Island Hospital and Gleneagles in central George Town, with a 15-kilometre radius that reaches Bayan Lepas and the bridge. No Penang price has been read off a page into this directory yet.", "notes": "A description of four hospitals and the water between them and their patients. Not advice about any of them." }, "geo": { "lat": 5.4245, "lon": 100.317, "precision": "city", "source": "s:osm-nominatim" }, "address": { "street": "Jalan Macalister", "city": "George Town", "area": "Pulau Pinang", "country": "MY", "postcode": "10450" }, "metrics": { "note": "No Penang-only patient count is carried here. The council's national figures count foreign passports rather than travellers, and the state-level revenue shares — 57 per cent in 2009, 66 per cent in 2010, 40.5 per cent in the 2024 analysis — are shares of revenue, not of people.", "as_of": "2024", "source": "s:mida-malaysia-medical-tourism-2024", "url": "https://www.mida.gov.my/mida-news/indonesia-remains-largest-contributor-to-malaysias-medical-tourism-market/" }, "kin": [ { "to": "island-hospital-penang", "as": "At 308 Jalan Macalister, 600 beds, the anchor of the George Town cluster.", "rel": "part" }, { "to": "malaysia", "as": "The country whose second cluster takes almost as much revenue as its capital.", "rel": "whole" }, { "to": "indonesia", "as": "The catchment: Medan is under an hour away, and about two-thirds of Malaysia's foreign patients are Indonesian on one 2024 analysis.", "rel": "kin" }, { "to": "mhtc", "as": "The state council that lists these hospitals and publishes the counts.", "rel": "governed-by" }, { "to": "executive-health-screening", "as": "The bundled screening that is most of what crosses the strait for.", "rel": "procedure" }, { "to": "cabg", "as": "The cardiac work-up that often follows the screening.", "rel": "procedure" }, { "to": "cataract-surgery", "as": "High-volume, short-stay work suited to a patient who can come back.", "rel": "procedure" }, { "to": "kuala-lumpur", "as": "The capital cluster selling complexity where this one sells proximity and repetition.", "rel": "contrast" }, { "to": "second-opinion", "as": "Much of what arrives here is a second reading of a scan done at home.", "rel": "step" }, { "to": "counting-patients", "as": "Why a foreign passport in a hospital register is not a medical traveller.", "rel": "story" }, { "to": "osm-facilities", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 15 kilometres of this point.", "rel": "measured-by" } ], "links": [ { "label": "Island Hospital", "url": "https://islandhospital.com/" }, { "label": "Malaysia Healthcare Travel Council", "url": "https://www.mhtc.org.my/" } ], "sources": [ "s:osm-nominatim", "s:wp-island-hospital", "s:wp-medical-tourism-malaysia", "s:mida-malaysia-medical-tourism-2024", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "streets and house numbers read off OpenStreetMap address tags and the Island Hospital article" }, "text.story": { "tier": "cited", "source": "s:wp-medical-tourism-malaysia", "note": "the revenue shares and the council's definition are cited to their publishers; the inline marks say which stretches are trade practice and inference" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "a point between Island Hospital and Gleneagles Penang, not a point anybody published" } } }, "x_commons_files": [ "File:George Town Penang Jalan Macalister.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "The tightest cluster in this batch. Island Hospital stands at 308 Jalan Macalister in central George Town, a 600-bed hospital opened in 1996 and building toward a thousand; Gleneagles Penang is 600 metres north-west at…", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "island-hospital-penang", "type": "facility", "name": "Island Hospital", "as": "At 308 Jalan Macalister, 600 beds, the anchor of the George Town cluster.", "rel": "part" }, { "to": "malaysia", "type": "destination", "name": "Malaysia", "as": "The country whose second cluster takes almost as much revenue as its capital.", "rel": "whole" }, { "to": "indonesia", "type": "destination", "name": "Indonesia", "as": "The catchment: Medan is under an hour away, and about two-thirds of Malaysia's foreign patients are Indonesian on one 2024 analysis.", "rel": "kin" }, { "to": "mhtc", "type": "org", "name": "Malaysia Healthcare Travel Council", "as": "The state council that lists these hospitals and publishes the counts.", "rel": "governed-by" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The bundled screening that is most of what crosses the strait for.", "rel": "procedure" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The cardiac work-up that often follows the screening.", "rel": "procedure" }, { "to": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "High-volume, short-stay work suited to a patient who can come back.", "rel": "procedure" }, { "to": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "The capital cluster selling complexity where this one sells proximity and repetition.", "rel": "contrast" }, { "to": "second-opinion", "type": "pathway", "name": "The second opinion", "as": "Much of what arrives here is a second reading of a scan done at home.", "rel": "step" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a foreign passport in a hospital register is not a medical traveller.", "rel": "story" }, { "to": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 15 kilometres of this point.", "rel": "measured-by" } ], "source_list": [ { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." }, { "id": "s:wp-island-hospital", "kind": "wikipedia", "title": "Island Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Island_Hospital", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-medical-tourism-malaysia", "kind": "web", "title": "Medical tourism in Malaysia", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_Malaysia", "accessed": "2026-09-16", "note": "used for the year-by-year MHTC series 2011-2016 and the Indonesian share of arrivals" }, { "id": "s:mida-malaysia-medical-tourism-2024", "kind": "news", "title": "Indonesia remains largest contributor to Malaysia's medical tourism market", "publisher": "Malaysian Investment Development Authority, reprinting The Sun", "url": "https://www.mida.gov.my/mida-news/indonesia-remains-largest-contributor-to-malaysias-medical-tourism-market/", "accessed": "2026-09-16", "date": "2024-09-19", "note": "the percentages in it are attributed to a TA Securities note, not to a government register." }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "streets and house numbers read off OpenStreetMap address tags and the Island Hospital article" }, "text.story": { "tier": "cited", "source": "s:wp-medical-tourism-malaysia", "note": "the revenue shares and the council's definition are cited to their publishers; the inline marks say which stretches are trade practice and inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "a point between Island Hospital and Gleneagles Penang, not a point anybody published" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "indonesia", "type": "destination", "name": "Indonesia", "as": "Forty minutes from Medan, and the cluster that lives on this outflow.", "rel": "destination" }, { "from": "malaysia", "type": "destination", "name": "Malaysia", "as": "The Indonesian half, forty minutes from Medan.", "rel": "part" }, { "from": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "The island cluster taking almost the same share of national revenue from a far smaller city.", "rel": "contrast" }, { "from": "island-hospital-penang", "type": "facility", "name": "Island Hospital", "as": "The hospital the Penang cluster is usually named for, on Jalan Macalister in George Town.", "rel": "place" }, { "from": "malaysia-mhtc-licence", "type": "rule", "name": "Malaysia's healthcare travel registration", "as": "The second cluster, and the one that draws from Indonesia.", "rel": "hub" } ] }, { "schema": 1, "id": "phuket", "type": "hub", "names": { "name": "Phuket", "aliases": [ "ภูเก็ต", "Phuket Town", "Mueang Phuket" ], "said": "Poo-ket, the h silent. The hospitals are not at the beaches: they are in and around Phuket Town, on the east side of the island, half an hour from Patong." }, "region": [ "southeast-asia" ], "facets": { "iso2": "TH", "radius_km": 15, "specialty": [ "cosmetic surgery", "gender-affirming surgery", "dentistry", "orthopaedics", "trauma", "health screening" ], "draws": [ "rhinoplasty", "breast-augmentation", "liposuction", "vaginoplasty", "dental-implant" ], "languages": [ "Thai", "English", "Russian", "Chinese" ] }, "text": { "what": "A small cluster on the eastern side of Phuket island, in and just outside Phuket Town. Bangkok Hospital Phuket stands off Prayoon Soi in the Samkong quarter, north of the old town; Phuket International Hospital — Sirirot on Thai signage — sits at 44 Chalermprakiat Ror 9 Road in Wichit, about two kilometres south; Vachira Phuket, the Ministry of Public Health's provincial hospital, holds the town itself. The province has six hospitals in all, three of them private.", "story": "Phuket's private hospitals were built for an island that received roughly ten million visitors in 2017 and where tourism made up about 80 per cent of provincial GDP, and for the hundred thousand or so foreigners estimated to have settled there. *Inference —* that is a different founding logic from Bangkok's. A hospital whose catchment is holidaymakers and residents starts with trauma, dive medicine, paediatrics and a twenty-four-hour emergency department, and adds elective surgery afterwards, rather than the other way round.\n\n*Trade practice —* what the island then sells to people who fly in on purpose is the short, recoverable operation that sits well beside a fortnight somewhere warm: cosmetic surgery, dentistry, laser eye work, and the gender-affirming surgery that Thai surgeons took up earlier than most. The pitch is recovery in a resort, and it is also the risk, because the aftercare is a taxi ride from a beach rather than a floor of a teaching hospital.\n\n*Inference —* the cluster is compact in a way Bangkok's is not. Three private hospitals within a few kilometres of one another is the whole of it, so a harvest set tight on Phuket Town catches the surgeries and dental practices strung between them and little that is irrelevant.", "how": "The island trades in two directions at once. A resident or a visitor with an emergency arrives at whichever hospital is nearest and is billed on an itemised account. A patient who flew for a procedure is quoted in advance, usually as a package, and is often booked into a recovery hotel rather than kept on a ward. Insurance settlement for the first kind is routine; the second is almost always paid for out of pocket.", "today": "As of 16 September 2026 no record in this directory carries a published price from a Phuket facility, and none of the island's hospitals is on this project's cast list yet. The harvest point sits between Bangkok Hospital Phuket and Phuket International, with a 15-kilometre radius that reaches Patong on the west coast and Thalang to the north.", "notes": "Recovery beside a beach is described here, not recommended. This page is not medical advice." }, "geo": { "lat": 7.9005, "lon": 98.372, "precision": "city", "source": "s:osm-nominatim" }, "address": { "city": "Phuket", "area": "Mueang Phuket District, Phuket Province", "country": "TH" }, "metrics": { "note": "No inbound patient count is carried for this island. The province's tourism figure — about ten million visitors in 2017, roughly 80 per cent of provincial GDP — counts arrivals of every kind and says nothing about how many came for treatment.", "as_of": "2017", "source": "s:wp-phuket-province", "url": "https://en.wikipedia.org/wiki/Phuket_Province" }, "kin": [ { "to": "thailand", "as": "The country whose second cluster this is.", "rel": "whole" }, { "to": "bangkok", "as": "The capital cluster that sells the complex work this island refers upward to.", "rel": "contrast" }, { "to": "rhinoplasty", "as": "One of the short operations the island's private hospitals quote to people who fly in.", "rel": "procedure" }, { "to": "breast-augmentation", "as": "Sold here on the same recovery-in-a-resort footing.", "rel": "procedure" }, { "to": "vaginoplasty", "as": "Thai surgeons took this work up early, and some of it is quoted on the island.", "rel": "procedure" }, { "to": "dental-implant", "as": "The shopfront trade strung along the roads into Phuket Town.", "rel": "procedure" }, { "to": "flying-after-surgery", "as": "The wait before boarding, which matters more on an island whose patients arrive by air.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Recovery in a hotel means the six-week check is somebody else's, somewhere else.", "rel": "risk" }, { "to": "osm-facilities", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 15 kilometres of this point.", "rel": "measured-by" } ], "links": [ { "label": "Bangkok Hospital Phuket", "url": "https://www.phukethospital.com/" }, { "label": "Phuket International Hospital", "url": "https://www.phuketinternationalhospital.com/" } ], "sources": [ "s:osm-nominatim", "s:wp-phuket-province", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "streets read off OpenStreetMap address tags; the hospital count is the Phuket Province article" }, "text.story": { "tier": "tradition", "note": "the trade's account of what an island cluster sells; the inline marks say which stretches are inference" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "the midpoint between the two private hospitals, not a point anybody published" } } }, "x_commons_files": [ "File:Phuket Town Thalang Road.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A small cluster on the eastern side of Phuket island, in and just outside Phuket Town.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "thailand", "type": "destination", "name": "Thailand", "as": "The country whose second cluster this is.", "rel": "whole" }, { "to": "bangkok", "type": "hub", "name": "Bangkok", "as": "The capital cluster that sells the complex work this island refers upward to.", "rel": "contrast" }, { "to": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "One of the short operations the island's private hospitals quote to people who fly in.", "rel": "procedure" }, { "to": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "Sold here on the same recovery-in-a-resort footing.", "rel": "procedure" }, { "to": "vaginoplasty", "type": "procedure", "name": "Vaginoplasty", "as": "Thai surgeons took this work up early, and some of it is quoted on the island.", "rel": "procedure" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The shopfront trade strung along the roads into Phuket Town.", "rel": "procedure" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The wait before boarding, which matters more on an island whose patients arrive by air.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Recovery in a hotel means the six-week check is somebody else's, somewhere else.", "rel": "risk" }, { "to": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 15 kilometres of this point.", "rel": "measured-by" } ], "source_list": [ { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." }, { "id": "s:wp-phuket-province", "kind": "wikipedia", "title": "Phuket Province", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Phuket_Province", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "streets read off OpenStreetMap address tags; the hospital count is the Phuket Province article" }, "text.story": { "tier": "tradition", "note": "the trade's account of what an island cluster sells; the inline marks say which stretches are inference" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "the midpoint between the two private hospitals, not a point anybody published" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "bangkok", "type": "hub", "name": "Bangkok", "as": "The island cluster that sells a different mix to a different arrival.", "rel": "contrast" }, { "from": "dialysis-holiday", "type": "procedure", "name": "Dialysis away from home", "as": "The resort with a hospital department named for this traffic.", "rel": "hub" } ] }, { "schema": 1, "id": "prague", "type": "hub", "names": { "name": "Prague", "aliases": [ "Praha" ], "said": "In the fertility trade Prague means egg donation, and the clinics say donor programme rather than donation because the donor is compensated and anonymous." }, "region": [ "europe-central" ], "facets": { "iso2": "CZ", "radius_km": 15, "specialty": [ "fertility", "reproductive medicine", "dentistry", "cosmetic surgery", "ophthalmology" ], "draws": [ "ivf", "egg-donation", "icsi", "pgt", "dental-implant" ], "languages": [ "Czech", "English", "German", "Italian" ] }, "text": { "what": "A capital of 1,407,084 people at the start of 2026, administered in 10 municipal and 22 administrative districts, with the fertility clinics that draw foreign patients spread across the inner districts — Vinohrady, Karlín, Smíchov — rather than gathered on one street. Prague's export is reproductive medicine: Czechia is one of the three European countries reporting the largest volumes of egg-donation cycles, and the patients arriving for them come from states where donation is scarcer, slower, or bound by rules that do not apply here.", "story": "The number that anchors this record is a registry return rather than a market estimate. The European IVF-monitoring Consortium of ESHRE, reporting on 2019, collected 1,077,813 treatment cycles from 1,488 clinics in 40 countries, and named Spain, Czechia and Russia as the sources of the highest egg-donation volumes.\n\n*Inference —* that ranking is the whole Prague story in one line. A country of ten and a half million does not generate that volume from its own residents. The cycles are bought by people who flew in, and what they flew from is usually a shortage of donors or a rule about who may be one.\n\nThe rules on the other side of the transaction are the subject of the donor anonymity record, and they differ sharply across the short distances involved here — which is why the same treatment is described as routine in one country and unavailable in its neighbour. Surrogacy sits in a different position again: it is not regulated by a Czech statute, and is generally treated as lawful for that reason, which is a weaker footing than a permission.\n\nAn insured EU patient has a reimbursement route under Directive 2011/24/EU at the home tariff, with prior authorisation required for some categories. *Trade practice —* fertility clinics here price for the self-payer and quote in euros.", "how": "*Trade practice —* the Prague donor cycle is sold as a programme: a video consultation, a donor matched on physical characteristics and blood group from a list the clinic holds, synchronisation, the donor's retrieval, fertilisation with the partner's or a donor's sperm, and one or two transfers, with the patient in the city for a few days around the transfer rather than for the cycle. Genetic testing of embryos is a priced extra. What the quote excludes is medication, freezing and storage, and the next attempt.", "today": "As of 16 September 2026 this record carries no price row for Prague. The clinic pages read for this batch quoted programme prices without stating the date they were set.", "notes": "Fifteen kilometres from the city point reaches Motol in the west and the outer administrative districts." }, "geo": { "lat": 50.0875, "lon": 14.4214, "precision": "city", "source": "s:wp-prague" }, "address": { "city": "Prague", "country": "CZ" }, "kin": [ { "to": "czechia", "as": "The country whose egg-donation volume this city carries most of.", "rel": "whole" }, { "to": "egg-donation", "as": "The treatment this city is known for, and the one its registry volume is built on.", "rel": "procedure" }, { "to": "ivf", "as": "The cycle the donation sits inside.", "rel": "procedure" }, { "to": "pgt", "as": "The priced extra on most programmes quoted here.", "rel": "procedure" }, { "to": "barcelona", "as": "The other European donation centre, reporting larger volumes still.", "rel": "contrast" }, { "to": "donor-anonymity-law", "as": "The rule that decides who arrives here and who does not.", "rel": "governed-by" }, { "to": "eu-directive-2011-24", "as": "The reimbursement route an insured EU patient can use, at the home tariff.", "rel": "governed-by" }, { "to": "reproductive-exile", "as": "The word for what brings most of this city's fertility traffic.", "rel": "term" }, { "to": "eshre", "as": "The society whose registry return is the only count this record stands on.", "rel": "measured-by" }, { "to": "surrogacy-law", "as": "Unregulated here rather than permitted, which is a different footing from a licence.", "rel": "governed-by" } ], "links": [ { "label": "ART in Europe, 2019 (ESHRE EIM)", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10694409/" } ], "sources": [ "s:wp-prague", "s:eshre-eim-2019", "s:wp-surrogacy-laws", "s:eu-directive-2011-24", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:eshre-eim-2019", "note": "the second paragraph is this project reasoning from the registry figure" }, "text.how": { "tier": "tradition", "note": "the shape of a donor programme; no single page read for this record states it" }, "geo": { "tier": "cited", "source": "s:wp-prague" }, "facets.radius_km": { "tier": "inference" } } }, "x_commons_files": [ "File:Vinohrady Prague street.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "A capital of 1,407,084 people at the start of 2026, administered in 10 municipal and 22 administrative districts, with the fertility clinics that draw foreign patients spread across the inner districts — Vinohrady…", "region_terms": [ { "key": "europe-central", "name": "Central Europe", "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia" } ], "kin_out": [ { "to": "czechia", "type": "destination", "name": "Czechia", "as": "The country whose egg-donation volume this city carries most of.", "rel": "whole" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The treatment this city is known for, and the one its registry volume is built on.", "rel": "procedure" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The cycle the donation sits inside.", "rel": "procedure" }, { "to": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "The priced extra on most programmes quoted here.", "rel": "procedure" }, { "to": "barcelona", "type": "hub", "name": "Barcelona", "as": "The other European donation centre, reporting larger volumes still.", "rel": "contrast" }, { "to": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The rule that decides who arrives here and who does not.", "rel": "governed-by" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The reimbursement route an insured EU patient can use, at the home tariff.", "rel": "governed-by" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The word for what brings most of this city's fertility traffic.", "rel": "term" }, { "to": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "The society whose registry return is the only count this record stands on.", "rel": "measured-by" }, { "to": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "Unregulated here rather than permitted, which is a different footing from a licence.", "rel": "governed-by" } ], "source_list": [ { "id": "s:wp-prague", "kind": "wikipedia", "title": "Prague", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Prague", "accessed": "2026-09-16", "note": "coordinates, population 1,407,084 at 1 January 2026, 10 municipal and 22 administrative districts, Vinohrady, Karlín, Smíchov and Motol" }, { "id": "s:eshre-eim-2019", "kind": "web", "title": "ART in Europe, 2019: results generated from European registries by ESHRE", "publisher": "Human Reproduction (Oxford University Press) for the European IVF-monitoring Consortium of ESHRE", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10694409/", "accessed": "2026-09-16", "note": "Smeenk J, Wyns C, De Geyter C, et al., Human Reproduction 2023;38(12):2321–2338, doi:10.1093/humrep/dead197. Registry returns, not a market estimate: 1,077,813 cycles from 1,488 clinics in 40 countries for 2019. Spain reported 137,276 cycles, second in Europe after Russia, from 244 IVF clinics; the highest egg-donation volumes came from Spain, Czechia and Russia." }, { "id": "s:wp-surrogacy-laws", "kind": "wikipedia", "title": "Surrogacy laws by country", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Surrogacy_laws_by_country", "accessed": "2026-09-16", "note": "states that Georgia permits altruistic and commercial surrogacy for domestic and international intended parents, restricted to couples married or in a domestic relationship of at least a year, and that Georgia absorbed clients from Ukraine after 2022; states surrogacy is unregulated in Czechia. No article or section number is given on the page for the Georgian instrument." }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:eshre-eim-2019", "note": "the second paragraph is this project reasoning from the registry figure" }, "text.how": { "tier": "tradition", "note": "the shape of a donor programme; no single page read for this record states it" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited", "source": "s:wp-prague" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "czechia", "type": "destination", "name": "Czechia", "as": "Where most of the clinics and the euro price lists are.", "rel": "part" }, { "from": "barcelona", "type": "hub", "name": "Barcelona", "as": "The other European donation centre, reporting the next largest volumes.", "rel": "contrast" }, { "from": "tbilisi", "type": "hub", "name": "Tbilisi", "as": "The other post-socialist fertility centre, selling donation rather than surrogacy.", "rel": "contrast" } ] }, { "schema": 1, "id": "san-jose-cr", "type": "hub", "names": { "name": "San José, Costa Rica", "aliases": [ "San José", "the Central Valley" ], "said": "San Ho-SAY. The private hospitals sit in and around Escazú, west of the centre, which is also where the patients stay." }, "region": [ "central-america" ], "facets": { "iso2": "CR", "radius_km": 20, "specialty": [ "dentistry", "cosmetic surgery", "orthopaedics", "bariatric surgery", "ophthalmology" ], "draws": [ "dental-implant", "all-on-four", "full-mouth-restoration", "facelift", "abdominoplasty", "breast-augmentation", "knee-replacement", "gastric-sleeve" ], "languages": [ "Spanish", "English" ] }, "text": { "what": "Costa Rica's capital, in the Central Valley, with a municipal population of about 352,000 and a metropolitan area of more than two million. Its private hospitals sell dentistry, cosmetic surgery and orthopaedic work to North Americans, a trade that predates most of the Asian hubs in this directory and grew alongside the country's retirement and residency market rather than its beaches.", "story": "The oldest institution in the cluster was a mission hospital. Hospital Clínica Bíblica opened in 1929 as the Hospital Clínico Bíblico, founded by Henry and Susan Strachan of what became the Latin American Mission, in a country where life expectancy was then around forty and the state hospital system did not yet reach most people. The Costa Rican Social Security system — the Caja — grew up around it, and the Bíblica became the largest private hospital in the country.\n\nWhat it sells abroad now is a hospital with a mark a North American recognises: the Bíblica states Joint Commission International accreditation on its own front page. What it does not sell is a number. Its quotation page invites a patient to choose a category — surgery and procedures, imaging, pharmacy, maternity — fill in a form, and wait for a call. Read on 16 September 2026 it printed no figure at all.\n\n*Inference —* that contrast is the point of putting San José beside Los Algodones. Both trade on price. One publishes it on a card in the window and the other treats it as the output of a consultation, and the difference is the product, not the candour: a crown is a thing with a price, and a knee is a thing with a patient attached.\n\n*Trade practice —* the sector has had a national promotion body for many years, PROMED, the country's council for providers serving international patients. Its domain now redirects to the Cámara Costarricense de la Salud, the Costa Rican health chamber, which this project records as an observation about the web and not as a statement about PROMED's status.", "how": "Patients fly into Juan Santamaría, stay in Escazú or Santa Ana near the hospitals, and are seen on a consult-then-treat schedule over one to three weeks depending on whether the work is dental, cosmetic or orthopaedic. Facilitators are a large part of the market here and sit between the patient and the surgeon, which changes who holds the deposit and who answers when something goes wrong. Costs are quoted per case rather than published.", "today": "As of 16 September 2026 Hospital Clínica Bíblica names its Joint Commission International accreditation on its own site and publishes no prices; the PROMED domain resolves to the Cámara Costarricense de la Salud." }, "geo": { "lat": 9.9325, "lon": -84.08, "precision": "city", "source": "s:wp-san-jose-cr" }, "address": { "city": "San José", "area": "San José", "country": "CR" }, "tags": [ { "tag": "no-price-published", "source": "s:clinica-biblica-presupuestos", "tier": "cited", "note": "the largest private hospital in the country routes every enquiry through a quotation form; read 16 September 2026", "url": "https://www.clinicabiblica.com/es/presupuestos" }, { "tag": "faith-based", "source": "s:wp-clinica-biblica", "tier": "cited", "note": "founded 1929 by Henry and Susan Strachan of the Latin American Mission" } ], "kin": [ { "to": "costa-rica", "as": "The country this cluster is, for practical purposes, the whole of.", "rel": "destination" }, { "to": "clinica-biblica", "as": "The hospital the cluster is usually named for, and the oldest part of it.", "rel": "place" }, { "to": "hospital-cima-san-jose", "as": "The other large private hospital in the Escazú cluster.", "rel": "place" }, { "to": "promed", "as": "The national council that certifies providers here for international patients.", "rel": "accredits" }, { "to": "los-algodones", "as": "The opposite pricing habit at a comparable distance from the same market: a card in the window against a form and a callback.", "rel": "contrast" }, { "to": "dental-implant", "as": "The single commonest reason a North American books a flight to this valley.", "rel": "performs" }, { "to": "choosing-a-facilitator", "as": "The step that matters most here, because a facilitator stands between patient and surgeon in much of this market.", "rel": "step" }, { "to": "getting-a-quote", "as": "In this city that is a form and a telephone call, not a page.", "rel": "step" }, { "to": "jci", "as": "The mark the cluster's flagship hospital leads with.", "rel": "accredited-by" }, { "to": "the-price-that-isnt", "as": "A hospital that sells on price and prints none is the other half of that argument.", "rel": "story" } ], "links": [ { "label": "Hospital Clínica Bíblica", "url": "https://www.clinicabiblica.com/es-cr/" }, { "label": "Hospital Clínica Bíblica — presupuestos", "url": "https://www.clinicabiblica.com/es/presupuestos" } ], "sources": [ "s:wp-san-jose-cr", "s:wp-clinica-biblica", "s:clinica-biblica", "s:clinica-biblica-presupuestos" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:wp-clinica-biblica", "note": "the founding is the encyclopedia article; the accreditation and quotation observations were read off the hospital's own pages on 16 September 2026; the last two paragraphs carry their own inline marks" }, "text.how": { "tier": "tradition", "note": "the general shape of a Central American treatment trip, and the role facilitators play in it" } } }, "x_commons_files": [ "File:San Jose Costa Rica.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "Costa Rica's capital, in the Central Valley, with a municipal population of about 352,000 and a metropolitan area of more than two million.", "region_terms": [ { "key": "central-america", "name": "Central America", "note": "Costa Rica, Panama, Guatemala, Belize" } ], "kin_out": [ { "to": "costa-rica", "type": "destination", "name": "Costa Rica", "as": "The country this cluster is, for practical purposes, the whole of.", "rel": "destination" }, { "to": "clinica-biblica", "type": "facility", "name": "Hospital Clínica Bíblica", "as": "The hospital the cluster is usually named for, and the oldest part of it.", "rel": "place" }, { "to": "hospital-cima-san-jose", "type": "facility", "name": "Hospital CIMA San José", "as": "The other large private hospital in the Escazú cluster.", "rel": "place" }, { "to": "promed", "type": "org", "name": "PROMED", "as": "The national council that certifies providers here for international patients.", "rel": "accredits" }, { "to": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "The opposite pricing habit at a comparable distance from the same market: a card in the window against a form and a callback.", "rel": "contrast" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The single commonest reason a North American books a flight to this valley.", "rel": "performs" }, { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "The step that matters most here, because a facilitator stands between patient and surgeon in much of this market.", "rel": "step" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "In this city that is a form and a telephone call, not a page.", "rel": "step" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The mark the cluster's flagship hospital leads with.", "rel": "accredited-by" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "A hospital that sells on price and prints none is the other half of that argument.", "rel": "story" } ], "source_list": [ { "id": "s:wp-san-jose-cr", "kind": "web", "title": "San José, Costa Rica", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/San_Jos%C3%A9,_Costa_Rica", "accessed": "2026-09-16" }, { "id": "s:wp-clinica-biblica", "kind": "web", "title": "Hospital Clínica Bíblica", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Hospital_Cl%C3%ADnica_B%C3%ADblica", "accessed": "2026-09-16", "note": "founded 1929 as the Hospital Clínico Bíblico by Henry and Susan Strachan of the Latin American Mission" }, { "id": "s:clinica-biblica", "kind": "web", "title": "Hospital Clínica Bíblica", "publisher": "Hospital Clínica Bíblica, San José, Costa Rica", "url": "https://www.clinicabiblica.com/en/", "accessed": "2026-09-16" }, { "id": "s:clinica-biblica-presupuestos", "kind": "web", "title": "Presupuestos", "publisher": "Hospital Clínica Bíblica, San José", "url": "https://www.clinicabiblica.com/es/presupuestos", "accessed": "2026-09-16", "note": "a quotation request form for surgery, imaging, pharmacy and maternity; no figure is printed" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:wp-clinica-biblica", "note": "the founding is the encyclopedia article; the accreditation and quotation observations were read off the hospital's own pages on 16 September 2026; the last two paragraphs carry their own inline marks" }, "text.how": { "tier": "tradition", "note": "the general shape of a Central American treatment trip, and the role facilitators play in it" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [ { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:clinica-biblica-presupuestos", "note": "the largest private hospital in the country routes every enquiry through a quotation form; read 16 September 2026", "tier": "cited", "url": "https://www.clinicabiblica.com/es/presupuestos" }, { "key": "faith-based", "label": "Faith-founded", "icon": "✝", "group": "welcome", "evidence": "the founding body's own statement or the hospital's charter", "source": "s:wp-clinica-biblica", "note": "founded 1929 by Henry and Susan Strachan of the Latin American Mission", "tier": "cited", "url": "" } ], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "costa-rica", "type": "destination", "name": "Costa Rica", "as": "The city that is nearly all of it.", "rel": "part" }, { "from": "panama-city", "type": "hub", "name": "Panama City", "as": "The neighbouring Central American cluster, older, larger and built on the same North American market.", "rel": "contrast" }, { "from": "clinica-biblica", "type": "facility", "name": "Hospital Clínica Bíblica", "as": "The older of the two private hospitals the San José cluster is built around, and the one in the city centre rather than the western suburbs.", "rel": "place" }, { "from": "hospital-cima-san-jose", "type": "facility", "name": "Hospital CIMA San José", "as": "The Escazú half of the San José cluster — motorway, medical towers, hotels, and the hospital in the middle of them.", "rel": "place" }, { "from": "promed", "type": "org", "name": "PROMED", "as": "The hub its member hospitals and dental clinics cluster in.", "rel": "place" } ] }, { "schema": 1, "id": "santo-domingo", "type": "hub", "names": { "name": "Santo Domingo", "aliases": [ "Santo Domingo de Guzmán", "Distrito Nacional" ], "said": "The city is coterminous with the Distrito Nacional; Greater Santo Domingo runs well past it." }, "region": [ "caribbean" ], "facets": { "iso2": "DO", "radius_km": 20, "specialty": [ "cosmetic surgery", "dentistry", "bariatric surgery", "ophthalmology" ], "draws": [ "bbl", "liposuction", "abdominoplasty", "breast-augmentation", "facelift", "dental-implant" ], "languages": [ "Spanish", "English" ] }, "text": { "what": "The capital of the Dominican Republic, founded 1496 and the oldest continuously inhabited European settlement in the Americas, with just over a million people in the city centre and 4.27 million in Greater Santo Domingo as of 2022. Its export trade in care is cosmetic surgery, sold largely to women in the United States, and it is the hub in this directory with the longest documented record of infections travelling home with the patients.", "story": "The outbreaks are the reason this city is a case study rather than a listing. In March 2013 to February 2014 United States health departments recorded a multistate cluster of rapidly growing nontuberculous mycobacteria — environmental bacteria that infect surgical wounds and are slow to respond to ordinary antibiotics — in patients who had had cosmetic surgery in the Dominican Republic.\n\nIt happened again. On 1 May 2017 the New York City health department told the Centers for Disease Control and Prevention about three patients with nontuberculous mycobacterial surgical site infections, all operated on by one surgeon at the Centro Internacional de Cirugía Plástica Avanzada, CIPLA. By 8 November 2017 the count stood at 52 patients across nine states, 38 of them meeting the confirmed case definition, with surgery dates between 4 January and 14 July 2017. Twenty-six of thirty-two confirmed patients with information available had been operated on at CIPLA, which was temporarily closed on 8 July 2017. One death was reported among confirmed cases.\n\nThe detail that matters most is the one that complicates the simple story. Whole genome sequencing of isolates from 22 cases by the New York State Wadsworth Center found three distinct genetic clusters, and none of them mapped to a single clinic or a single surgeon. Fourteen surgeons across seven centres were implicated in all. This was not one bad operator.\n\n*Inference —* a pattern that recurs across a sector four years apart, in clinics that do not share a surgeon or an organism, points at something the sector holds in common — water, instruments, reprocessing, or the practice of operating on several patients in one session — rather than at an individual. CDC's report does not say which, and neither does this record.", "how": "Patients fly in from the east coast of the United States, are operated on within a day or two of arrival, recover in a rented flat or a recovery house rather than a ward, and fly home inside two weeks. Packages are sold through intermediaries and often include the accommodation and the post-operative massages. The surgeon is frequently not met until shortly before the operation. Follow-up, when an infection appears weeks later, happens in an emergency department in the United States that did not perform the surgery and has no operative note.", "today": "As of 16 September 2026 the CDC report closest to hand on this city remains Gaines and colleagues in MMWR, 2018, covering the 2017 cluster and citing the 2013–2014 one before it." }, "geo": { "lat": 18.4625, "lon": -69.9361, "precision": "city", "source": "s:wp-santo-domingo" }, "address": { "city": "Santo Domingo", "area": "Distrito Nacional", "country": "DO" }, "kin": [ { "to": "dominican-republic", "as": "The country whose cosmetic surgery export runs almost entirely through this city.", "rel": "destination" }, { "to": "dominican-republic-ntm-outbreak", "as": "The 2017 cluster: 52 patients, nine states, one clinic temporarily closed, three genetic clusters and no single culprit.", "rel": "event" }, { "to": "united-states", "as": "Where the patients live and where every one of these infections was diagnosed.", "rel": "kin" }, { "to": "medellin", "as": "The other cosmetic surgery hub in this batch, with a hospital group that publishes and a sector that does not.", "rel": "contrast" }, { "to": "havana", "as": "The other Caribbean hub — public, neurological and legally hard to reach, where this one is private and a two-hour flight.", "rel": "contrast" }, { "to": "bbl", "as": "Among the operations sold here, and the one with its own mortality record in this directory.", "rel": "performs" }, { "to": "liposuction", "as": "The base of the body-contouring trade, and the wound the mycobacteria entered.", "rel": "performs" }, { "to": "nontuberculous-mycobacteria", "as": "The organism that made this city a case study, twice, four years apart.", "rel": "risk" }, { "to": "follow-up-gap", "as": "An infection that presents at week six, in a country the surgeon does not practise in.", "rel": "risk" }, { "to": "malpractice-recourse", "as": "What a patient has after an infection acquired in a clinic that has since been closed.", "rel": "risk" }, { "to": "alone-after-discharge", "as": "A recovery house is not a ward, and the difference shows up in who notices a wound going wrong.", "rel": "risk" } ], "links": [ { "label": "MMWR 2018;67(12):369–370", "url": "https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a5.htm" } ], "sources": [ "s:wp-santo-domingo", "s:cdc-mmwr-dr-ntm-2018" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:cdc-mmwr-dr-ntm-2018", "note": "every figure, date and name in the first three paragraphs is from the MMWR report; the fourth is marked as this project's reasoning" }, "text.how": { "tier": "tradition", "note": "the general shape of a cosmetic surgery trip to the Caribbean; the CDC report supports the multi-clinic and intermediary picture but does not describe an itinerary" } } }, "x_commons_files": [ "File:Santo Domingo Zona Colonial.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "The capital of the Dominican Republic, founded 1496 and the oldest continuously inhabited European settlement in the Americas, with just over a million people in the city centre and 4.27 million in Greater Santo Domingo…", "region_terms": [ { "key": "caribbean", "name": "The Caribbean", "note": "the Dominican Republic, Cuba, Barbados, the Caymans" } ], "kin_out": [ { "to": "dominican-republic", "type": "destination", "name": "Dominican Republic", "as": "The country whose cosmetic surgery export runs almost entirely through this city.", "rel": "destination" }, { "to": "dominican-republic-ntm-outbreak", "type": "event", "name": "The Dominican mycobacterial outbreaks, 2013–14 and 2017", "as": "The 2017 cluster: 52 patients, nine states, one clinic temporarily closed, three genetic clusters and no single culprit.", "rel": "event" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "Where the patients live and where every one of these infections was diagnosed.", "rel": "kin" }, { "to": "medellin", "type": "hub", "name": "Medellín", "as": "The other cosmetic surgery hub in this batch, with a hospital group that publishes and a sector that does not.", "rel": "contrast" }, { "to": "havana", "type": "hub", "name": "Havana", "as": "The other Caribbean hub — public, neurological and legally hard to reach, where this one is private and a two-hour flight.", "rel": "contrast" }, { "to": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "Among the operations sold here, and the one with its own mortality record in this directory.", "rel": "performs" }, { "to": "liposuction", "type": "procedure", "name": "Liposuction", "as": "The base of the body-contouring trade, and the wound the mycobacteria entered.", "rel": "performs" }, { "to": "nontuberculous-mycobacteria", "type": "risk", "name": "Nontuberculous mycobacteria", "as": "The organism that made this city a case study, twice, four years apart.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "An infection that presents at week six, in a country the surgeon does not practise in.", "rel": "risk" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "What a patient has after an infection acquired in a clinic that has since been closed.", "rel": "risk" }, { "to": "alone-after-discharge", "type": "risk", "name": "Discharged alone", "as": "A recovery house is not a ward, and the difference shows up in who notices a wound going wrong.", "rel": "risk" } ], "source_list": [ { "id": "s:wp-santo-domingo", "kind": "web", "title": "Santo Domingo", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Santo_Domingo", "accessed": "2026-09-16" }, { "id": "s:cdc-mmwr-dr-ntm-2018", "kind": "journal", "title": "Notes from the Field: Nontuberculous Mycobacteria Infections in U.S. Medical Tourists Associated with Plastic Surgery — Dominican Republic, 2017", "publisher": "MMWR Morbidity and Mortality Weekly Report (US Centers for Disease Control and Prevention), 2018;67(12):369–370", "url": "https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a5.htm", "accessed": "2026-09-16", "note": "Gaines J, Poy J, Musser KA, et al." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:cdc-mmwr-dr-ntm-2018", "note": "every figure, date and name in the first three paragraphs is from the MMWR report; the fourth is marked as this project's reasoning" }, "text.how": { "tier": "tradition", "note": "the general shape of a cosmetic surgery trip to the Caribbean; the CDC report supports the multi-clinic and intermediary picture but does not describe an itinerary" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "dominican-republic", "type": "destination", "name": "Dominican Republic", "as": "Where the clinics named in both CDC reports sit.", "rel": "part" }, { "from": "havana", "type": "hub", "name": "Havana", "as": "The other Caribbean hub — private, cosmetic and reachable, where this one is public, neurological and not.", "rel": "contrast" }, { "from": "nontuberculous-mycobacteria", "type": "risk", "name": "Nontuberculous mycobacteria", "as": "The city the named clinics operated in.", "rel": "place" } ] }, { "schema": 1, "id": "seoul", "type": "hub", "names": { "name": "Seoul", "aliases": [ "서울", "Gangnam", "강남" ], "said": "Seo-ul. Two different cities to a patient: Gangnam, which means the clinics, and the big four university hospitals, which are somewhere else entirely and take a different kind of referral." }, "region": [ "east-asia" ], "facets": { "iso2": "KR", "radius_km": 20, "specialty": [ "cosmetic surgery", "dermatology", "health screening", "spine surgery", "oncology", "transplant" ], "draws": [ "rhinoplasty", "facelift", "hair-transplant-fue", "executive-health-screening", "spinal-fusion", "liver-transplant" ], "languages": [ "Korean", "English", "Mandarin", "Japanese", "Russian" ] }, "text": { "what": "The cosmetic trade occupies a few blocks of Gangnam-gu south of the Han river: Apgujeong-ro and the Garosu-gil end of Sinsa-dong, running east through Cheongdam, with the Gangnam-gu Office's own medical-travel desk on the ground floor of the Gangnam Tour Information Center at 161 Apgujeong-ro. The hospitals that do the hard work are elsewhere. Samsung Medical Center is at 81 Irwon-ro in Irwon-dong, in the south-eastern corner of the same district; Asan Medical Center is across the district line at 88 Olympic-ro 43-gil, Pungnap-dong, Songpa-gu, by the river; Severance is north of it all at 50-1 Yonsei-ro in Sinchon, Seodaemun-gu. Subway line 3 links the first two; nothing links them to the third but the 2 line and a change.", "story": "Korea's count of foreign patients, kept by the Korea Health Industry Development Institute, rose from 60,201 from 139 countries in 2009 to a cumulative 2,760,553 from 198 countries by 2019, with 497,464 in 2019 alone; foreign cosmetic patients numbered 464,452 in 2018, up 16.7 per cent on 397,882 the year before. Those are registrations reported by institutions, and a patient who attends three clinics is counted by each.\n\n*Inference —* the two Seouls in this record are an artefact of what Korea sells. A dermatology or rhinoplasty patient books a clinic on a shopping street, pays cash, stays a week and is counted; a liver transplant or a cancer case arrives at Asan or Samsung through a referral and a foreign-patient office. They share a city, a visa and a statistical series, and they share nothing else. A directory that treats the series as one number has merged them.\n\n*Trade practice —* Gangnam's density is the thing people actually travel for: a street where a dozen clinics compete on price within a few hundred metres, with consultation, photographs and a quote on the same afternoon. The Gangnam-gu Office's own list of partner institutions runs to eighty-odd and is a partner list, not a register of the district.", "how": "A Gangnam clinic quotes per procedure, often after photographs sent ahead, and takes payment in cash or by card before or on the day. The university hospitals run international healthcare centres that take a referral and a set of records, quote an estimate, and bill against it. Korea's foreign-patient system requires institutions treating foreign patients to register with the state and report, which is where the counts above come from.", "today": "As of 16 September 2026 the harvest point for this hub sits between the Apgujeong clinic blocks and the Samsung and Asan campuses, with a 20-kilometre radius that reaches Severance at Sinchon and Seoul National University Hospital in Jongno. No Seoul price has been read off a page into this directory yet.", "notes": "This page describes a district and a set of hospitals. It says nothing about whether anyone should have an operation in either." }, "geo": { "lat": 37.526, "lon": 127.025, "precision": "city", "source": "s:osm-nominatim" }, "address": { "city": "Seoul", "area": "Gangnam-gu, Songpa-gu and Seodaemun-gu", "country": "KR" }, "metrics": { "annual_foreign_patients": 497464, "foreign_patient_countries": 198, "note": "The Korea Health Industry Development Institute's 2019 count for the whole country, not for Seoul and not for Gangnam. It counts foreign patients registered by reporting institutions in the year; somebody who attends three clinics is counted three times. No district breakdown was found.", "as_of": "2019", "source": "s:wp-medical-tourism-south-korea", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_South_Korea" }, "kin": [ { "to": "samsung-medical-center", "as": "At 81 Irwon-ro in Irwon-dong, the Gangnam-gu end of the university hospital pair.", "rel": "part" }, { "to": "asan-medical-center", "as": "At 88 Olympic-ro 43-gil in Songpa-gu, by the Han river.", "rel": "part" }, { "to": "severance", "as": "North of the river at 50-1 Yonsei-ro, Sinchon, and on the other side of the city from the clinics.", "rel": "part" }, { "to": "wooridul", "as": "The spine hospital that made Korean spinal surgery a destination in its own right.", "rel": "part" }, { "to": "south-korea", "as": "The country whose foreign-patient count this city dominates.", "rel": "whole" }, { "to": "rhinoplasty", "as": "The operation the Apgujeong blocks are built on.", "rel": "procedure" }, { "to": "executive-health-screening", "as": "The one-day screening the university hospitals sell to the region.", "rel": "procedure" }, { "to": "spinal-fusion", "as": "Korean spine surgery draws its own referrals, separate from the cosmetic trade.", "rel": "procedure" }, { "to": "khidi", "as": "The state institute that keeps the foreign-patient count this record quotes.", "rel": "measured-by" }, { "to": "korea-foreign-patient-registration", "as": "The registration and reporting regime that produces those numbers.", "rel": "governed-by" }, { "to": "counting-patients", "as": "Why a clinic registration count is not a headcount of travellers.", "rel": "story" }, { "to": "osm-facilities", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 20 kilometres of this point.", "rel": "measured-by" } ], "links": [ { "label": "Gangnam Medi Tour — Gangnam-gu Office", "url": "https://medicaltour.gangnam.go.kr/" }, { "label": "Asan Medical Center", "url": "https://eng.amc.seoul.kr/" } ], "sources": [ "s:osm-nominatim", "s:wp-asan-medical-center", "s:wp-samsung-medical-center", "s:wp-gangnam-district", "s:wp-medical-tourism-south-korea", "s:gangnam-medi-tour", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "roads, dong and gu read off OpenStreetMap address tags; the Gangnam-gu desk address is from its own site" }, "text.story": { "tier": "cited", "source": "s:wp-medical-tourism-south-korea", "note": "the KHIDI counts are cited; the inline marks say which stretches are inference and trade practice" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "a point between the Apgujeong clinic blocks and the two southern university campuses, not a point anybody published" } } }, "x_commons_files": [ "File:Gangnam-gu Apgujeong-ro.jpg", "File:Asan Medical Center.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "The cosmetic trade occupies a few blocks of Gangnam-gu south of the Han river: Apgujeong-ro and the Garosu-gil end of Sinsa-dong, running east through Cheongdam, with the Gangnam-gu Office's own medical-travel desk on…", "region_terms": [ { "key": "east-asia", "name": "East Asia", "note": "South Korea, Japan, Taiwan, China" } ], "kin_out": [ { "to": "samsung-medical-center", "type": "facility", "name": "Samsung Medical Center", "as": "At 81 Irwon-ro in Irwon-dong, the Gangnam-gu end of the university hospital pair.", "rel": "part" }, { "to": "asan-medical-center", "type": "facility", "name": "Asan Medical Center", "as": "At 88 Olympic-ro 43-gil in Songpa-gu, by the Han river.", "rel": "part" }, { "to": "severance", "type": "facility", "name": "Severance Hospital", "as": "North of the river at 50-1 Yonsei-ro, Sinchon, and on the other side of the city from the clinics.", "rel": "part" }, { "to": "wooridul", "type": "facility", "name": "Wooridul Spine Hospital", "as": "The spine hospital that made Korean spinal surgery a destination in its own right.", "rel": "part" }, { "to": "south-korea", "type": "destination", "name": "South Korea", "as": "The country whose foreign-patient count this city dominates.", "rel": "whole" }, { "to": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "The operation the Apgujeong blocks are built on.", "rel": "procedure" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The one-day screening the university hospitals sell to the region.", "rel": "procedure" }, { "to": "spinal-fusion", "type": "procedure", "name": "Spinal fusion", "as": "Korean spine surgery draws its own referrals, separate from the cosmetic trade.", "rel": "procedure" }, { "to": "khidi", "type": "org", "name": "Korea Health Industry Development Institute", "as": "The state institute that keeps the foreign-patient count this record quotes.", "rel": "measured-by" }, { "to": "korea-foreign-patient-registration", "type": "rule", "name": "Korea's foreign patient attraction registration", "as": "The registration and reporting regime that produces those numbers.", "rel": "governed-by" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a clinic registration count is not a headcount of travellers.", "rel": "story" }, { "to": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 20 kilometres of this point.", "rel": "measured-by" } ], "source_list": [ { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." }, { "id": "s:wp-asan-medical-center", "kind": "wikipedia", "title": "Asan Medical Center", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Asan_Medical_Center", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-samsung-medical-center", "kind": "wikipedia", "title": "Samsung Medical Center", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Samsung_Medical_Center", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-gangnam-district", "kind": "wikipedia", "title": "Gangnam District", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Gangnam_District", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-medical-tourism-south-korea", "kind": "wikipedia", "title": "Medical tourism in South Korea", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_South_Korea", "license": "CC BY-SA 4.0", "accessed": "2026-09-16", "note": "quotes the Korea Health Industry Development Institute's annual counts of registered foreign patients; the article does not break them down by district." }, { "id": "s:gangnam-medi-tour", "kind": "org", "title": "Gangnam Medi Tour", "publisher": "Gangnam-gu Office, Seoul", "url": "https://medicaltour.gangnam.go.kr/", "accessed": "2026-09-16", "note": "the district government's own medical-travel desk, at the ground floor of the Gangnam Tour Information Center, 161 Apgujeong-ro. Lists its partner clinics, which is a partner list and not a register of every clinic in the district." }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "roads, dong and gu read off OpenStreetMap address tags; the Gangnam-gu desk address is from its own site" }, "text.story": { "tier": "cited", "source": "s:wp-medical-tourism-south-korea", "note": "the KHIDI counts are cited; the inline marks say which stretches are inference and trade practice" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "a point between the Apgujeong clinic blocks and the two southern university campuses, not a point anybody published" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "south-korea", "type": "destination", "name": "South Korea", "as": "Where 85.4 per cent of it happened in 2024.", "rel": "part" }, { "from": "taipei", "type": "hub", "name": "Taipei", "as": "The neighbouring East Asian cluster that turned its hospitals outward, where Taipei mostly did not.", "rel": "contrast" }, { "from": "asan-medical-center", "type": "facility", "name": "Asan Medical Center", "as": "The largest of the three Seoul hospitals here, across the river in Songpa by the Olympic park.", "rel": "place" }, { "from": "samsung-medical-center", "type": "facility", "name": "Samsung Medical Center", "as": "The Gangnam hospital of the three the Seoul cluster is built on.", "rel": "place" }, { "from": "severance", "type": "facility", "name": "Severance Hospital", "as": "The oldest of the three Seoul hospitals here, at Sinchon in the north-west of the city.", "rel": "place" }, { "from": "wooridul", "type": "facility", "name": "Wooridul Spine Hospital", "as": "Sits in Cheongdam, in the Gangnam blocks the city's clinic trade is named for, and does none of the work that trade is known for.", "rel": "place" }, { "from": "korea-foreign-patient-registration", "type": "rule", "name": "Korea's foreign patient attraction registration", "as": "Where most registered institutions are.", "rel": "hub" }, { "from": "khidi", "type": "org", "name": "Korea Health Industry Development Institute", "as": "The city that takes 85 per cent of the patients in its own count.", "rel": "place" } ] }, { "schema": 1, "id": "singapore-city", "type": "hub", "names": { "name": "Singapore", "aliases": [ "Orchard medical belt", "Novena health city", "新加坡" ], "said": "The trade says Orchard and Novena. Both are stops on the North–South line, four minutes apart, and between them they hold most of the private beds a foreign patient will be quoted for." }, "region": [ "southeast-asia" ], "facets": { "iso2": "SG", "radius_km": 15, "specialty": [ "oncology", "cardiac surgery", "neurosurgery", "transplant", "paediatrics", "health screening" ], "draws": [ "cabg", "heart-valve-replacement", "bone-marrow-transplant", "executive-health-screening", "cataract-surgery" ], "languages": [ "English", "Mandarin", "Malay", "Tamil", "Indonesian", "Bahasa" ] }, "text": { "what": "Two clusters, four minutes apart on the subway. The Orchard belt holds Mount Elizabeth Hospital at 3 Mount Elizabeth in Cairnhill, 345 beds, open since 8 December 1979, and Gleneagles Hospital at 6 Napier Road in Tanglin, with the specialist suites of Paragon and Camden on Orchard Road between them. Novena, a kilometre and a half north, holds Mount Elizabeth Novena at 38 Irrawaddy Road, 313 beds, alongside Tan Tock Seng and the medical school. Raffles Hospital is separate again, at 585 North Bridge Road on the edge of Bugis, 380 beds, opened on 16 March 2002.", "story": "Singapore went after the trade as policy. SingaporeMedicine launched in October 2003 with a target of a million foreign patients a year by 2012, on a base of over 200,000 in 2002. Khaw Boon Wan, then health minister, put the reasoning plainly: \"In three specialties alone, heart, eye and cancer, I see tens of millions of middle-class patients within a 7-hour flying radius.\"\n\nThe target was not met, and the trade turned. Medical expenditure from foreign patients was S$832 million in 2013, down 25 per cent from S$1.11 billion in 2012, as hospitals lost the less complex work to neighbouring countries. *Inference —* that decline is the most instructive number in this record. Singapore did not become cheaper; Bangkok, Kuala Lumpur and Penang became good enough at the routine operation, and what stayed was the case nobody else wanted to take.\n\n*Trade practice —* what the city now sells is complexity and a legal system. Paediatric oncology, complex cardiac surgery, transplant, the second opinion on a difficult scan, and the assurance of a regulator and a court that a patient's own country may not offer. It is the most expensive destination in this batch and says so in its own quotes.", "how": "Private hospitals here are run by two groups — Parkway Pantai, which holds Gleneagles, Mount Elizabeth, Mount Elizabeth Novena and Parkway East and is owned by IHH Healthcare, and Raffles Medical Group. A quote is an itemised estimate against a room class, a surgeon's fee schedule and a projected stay, and the surgeon's fee is separate from the hospital's. Public hospitals treat foreign patients at an unsubsidised rate that is published.", "today": "As of 16 September 2026 the harvest point for this hub sits between the Orchard and Novena clusters, with a 15-kilometre radius that reaches most of the island. No Singapore price has been read off a page into this directory yet.", "notes": "A description of two hospital districts and one policy. Not advice about either." }, "geo": { "lat": 1.309, "lon": 103.839, "precision": "city", "source": "s:osm-nominatim" }, "address": { "city": "Singapore", "area": "Orchard and Novena", "country": "SG" }, "metrics": { "revenue_usd": null, "note": "Foreign patients' medical expenditure in Singapore was S$832 million in 2013, down about 25 per cent from S$1.11 billion in 2012. That is a spending figure, not a patient count, and it is national rather than for these two districts. No dollar conversion is carried because the series is in Singapore dollars and this project converts only dated price rows.", "as_of": "2013", "source": "s:wp-medical-tourism", "url": "https://en.wikipedia.org/wiki/Medical_tourism" }, "kin": [ { "to": "mount-elizabeth", "as": "At 3 Mount Elizabeth in Cairnhill, 345 beds, the anchor of the Orchard belt.", "rel": "part" }, { "to": "raffles-hospital", "as": "At 585 North Bridge Road, 380 beds, the group's own hospital away from both clusters.", "rel": "part" }, { "to": "singapore", "as": "The country whose entire private trade sits in these few square kilometres.", "rel": "whole" }, { "to": "cabg", "as": "One of the three specialties the 2003 policy was written around.", "rel": "procedure" }, { "to": "bone-marrow-transplant", "as": "The complex work that stayed when the routine work left.", "rel": "procedure" }, { "to": "executive-health-screening", "as": "The regional screening trade, now competed for by Penang and Bangkok.", "rel": "procedure" }, { "to": "kuala-lumpur", "as": "One of the neighbours that took the less complex work after 2012.", "rel": "contrast" }, { "to": "bangkok", "as": "The other, and the one that made the published package price ordinary.", "rel": "contrast" }, { "to": "malpractice-recourse", "as": "Part of what is being bought here: a regulator and a court that will hear a complaint.", "rel": "risk" }, { "to": "is-it-cheaper", "as": "The destination that answers no, and sells on something else.", "rel": "story" }, { "to": "osm-facilities", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 15 kilometres of this point.", "rel": "measured-by" } ], "links": [ { "label": "Mount Elizabeth Hospital", "url": "https://www.mountelizabeth.com.sg/" }, { "label": "Raffles Hospital", "url": "https://www.rafflesmedicalgroup.com/" } ], "sources": [ "s:osm-nominatim", "s:wp-mount-elizabeth", "s:wp-raffles-hospital", "s:wp-healthcare-singapore", "s:wp-medical-tourism", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "streets and house numbers read off OpenStreetMap address tags and the hospitals' Wikipedia entries" }, "text.story": { "tier": "cited", "source": "s:wp-healthcare-singapore", "note": "the 2003 policy, the target and the minister's words are cited; the 2013 decline is from the Wikipedia article on the field; the inline marks say which stretches are inference and trade practice" }, "text.how": { "tier": "tradition", "note": "the ownership of the two groups is cited to the Healthcare in Singapore article" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "a point between the Orchard and Novena clusters, not a point anybody published" }, "metrics": { "tier": "cited", "note": "the S$832 million figure is quoted in the Wikipedia article on the field, which attributes it to reporting rather than to a government release; flagged for verification" } } }, "x_commons_files": [ "File:Mount Elizabeth Hospital Singapore.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "Two clusters, four minutes apart on the subway. The Orchard belt holds Mount Elizabeth Hospital at 3 Mount Elizabeth in Cairnhill, 345 beds, open since 8 December 1979, and Gleneagles Hospital at 6 Napier Road in…", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "mount-elizabeth", "type": "facility", "name": "Mount Elizabeth Hospital", "as": "At 3 Mount Elizabeth in Cairnhill, 345 beds, the anchor of the Orchard belt.", "rel": "part" }, { "to": "raffles-hospital", "type": "facility", "name": "Raffles Hospital", "as": "At 585 North Bridge Road, 380 beds, the group's own hospital away from both clusters.", "rel": "part" }, { "to": "singapore", "type": "destination", "name": "Singapore", "as": "The country whose entire private trade sits in these few square kilometres.", "rel": "whole" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "One of the three specialties the 2003 policy was written around.", "rel": "procedure" }, { "to": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "The complex work that stayed when the routine work left.", "rel": "procedure" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The regional screening trade, now competed for by Penang and Bangkok.", "rel": "procedure" }, { "to": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "One of the neighbours that took the less complex work after 2012.", "rel": "contrast" }, { "to": "bangkok", "type": "hub", "name": "Bangkok", "as": "The other, and the one that made the published package price ordinary.", "rel": "contrast" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "Part of what is being bought here: a regulator and a court that will hear a complaint.", "rel": "risk" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The destination that answers no, and sells on something else.", "rel": "story" }, { "to": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 15 kilometres of this point.", "rel": "measured-by" } ], "source_list": [ { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." }, { "id": "s:wp-mount-elizabeth", "kind": "wikipedia", "title": "Mount Elizabeth Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Mount_Elizabeth_Hospital", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-raffles-hospital", "kind": "wikipedia", "title": "Raffles Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Raffles_Hospital", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-healthcare-singapore", "kind": "wikipedia", "title": "Healthcare in Singapore", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Healthcare_in_Singapore", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-medical-tourism", "kind": "wikipedia", "title": "Medical tourism", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism", "license": "CC BY-SA 4.0", "accessed": "2026-09-16", "note": "the field's general article; used in this batch only for the Singapore foreign-patient expenditure figures, which it attributes to reporting rather than to a government release." }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "streets and house numbers read off OpenStreetMap address tags and the hospitals' Wikipedia entries" }, "text.story": { "tier": "cited", "source": "s:wp-healthcare-singapore", "note": "the 2003 policy, the target and the minister's words are cited; the 2013 decline is from the Wikipedia article on the field; the inline marks say which stretches are inference and trade practice" }, "text.how": { "tier": "tradition", "note": "the ownership of the two groups is cited to the Healthcare in Singapore article" }, "text.today": { "tier": "cited" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "a point between the Orchard and Novena clusters, not a point anybody published" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "note": "the S$832 million figure is quoted in the Wikipedia article on the field, which attributes it to reporting rather than to a government release; flagged for verification" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "singapore", "type": "destination", "name": "Singapore", "as": "The country and the cluster are the same place.", "rel": "part" }, { "from": "taipei", "type": "hub", "name": "Taipei", "as": "The other high-cost regional centre competing for the complex case.", "rel": "contrast" }, { "from": "mount-elizabeth", "type": "facility", "name": "Mount Elizabeth Hospital", "as": "The Orchard Road hospital the Singapore cluster is usually named for.", "rel": "place" }, { "from": "raffles-hospital", "type": "facility", "name": "Raffles Hospital", "as": "The private hospital at the Bugis end of the city, on the Blanco Court site.", "rel": "place" } ] }, { "schema": 1, "id": "sopron", "type": "hub", "names": { "name": "Sopron", "aliases": [ "Ödenburg" ], "said": "Ödenburg in German, and the street signs say both. An Austrian patient says Sopron the way a Londoner says Croydon — a place reached and returned from in a day." }, "region": [ "europe-central" ], "facets": { "iso2": "HU", "radius_km": 12, "specialty": [ "dentistry", "oral surgery", "prosthodontics" ], "draws": [ "dental-implant", "dental-crown", "root-canal", "all-on-four", "full-mouth-restoration", "veneers" ], "languages": [ "Hungarian", "German", "English" ] }, "text": { "what": "A Hungarian border town of 62,116 people, 70 km from Vienna and 77 km from Bratislava, whose economy carries an unusual weight of dental surgeries — Wikipedia puts it at more than 300 and repeats the trade's name for the place, the dental capital of the world. Street and traffic signs are in Hungarian and German. A patient from Vienna can be treated between breakfast and dinner, and many are: the practices are sized for the day trip, with a driver, a German-speaking desk and a treatment room, rather than for a stay.", "story": "The trade is a direct product of where the Iron Curtain used to be. Sopron sat against a closed frontier; when it opened, an Austrian price and a Hungarian cost sat 70 km apart with a motorway between them, and dentistry — portable, elective, priced per unit and barely covered by Austrian insurance — was the first thing to cross.\n\nThe density claim deserves its provenance stated, because this directory keeps finding the record attached to the wrong town. Sopron's figure of more than 300 dental clinics rests, in the encyclopaedia that carries it, on a 2005 newspaper travel piece and on a column whose site is dead. The count that is actually documented belongs to Mosonmagyaróvár, 80 km north on the same border: about 350 practising dentists as of 2015, reported in a national newspaper, which is stated there as the highest ratio of dentists to population anywhere. The same passage reports official Hungarian government figures of 160,000 Austrians crossing the border for dental care each year.\n\n*Inference —* Sopron is the better-known name and Mosonmagyaróvár is the better-documented one, and both are the same phenomenon: a frontier, a price step, and a procedure small enough to drive to. Treat the clinic counts on either side of that border as reputation, not as a census.\n\nFor an insured EU patient the price is not the only route. Directive 2011/24/EU allows reimbursement at the home tariff for care that would have been covered at home, which for Austrian dentistry means a share rather than the bill.", "how": "*Trade practice —* the Sopron practice sells the appointment, not the journey. A consultation and a radiograph on the first morning, treatment the same day where the work is a filling, a crown or an extraction, and a second date some months later where implants have to integrate. German is the working language of the desk. Transport is often the practice's own minibus from a Vienna meeting point, and the fee for it is quoted separately or waived above a threshold.", "today": "As of 16 September 2026 this record carries no price row. The prices in circulation for Sopron are comparisons against Vienna rather than figures with a date and an inclusion list on a named page, and a comparison is not a price.", "notes": "Twelve kilometres around the town point is the whole town and its approaches, and stops short of the Austrian border villages." }, "geo": { "lat": 47.685, "lon": 16.5831, "precision": "city", "source": "s:wp-sopron" }, "address": { "city": "Sopron", "area": "Győr-Moson-Sopron", "country": "HU" }, "kin": [ { "to": "hungary", "as": "The country whose border-town dentistry this place is the emblem of.", "rel": "whole" }, { "to": "budapest", "as": "The capital version of the same trade, reached by air rather than by car.", "rel": "contrast" }, { "to": "dental-implant", "as": "The work that brings a second visit, and the reason a day trip becomes two.", "rel": "procedure" }, { "to": "dental-crown", "as": "The unit most of this town's traffic is actually booked for.", "rel": "procedure" }, { "to": "root-canal", "as": "Day-case work that fits between a morning drive and an evening one.", "rel": "procedure" }, { "to": "eu-directive-2011-24", "as": "The route an Austrian patient can claim a share of the bill back through.", "rel": "governed-by" }, { "to": "counting-patients", "as": "Why this town's clinic count is a reputation rather than a census.", "rel": "story" }, { "to": "revision-at-home", "as": "Who repairs the crown, ninety minutes back across the border.", "rel": "risk" } ], "links": [ { "label": "Sopron", "url": "https://en.wikipedia.org/wiki/Sopron" } ], "sources": [ "s:wp-sopron", "s:wp-mosonmagyarovar", "s:guardian-cross-border-2015", "s:usatoday-incidental-tourist", "s:wp-medical-travel", "s:eu-directive-2011-24", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:wp-sopron", "note": "the clinic count is carried as the encyclopaedia carries it, with its own weak sourcing named in the story" }, "text.story": { "tier": "cited", "source": "s:wp-mosonmagyarovar", "note": "third paragraph is this project reasoning about which town the documented record belongs to" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "cited", "source": "s:wp-sopron" }, "facets.radius_km": { "tier": "inference", "note": "12 km is the town and its approaches; the cluster is compact" } } }, "x_commons_files": [ "File:Sopron Fő tér.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A Hungarian border town of 62,116 people, 70 km from Vienna and 77 km from Bratislava, whose economy carries an unusual weight of dental surgeries — Wikipedia puts it at more than 300 and repeats the trade's name for…", "region_terms": [ { "key": "europe-central", "name": "Central Europe", "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia" } ], "kin_out": [ { "to": "hungary", "type": "destination", "name": "Hungary", "as": "The country whose border-town dentistry this place is the emblem of.", "rel": "whole" }, { "to": "budapest", "type": "hub", "name": "Budapest", "as": "The capital version of the same trade, reached by air rather than by car.", "rel": "contrast" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The work that brings a second visit, and the reason a day trip becomes two.", "rel": "procedure" }, { "to": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "The unit most of this town's traffic is actually booked for.", "rel": "procedure" }, { "to": "root-canal", "type": "procedure", "name": "Root canal treatment", "as": "Day-case work that fits between a morning drive and an evening one.", "rel": "procedure" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route an Austrian patient can claim a share of the bill back through.", "rel": "governed-by" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why this town's clinic count is a reputation rather than a census.", "rel": "story" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who repairs the crown, ninety minutes back across the border.", "rel": "risk" } ], "source_list": [ { "id": "s:wp-sopron", "kind": "wikipedia", "title": "Sopron", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Sopron", "accessed": "2026-09-16", "note": "coordinates, population 62,116 (2022), 70 km from Vienna and 77 km from Bratislava, bilingual Hungarian and German street signs. Its dental-clinic count — more than 300, with the phrase dental capital of the world — is cited by Wikipedia to a 2005 USA Today piece and to a dead travel column, and is carried here as trade reputation rather than a count anybody published." }, { "id": "s:wp-mosonmagyarovar", "kind": "wikipedia", "title": "Mosonmagyaróvár", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Mosonmagyar%C3%B3v%C3%A1r", "accessed": "2026-09-16", "note": "about 350 practising dentists as of 2015, cited to The Guardian; states that official Hungarian government figures show 160,000 Austrians crossing the border yearly for dental care" }, { "id": "s:guardian-cross-border-2015", "kind": "web", "title": "Shop frontiers: the rise of cross-border buying around the world", "publisher": "The Guardian", "url": "https://www.theguardian.com/money/2015/jul/02/cross-border-buying-shopping-bargains-globalisation", "accessed": "2026-09-16", "note": "dated 2 July 2015; the source Wikipedia cites for the roughly 350 dentists in Mosonmagyaróvár" }, { "id": "s:usatoday-incidental-tourist", "kind": "web", "title": "The inciDENTAL tourist", "publisher": "USA Today", "url": "https://www.usatoday.com/travel/news/2005-07-28-dental-tourism_x.htm", "accessed": "2026-09-16", "note": "dated 28 July 2005; the oldest reference behind the Hungarian border-dentistry reputation, and twenty-one years old" }, { "id": "s:wp-medical-travel", "kind": "wikipedia", "title": "Medical tourism", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism", "accessed": "2026-09-16", "note": "used only for the figures it attributes to a named reference: Mosonmagyaróvár's dental clinic count, a Lithuanian hip replacement at £3,340 against a British commercial price roughly three times it, and Tunisia's thalassotherapy ranking. Its country-level traffic figures rest on market-research summaries and are not carried here." }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:wp-sopron", "note": "the clinic count is carried as the encyclopaedia carries it, with its own weak sourcing named in the story" }, "text.story": { "tier": "cited", "source": "s:wp-mosonmagyarovar", "note": "third paragraph is this project reasoning about which town the documented record belongs to" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited", "source": "s:wp-sopron" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "budapest", "type": "hub", "name": "Budapest", "as": "The border version of the same trade: a morning from Vienna instead of a flight.", "rel": "contrast" } ] }, { "schema": 1, "id": "taipei", "type": "hub", "names": { "name": "Taipei", "aliases": [ "臺北", "Taipei City" ], "said": "Tai-bei. The medical centres are named for who built them rather than for where they are — Veterans, National Taiwan, Taipei Medical University — and a patient learns the district afterwards." }, "region": [ "east-asia" ], "facets": { "iso2": "TW", "radius_km": 20, "specialty": [ "health screening", "transplant", "oncology", "cardiology", "dentistry", "ophthalmology" ], "draws": [ "executive-health-screening", "liver-transplant", "cataract-surgery", "dental-implant", "icl" ], "languages": [ "Mandarin", "Taiwanese Hokkien", "English", "Japanese" ] }, "text": { "what": "Taipei's large hospitals are strung down the middle of the city from north to south. Taipei Veterans General Hospital, founded 1958 and running 3,000 beds, stands at 201 Shipai Road Section 2 in Beitou, at the northern end; National Taiwan University Hospital, founded on 18 June 1895 and now the island's largest public hospital with 2,400 beds, sits at 1 Changde Street in Zhongzheng, beside the old city; Taipei Medical University Hospital is at 252 Wuxing Street in Xinyi, east of the centre. The private cosmetic and dental shopfronts are not on those campuses at all: they are along Zhongxiao East Road and Dunhua South Road, in the shopping blocks between them.", "story": "Both of the big hospitals here predate the trade by a long way — one founded under Japanese rule in 1895, one built for veterans in 1958 — and neither was built to sell anything. *Inference —* that is the character of the Taipei cluster and the reason it is thin in this directory. Taiwan's medicine grew inside a national health insurance system serving its own population, and the foreign patient is an addition to a full hospital rather than the reason the hospital exists.\n\n*Trade practice —* what the island is known for abroad is the screening package, the dental work, and a transplant and hepatology tradition built on decades of endemic hepatitis B. Prices are quoted well below Japanese, Korean and Singaporean equivalents for comparable work.\n\n*Inference —* this project has not yet read a Taiwanese price off a page, has found no Taiwanese ministry count of foreign patients it could verify, and carries none of the figures that circulate for the island. This record is geography and hedge until one of those is read.", "how": "A Taipei medical centre runs an international medical service centre that takes an inquiry, quotes against the hospital's own published self-pay schedule, and arranges the interpreter. Taiwan's national health insurance does not cover a visiting foreigner, so the quote is the self-pay rate rather than the insured one, and those two numbers differ.", "today": "As of 16 September 2026 the harvest point for this hub sits in central Taipei, with a 20-kilometre radius reaching Beitou to the north, Xinyi to the east and the New Taipei hospitals across the river. No Taipei price and no Taiwanese patient count has been read off a page into this directory.", "notes": "Geography and a list of hospitals. Nothing here advises anyone about treatment in Taiwan." }, "geo": { "lat": 25.062, "lon": 121.534, "precision": "city", "source": "s:osm-nominatim" }, "address": { "city": "Taipei", "area": "Zhongzheng, Beitou and Xinyi", "country": "TW" }, "metrics": { "note": "No inbound patient count is carried for Taipei. The general literature this project read names no Taiwanese figure it could attribute to a register, and the one cost comparison found — a liver transplant put at about US$91,000 against US$300,000 in the United States — is an undated secondary estimate and is not carried as a price.", "as_of": "2026-09-16", "source": "s:wp-medical-tourism", "url": "https://en.wikipedia.org/wiki/Medical_tourism" }, "kin": [ { "to": "taiwan", "as": "The country whose medical centres cluster in this city.", "rel": "whole" }, { "to": "executive-health-screening", "as": "The package the island is best known for selling across the strait and to Japan.", "rel": "procedure" }, { "to": "liver-transplant", "as": "Built on decades of endemic hepatitis B and the hepatology that followed it.", "rel": "procedure" }, { "to": "dental-implant", "as": "The shopfront trade along Zhongxiao East Road rather than on the hospital campuses.", "rel": "procedure" }, { "to": "cataract-surgery", "as": "High-volume short-stay work quoted at a published self-pay rate.", "rel": "procedure" }, { "to": "seoul", "as": "The neighbouring East Asian cluster that turned its hospitals outward, where Taipei mostly did not.", "rel": "contrast" }, { "to": "singapore-city", "as": "The other high-cost regional centre competing for the complex case.", "rel": "contrast" }, { "to": "what-the-data-cannot-see", "as": "A hub with no count this project could verify, which is itself the finding.", "rel": "story" }, { "to": "osm-facilities", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 20 kilometres of this point.", "rel": "measured-by" } ], "links": [ { "label": "National Taiwan University Hospital", "url": "https://www.ntuh.gov.tw/" }, { "label": "Taipei Veterans General Hospital", "url": "https://www.vghtpe.gov.tw/" } ], "sources": [ "s:osm-nominatim", "s:wp-ntuh", "s:wp-tvgh", "s:wp-medical-tourism", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "streets and house numbers read off OpenStreetMap address tags; founding dates and bed counts from the two hospitals' Wikipedia entries" }, "text.story": { "tier": "inference", "note": "this project reasoning from the founding dates and from what it could not find; the inline marks say which stretches are trade practice" }, "text.how": { "tier": "tradition", "note": "the general shape of an international medical service centre in a Taiwanese medical centre; unverified against any one hospital's page" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "a central point chosen to reach the three campuses, not a point anybody published" } } }, "x_commons_files": [ "File:National Taiwan University Hospital.jpg" ], "needs_verification": true, "confidence": "low", "updated": "2026-09-16", "blurb": "Taipei's large hospitals are strung down the middle of the city from north to south.", "region_terms": [ { "key": "east-asia", "name": "East Asia", "note": "South Korea, Japan, Taiwan, China" } ], "kin_out": [ { "to": "taiwan", "type": "destination", "name": "Taiwan", "as": "The country whose medical centres cluster in this city.", "rel": "whole" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The package the island is best known for selling across the strait and to Japan.", "rel": "procedure" }, { "to": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "Built on decades of endemic hepatitis B and the hepatology that followed it.", "rel": "procedure" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The shopfront trade along Zhongxiao East Road rather than on the hospital campuses.", "rel": "procedure" }, { "to": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "High-volume short-stay work quoted at a published self-pay rate.", "rel": "procedure" }, { "to": "seoul", "type": "hub", "name": "Seoul", "as": "The neighbouring East Asian cluster that turned its hospitals outward, where Taipei mostly did not.", "rel": "contrast" }, { "to": "singapore-city", "type": "hub", "name": "Singapore", "as": "The other high-cost regional centre competing for the complex case.", "rel": "contrast" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "A hub with no count this project could verify, which is itself the finding.", "rel": "story" }, { "to": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 20 kilometres of this point.", "rel": "measured-by" } ], "source_list": [ { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." }, { "id": "s:wp-ntuh", "kind": "wikipedia", "title": "National Taiwan University Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/National_Taiwan_University_Hospital", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-tvgh", "kind": "wikipedia", "title": "Taipei Veterans General Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Taipei_Veterans_General_Hospital", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-medical-tourism", "kind": "wikipedia", "title": "Medical tourism", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism", "license": "CC BY-SA 4.0", "accessed": "2026-09-16", "note": "the field's general article; used in this batch only for the Singapore foreign-patient expenditure figures, which it attributes to reporting rather than to a government release." }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:osm-nominatim", "note": "streets and house numbers read off OpenStreetMap address tags; founding dates and bed counts from the two hospitals' Wikipedia entries" }, "text.story": { "tier": "inference", "note": "this project reasoning from the founding dates and from what it could not find; the inline marks say which stretches are trade practice" }, "text.how": { "tier": "tradition", "note": "the general shape of an international medical service centre in a Taiwanese medical centre; unverified against any one hospital's page" }, "text.today": { "tier": "cited" }, "geo": { "tier": "inference", "source": "s:osm-nominatim", "note": "a central point chosen to reach the three campuses, not a point anybody published" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "taiwan", "type": "destination", "name": "Taiwan", "as": "Where the international medical centres are.", "rel": "part" } ] }, { "schema": 1, "id": "tbilisi", "type": "hub", "names": { "name": "Tbilisi", "aliases": [ "თბილისი", "Tiflis" ], "said": "Agencies say Georgia and mean Tbilisi; the clinics are in Vake, Saburtalo and Vera, and the programmes are quoted in dollars or euros." }, "region": [ "west-asia" ], "facets": { "iso2": "GE", "radius_km": 15, "specialty": [ "fertility", "reproductive medicine", "hair restoration", "dentistry", "cosmetic surgery" ], "draws": [ "ivf", "surrogacy", "egg-donation", "icsi", "hair-transplant-fue" ], "languages": [ "Georgian", "Russian", "English" ] }, "text": { "what": "A capital of 1,369,400 people whose private clinics concentrate in Vake and Saburtalo, with Vera and Mtatsminda between them and the older hospital estate scattered across the city. Georgia runs universal coverage introduced in 2013 over a hospital system that is largely private, and the State Regulation Agency for Medical Activities licenses both facilities and professionals. The work foreign patients arrive for is reproductive medicine — in vitro fertilisation, donor cycles and gestational surrogacy — with hair restoration and dentistry beside it.", "story": "Georgia's position in the fertility trade comes from its law rather than its laboratories. It permits gestational surrogacy, altruistic and commercial, for domestic and for international intended parents, restricted to couples married or in a domestic relationship of at least a year. That permission is rare enough in Europe and its neighbourhood to be the whole reason for most of the traffic.\n\nWhen Ukraine's surrogacy trade stopped in 2022, some of its clients moved here.\n\n*Inference —* a market that exists because of a permission is a market that can end with an amendment, and it is the kind of rule that moves. This record therefore names no article and no section: the reference read for it gives none, and a law that cannot be cited cannot be dated. Whether the permission still extends to foreign intended parents on the day a reader arrives is a question for the surrogacy law record, and this record does not answer it.\n\n*Trade practice —* the Tbilisi programme is agency-led. A coordinator matches the surrogate or the donor, the clinic runs the cycle, and the intended parents fly in twice: once around the transfer, once for the birth and the paperwork. The paperwork is the part that decides the outcome, and it is handled in the country of citizenship rather than here.", "how": "*Trade practice —* programmes are quoted as a total with the surrogate's compensation, the medical cycle, the agency's fee and the legal work broken out, and paid in stages against milestones. The costs that fall outside are the ones nobody can schedule: a failed transfer and the next attempt, a twin pregnancy, a neonatal admission, and a delay in the exit documents that keeps a family in the city for weeks.", "today": "As of 16 September 2026 this record carries no price row for Tbilisi and no count of arriving patients. No country record for Georgia exists in this directory yet, so this hub's kin reach the procedures and rules rather than a destination page.", "notes": "Fifteen kilometres from the city point covers Vake, Saburtalo, Mtatsminda, Vera and the Old Town, and reaches the hospital campuses on the northern edge." }, "geo": { "lat": 41.7225, "lon": 44.7925, "precision": "city", "source": "s:wp-tbilisi" }, "address": { "city": "Tbilisi", "country": "GE" }, "kin": [ { "to": "surrogacy", "as": "The treatment that brings most of this city's foreign traffic, and the one its law is the reason for.", "rel": "procedure" }, { "to": "surrogacy-law", "as": "The rule this whole cluster rests on, and the one this record declines to date.", "rel": "governed-by" }, { "to": "ivf", "as": "The cycle every programme here is built around.", "rel": "procedure" }, { "to": "egg-donation", "as": "Sold alongside, into the same European shortage.", "rel": "procedure" }, { "to": "hair-transplant-fue", "as": "The other export, priced against Istanbul at a shorter flight from the north.", "rel": "procedure" }, { "to": "reproductive-exile", "as": "The word for the journey most of this city's patients are making.", "rel": "term" }, { "to": "circumvention", "as": "Why a permission in one country becomes an industry in its capital.", "rel": "story" }, { "to": "istanbul", "as": "The neighbouring cluster this city's hair clinics price against.", "rel": "contrast" }, { "to": "prague", "as": "The other post-socialist fertility centre, selling donation rather than surrogacy.", "rel": "contrast" } ], "links": [ { "label": "Health in Georgia", "url": "https://en.wikipedia.org/wiki/Health_in_Georgia_(country)" } ], "sources": [ "s:wp-tbilisi", "s:wp-health-georgia", "s:wp-surrogacy-laws", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:wp-surrogacy-laws", "note": "no instrument is named because the source names none; paragraphs three and four are marked inline" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "cited", "source": "s:wp-tbilisi" }, "facets.radius_km": { "tier": "inference" } } }, "x_commons_files": [ "File:Tbilisi Vake district.jpg" ], "needs_verification": true, "confidence": "low", "updated": "2026-09-16", "blurb": "A capital of 1,369,400 people whose private clinics concentrate in Vake and Saburtalo, with Vera and Mtatsminda between them and the older hospital estate scattered across the city.", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "The treatment that brings most of this city's foreign traffic, and the one its law is the reason for.", "rel": "procedure" }, { "to": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "The rule this whole cluster rests on, and the one this record declines to date.", "rel": "governed-by" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The cycle every programme here is built around.", "rel": "procedure" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "Sold alongside, into the same European shortage.", "rel": "procedure" }, { "to": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The other export, priced against Istanbul at a shorter flight from the north.", "rel": "procedure" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The word for the journey most of this city's patients are making.", "rel": "term" }, { "to": "circumvention", "type": "story", "name": "Circumvention", "as": "Why a permission in one country becomes an industry in its capital.", "rel": "story" }, { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "The neighbouring cluster this city's hair clinics price against.", "rel": "contrast" }, { "to": "prague", "type": "hub", "name": "Prague", "as": "The other post-socialist fertility centre, selling donation rather than surrogacy.", "rel": "contrast" } ], "source_list": [ { "id": "s:wp-tbilisi", "kind": "wikipedia", "title": "Tbilisi", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Tbilisi", "accessed": "2026-09-16", "note": "coordinates, population 1,369,400 (2026); Vake, Saburtalo and Mtatsminda districts, with Vera inside Mtatsminda" }, { "id": "s:wp-health-georgia", "kind": "wikipedia", "title": "Health in Georgia (country)", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Health_in_Georgia_(country)", "accessed": "2026-09-16", "note": "universal coverage from 2013 over a largely privatised hospital estate; the State Regulation Agency for Medical Activities licenses facilities and professionals; 12,830 hospital beds by 2015" }, { "id": "s:wp-surrogacy-laws", "kind": "wikipedia", "title": "Surrogacy laws by country", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Surrogacy_laws_by_country", "accessed": "2026-09-16", "note": "states that Georgia permits altruistic and commercial surrogacy for domestic and international intended parents, restricted to couples married or in a domestic relationship of at least a year, and that Georgia absorbed clients from Ukraine after 2022; states surrogacy is unregulated in Czechia. No article or section number is given on the page for the Georgian instrument." }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:wp-surrogacy-laws", "note": "no instrument is named because the source names none; paragraphs three and four are marked inline" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited", "source": "s:wp-tbilisi" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "georgia", "type": "destination", "name": "Georgia", "as": "Where nearly all of it happens.", "rel": "part" } ] }, { "schema": 1, "id": "tel-aviv", "type": "hub", "names": { "name": "Tel Aviv", "aliases": [ "Tel Aviv-Yafo", "תל אביב-יפו" ], "said": "Patients and taxi drivers say Ichilov; the hospital's own name is the Tel Aviv Sourasky Medical Center, and the two are the same building." }, "region": [ "west-asia" ], "facets": { "iso2": "IL", "radius_km": 15, "specialty": [ "fertility", "reproductive medicine", "oncology", "haematology", "neurosurgery" ], "draws": [ "ivf", "icsi", "pgt", "egg-donation", "car-t" ], "languages": [ "Hebrew", "English", "Russian", "Arabic" ] }, "text": { "what": "A city of 494,900 people whose inbound medical work runs through large public teaching hospitals rather than through a clinic strip. The Tel Aviv Sourasky Medical Center — founded in 1963, public, 1,171 beds as of 2020 on Israel Ministry of Health figures, and known to everyone as Ichilov — is the largest teaching hospital serving the city and its metropolitan area, and the second largest hospital complex in the country. The work foreign patients arrive for is reproductive medicine, oncology and haematology, and the agents who bring them are registered with the government.", "story": "The trade is small, public-sector and regulated, which makes it unlike almost every other cluster in this directory. The counts are correspondingly modest: 15,000 people came to Israel for treatment in 2006, bringing about $40 million; 30,000 were treated in 2010; income was assessed at roughly $140 million in 2012. Those figures come from newspaper reporting rather than from a statistics office, and no more recent count could be read for this record.\n\nBecause the hospitals are public, the argument here is domestic. A foreign patient paying full cost occupies a bed and an operating list inside a system that funds beds and lists for residents, and the objection is queue displacement rather than price.\n\n*Inference —* that is why registration exists at all. A country regulating this trade in a public hospital estate is not regulating the export; it is rationing it against its own citizens' claim on the same theatre.\n\n*Trade practice —* Israeli fertility medicine is the draw most often named, and the reason given is volume: a system that funds treatment generously for its own residents builds laboratories and embryologists that a foreign self-payer can then buy into.", "how": "*Trade practice —* the route runs through a registered agent who arranges the estimate, the deposit, the interpreter and the accommodation, and through a hospital's international department that quotes a price for the episode. The hospitals are public, so the bill is a schedule rather than a negotiated package, and what falls outside it is the same list as everywhere: imaging before admission, a complication, a night past the estimate.", "today": "As of 16 September 2026 medical travel agents are required by Israeli law to register with the government. This record names no statute and no date for that requirement: the government page stating it could not be opened for this batch, and the requirement is carried here on the encyclopaedia entry that cites it.", "notes": "Fifteen kilometres from the city point reaches Ramat Gan and the Sheba campus at Tel HaShomer, and covers the Tel Aviv district hospitals." }, "geo": { "lat": 32.08, "lon": 34.78, "precision": "city", "source": "s:wp-tel-aviv" }, "address": { "city": "Tel Aviv-Yafo", "country": "IL" }, "kin": [ { "to": "israel", "as": "The country whose registration requirement governs the agents who bring patients here.", "rel": "whole" }, { "to": "sheba", "as": "The larger hospital campus at Tel HaShomer, inside this record's harvest radius.", "rel": "part" }, { "to": "ivf", "as": "The treatment most often named as the reason for the journey.", "rel": "procedure" }, { "to": "pgt", "as": "Sold alongside the cycle, and a reason some patients choose this system over their own.", "rel": "procedure" }, { "to": "car-t", "as": "The kind of work a large public teaching hospital takes and a clinic strip cannot.", "rel": "procedure" }, { "to": "surrogacy-law", "as": "The rule whose changes here decided who could use this city's clinics and when.", "rel": "governed-by" }, { "to": "counting-patients", "as": "Why a fifteen-year-old newspaper figure is still the count in circulation.", "rel": "story" }, { "to": "insurance-exclusions", "as": "What a public hospital's schedule does and does not absorb when something goes wrong.", "rel": "governed-by" } ], "links": [ { "label": "Tel Aviv Sourasky Medical Center", "url": "https://en.wikipedia.org/wiki/Tel_Aviv_Sourasky_Medical_Center" } ], "sources": [ "s:wp-tel-aviv", "s:wp-sourasky", "s:wp-medical-tourism-israel", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:wp-medical-tourism-israel", "note": "the third and fourth paragraphs are marked inline as inference and trade practice" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited", "source": "s:wp-medical-tourism-israel", "note": "the primary government page could not be opened for this batch; the requirement is second-hand and flagged as such" }, "geo": { "tier": "cited", "source": "s:wp-tel-aviv" }, "facets.radius_km": { "tier": "inference" } } }, "x_commons_files": [ "File:Tel Aviv Sourasky Medical Center.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A city of 494,900 people whose inbound medical work runs through large public teaching hospitals rather than through a clinic strip.", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "israel", "type": "destination", "name": "Israel", "as": "The country whose registration requirement governs the agents who bring patients here.", "rel": "whole" }, { "to": "sheba", "type": "facility", "name": "Sheba Medical Center", "as": "The larger hospital campus at Tel HaShomer, inside this record's harvest radius.", "rel": "part" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment most often named as the reason for the journey.", "rel": "procedure" }, { "to": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "Sold alongside the cycle, and a reason some patients choose this system over their own.", "rel": "procedure" }, { "to": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "The kind of work a large public teaching hospital takes and a clinic strip cannot.", "rel": "procedure" }, { "to": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "The rule whose changes here decided who could use this city's clinics and when.", "rel": "governed-by" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a fifteen-year-old newspaper figure is still the count in circulation.", "rel": "story" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "What a public hospital's schedule does and does not absorb when something goes wrong.", "rel": "governed-by" } ], "source_list": [ { "id": "s:wp-tel-aviv", "kind": "wikipedia", "title": "Tel Aviv", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Tel_Aviv", "accessed": "2026-09-16", "note": "coordinates, population 494,900 (2024), the Neve Tzedek and Neve Shalom neighbourhoods" }, { "id": "s:wp-sourasky", "kind": "wikipedia", "title": "Tel Aviv Sourasky Medical Center", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Tel_Aviv_Sourasky_Medical_Center", "accessed": "2026-09-16", "note": "founded 1963, public, 1,171 beds as of 2020 per Israel Ministry of Health data, commonly called Ichilov; coordinates 32°04′50″N 34°47′24″E" }, { "id": "s:wp-medical-tourism-israel", "kind": "wikipedia", "title": "Medical tourism in Israel", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_Israel", "accessed": "2026-09-16", "note": "carries 15,000 inbound patients in 2006 and 30,000 in 2010 cited to Haaretz, and about $140 million of income in 2012 cited to USA Today; states that medical travel agents must register with the Israeli government, citing gov.il, a page this project could not open" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:wp-medical-tourism-israel", "note": "the third and fourth paragraphs are marked inline as inference and trade practice" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited", "source": "s:wp-medical-tourism-israel", "note": "the primary government page could not be opened for this batch; the requirement is second-hand and flagged as such" }, "geo": { "tier": "cited", "source": "s:wp-tel-aviv" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "israel", "type": "destination", "name": "Israel", "as": "Where most of the inbound work is done.", "rel": "part" }, { "from": "hadassah", "type": "facility", "name": "Hadassah Medical Center", "as": "The cluster an hour west; Jerusalem has no hub record of its own in this directory.", "rel": "place" }, { "from": "sheba", "type": "facility", "name": "Sheba Medical Center", "as": "The hospital the Tel Aviv cluster is built on, though its campus is in Ramat Gan rather than the city.", "rel": "place" } ] }, { "schema": 1, "id": "tijuana", "type": "hub", "names": { "name": "Tijuana", "aliases": [ "TJ", "Tijuana, Baja California" ], "said": "Tee-HWA-na. San Diego says TJ. Patients say across the line." }, "region": [ "mexico", "north-america" ], "facets": { "iso2": "MX", "radius_km": 20, "specialty": [ "bariatric surgery", "dentistry", "cosmetic surgery", "ophthalmology", "oncology" ], "draws": [ "gastric-sleeve", "gastric-bypass", "dental-implant", "all-on-four", "liposuction", "abdominoplasty", "breast-augmentation", "stem-cell-unproven" ], "languages": [ "Spanish", "English" ] }, "text": { "what": "A city of roughly 2.3 million on the Pacific end of the Mexico–United States border, sharing about 24 kilometres of line with San Diego. Its Wikipedia article calls it the most visited border city in the world and puts the crossings between the two cities at more than fifty million a year. The clinical trade here is surgical rather than dental-first: weight-loss operations above all, then cosmetic surgery, dentistry and a fringe of clinics selling treatments that are not licensed in the United States.", "story": "Tijuana's medical trade is a by-product of proximity. The Bureau of Transportation Statistics counted 7,968,038 northbound pedestrian crossings at San Ysidro in calendar 2025 — a figure that counts crossings and not people, and includes commuters, shoppers, families and patients without distinguishing them. No published series separates out the last group, and this directory does not repeat the round numbers that circulate for it.\n\nWhat is documented is what went wrong. Between August 2018 and December 2019 the Centers for Disease Control and Prevention traced 44 cases of an extensively drug-resistant Pseudomonas aeruginosa, carrying the Verona integron-encoded metallo-β-lactamase, across 19 United States states. Of 38 patients with confirmed or probable infection, 34 had undergone sleeve gastrectomy — a weight-loss operation — at a single unnamed facility in Tijuana. Their median age was 39 and 89.5 per cent were women. One of the sixteen admitted to hospital died nine days after surgery. CDC issued an Alert Level 2 travel health notice in January 2019. An earlier Mexican regulatory inspection of the facility in December 2018 had recorded poor hand hygiene, incomplete clinical records, and no chemical or biological indicators to confirm that reprocessed instruments had been sterilised.\n\n*Inference —* the episode is instructive less for the organism than for the accounting. The operation was cheap and the infection was not, and the cost of the infection fell on United States hospitals and insurers who had not priced it. That asymmetry — the bill split across a border that the patient crossed in twenty minutes — is the structural fact about this hub.\n\n*Trade practice —* Tijuana also hosts clinics selling stem cell and other unlicensed interventions to United States patients, trading precisely on the fact that the treatment cannot lawfully be sold to them at home.", "how": "Most patients drive or fly to San Diego and are collected on the United States side by a driver the clinic sends; the crossing southbound is fast and unremarked, and the clinic handles the return. Bariatric packages are sold as a fixed bundle covering the operation, the hospital nights and the transfers, and the exclusions are the tell: a leak, a revision, an intensive-care night, and the flight home if the patient cannot board. Surgery is done in small private hospitals rather than in the public system, which does not sell to foreigners.", "today": "As of 16 September 2026 Tijuana is the busiest surgical border town on the continent and the only one in this directory with a named, dated, multi-state outbreak attached to it in the peer-reviewed literature. The paper is Kracalik and colleagues in Emerging Infectious Diseases, 2022.", "notes": "This page describes a place and reports a published outbreak investigation. It is not advice about whether to have an operation, or where." }, "geo": { "lat": 32.525, "lon": -117.0333, "precision": "city", "source": "s:wp-tijuana" }, "address": { "city": "Tijuana", "area": "Baja California", "country": "MX" }, "kin": [ { "to": "mexico", "as": "The country whose surgical export trade is most concentrated here.", "rel": "destination" }, { "to": "united-states", "as": "The source market, fifteen miles away, and the health system that treats the complications.", "rel": "kin" }, { "to": "los-algodones", "as": "The other Baja California cluster — dental, smaller, and priced in the window.", "rel": "contrast" }, { "to": "hospital-angeles-tijuana", "as": "One of the private hospitals the international trade runs through.", "rel": "place" }, { "to": "gastric-sleeve", "as": "The operation this city sells most, and the one named in the 2018–2019 outbreak.", "rel": "performs" }, { "to": "gastric-bypass", "as": "The other weight-loss operation on the package lists here.", "rel": "performs" }, { "to": "antimicrobial-resistance", "as": "What the CDC actually found: an organism resistant to the first-line drugs, carried home in 19 states.", "rel": "risk" }, { "to": "surgical-site-infection", "as": "The route the resistant organism took — abdominal wounds after sleeve gastrectomy.", "rel": "risk" }, { "to": "stem-cell-unproven", "as": "Sold here to patients who cannot buy it at home, which is the whole of its business model.", "rel": "performs" }, { "to": "circumvention", "as": "Travel undertaken because the thing is not available at home; Tijuana is the North American case.", "rel": "story" }, { "to": "malpractice-recourse", "as": "What a patient has, and does not have, when the surgeon is in another jurisdiction twenty minutes away.", "rel": "risk" } ], "links": [ { "label": "Kracalik et al., Emerging Infectious Diseases 2022;28(1):51–61", "url": "https://wwwnc.cdc.gov/eid/article/28/1/21-1880_article" }, { "label": "Border Crossing/Entry Data — San Ysidro, California", "url": "https://data.bts.gov/d/keg4-3bc2" } ], "sources": [ "s:wp-tijuana", "s:bts-border-crossing", "s:cdc-eid-tijuana-vim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:cdc-eid-tijuana-vim", "note": "the outbreak paragraph is the CDC paper; the crossing count is harvested from the federal series; the last two paragraphs carry their own inline marks" }, "text.how": { "tier": "tradition", "note": "the general shape of a cross-border bariatric package; no single page describes it" } } }, "x_commons_files": [ "File:Tijuana skyline.jpg", "File:San Ysidro Port of Entry.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "A city of roughly 2.3 million on the Pacific end of the Mexico–United States border, sharing about 24 kilometres of line with San Diego.", "region_terms": [ { "key": "mexico", "name": "Mexico", "note": "its own entry because the border towns are a category of their own" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "mexico", "type": "destination", "name": "Mexico", "as": "The country whose surgical export trade is most concentrated here.", "rel": "destination" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The source market, fifteen miles away, and the health system that treats the complications.", "rel": "kin" }, { "to": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "The other Baja California cluster — dental, smaller, and priced in the window.", "rel": "contrast" }, { "to": "hospital-angeles-tijuana", "type": "facility", "name": "Hospital Angeles Tijuana", "as": "One of the private hospitals the international trade runs through.", "rel": "place" }, { "to": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "The operation this city sells most, and the one named in the 2018–2019 outbreak.", "rel": "performs" }, { "to": "gastric-bypass", "type": "procedure", "name": "Gastric bypass", "as": "The other weight-loss operation on the package lists here.", "rel": "performs" }, { "to": "antimicrobial-resistance", "type": "risk", "name": "Antimicrobial resistance acquired abroad", "as": "What the CDC actually found: an organism resistant to the first-line drugs, carried home in 19 states.", "rel": "risk" }, { "to": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The route the resistant organism took — abdominal wounds after sleeve gastrectomy.", "rel": "risk" }, { "to": "stem-cell-unproven", "type": "procedure", "name": "Unapproved stem cell treatment", "as": "Sold here to patients who cannot buy it at home, which is the whole of its business model.", "rel": "performs" }, { "to": "circumvention", "type": "story", "name": "Circumvention", "as": "Travel undertaken because the thing is not available at home; Tijuana is the North American case.", "rel": "story" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "What a patient has, and does not have, when the surgeon is in another jurisdiction twenty minutes away.", "rel": "risk" } ], "source_list": [ { "id": "s:wp-tijuana", "kind": "web", "title": "Tijuana", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Tijuana", "accessed": "2026-09-16" }, { "id": "s:bts-border-crossing", "kind": "dataset", "title": "Border Crossing/Entry Data", "publisher": "United States Bureau of Transportation Statistics", "url": "https://data.bts.gov/d/keg4-3bc2", "accessed": "2026-09-16", "note": "monthly counts by port of entry and measure, queried through the Socrata API at https://data.bts.gov/resource/keg4-3bc2.json. Counts crossings, not people." }, { "id": "s:cdc-eid-tijuana-vim", "kind": "journal", "title": "Extensively Drug-Resistant Carbapenemase-Producing Pseudomonas aeruginosa and Medical Tourism from the United States to Mexico, 2018–2019", "publisher": "Emerging Infectious Diseases (US Centers for Disease Control and Prevention), 2022;28(1):51–61", "url": "https://wwwnc.cdc.gov/eid/article/28/1/21-1880_article", "accessed": "2026-09-16", "note": "Kracalik I, et al. doi:10.3201/eid2801.211880" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:cdc-eid-tijuana-vim", "note": "the outbreak paragraph is the CDC paper; the crossing count is harvested from the federal series; the last two paragraphs carry their own inline marks" }, "text.how": { "tier": "tradition", "note": "the general shape of a cross-border bariatric package; no single page describes it" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "mexico", "type": "destination", "name": "Mexico", "as": "Where the weight-loss surgery is done, half an hour from a US hospital.", "rel": "part" }, { "from": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "The other Baja California cluster — bigger, surgical, and reached by a different kind of trip.", "rel": "contrast" }, { "from": "monterrey", "type": "hub", "name": "Monterrey", "as": "The other Mexican surgical hub — cheaper, faster, and sold through packages rather than referrals.", "rel": "contrast" }, { "from": "gastric-bypass", "type": "procedure", "name": "Gastric bypass", "as": "The city that prices eight bariatric operations in one column.", "rel": "place" }, { "from": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "The border city whose packages include the ground transfer from the United States.", "rel": "place" }, { "from": "stem-cell-unproven", "type": "procedure", "name": "Unapproved stem cell treatment", "as": "The city the one published count of these clinics was made in.", "rel": "hub" }, { "from": "hospital-angeles-tijuana", "type": "facility", "name": "Hospital Angeles Tijuana", "as": "The largest private hospital in the city, twenty minutes from the San Ysidro crossing.", "rel": "place" } ] }, { "schema": 1, "id": "tunis", "type": "hub", "names": { "name": "Tunis", "aliases": [ "تونس" ], "said": "The trade word here is clinique, not hospital, and it is French because the market is: the quote arrives in French and in euros." }, "region": [ "africa-north" ], "facets": { "iso2": "TN", "radius_km": 18, "specialty": [ "cosmetic surgery", "bariatric surgery", "dentistry", "ophthalmology", "thalassotherapy" ], "draws": [ "rhinoplasty", "liposuction", "abdominoplasty", "breast-augmentation", "gastric-sleeve", "dental-implant" ], "languages": [ "Arabic", "French", "English" ] }, "text": { "what": "A capital of 693,210 people, 2,885,040 across its metropolitan area, administered in fifteen municipal districts including El Menzah and the Medina. The private clinics that take foreign patients sit in the northern and coastal districts of the agglomeration rather than in the old city, and they sell cosmetic and bariatric surgery to a French-speaking market, alongside a separate seaside trade in thalassotherapy. Tunisia's private sector holds about 12% of the country's hospital beds and about 70% of its top-range medical equipment.", "story": "Two claims travel with this city and both need their footing stated. The first is that medical travel is Tunisia's second largest employer and second highest foreign currency earner — carried in the encyclopaedia entry on Tunisian healthcare without a date and without a statistics office behind it, and repeated widely since. The second is a ranking: Tunisia placed second in Africa for health tourism and named the world's second thalassotherapy destination behind France, again a ranking rather than a count.\n\n*Inference —* neither claim tells a reader how many operations were performed on how many people, which is the thing a directory needs. What is documented is the structure: a private hospital sector holding a tenth of the beds and most of the modern equipment, which is the shape of a system with an export wing attached to a public one.\n\n*Trade practice —* the market is French and francophone African. Quotes arrive in euros, the surgeon corresponds in French, and the package includes the clinic stay, a convalescence hotel and the transfers. Cosmetic surgery is the advertised core, with sleeve gastrectomy beside it.\n\nLibyan patients are the other flow, and they arrive for reasons that have nothing to do with price. A neighbouring health system under prolonged disruption sends patients across a land border for ordinary care as well as for surgery, and that traffic is a referral trade rather than an elective one.", "how": "*Trade practice —* the Tunis package is quoted per procedure with the nights, the transfers and a convalescence hotel written in, and arranged through an agency that corresponds in French. A deposit holds the date; the balance is paid on arrival. What sits outside is the same list as everywhere — imaging, a complication, a night past the package, and the revision six months later at home.", "today": "As of 16 September 2026 this record carries no price row and no inbound patient count for Tunis. The claims in circulation are rankings and shares rather than counts with a method.", "notes": "Eighteen kilometres from the city point covers the Medina, El Menzah, the lake districts and the coastal suburbs toward La Marsa." }, "geo": { "lat": 36.8064, "lon": 10.1817, "precision": "city", "source": "s:wp-tunis" }, "address": { "city": "Tunis", "country": "TN" }, "kin": [ { "to": "tunisia", "as": "The country whose export wing this city holds most of.", "rel": "whole" }, { "to": "rhinoplasty", "as": "The advertised core of the francophone cosmetic trade here.", "rel": "procedure" }, { "to": "abdominoplasty", "as": "Sold here with the convalescence hotel written into the quote.", "rel": "procedure" }, { "to": "gastric-sleeve", "as": "The bariatric line beside the cosmetic one.", "rel": "procedure" }, { "to": "wellness-travel", "as": "The thalassotherapy coast belongs to this older category and is counted in the same figures.", "rel": "term" }, { "to": "istanbul", "as": "The other Mediterranean cosmetic cluster, selling to a different language market.", "rel": "contrast" }, { "to": "counting-patients", "as": "Why a ranking keeps standing in for a count here.", "rel": "story" }, { "to": "revision-at-home", "as": "Who operates again, in Paris or Lyon, when a result needs correcting.", "rel": "risk" } ], "links": [ { "label": "Healthcare in Tunisia", "url": "https://en.wikipedia.org/wiki/Healthcare_in_Tunisia" } ], "sources": [ "s:wp-tunis", "s:wp-healthcare-tunisia", "s:wp-medical-travel", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:wp-healthcare-tunisia", "note": "the two claims are carried with their weak provenance stated; paragraphs two to four are marked inline" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "cited", "source": "s:wp-tunis" }, "facets.radius_km": { "tier": "inference" } } }, "x_commons_files": [ "File:Tunis Avenue Habib Bourguiba.jpg" ], "needs_verification": true, "confidence": "low", "updated": "2026-09-16", "blurb": "A capital of 693,210 people, 2,885,040 across its metropolitan area, administered in fifteen municipal districts including El Menzah and the Medina.", "region_terms": [ { "key": "africa-north", "name": "North Africa", "note": "Tunisia, Morocco, Egypt" } ], "kin_out": [ { "to": "tunisia", "type": "destination", "name": "Tunisia", "as": "The country whose export wing this city holds most of.", "rel": "whole" }, { "to": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "The advertised core of the francophone cosmetic trade here.", "rel": "procedure" }, { "to": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "Sold here with the convalescence hotel written into the quote.", "rel": "procedure" }, { "to": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "The bariatric line beside the cosmetic one.", "rel": "procedure" }, { "to": "wellness-travel", "type": "term", "name": "Wellness travel", "as": "The thalassotherapy coast belongs to this older category and is counted in the same figures.", "rel": "term" }, { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "The other Mediterranean cosmetic cluster, selling to a different language market.", "rel": "contrast" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a ranking keeps standing in for a count here.", "rel": "story" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who operates again, in Paris or Lyon, when a result needs correcting.", "rel": "risk" } ], "source_list": [ { "id": "s:wp-tunis", "kind": "wikipedia", "title": "Tunis", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Tunis", "accessed": "2026-09-16", "note": "coordinates, city population 693,210 (2024) and metropolitan 2,885,040; fifteen municipal districts including El Menzah and the Medina" }, { "id": "s:wp-healthcare-tunisia", "kind": "wikipedia", "title": "Healthcare in Tunisia", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Healthcare_in_Tunisia", "accessed": "2026-09-16", "note": "states the private sector holds 12% of total bed capacity and 70% of the top-range medical equipment, and that medical travel is the country's second largest employer and second highest foreign currency earner — a claim the page does not date or attribute to a statistics office" }, { "id": "s:wp-medical-travel", "kind": "wikipedia", "title": "Medical tourism", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism", "accessed": "2026-09-16", "note": "used only for the figures it attributes to a named reference: Mosonmagyaróvár's dental clinic count, a Lithuanian hip replacement at £3,340 against a British commercial price roughly three times it, and Tunisia's thalassotherapy ranking. Its country-level traffic figures rest on market-research summaries and are not carried here." }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:wp-healthcare-tunisia", "note": "the two claims are carried with their weak provenance stated; paragraphs two to four are marked inline" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited", "source": "s:wp-tunis" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "tunisia", "type": "destination", "name": "Tunisia", "as": "Where the clinics and the agencies are.", "rel": "part" } ] }, { "schema": 1, "id": "vilnius", "type": "hub", "names": { "name": "Vilnius", "aliases": [ "Wilno", "Vilna" ], "said": "Baltic clinics sell to Britain, Ireland and Scandinavia in English and quote in euros; the Lithuanian name of the street rarely appears in the quote." }, "region": [ "europe-north" ], "facets": { "iso2": "LT", "radius_km": 12, "specialty": [ "dentistry", "orthopaedics", "cosmetic surgery", "fertility", "bariatric surgery" ], "draws": [ "dental-implant", "all-on-four", "hip-replacement", "ivf", "gastric-sleeve" ], "languages": [ "Lithuanian", "English", "Russian", "Polish" ] }, "text": { "what": "A capital of 619,405 people in mid-2026, administered in twenty elderships, with the private clinics that take foreign patients in and around Naujamiestis and the streets north of the Old Town, and the large public hospital estate out at Santariškės. Vilnius sells dentistry, joint replacement and cosmetic surgery to patients from Britain, Ireland and the Nordic countries on short flights, against waiting lists rather than against uninsured bills.", "story": "The Baltic pitch is a queue argument, not a price argument, and the numbers that get quoted say so. The commonly cited Lithuanian figure is a hip replacement at £3,340, put at roughly a third of what the same operation costs privately in the United Kingdom — a comparison carried in the encyclopaedia to a named reference, without a date on the page, and old enough that this record treats it as a claim about the shape of the gap rather than a current price.\n\n*Inference —* that shape explains who comes. A patient with no insurance is choosing between a bill and nothing; a patient inside a public system is choosing between a wait and a fee, and the fee has to beat the wait rather than beat a competing bill. Elective orthopaedics is the procedure where that calculation bites hardest, and it is what the Baltic clinics lead with.\n\nDirective 2011/24/EU gives an insured EU patient reimbursement at the home tariff for care that would have been covered at home, with prior authorisation required for some categories — the route by which a wait in one member state is converted into a booking in another. *Trade practice —* Lithuanian clinics quote the self-payer anyway, because the reimbursement is a fraction and arrives afterwards.", "how": "*Trade practice —* the Vilnius booking is made by email in English, confirmed with imaging sent ahead, and sized to a long weekend for dentistry and to a week or more for a joint. Packages name the nights, the surgeon and the physiotherapy sessions; the implant is a separate line on the orthopaedic quotes, as it is nearly everywhere. Rehabilitation after a joint replacement is the part that goes home unbooked.", "today": "As of 16 September 2026 this record carries no price row for Vilnius: the figure in circulation has no date attached to a page this project could read.", "notes": "Twelve kilometres from the city point covers the Old Town, Naujamiestis, Žirmūnai and the Santariškės hospital campus." }, "geo": { "lat": 54.6872, "lon": 25.28, "precision": "city", "source": "s:wp-vilnius" }, "address": { "city": "Vilnius", "country": "LT" }, "kin": [ { "to": "lithuania", "as": "The country this cluster is the capital of.", "rel": "whole" }, { "to": "hip-replacement", "as": "The operation the Baltic pitch leads with, sold against a waiting list.", "rel": "procedure" }, { "to": "dental-implant", "as": "The short-stay work that fills the rest of the schedule.", "rel": "procedure" }, { "to": "eu-directive-2011-24", "as": "The route that converts a wait in one member state into a booking here.", "rel": "governed-by" }, { "to": "uk-nhs-treatment-abroad", "as": "The scheme a British patient would be claiming under, and the reason the queue is the argument.", "rel": "governed-by" }, { "to": "implant-excluded", "as": "The line an orthopaedic quote from here usually carries separately.", "rel": "risk" }, { "to": "aftercare-at-home", "as": "Where the physiotherapy after a joint replacement actually happens.", "rel": "step" }, { "to": "oecd-waiting-times", "as": "The series that measures the queue this cluster sells against.", "rel": "measured-by" } ], "links": [ { "label": "Directive 2011/24/EU", "url": "https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX:32011L0024" } ], "sources": [ "s:wp-vilnius", "s:wp-medical-travel", "s:eu-directive-2011-24", "s:oecd-health-statistics", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:wp-medical-travel", "note": "the £3,340 comparison is carried as the encyclopaedia carries it, undated; the second paragraph is this project reasoning" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "cited", "source": "s:wp-vilnius" }, "facets.radius_km": { "tier": "inference" } } }, "x_commons_files": [ "File:Vilnius Old Town rooftops.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A capital of 619,405 people in mid-2026, administered in twenty elderships, with the private clinics that take foreign patients in and around Naujamiestis and the streets north of the Old Town, and the large public…", "region_terms": [ { "key": "europe-north", "name": "Northern Europe", "note": "the Nordics and the Baltics" } ], "kin_out": [ { "to": "lithuania", "type": "destination", "name": "Lithuania", "as": "The country this cluster is the capital of.", "rel": "whole" }, { "to": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "The operation the Baltic pitch leads with, sold against a waiting list.", "rel": "procedure" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The short-stay work that fills the rest of the schedule.", "rel": "procedure" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route that converts a wait in one member state into a booking here.", "rel": "governed-by" }, { "to": "uk-nhs-treatment-abroad", "type": "rule", "name": "NHS funding for treatment abroad", "as": "The scheme a British patient would be claiming under, and the reason the queue is the argument.", "rel": "governed-by" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The line an orthopaedic quote from here usually carries separately.", "rel": "risk" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "Where the physiotherapy after a joint replacement actually happens.", "rel": "step" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The series that measures the queue this cluster sells against.", "rel": "measured-by" } ], "source_list": [ { "id": "s:wp-vilnius", "kind": "wikipedia", "title": "Vilnius", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Vilnius", "accessed": "2026-09-16", "note": "coordinates, population 619,405 at 1 July 2026, twenty elderships including Senamiestis, Naujamiestis and Žirmūnai" }, { "id": "s:wp-medical-travel", "kind": "wikipedia", "title": "Medical tourism", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism", "accessed": "2026-09-16", "note": "used only for the figures it attributes to a named reference: Mosonmagyaróvár's dental clinic count, a Lithuanian hip replacement at £3,340 against a British commercial price roughly three times it, and Tunisia's thalassotherapy ranking. Its country-level traffic figures rest on market-research summaries and are not carried here." }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:oecd-health-statistics", "kind": "dataset", "title": "OECD Health Statistics", "publisher": "Organisation for Economic Co-operation and Development", "url": "https://www.oecd.org/en/data/datasets/oecd-health-statistics.html", "accessed": "2026-09-16" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:wp-medical-travel", "note": "the £3,340 comparison is carried as the encyclopaedia carries it, undated; the second paragraph is this project reasoning" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited", "source": "s:wp-vilnius" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "lithuania", "type": "destination", "name": "Lithuania", "as": "The capital cluster, where most of the English-language clinics are.", "rel": "part" } ] }, { "schema": 1, "id": "warsaw", "type": "hub", "names": { "name": "Warsaw", "aliases": [ "Warszawa" ], "said": "Clinics quote a district — Śródmieście, Mokotów, Wola — the way a London clinic quotes a postcode." }, "region": [ "europe-central" ], "facets": { "iso2": "PL", "radius_km": 15, "specialty": [ "dentistry", "cosmetic surgery", "bariatric surgery", "fertility", "orthopaedics" ], "draws": [ "dental-implant", "all-on-four", "rhinoplasty", "gastric-sleeve", "ivf" ], "languages": [ "Polish", "English", "German" ] }, "text": { "what": "A capital of 1,866,729 people at the end of 2025, laid out in 18 districts, with the private clinics that take foreign patients concentrated in central Śródmieście and in Mokotów, Wola and Ochota around it. Warsaw sells dentistry and cosmetic and bariatric surgery to British, Irish and German patients on a two-hour flight, and it is also a departure point: the city is in a country whose own residents travel out for care its law does not provide.", "story": "Poland arrived in the trade the way Hungary did, through the price step that opened when the border did, and then through EU membership in 2004, which put Polish clinics inside the same regulatory market as the patients flying to them. Directive 2011/24/EU on patients' rights in cross-border healthcare gives an insured EU patient a reimbursement route at the home tariff, with prior authorisation required for some categories.\n\nThe outward flow is the part most directories leave out. Roughly 7,000 Polish women a year travel to the United Kingdom for abortion care, where it is provided free through the National Health Service — a figure the encyclopaedia that carries it attributes to a named reference rather than to a statistics office, and a flow driven by law rather than by price.\n\n*Inference —* a city can be both ends of the same subject at once, and Warsaw is. Somebody lands at Chopin for a dental arch that costs a third of the Dublin price on the same morning somebody else takes off for a procedure that is lawful at the other end and not at this one. The two journeys share an airport and almost nothing else, and a directory that only counted the arrivals would describe half a city.", "how": "*Trade practice —* the Warsaw clinic sells in English by email, quotes per unit, asks for a deposit and books the consultation and the procedure into the same trip. Dentistry runs on the usual two-visit implant course. Bariatric and cosmetic work is quoted as a package with the nights named, and the exclusions are the usual ones: imaging, laboratory work, a complication, and the night past the package.", "today": "As of 16 September 2026 this record carries no price row for Warsaw and no count of arrivals. The clinic pages read for this batch quoted ranges without a date.", "notes": "Fifteen kilometres from the city point covers all 18 districts." }, "geo": { "lat": 52.23, "lon": 21.0111, "precision": "city", "source": "s:wp-warsaw" }, "address": { "city": "Warsaw", "country": "PL" }, "kin": [ { "to": "poland", "as": "The country this cluster is the capital of, and one that trades in both directions.", "rel": "whole" }, { "to": "budapest", "as": "The other central European capital the same dental traffic is sent to.", "rel": "contrast" }, { "to": "dental-implant", "as": "The commonest booking, priced per implant.", "rel": "procedure" }, { "to": "gastric-sleeve", "as": "Sold here as a package with the nights named.", "rel": "procedure" }, { "to": "abortion-care", "as": "The care Polish residents leave the country to obtain, which makes this city a departure point as well as an arrival one.", "rel": "procedure" }, { "to": "circumvention-travel", "as": "The word for the outward half of this city's traffic.", "rel": "term" }, { "to": "eu-directive-2011-24", "as": "The reimbursement route an insured EU patient can use for care bought here.", "rel": "governed-by" }, { "to": "abortion-travel-law", "as": "The rule that decides which direction a patient moves in, and it is not price.", "rel": "governed-by" }, { "to": "who-travels", "as": "Why an arrivals count describes half a city.", "rel": "story" } ], "links": [ { "label": "Directive 2011/24/EU", "url": "https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX:32011L0024" } ], "sources": [ "s:wp-warsaw", "s:wp-medical-travel", "s:eu-directive-2011-24", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:wp-medical-travel", "note": "the 7,000 figure is carried as the encyclopaedia carries it, with its weak provenance stated; the last paragraph is this project reasoning" }, "text.how": { "tier": "tradition" }, "geo": { "tier": "cited", "source": "s:wp-warsaw" }, "facets.radius_km": { "tier": "inference" } } }, "x_commons_files": [ "File:Warsaw Śródmieście skyline.jpg" ], "needs_verification": true, "confidence": "medium", "updated": "2026-09-16", "blurb": "A capital of 1,866,729 people at the end of 2025, laid out in 18 districts, with the private clinics that take foreign patients concentrated in central Śródmieście and in Mokotów, Wola and Ochota around it.", "region_terms": [ { "key": "europe-central", "name": "Central Europe", "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia" } ], "kin_out": [ { "to": "poland", "type": "destination", "name": "Poland", "as": "The country this cluster is the capital of, and one that trades in both directions.", "rel": "whole" }, { "to": "budapest", "type": "hub", "name": "Budapest", "as": "The other central European capital the same dental traffic is sent to.", "rel": "contrast" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The commonest booking, priced per implant.", "rel": "procedure" }, { "to": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "Sold here as a package with the nights named.", "rel": "procedure" }, { "to": "abortion-care", "type": "procedure", "name": "Abortion", "as": "The care Polish residents leave the country to obtain, which makes this city a departure point as well as an arrival one.", "rel": "procedure" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The word for the outward half of this city's traffic.", "rel": "term" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The reimbursement route an insured EU patient can use for care bought here.", "rel": "governed-by" }, { "to": "abortion-travel-law", "type": "rule", "name": "Travelling for a termination", "as": "The rule that decides which direction a patient moves in, and it is not price.", "rel": "governed-by" }, { "to": "who-travels", "type": "story", "name": "Who travels", "as": "Why an arrivals count describes half a city.", "rel": "story" } ], "source_list": [ { "id": "s:wp-warsaw", "kind": "wikipedia", "title": "Warsaw", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Warsaw", "accessed": "2026-09-16", "note": "coordinates, population 1,866,729 at 31 December 2025, the 18 districts including Śródmieście, Mokotów, Wola and Ochota" }, { "id": "s:wp-medical-travel", "kind": "wikipedia", "title": "Medical tourism", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism", "accessed": "2026-09-16", "note": "used only for the figures it attributes to a named reference: Mosonmagyaróvár's dental clinic count, a Lithuanian hip replacement at £3,340 against a British commercial price roughly three times it, and Tunisia's thalassotherapy ranking. Its country-level traffic figures rest on market-research summaries and are not carried here." }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:wp-medical-travel", "note": "the 7,000 figure is carried as the encyclopaedia carries it, with its weak provenance stated; the last paragraph is this project reasoning" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited", "source": "s:wp-warsaw" }, "address": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "poland", "type": "destination", "name": "Poland", "as": "The capital cluster, weighted to cosmetic and aesthetic work.", "rel": "part" }, { "from": "budapest", "type": "hub", "name": "Budapest", "as": "The other central European capital British and Irish dental patients are sent to.", "rel": "contrast" } ] }, { "schema": 1, "id": "abdominoplasty", "type": "procedure", "names": { "name": "Abdominoplasty", "aliases": [ "tummy tuck", "lipectomy", "mini abdominoplasty", "panniculectomy" ], "said": "Price lists say tummy tuck. Hospital tables say lipectomy. Panniculectomy is the narrower operation - the apron of skin removed and nothing tightened - and is the version a health service occasionally funds after large weight loss." }, "etymology": { "root": "abdominoplasty: Latin abdomen, the belly, plus Greek plastos, moulded. Lipectomy is fat plus ektome, a cutting out, and it is the older and more accurate word for what the operation does to fat.", "tier": "tradition", "note": "a full abdominoplasty moves the navel and usually repairs the separated abdominal muscles; a mini does neither. The two words sit one line apart on most price lists and differ by a third of the price." }, "region": [ "global" ], "facets": { "family": "cosmetic", "setting": "inpatient", "anaesthesia": "general" }, "text": { "what": "Skin and fat are cut away from the lower abdomen through a long transverse incision above the pubis, the separated abdominal muscles are usually stitched back together, the navel is brought out through a new opening and the remaining skin is drawn down and closed. Drains are common. It is the largest of the routine cosmetic operations, and the one whose recovery most resembles general surgery.", "story": "Abdominoplasty is where cosmetic surgery meets the aftermath of bariatric surgery and of pregnancy, and where the queue at home and the fee abroad meet most directly: health services fund the operation narrowly, if at all, after large weight loss, and privately it is priced as a major procedure everywhere.\n\nThe published prices differ by a factor of ten and by more than that in what they cover. Yanhee in Bangkok prices a tummy tuck for a patient under 70 kilograms at 126,000 baht with three nights on the ward - a weight condition on the face of the price list. Premier Clinic in Prague prices abdominoplasty from 62,000 koruna and a mini from 47,000. Artplastica in Poland prices a full abdominoplasty at 26,000 zloty with the ward day charged separately at 800. The American society publishes 8,174 US dollars as a surgeon's fee alone.\n\n*Trade practice --* this is the operation on which the flight home matters most. It combines a long wound, drains, restricted movement and a patient who has been immobile, and the usual guidance on flying after abdominal surgery is measured in weeks rather than days. A package that ends at discharge leaves the flight, the accommodation and the drain removal to be arranged by somebody.", "how": "General anaesthesia, three or more nights in published packages, drains for several days, compression garment for weeks. Patients walk bent forward at first because the skin has been pulled tight. Return to ordinary activity runs to six weeks and to lifting longer. Muscle repair, where done, adds pain and adds time. Where the operation follows major weight loss, the skin quality and the weight stability decide the result more than the technique.", "today": "Four published prices, read in September 2026, from Thailand, Czechia, Poland and the United States. The Thai one carries a body-weight condition, the Polish one excludes the ward, the Czech one begins with from, and the American one is a fee rather than a bill.", "notes": "This page describes an operation. It offers no advice on having one." }, "metrics": { "stay_days": 3, "days_before_flying": 10, "note": "Three nights is the ward stay printed beside the tummy tuck line on the Yanhee table read for this record, not a clinical standard. The ten-day figure is the CDC Yellow Book's guidance against flying for ten days after abdominal surgery; several plastic surgery bodies quote longer for this operation, and the record carries the shortest sourced figure rather than the longest unsourced one.", "as_of": "2026-09-16", "source": "s:cdc-yellowbook-medical-tourism", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism" }, "prices": [ { "procedure": "abdominoplasty", "country": "TH", "city": "Bangkok", "amount": 126000, "currency": "THB", "as_of": "2026-09-16", "kind": "list", "includes": [ "tummy tuck (lipectomy)", "three nights on the ward" ], "excludes": [ "patients over 70 kg: the price line states body weight less than 70 kgs" ], "source": "s:yanhee-plastic-prices", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "note": "the weight condition is printed in the procedure name on the hospital's own table, which is unusual: most price lists put that condition in a consultation rather than on the page", "tier": "cited", "usd": 3784.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "abdominoplasty", "country": "CZ", "city": "Prague", "amount": 62000, "currency": "CZK", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [ "abdominoplasty" ], "excludes": [ "not stated on the page" ], "source": "s:premier-clinic-prague-prices", "url": "https://www.premier-clinic.cz/en/price-list-plastic-surgery/", "note": "listed as 'from'; mini abdominoplasty from 47,000 CZK on the same list, and a line for abdominoplasty including muscle repair at 58,300 CZK which sits below the plain one", "tier": "cited", "usd": 2944.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "abdominoplasty", "country": "PL", "city": "Szczecin", "amount": 26000, "currency": "PLN", "as_of": "2026-09-16", "kind": "list", "includes": [ "full abdominoplasty" ], "excludes": [ "hospitalisation, listed separately at 800 PLN a day" ], "source": "s:artplastica-cennik", "url": "https://www.artplastica.pl/cennik-zabiegi-operacje-plastyczne/", "note": "the clinic states its prices are indicative and may change at consultation; with three nights the ward adds 2,400 PLN to this line", "tier": "cited", "usd": 6909.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "abdominoplasty", "country": "US", "amount": 8174, "currency": "USD", "as_of": "2026-09-16", "kind": "survey", "includes": [ "surgeon fee only" ], "excludes": [ "anesthesia", "operating room facilities", "other related expenses" ], "source": "s:asps-cost-tummy-tuck", "url": "https://www.plasticsurgery.org/cosmetic-procedures/tummy-tuck/cost", "note": "no year named on the page", "tier": "cited", "usd": 8174.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "liposuction", "as": "The operation that takes the fat and leaves the skin; this one takes the skin.", "rel": "contrast" }, { "to": "gastric-sleeve", "as": "The operation that fills this one's waiting room, and whose patients arrive with skin nobody funded removing.", "rel": "kin" }, { "to": "flying-after-surgery", "as": "The wound, the drains and the clot risk that set the earliest flight home.", "rel": "risk" }, { "to": "dvt-pe", "as": "The clot this operation and the flight home both raise.", "rel": "risk" }, { "to": "the-companion", "as": "Somebody has to be there for the drains and the first week bent forward.", "rel": "step" }, { "to": "thailand", "as": "Where the price carries a body-weight condition on its face.", "rel": "destination" }, { "to": "czechia", "as": "Where the mini and the full operation are priced a line apart.", "rel": "destination" }, { "to": "poland", "as": "Where the ward day is a separate line from the operation.", "rel": "destination" }, { "to": "reading-the-exclusions", "as": "The step at which a weight limit or a missing ward night turns up.", "rel": "step" } ], "confusable_with": [ { "id": "liposuction", "tell": "A tummy tuck cuts skin away and moves the navel; liposuction does neither. Bundled 'body contouring' quotes can mean either." } ], "links": [ { "label": "Yanhee price table", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/" } ], "sources": [ "s:yanhee-plastic-prices", "s:premier-clinic-prague-prices", "s:artplastica-cennik", "s:asps-cost-tummy-tuck", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "prices read off the four named pages; the flight paragraph is marked as trade practice inline" }, "text.how": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:cdc-yellowbook-medical-tourism" }, "etymology": { "tier": "tradition" } } }, "x_commons_files": [ "File:Abdominoplasty.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "Skin and fat are cut away from the lower abdomen through a long transverse incision above the pubis, the separated abdominal muscles are usually stitched back together, the navel is brought out through a new opening and…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "liposuction", "type": "procedure", "name": "Liposuction", "as": "The operation that takes the fat and leaves the skin; this one takes the skin.", "rel": "contrast" }, { "to": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "The operation that fills this one's waiting room, and whose patients arrive with skin nobody funded removing.", "rel": "kin" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The wound, the drains and the clot risk that set the earliest flight home.", "rel": "risk" }, { "to": "dvt-pe", "type": "risk", "name": "Deep vein thrombosis and pulmonary embolism", "as": "The clot this operation and the flight home both raise.", "rel": "risk" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "Somebody has to be there for the drains and the first week bent forward.", "rel": "step" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the price carries a body-weight condition on its face.", "rel": "destination" }, { "to": "czechia", "type": "destination", "name": "Czechia", "as": "Where the mini and the full operation are priced a line apart.", "rel": "destination" }, { "to": "poland", "type": "destination", "name": "Poland", "as": "Where the ward day is a separate line from the operation.", "rel": "destination" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step at which a weight limit or a missing ward night turns up.", "rel": "step" } ], "source_list": [ { "id": "s:yanhee-plastic-prices", "kind": "web", "title": "Plastic Surgery Prices", "publisher": "Yanhee Hospital, Bangkok", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "accessed": "2026-09-16", "note": "hospital's own price table: procedure, nights, price in Thai baht. The page carries no validity date and no inclusion list." }, { "id": "s:premier-clinic-prague-prices", "kind": "web", "title": "Price List - Plastic Surgery", "publisher": "Premier Clinic, Prague", "url": "https://www.premier-clinic.cz/en/price-list-plastic-surgery/", "accessed": "2026-09-16", "note": "clinic's own English price list, every line prefixed 'from', in Czech koruna" }, { "id": "s:artplastica-cennik", "kind": "web", "title": "Cennik zabiegow i operacji plastycznych", "publisher": "Beauty Group - Artplastica, Szczecin", "url": "https://www.artplastica.pl/cennik-zabiegi-operacje-plastyczne/", "accessed": "2026-09-16", "note": "clinic's own price list in zloty; the page states the prices are indicative and may change at consultation, and lists hospitalisation at 800 PLN a day separately" }, { "id": "s:asps-cost-tummy-tuck", "kind": "org", "title": "Tummy Tuck Cost", "publisher": "American Society of Plastic Surgeons", "url": "https://www.plasticsurgery.org/cosmetic-procedures/tummy-tuck/cost", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "prices read off the four named pages; the flight paragraph is marked as trade practice inline" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:cdc-yellowbook-medical-tourism" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "australia", "type": "destination", "name": "Australia", "as": "The procedure that came back most often in the Australian series.", "rel": "procedure" }, { "from": "brazil", "type": "destination", "name": "Brazil", "as": "A Brazilian staple, and one of the pairings sold on a single list.", "rel": "procedure" }, { "from": "dominican-republic", "type": "destination", "name": "Dominican Republic", "as": "The second commonest, at 58%.", "rel": "procedure" }, { "from": "panama", "type": "destination", "name": "Panama", "as": "One of the body operations behind the surgical count.", "rel": "procedure" }, { "from": "tunis", "type": "hub", "name": "Tunis", "as": "Sold here with the convalescence hotel written into the quote.", "rel": "procedure" }, { "from": "liposuction", "type": "procedure", "name": "Liposuction", "as": "The operation that removes the skin this one leaves behind, and the one it is often sold beside.", "rel": "contrast" }, { "from": "dvt-pe", "type": "risk", "name": "Deep vein thrombosis and pulmonary embolism", "as": "A long operation on a patient kept still, and one of the commonest reasons for travel.", "rel": "procedure" }, { "from": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "Abdominal surgery, which is what the ten-day figure names.", "rel": "procedure" }, { "from": "nontuberculous-mycobacteria", "type": "risk", "name": "Nontuberculous mycobacteria", "as": "Among the procedures in both Dominican clusters.", "rel": "procedure" }, { "from": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The highest cost per patient in the Royal Free series.", "rel": "procedure" }, { "from": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The procedure with the longest stay among UK patients readmitted after surgery abroad.", "rel": "procedure" } ] }, { "schema": 1, "id": "abortion-care", "type": "procedure", "names": { "name": "Abortion", "aliases": [ "termination of pregnancy", "induced abortion", "medical abortion", "surgical abortion", "vacuum aspiration", "interrupción voluntaria del embarazo", "IVG" ], "said": "Clinics say the abortion pill for the tablets and surgical for the procedure. Statutes say termination of pregnancy. Registers say induced abortion and count by gestational week, because the week is what the law usually turns on." }, "etymology": { "root": "abortion: Latin abortio, from aboriri, to miscarry or pass away — ab-, away, plus oriri, to rise or be born. The Latin word covered what English separates into miscarriage and induced abortion, and several languages still use one word for both; a statistic that does not say which it counts is not readable.", "tier": "tradition", "note": "Medical abortion means drugs — mifepristone followed by misoprostol — and no instruments. Surgical abortion means vacuum aspiration up to about fourteen weeks and dilatation and evacuation after it. Price lists are usually organised by that split and then by week, because both the price and the law change at the week boundaries." }, "region": [ "global", "europe-west", "north-america" ], "facets": { "family": "reproductive", "setting": "day-case", "anaesthesia": "varies" }, "text": { "what": "A pregnancy is ended, either with drugs or with a procedure. The drug route is two medicines taken a day or two apart, most of it completed at home, and it is used in early pregnancy. The procedure route empties the uterus through the cervix — by suction in the first trimester, by instruments later — takes minutes, and is done under local anaesthetic, sedation or general anaesthetic depending on the gestation and the clinic. Both are day cases; later gestations may take two days and a night.", "story": "Almost nothing about this journey is medical. The procedure is short and the same in every country that performs it; what differs is whether it may be performed, up to what week, on whose authorisation, and who pays. Where the law at home says no and the law next door says yes, the difference between them is a plane ticket, and that is the whole of the market.\n\nThe pricing follows the law rather than the medicine. The British Pregnancy Advisory Service publishes one list in two currencies, sterling and euro, which is the clearest single artefact of cross-border travel in this directory: an organisation states that \"97% of the women we see, have their treatment paid for by the NHS (or another government department)\" and prices the remaining cases in the currency of the countries its other patients come from. On that list the abortion pill under ten weeks is £622 in total, £180 of it consultation; surgical treatment to fourteen weeks is £1,166; fourteen to twenty weeks £1,373; over twenty weeks £3,044. It notes special prices for women from the Republic of Ireland and the Channel Islands, restricts its pills-by-post service to England and Wales, and points European patients to the Abortion Support Network.\n\nIn the Netherlands the price is not published at all, and the reason is the same. Abortuskliniek Stimezo in Zwolle states that treatment is free for women living in the Netherlands, paid directly by the Ministry of Health, with no deductible and no notification of the insurer or the family doctor. For a woman who lives elsewhere it gives a telephone number: \"Bel ons op 038 - 421 7000 voor een persoonlijke prijsopgave.\" A tariff that exists for residents and becomes a phone call for everyone else is a legal boundary with a price attached.\n\nIn the United States the split runs inside the country rather than across a border, and a provider's price page shows it: carafem publishes ranges beginning at nothing — in-office abortion pill appointments at 0 to 475 dollars, procedures at 0 to 550 in Atlanta and Washington and 0 to 600 in Chicago — with the floor explained by abortion funds rather than by insurance.\n\nBy post, a route with no destination country at all: Women on Web, a Canadian non-profit, states that \"A donation of €90 can give one woman or pregnant person access to this essential health service\" and describes working across almost 200 countries \"in a complex technology landscape that involves Internet censorship\".\n\nThe country-by-country reading of who may be treated, up to which week, on whose authority, sits on this directory's abortion travel law page. It is not on this one, because it changes and a stale legal row is a wrong one.", "how": "Medical abortion: mifepristone, then misoprostol 24 to 48 hours later, with the bleeding and cramping that follow taking hours to a day. Surgical abortion: cervical preparation, then vacuum aspiration or, later, dilatation and evacuation, followed by an hour or two of recovery. Both need a way to reach a clinician if bleeding is heavy or pain is severe, and that is the part a journey home interrupts. Prices are quoted by gestational week and by method, and the consultation is frequently a separate line: on the one full list read for this record it is £180 of a £622 total.", "today": "As of 17 September 2026 two countries' provider pages carrying published abortion prices were read for this record, the United Kingdom and the United States, and a third, the Netherlands, publishes a price of zero for residents and a telephone number for everyone else. The dual-currency column on the British list is the closest thing in this directory to a published price for a border.", "notes": "This page describes a procedure and reports published prices and published statements. It is not medical advice and it is not legal advice, and it takes no position on the law of any country." }, "metrics": { "stay_days": 0, "days_before_flying": null, "recovery_weeks": null, "note": "A day case in both routes; the later gestations on the one full price list read here are still priced as treatment rather than as an admission. No source read for this record publishes a wait before flying, and the constraint after a medical abortion is being within reach of a clinician while the bleeding settles rather than the flight itself.", "as_of": "2026-09-17", "source": "s:bpas-prices", "url": "https://www.bpas.org/abortion-care/considering-abortion/costs-and-pricing/" }, "prices": [ { "procedure": "abortion-care", "country": "GB", "amount": 622, "currency": "GBP", "as_of": "2026-09-17", "kind": "list", "includes": [ "consultation, £180", "treatment, £442", "abortion pill treatment up to 10 weeks" ], "excludes": [ "anything after 10 weeks, which is priced on separate lines", "travel and accommodation" ], "source": "s:bpas-prices", "url": "https://www.bpas.org/abortion-care/considering-abortion/costs-and-pricing/", "note": "the provider publishes every line twice, in sterling and in euro: this one is €820. It states that 97% of the women it sees have treatment paid for by the NHS or another government department, and that special prices apply for women from the Republic of Ireland and the Channel Islands.", "tier": "cited", "usd": 838.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "abortion-care", "country": "GB", "amount": 1166, "amount_high": 3044, "currency": "GBP", "as_of": "2026-09-17", "kind": "list", "includes": [ "consultation at £180 in every band", "surgical treatment" ], "excludes": [ "travel and accommodation", "any second visit" ], "source": "s:bpas-prices", "url": "https://www.bpas.org/abortion-care/considering-abortion/costs-and-pricing/", "note": "the surgical bands on the same list: to 14 weeks £1,166 total (€1,520), 14-20 weeks £1,373 (€1,790), over 20 weeks £3,044 (€3,970). The price roughly doubles at twenty weeks, which is also where several European statutes stop.", "tier": "cited", "usd": 1571.0, "usd_high": 4102.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "abortion-care", "country": "US", "amount": 0, "amount_high": 600, "currency": "USD", "as_of": "2026-09-17", "kind": "list", "includes": [ "the in-office appointment" ], "excludes": [ "travel between states, which for many of this provider's patients is the larger number", "any figure the page does not name" ], "source": "s:carafem-cost", "url": "https://carafem.org/cost", "note": "ranges by clinic city: in-office abortion pill 0-475 dollars in Atlanta and Chicago and 0-450 in Washington DC; in-office procedure 0-550 in Atlanta and Washington and 0-600 in Chicago. Online evaluation and video visit are 0-399. The zero floor is explained on the page by partnership with abortion funds, not by insurance.", "tier": "cited", "usd": 0.0, "usd_high": 600.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "abortion-travel-law", "as": "Where the country-by-country reading sits: who may be treated, up to what week, and on whose authorisation.", "rel": "governed-by" }, { "to": "circumvention-travel", "as": "The name for crossing a border to do lawfully what home law forbids.", "rel": "term" }, { "to": "united-kingdom", "as": "Where a provider publishes one price list in two currencies, sterling and euro.", "rel": "destination" }, { "to": "united-states", "as": "Where the same journey runs between states and a provider's price floor is an abortion fund.", "rel": "destination" }, { "to": "ireland", "as": "The route the euro column on the British list was written for.", "rel": "destination" }, { "to": "cross-border-prescriptions", "as": "The by-post route, where the medicine crosses the border instead of the patient.", "rel": "rule" }, { "to": "getting-a-quote", "as": "The step at which a resident's price of zero becomes a non-resident's telephone call.", "rel": "step" }, { "to": "reading-the-exclusions", "as": "The consultation is a separate line on every list read here, and it is a third of the smallest total.", "rel": "step" }, { "to": "the-flight-home", "as": "Where a day case stops being a day case: the bleeding and the distance from a clinician.", "rel": "step" }, { "to": "patient-data-transfer", "as": "What is recorded, who is told, and what follows the patient home — a Dutch clinic states it informs neither insurer nor family doctor.", "rel": "rule" }, { "to": "ivf", "as": "The other reproductive procedure whose travel is set by what each country's law allows rather than by price.", "rel": "contrast" } ], "confusable_with": [ { "id": "ivf", "tell": "Both are called reproductive travel and both are driven by statute rather than by surgery, but one is sought to end a pregnancy and the other to begin one, and no country's law treats them as the same question." } ], "links": [ { "label": "BPAS abortion and contraception price list", "url": "https://www.bpas.org/abortion-care/considering-abortion/costs-and-pricing/" }, { "label": "carafem — cost", "url": "https://carafem.org/cost" }, { "label": "Abortuskliniek Stimezo Zwolle — kosten van abortus", "url": "https://www.stimezo-zwolle.nl/kosten-abortus/" } ], "sources": [ "s:bpas-prices", "s:carafem-cost", "s:stimezo-zwolle-kosten", "s:women-on-web" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "tradition", "note": "standard description of the two routes; the gestational boundaries follow the price lists rather than any one statute" }, "text.story": { "tier": "cited", "source": "s:bpas-prices", "note": "every price and every quotation is read off the named page" }, "text.how": { "tier": "tradition", "note": "standard clinical sequence; the £180 consultation figure is cited to the price list" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:bpas-prices" }, "metrics": { "tier": "cited", "source": "s:bpas-prices" } } }, "x_commons_files": [ "File:Mifepristone and misoprostol.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "A pregnancy is ended, either with drugs or with a procedure. The drug route is two medicines taken a day or two apart, most of it completed at home, and it is used in early pregnancy.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "abortion-travel-law", "type": "rule", "name": "Travelling for a termination", "as": "Where the country-by-country reading sits: who may be treated, up to what week, and on whose authorisation.", "rel": "governed-by" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The name for crossing a border to do lawfully what home law forbids.", "rel": "term" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Where a provider publishes one price list in two currencies, sterling and euro.", "rel": "destination" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "Where the same journey runs between states and a provider's price floor is an abortion fund.", "rel": "destination" }, { "to": "ireland", "type": "destination", "name": "Ireland", "as": "The route the euro column on the British list was written for.", "rel": "destination" }, { "to": "cross-border-prescriptions", "type": "rule", "name": "A prescription that crosses a border", "as": "The by-post route, where the medicine crosses the border instead of the patient.", "rel": "rule" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step at which a resident's price of zero becomes a non-resident's telephone call.", "rel": "step" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The consultation is a separate line on every list read here, and it is a third of the smallest total.", "rel": "step" }, { "to": "the-flight-home", "type": "pathway", "name": "The flight home", "as": "Where a day case stops being a day case: the bleeding and the distance from a clinician.", "rel": "step" }, { "to": "patient-data-transfer", "type": "rule", "name": "Moving a medical record across a border", "as": "What is recorded, who is told, and what follows the patient home — a Dutch clinic states it informs neither insurer nor family doctor.", "rel": "rule" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The other reproductive procedure whose travel is set by what each country's law allows rather than by price.", "rel": "contrast" } ], "source_list": [ { "id": "s:bpas-prices", "kind": "web", "title": "Abortion and Contraception Price List", "publisher": "British Pregnancy Advisory Service", "url": "https://www.bpas.org/abortion-care/considering-abortion/costs-and-pricing/", "accessed": "2026-09-16" }, { "id": "s:carafem-cost", "kind": "web", "title": "Abortion Cost and reproductive health care services", "publisher": "carafem (Atlanta, Chicago, Washington DC)", "url": "https://carafem.org/cost", "accessed": "2026-09-16", "note": "sliding-scale prices by clinic city" }, { "id": "s:stimezo-zwolle-kosten", "kind": "web", "title": "Kosten van abortus", "publisher": "Abortuskliniek Stimezo, Zwolle", "url": "https://www.stimezo-zwolle.nl/kosten-abortus/", "accessed": "2026-09-16", "note": "free for women resident in the Netherlands, paid by the Ministry of Health; other tariffs for women without Dutch insurance or address, quoted by telephone rather than published" }, { "id": "s:women-on-web", "kind": "org", "title": "I need an abortion", "publisher": "Women on Web", "url": "https://www.womenonweb.org/en/page/521/i-need-an-abortion", "accessed": "2026-09-16", "note": "a Canadian non-profit facilitating online access to abortion pills, asking a donation of 90 euro" } ], "tiers": { "text.what": { "tier": "tradition", "note": "standard description of the two routes; the gestational boundaries follow the price lists rather than any one statute" }, "text.story": { "tier": "cited", "source": "s:bpas-prices", "note": "every price and every quotation is read off the named page" }, "text.how": { "tier": "tradition", "note": "standard clinical sequence; the £180 consultation figure is cited to the price list" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:bpas-prices" }, "metrics": { "tier": "cited", "source": "s:bpas-prices" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "ireland", "type": "destination", "name": "Ireland", "as": "The journey the euro column on a British price list was written for.", "rel": "procedure" }, { "from": "warsaw", "type": "hub", "name": "Warsaw", "as": "The care Polish residents leave the country to obtain, which makes this city a departure point as well as an arrival one.", "rel": "procedure" }, { "from": "abortion-travel-law", "type": "rule", "name": "Travelling for a termination", "as": "The procedure these instruments govern.", "rel": "procedure" } ] }, { "schema": 1, "id": "acl-reconstruction", "type": "procedure", "names": { "name": "Anterior cruciate ligament reconstruction", "aliases": [ "ACL reconstruction", "ACLR", "knee ligament reconstruction" ], "said": "Everyone says ACL. Surgeons add the graft — hamstring, patellar tendon, quadriceps — because that is the decision the operation turns on. Package pages say knee ligament surgery and bundle the meniscus in with it." }, "etymology": { "root": "cruciate: Latin cruciatus, from crux, a cross — the two ligaments cross inside the knee. Anterior is Latin for the one in front. Graft comes through French greffe from Greek graphion, a stylus, for the shape of the shoot a gardener slips under bark.", "tier": "tradition", "note": "Reconstruction, not repair: the torn ligament is replaced with tendon, from the patient's own knee, from the other leg, or from a donor. Which graft a price covers is rarely on the price page." }, "region": [ "global" ], "facets": { "family": "orthopaedic", "setting": "inpatient", "anaesthesia": "general" }, "text": { "what": "The torn cruciate ligament is replaced with a tendon graft threaded through tunnels drilled in the femur and the tibia and fixed at both ends. It is done arthroscopically, often with a meniscal repair in the same anaesthetic, and it is the operation of young sport rather than old arthritis. The rehabilitation, not the surgery, is the long part.", "story": "The ACL is the youngest patient on this site's price table, and it changes what travelling costs. A knee replacement patient is leaving a queue; an ACL patient is leaving a season, and the calculation is weeks rather than pain.\n\nThe published prices come in the usual four shapes. Bumrungrad in Bangkok packages arthroscopic knee ligament surgery — its page names ACL and PCL and says meniscus work is included — at 279,000 baht with two nights, marked down 10% from 310,000 under a campaign. Practice Plus Group in England lists ACL reconstruction at £7,399, with theatre, anaesthetic, any overnight stay, physiotherapy and post-operative appointments inside the figure. Nordorthopaedics in Kaunas advertises it \"from 2.500 € / 2.085 £\" and states no inclusions at all. Australia's schedule sets item 49542 at $1,577.30 as at 1 July 2026, and the item's own wording folds in graft harvest, donor site repair, meniscal repair, collateral ligament repair and any other associated intra-articular surgery — five things for one fee.\n\n*Inference —* the English price is the only one of the four that names physiotherapy. On an operation where the graft is sound at six weeks and the knee is not trusted for nine months, the physiotherapy line is the one worth reading first, and three of the four price pages are silent about it.", "how": "General anaesthesia, day case or one to two nights. The surgeon harvests the graft, drills the tunnels through the tibia and femur, pulls the graft through, and fixes it with screws, buttons or staples. Weight-bearing starts within days; the rehabilitation programme runs months and is supervised. Bumrungrad's ligament package books two nights; the same hospital prices a heavier multi-ligament package — PCL with posterolateral corner — at 299,400 baht.", "today": "As of 16 September 2026 the ACL prices on this site run from an advertised Lithuanian floor of 2,500 euro to £7,399 in England, with Bangkok at 279,000 baht for two nights and the Australian schedule fee at $1,577.30 for the surgeon's service alone.", "notes": "This page describes an operation and the prices published for it, and gives no clinical guidance." }, "metrics": { "stay_days": 2, "days_before_flying": 10, "recovery_weeks": null, "note": "Two nights is the stay named on Bumrungrad's ligament package listing. No page read for this record publishes a return-to-sport or recovery span, so recovery_weeks stays empty even though rehabilitation is the long half of this operation. The ten days before flying is the CDC's guidance for chest or abdominal surgery, applied by analogy for the clot risk of lower-limb surgery.", "as_of": "2026-09-16", "source": "s:bumrungrad-joint-packages", "url": "https://www.bumrungrad.com/en/packages/packages-center/joint-replacement-surgery" }, "prices": [ { "procedure": "acl-reconstruction", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 279000, "currency": "THB", "as_of": "2026-09-16", "kind": "package", "includes": [ "arthroscopic knee ligament based surgery (ie. ACL, PCL)", "meniscus work", "2 nights of hospital stay" ], "excludes": [], "source": "s:bumrungrad-joint-packages", "url": "https://www.bumrungrad.com/en/packages/packages-center/joint-replacement-surgery", "note": "listed at 279,000 THB against 310,000 THB under a campaign the page labels \"Special Campaign Receive a 10% Discount\". The package list page names the nights and the inclusion of meniscus work; the per-package exclusion list sits on the package's own detail page, which was not read for this record. A heavier multi-ligament package on the same page is 299,400 THB.", "tier": "cited", "usd": 8380.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "acl-reconstruction", "country": "GB", "city": "England", "amount": 7399, "currency": "GBP", "as_of": "2026-09-16", "kind": "list", "includes": [ "pre-operative nurse review", "prescriptions, dressings and equipment", "anaesthetic", "any overnight stay required", "physiotherapy", "pathology and histology needed whilst admitted", "any post-operative appointments required", "a named knee consultant from start to finish" ], "excludes": [ "the initial consultation, listed separately at £145, which the page says includes x-ray, bloods and swabs" ], "source": "s:practiceplus-knee", "url": "https://practiceplusgroup.com/treatments/knee-surgery/", "note": "the group's published self-pay price, and the only one of the four read for this record that names physiotherapy inside the figure.", "tier": "cited", "usd": 9971.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "acl-reconstruction", "country": "LT", "city": "Kaunas", "amount": 2500, "currency": "EUR", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [], "excludes": [], "source": "s:nordorthopaedics-prices", "url": "https://www.nordorthopaedics.com/hip-knee-wrist-hand-ankle-foot-shoulder-surgery-prices/", "note": "advertised as \"from 2.500 € / 2.085 £\" with no inclusion list on the page.", "tier": "cited", "usd": 2884.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "acl-reconstruction", "country": "AU", "amount": 1577.3, "currency": "AUD", "as_of": "2026-07-01", "kind": "tariff", "includes": [ "the medical service described in item 49542: reconstruction of anterior or posterior cruciate ligament of knee, by open or arthroscopic means, including graft harvest, donor site repair, meniscal repair, collateral ligament repair, extra-articular tenodesis and any other associated intra-articular surgery if performed" ], "excludes": [ "hospital accommodation and theatre", "fixation devices", "the anaesthetist's own items", "physiotherapy", "any amount charged above the schedule fee" ], "source": "s:mbs-49542", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=49542&qt=item", "note": "Medicare Benefits Schedule item 49542, fee last updated 1 July 2026; 75% benefit $1,183.00. The same fee as a total hip replacement under item 49318, which is what a fee schedule looks like when it prices work rather than joints.", "tier": "cited", "usd": 1124.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "knee-arthroscopy", "as": "The smaller operation done through the same portals, and often in the same anaesthetic.", "rel": "contrast" }, { "to": "knee-replacement", "as": "The other knee on the price table, thirty years further on.", "rel": "contrast" }, { "to": "bumrungrad", "as": "Packages this operation with meniscus work and two nights.", "rel": "performed-at" }, { "to": "thailand", "as": "Where the Bangkok ligament package on this page is sold.", "rel": "destination" }, { "to": "united-kingdom", "as": "Where the £7,399 self-pay price on this page is sold, physiotherapy inside it.", "rel": "destination" }, { "to": "lithuania", "as": "Where the advertised floor price on this page comes from.", "rel": "destination" }, { "to": "australia", "as": "Whose schedule pays the same fee for this as for a hip replacement.", "rel": "destination" }, { "to": "follow-up-gap", "as": "Who supervises nine months of rehabilitation after a two-night admission abroad.", "rel": "risk" }, { "to": "aftercare-at-home", "as": "The step this operation lives or dies by, and which most price pages leave out.", "rel": "step" }, { "to": "package-price", "as": "The form the Bangkok price takes, meniscus work folded in.", "rel": "term" } ], "confusable_with": [ { "id": "knee-arthroscopy", "tell": "Both are keyhole knee operations; one replaces a ligament with a graft, the other trims or repairs cartilage, and the price gap between them is threefold." } ], "links": [ { "label": "MBS item 49542", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=49542&qt=item" }, { "label": "Practice Plus Group knee prices", "url": "https://practiceplusgroup.com/treatments/knee-surgery/" } ], "sources": [ "s:bumrungrad-joint-packages", "s:practiceplus-knee", "s:nordorthopaedics-prices", "s:mbs-49542", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "four prices read off four named pages; the closing stretch is this project's reading of what they leave out" }, "text.how": { "tier": "tradition", "note": "standard operative description; nights and the multi-ligament price are cited to the package page" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:bumrungrad-joint-packages" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:ACL reconstruction arthroscopic view.jpg", "File:Anterior cruciate ligament.png" ], "confidence": "high", "updated": "2026-09-16", "blurb": "The torn cruciate ligament is replaced with a tendon graft threaded through tunnels drilled in the femur and the tibia and fixed at both ends.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "knee-arthroscopy", "type": "procedure", "name": "Knee arthroscopy", "as": "The smaller operation done through the same portals, and often in the same anaesthetic.", "rel": "contrast" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The other knee on the price table, thirty years further on.", "rel": "contrast" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Packages this operation with meniscus work and two nights.", "rel": "performed-at" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the Bangkok ligament package on this page is sold.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Where the £7,399 self-pay price on this page is sold, physiotherapy inside it.", "rel": "destination" }, { "to": "lithuania", "type": "destination", "name": "Lithuania", "as": "Where the advertised floor price on this page comes from.", "rel": "destination" }, { "to": "australia", "type": "destination", "name": "Australia", "as": "Whose schedule pays the same fee for this as for a hip replacement.", "rel": "destination" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who supervises nine months of rehabilitation after a two-night admission abroad.", "rel": "risk" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The step this operation lives or dies by, and which most price pages leave out.", "rel": "step" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The form the Bangkok price takes, meniscus work folded in.", "rel": "term" } ], "source_list": [ { "id": "s:bumrungrad-joint-packages", "kind": "web", "title": "Sports Medicine & Joint Center — package list", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/packages-center/joint-replacement-surgery", "accessed": "2026-09-16", "note": "arthroscopy, ligament, knee and hip package prices in one table; read in a browser because the page is rendered by script" }, { "id": "s:practiceplus-knee", "kind": "web", "title": "Private knee surgery and treatment — self-pay price list", "publisher": "Practice Plus Group", "url": "https://practiceplusgroup.com/treatments/knee-surgery/", "accessed": "2026-09-16" }, { "id": "s:nordorthopaedics-prices", "kind": "web", "title": "Orthopaedic Surgery Prices", "publisher": "Nordorthopaedics Clinic, Kaunas", "url": "https://www.nordorthopaedics.com/hip-knee-wrist-hand-ankle-foot-shoulder-surgery-prices/", "accessed": "2026-09-16", "note": "every figure is written as a 'from' price in euro and sterling; the page carries no inclusion list" }, { "id": "s:mbs-49542", "kind": "gov", "title": "MBS item 49542 — reconstruction of anterior or posterior cruciate ligament of knee", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=49542&qt=item", "accessed": "2026-09-16", "note": "schedule fee $1,577.30, fee last updated 01-Jul-2026" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "four prices read off four named pages; the closing stretch is this project's reading of what they leave out" }, "text.how": { "tier": "tradition", "note": "standard operative description; nights and the multi-ligament price are cited to the package page" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:bumrungrad-joint-packages" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "knee-arthroscopy", "type": "procedure", "name": "Knee arthroscopy", "as": "The bigger operation through the same portals, and three times the price.", "rel": "contrast" } ] }, { "schema": 1, "id": "addiction-rehab", "type": "procedure", "names": { "name": "Residential addiction treatment", "aliases": [ "rehab", "inpatient rehabilitation", "detox and rehab", "residential treatment programme" ], "said": "The trade says rehab and prices it by the programme: 28 days, 30 days, twelve weeks. Detox is the medical part and is sometimes sold on its own; the rest is therapy, accommodation and time." }, "etymology": { "root": "rehabilitation: Latin re- plus habilitare, to make fit again, from habilis, able. The word entered medicine through war injury and industrial compensation before it attached to drinking and drugs, which is part of why the treatment is priced like a hotel with clinicians attached rather than like an operation.", "tier": "tradition", "note": "detox and rehab are different products. Detox is a supervised withdrawal measured in days; a rehabilitation programme is measured in weeks, and a price for one is not a price for the other." }, "region": [ "global", "southeast-asia", "europe-west" ], "facets": { "family": "rehabilitation", "setting": "inpatient", "anaesthesia": "none" }, "text": { "what": "A stay of several weeks in a residential centre: medically supervised withdrawal where it is needed, then individual and group therapy, structured days, and an aftercare plan. The unit of sale is the programme or the week, not the procedure. Accommodation, food and staff time are most of the cost, which is why the price maps onto the local cost of living more directly than any surgical price does.", "story": "Residential addiction treatment crossed borders for the same reason cosmetic surgery did, and earlier: the product is staff-intensive, it is rarely funded, and the price gap between a Thai centre and a British one is a multiple rather than a margin.\n\nThe Dawn in Chiang Mai publishes a bracket rather than a price - 10,000 to 20,000 US dollars for a month's stay - and publishes both lists that matter. Included: private en suite accommodation, three meals, medically supervised detox where needed, two individual therapy sessions and fifteen hours of group therapy a week, 24-hour nursing, daily wellness activities, weekly outings, airport transfers and lifetime weekly aftercare groups. Excluded: international flights, visa extension fees, medications, TMS therapy, off-site medical services, unrelated transport and travel or health insurance.\n\nThe Priory in the United Kingdom publishes named programmes with prices: Transform 28, a 28-day inpatient hospital programme with therapy, twelve months of aftercare and optional detox, from 21,813 pounds; Reset, a seven to ten day detox-only programme with medical supervision, accommodation and meals, from 6,540; Flourish, residential recovery without detox, from 4,410 for fourteen days; individual outpatient therapy at 155 pounds a session.\n\n*Trade practice --* two things make this trade different from surgical travel. The first is that the treatment has no discharge date that ends it: relapse is part of the condition being treated, and every centre's aftercare promise is a promise made at a distance once the patient flies home. The second is the visa. A month or three months in a country on a visitor entry is a question for that country's immigration rules, and the centre that quotes the programme is rarely the body that answers it - The Dawn's own exclusion list puts visa extension fees on the patient.", "how": "Admission after a telephone or video assessment; detox first where the substance requires it, under nursing observation; then a daily timetable of individual and group therapy running several weeks. Families are involved by video across time zones. Discharge comes with an aftercare plan that usually means online groups, because the therapist is in another country. Medication prescribed abroad may not be dispensable at home, which is a cross-border prescription question rather than a clinical one.", "today": "Two published prices sit on this record, from Thailand and the United Kingdom, read in September 2026. A third country could not be sourced to a provider's own published tariff: the South African and Spanish centres checked for this record publish ranges through third-party guides rather than prices of their own.", "notes": "This page describes a service and how it is priced. It is not clinical advice, and it does not say where anyone should be treated." }, "metrics": { "stay_days": 28, "note": "28 days is the programme length both published tariffs on this record are built around - The Dawn quotes by the month, the Priory's Transform 28 by the four weeks. It is a commercial unit rather than a clinical one; the evidence on how long residential treatment should run is not settled by either page.", "as_of": "2026-09-16", "source": "s:priory-rehab-cost", "url": "https://www.priorygroup.com/addiction-treatment/how-much-does-rehab-cost" }, "prices": [ { "procedure": "addiction-rehab", "country": "TH", "city": "Chiang Mai", "amount": 10000, "amount_high": 20000, "currency": "USD", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [ "private en suite accommodation with daily housekeeping and laundry", "three meals a day", "medically supervised detox when needed", "two individual therapy sessions a week", "fifteen hours of group therapy a week", "24/7 on-site medical care with nursing staff", "daily wellness activities", "weekly outings with entrance fees and meals", "airport transfers", "lifetime weekly aftercare groups at no additional cost" ], "excludes": [ "international flights", "visa extension fees", "medications", "TMS therapy", "off-site medical services and purchases", "transport unrelated to the stay", "travel and health insurance" ], "source": "s:dawn-rehab-rates", "url": "https://thedawnrehab.com/service-rate/", "note": "quoted as a bracket for a month's stay; the centre states programme pricing is customised to the individual and the length of stay", "tier": "cited", "usd": 10000.0, "usd_high": 20000.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "addiction-rehab", "country": "GB", "amount": 21813, "currency": "GBP", "as_of": "2026-09-16", "kind": "package", "includes": [ "28 day inpatient hospital programme", "therapy", "twelve months aftercare", "optional detox", "accommodation and meals" ], "excludes": [ "not itemised on the page" ], "source": "s:priory-rehab-cost", "url": "https://www.priorygroup.com/addiction-treatment/how-much-does-rehab-cost", "note": "the Transform 28 programme, listed as 'from'. The same page prices a seven to ten day detox-only programme (Reset) from 6,540 GBP, a fourteen-day residential programme without detox (Flourish) from 4,410 GBP, and individual outpatient therapy at 155 GBP a session.", "tier": "cited", "usd": 29396.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "thailand", "as": "Where a month of residential treatment is published as a bracket with both lists attached.", "rel": "destination" }, { "to": "united-kingdom", "as": "The source market whose own tariff is the comparison being made.", "rel": "destination" }, { "to": "panchakarma", "as": "The other long-stay course sold by the night, in the same countries, to a different buyer.", "rel": "contrast" }, { "to": "wellness-travel", "as": "The trade this one is marketed beside, and is repeatedly confused with.", "rel": "term" }, { "to": "thai-medical-visa", "as": "Whether a month or a quarter of treatment fits the entry the patient arrived on.", "rel": "governed-by" }, { "to": "cross-border-prescriptions", "as": "What happens to the medication started abroad when the patient lands at home.", "rel": "governed-by" }, { "to": "aftercare-at-home", "as": "Where the promise of lifetime aftercare groups has to be kept, by video.", "rel": "step" }, { "to": "insurance-exclusions", "as": "Whether any of this is funded at home, which decides who travels.", "rel": "governed-by" }, { "to": "the-companion", "as": "Family involvement across time zones is part of the treatment and none of the price.", "rel": "step" } ], "confusable_with": [ { "id": "panchakarma", "tell": "Both are long residential stays sold by the week in the same part of the world. One treats dependence with therapy and nursing; the other is an Ayurvedic course of oil treatments and diet." } ], "links": [ { "label": "The Dawn published service rates", "url": "https://thedawnrehab.com/service-rate/" }, { "label": "Priory programme tariffs", "url": "https://www.priorygroup.com/addiction-treatment/how-much-does-rehab-cost" } ], "sources": [ "s:dawn-rehab-rates", "s:priory-rehab-cost" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "inclusion and exclusion lists are the centres' own; the closing paragraph is marked as trade practice inline" }, "text.how": { "tier": "tradition" }, "etymology": { "tier": "tradition" } } }, "x_commons_files": [], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "A stay of several weeks in a residential centre: medically supervised withdrawal where it is needed, then individual and group therapy, structured days, and an aftercare plan.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where a month of residential treatment is published as a bracket with both lists attached.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The source market whose own tariff is the comparison being made.", "rel": "destination" }, { "to": "panchakarma", "type": "procedure", "name": "Panchakarma", "as": "The other long-stay course sold by the night, in the same countries, to a different buyer.", "rel": "contrast" }, { "to": "wellness-travel", "type": "term", "name": "Wellness travel", "as": "The trade this one is marketed beside, and is repeatedly confused with.", "rel": "term" }, { "to": "thai-medical-visa", "type": "rule", "name": "Thailand's medical treatment visa", "as": "Whether a month or a quarter of treatment fits the entry the patient arrived on.", "rel": "governed-by" }, { "to": "cross-border-prescriptions", "type": "rule", "name": "A prescription that crosses a border", "as": "What happens to the medication started abroad when the patient lands at home.", "rel": "governed-by" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "Where the promise of lifetime aftercare groups has to be kept, by video.", "rel": "step" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "Whether any of this is funded at home, which decides who travels.", "rel": "governed-by" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "Family involvement across time zones is part of the treatment and none of the price.", "rel": "step" } ], "source_list": [ { "id": "s:dawn-rehab-rates", "kind": "web", "title": "The Cost of Rehab in Thailand - service rates", "publisher": "The Dawn Rehab, Chiang Mai", "url": "https://thedawnrehab.com/service-rate/", "accessed": "2026-09-16" }, { "id": "s:priory-rehab-cost", "kind": "web", "title": "How Much Does Rehab Cost in the UK", "publisher": "Priory Group", "url": "https://www.priorygroup.com/addiction-treatment/how-much-does-rehab-cost", "accessed": "2026-09-16", "note": "named programme tariffs, each prefixed 'from'" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "inclusion and exclusion lists are the centres' own; the closing paragraph is marked as trade practice inline" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "cuba", "type": "destination", "name": "Cuba", "as": "A course of weeks, which is the shape of what the state seller quotes.", "rel": "procedure" }, { "from": "switzerland", "type": "destination", "name": "Switzerland", "as": "The residential programme priced by the week and never published.", "rel": "procedure" }, { "from": "havana", "type": "hub", "name": "Havana", "as": "One of the courses of treatment the state company sells to foreign patients.", "rel": "performs" }, { "from": "panchakarma", "type": "procedure", "name": "Panchakarma", "as": "The other long-stay residential course, priced the same way and bought by a different traveller.", "rel": "contrast" }, { "from": "counterfeit-medicines", "type": "risk", "name": "Substandard and falsified medicines", "as": "Where the substance itself is the treatment, and its identity is the whole of the question.", "rel": "procedure" }, { "from": "thai-medical-visa", "type": "rule", "name": "Thailand's medical treatment visa", "as": "One of the long courses that outruns the 90-day ceiling.", "rel": "procedure" } ] }, { "schema": 1, "id": "all-on-four", "type": "procedure", "names": { "name": "All-on-4", "aliases": [ "All-on-four", "full-arch fixed bridge on four implants", "fixed hybrid denture", "teeth in a day" ], "said": "Clinics say All-on-4 and mean one jaw. Price lists in three countries print it the same way, which is what a trademark does: it standardises the word without standardising the bill." }, "etymology": { "root": "Not a derivation but a trade name, coined in 2003. Maló, Rangert and Nobre published the \"All-on-Four\" immediate-function concept with Brånemark System implants for completely edentulous mandibles in Clinical Implant Dentistry and Related Research, 2003;5 Suppl 1:2-9 — 44 patients, 176 immediately loaded implants, a fixed complete-arch prosthesis in function within two hours. Nobel Biocare lists All-on-4 among its registered trademarks, with \"treatment concept\" given as the generic term.", "first_attested": "2003", "tier": "cited", "source": "s:malo-all-on-four-2003", "note": "Four implants with the back two tilted is a technique. All-on-4 is a brand. A clinic advertising the brand is not necessarily using the manufacturer's implants or the published protocol." }, "region": [ "global" ], "facets": { "family": "dental", "setting": "staged", "anaesthesia": "varies" }, "text": { "what": "Four implants are placed in one jaw, the back pair angled forward to avoid the sinus or the nerve, and a fixed bridge of ten to fourteen teeth is screwed onto them — often a temporary one within about a day, with the definitive bridge months later. One arch, one price. Two arches is two prices on every list read for this record.", "story": "The name is the first thing to read on the bill. All-on-4 is a registered trademark of Nobel Biocare, used for products and services alike, and it names a technique — four implants, the back two tilted, loaded at once — rather than a material or a standard.\n\nThe three price lists read for this record all quote it per arch and all quote it differently. Sani Dental Group in Los Algodones prints three versions of the same trademark side by side: the system with an acrylic hybrid fixed denture at $8,110, the same thing on Nobel implants at $8,950 and on Straumann implants at $9,710, each marked as one arch, each with a \"US COST\" column beside it — $25,000, $27,000, $30,000 — that is the clinic's own comparison and carries no source. Medicare Dental Clinic in Budapest splits the bill the way it splits every other: All-on-4 zirconium at €2,503 of treatment plus €1,668 of laboratory fee, All-on-4 metal-ceramic at €2,265 plus €1,509, with the six-implant versions above them. Bangkok International Dental Center quotes All-on-4 and ProArch hybrid bridges from 290,000 baht and, on the same page, dental implants plus fixed bridges from 140,000 plus 250,000 — a second route to the same jaw at nearly twice the price.\n\n*Inference —* the gap between the Budapest figure and the Mexican one is not a gap between two countries' surgery. It is a gap between two ways of writing a price list: Budapest names the laboratory fee and leaves the implants to their own lines, Los Algodones bundles implants, abutments and bridge into one number. A reader comparing €4,171 with $8,110 is comparing a subtotal with a total.", "how": "Assessment and a CT scan, extraction of whatever teeth remain, four implants placed under local anaesthetic with or without sedation, and a provisional bridge fitted the same day or the next. Months of healing follow, then the definitive bridge. For a patient who has flown in, that is two trips or a long stay, and none of the price pages read for this record states which it assumes.\n\nWhat moves the number on these pages is the implant brand and the material of the bridge, in that order: acrylic hybrid at the bottom, zirconia at the top, with the same four screws underneath. Bone grafting and sinus lifting, the procedures the tilted-implant technique exists to avoid, are priced separately where they are needed.", "today": "As of 17 September 2026 the published per-arch prices read for this record are 290,000 baht and up in Bangkok, €4,171 including the laboratory fee in Budapest, and $8,110 to $9,710 in Los Algodones. Whole-mouth work is two arches, and none of the three pages says so in the same sentence as the price.", "notes": "This page describes a dental procedure and the prices published for it. It is not dental advice. The trade uses this trademark as a common noun. This directory files it as a procedure rather than a word, because it is priced as one." }, "metrics": { "stay_days": 0, "days_before_flying": null, "recovery_weeks": null, "success_rate_pct": null, "note": "No hospital admission on any page read for this record: these are clinic fees. The months between the provisional bridge and the definitive one are the figure a travelling patient most needs and no price page read here states it, so recovery_weeks stays empty. No regulator read for this record publishes survival rates for full-arch prostheses, so success_rate_pct stays empty; the figures quoted in the trade come from the trademark holder's own follow-up studies.", "as_of": "2026-09-17", "source": "s:wp-all-on-4", "url": "https://en.wikipedia.org/wiki/All-on-4" }, "prices": [ { "procedure": "all-on-four", "country": "TH", "city": "Bangkok", "amount": 290000, "currency": "THB", "as_of": "2026-09-17", "kind": "quoted-range", "includes": [ "All-on-4 / ProArch hybrid bridge, one arch, as listed" ], "excludes": [ "x-rays, medications, sterilisation, nursing fees and clinic service fees, which the page states are charged separately", "the second arch", "bone grafting or sinus lifting where needed" ], "source": "s:bidc-fees", "url": "https://bangkokdentalcenter.com/fees/", "note": "listed as from 290,000 THB. The same page offers two other routes to a full jaw: implants plus removable dentures from 70,000 plus 85,000, and implants plus fixed bridges from 140,000 plus 250,000. The page states package rates are applicable till 30 September 2026.", "tier": "cited", "usd": 8710.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "all-on-four", "country": "HU", "city": "Budapest", "amount": 4171, "currency": "EUR", "as_of": "2026-09-17", "kind": "list", "includes": [ "All-on-4 zirconium denture: €2,503 treatment plus €1,668 fabrication" ], "excludes": [ "nothing stated on the page beyond the split itself" ], "source": "s:mdental-budapest-prices", "url": "https://www.mdentalclinic.eu/prices", "note": "the clinic prints treatment and laboratory as two lines and the total is the sum: metal-ceramic is €2,265 plus €1,509 for €3,774, All-on-6 zirconium €2,622 plus €1,748 for €4,370. The page's own note reads that many treatments carry both a treatment price and a separate fabrication fee.", "tier": "cited", "usd": 4812.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "all-on-four", "country": "MX", "city": "Los Algodones", "amount": 8110, "amount_high": 9710, "currency": "USD", "as_of": "2026-09-17", "kind": "list", "includes": [ "the four implants, the abutments and a fixed hybrid denture for one arch" ], "excludes": [ "the second arch", "bone graft at $420 per unit and sinus lift at $700, listed separately on the same page" ], "source": "s:sani-dental-prices", "url": "https://sanidentalgroup.com/price-list", "note": "three rows of one trademark: acrylic hybrid $8,110, Nobel $8,950, Straumann $9,710, the acrylic row marked per arch. The page prints a US comparison column of $25,000, $27,000 and $30,000 with no source, and states that all prices are a base or starting price and that the estimate is not an official price until diagnosis.", "tier": "cited", "usd": 8110.0, "usd_high": 9710.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "dental-implant", "as": "The single screw this technique uses four of, priced one at a time on the same lists.", "rel": "part" }, { "to": "full-mouth-restoration", "as": "What two of these arches add up to, and the price nobody prints as one number.", "rel": "whole" }, { "to": "dental-crown", "as": "The single-tooth version of the same laboratory work, and the line that shows how each clinic splits a bill.", "rel": "contrast" }, { "to": "thailand", "as": "Where this arch is quoted from 290,000 baht with the clinic fees outside it.", "rel": "destination" }, { "to": "hungary", "as": "Where the laboratory fee for the bridge is printed as its own line.", "rel": "destination" }, { "to": "mexico", "as": "Where the trademark is sold in three implant brands with a US comparison column beside it.", "rel": "destination" }, { "to": "los-algodones", "as": "The border town whose clinics price this arch against a US figure of their own making.", "rel": "place" }, { "to": "budapest", "as": "The city that prices the same arch in two lines and half the money.", "rel": "place" }, { "to": "reading-the-exclusions", "as": "The step at which per-arch turns into per-mouth and the bill doubles.", "rel": "step" }, { "to": "implant-excluded", "as": "The same trap as the joint implant: a headline price that is a subtotal.", "rel": "risk" }, { "to": "revision-at-home", "as": "Who remakes the bridge when it fractures, and at whose price.", "rel": "risk" }, { "to": "package-price", "as": "The pricing form this technique is sold in, one arch at a time.", "rel": "term" }, { "to": "graft", "as": "The other trade unit whose count decides a price, in a different trade.", "rel": "contrast" } ], "confusable_with": [ { "id": "dental-implant", "tell": "An implant price is one screw; an All-on-4 price is four screws and a bridge for one jaw." }, { "id": "full-mouth-restoration", "tell": "All-on-4 rebuilds one arch on implants; full-mouth work covers both jaws and often mixes crowns, bridges and implants." } ], "links": [ { "label": "Sani Dental Group price list", "url": "https://sanidentalgroup.com/price-list" }, { "label": "Medicare Dental Clinic, Budapest — treatment prices", "url": "https://www.mdentalclinic.eu/prices" } ], "sources": [ "s:wp-all-on-4", "s:bidc-fees", "s:mdental-budapest-prices", "s:sani-dental-prices", "s:malo-all-on-four-2003", "s:nobel-biocare-trademarks" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:sani-dental-prices", "note": "every figure read off the clinic's own price page on the accessed date; the closing stretch is this project's reasoning and is marked" }, "text.how": { "tier": "tradition", "note": "standard staging of a full-arch immediate-load case; the brand-and-material point is cited to the three price lists" }, "etymology": { "tier": "cited", "source": "s:wp-all-on-4" }, "metrics": { "tier": "cited", "source": "s:wp-all-on-4" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:All-on-4 dental implants.jpg", "File:Dental implant bridge.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "Four implants are placed in one jaw, the back pair angled forward to avoid the sinus or the nerve, and a fixed bridge of ten to fourteen teeth is screwed onto them — often a temporary one within about a day, with the…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The single screw this technique uses four of, priced one at a time on the same lists.", "rel": "part" }, { "to": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "What two of these arches add up to, and the price nobody prints as one number.", "rel": "whole" }, { "to": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "The single-tooth version of the same laboratory work, and the line that shows how each clinic splits a bill.", "rel": "contrast" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where this arch is quoted from 290,000 baht with the clinic fees outside it.", "rel": "destination" }, { "to": "hungary", "type": "destination", "name": "Hungary", "as": "Where the laboratory fee for the bridge is printed as its own line.", "rel": "destination" }, { "to": "mexico", "type": "destination", "name": "Mexico", "as": "Where the trademark is sold in three implant brands with a US comparison column beside it.", "rel": "destination" }, { "to": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "The border town whose clinics price this arch against a US figure of their own making.", "rel": "place" }, { "to": "budapest", "type": "hub", "name": "Budapest", "as": "The city that prices the same arch in two lines and half the money.", "rel": "place" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step at which per-arch turns into per-mouth and the bill doubles.", "rel": "step" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The same trap as the joint implant: a headline price that is a subtotal.", "rel": "risk" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who remakes the bridge when it fractures, and at whose price.", "rel": "risk" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The pricing form this technique is sold in, one arch at a time.", "rel": "term" }, { "to": "graft", "type": "term", "name": "Graft", "as": "The other trade unit whose count decides a price, in a different trade.", "rel": "contrast" } ], "source_list": [ { "id": "s:wp-all-on-4", "kind": "wikipedia", "title": "All-on-4", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/All-on-4", "license": "CC BY-SA 4.0", "accessed": "2026-09-17", "note": "states that the name All-on-4 is a registered trademark of Nobel Biocare, used globally for both dental products and services; four implants, the back two tilted about 30 to 45 degrees, prosthesis placed within about 24 hours. The article carries editorial notices about promotional tone." }, { "id": "s:bidc-fees", "kind": "web", "title": "Dental Fees — standardised treatment fees", "publisher": "Bangkok International Dental Center", "url": "https://bangkokdentalcenter.com/fees/", "accessed": "2026-09-16", "note": "implant fixture and implant crown priced in separate columns; page states package rates applicable till 30 September 2026" }, { "id": "s:mdental-budapest-prices", "kind": "web", "title": "Treatment Prices", "publisher": "Medicare Dental Clinic, Budapest", "url": "https://www.mdentalclinic.eu/prices", "accessed": "2026-09-16", "note": "treatment price and lab fee shown as separate lines; packages name accommodation and transfers" }, { "id": "s:sani-dental-prices", "kind": "web", "title": "Dental Price List in Mexico", "publisher": "Sani Dental Group, Los Algodones", "url": "https://sanidentalgroup.com/price-list", "accessed": "2026-09-16", "note": "prices in US dollars with a Mexican peso figure beside each; the page states every price is a base or starting price" }, { "id": "s:malo-all-on-four-2003", "kind": "paper", "title": "\"All-on-Four\" immediate-function concept with Brånemark System implants for completely edentulous mandibles: a retrospective clinical study", "publisher": "Maló P, Rangert B, Nobre M. Clinical Implant Dentistry and Related Research 2003;5 Suppl 1:2-9", "url": "https://pubmed.ncbi.nlm.nih.gov/12691645/", "accessed": "2026-09-17", "note": "citation verified through the NCBI esummary API on 17 September 2026 (PMID 12691645)" }, { "id": "s:nobel-biocare-trademarks", "kind": "web", "title": "Trademarks", "publisher": "Nobel Biocare Services AG", "url": "https://www.nobelbiocare.com/en-us/trademarks", "accessed": "2026-09-17", "note": "lists All-on-4 as a registered trademark with \"treatment concept\" given as the suggested generic term; no registration number read" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:sani-dental-prices", "note": "every figure read off the clinic's own price page on the accessed date; the closing stretch is this project's reasoning and is marked" }, "text.how": { "tier": "tradition", "note": "standard staging of a full-arch immediate-load case; the brand-and-material point is cited to the three price lists" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "cited", "source": "s:wp-all-on-4" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-all-on-4" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "costa-rica", "type": "destination", "name": "Costa Rica", "as": "The full-arch course sold across two trips, with the second flight in the total.", "rel": "procedure" }, { "from": "croatia", "type": "destination", "name": "Croatia", "as": "The full-arch case that makes a two-visit trip worth the drive.", "rel": "procedure" }, { "from": "hungary", "type": "destination", "name": "Hungary", "as": "The full-arch job this corridor sells to patients who have run out of teeth.", "rel": "procedure" }, { "from": "romania", "type": "destination", "name": "Romania", "as": "The full-arch case where the price gap covers the flights.", "rel": "procedure" }, { "from": "vietnam", "type": "destination", "name": "Vietnam", "as": "The full-arch package sold to visitors on a two-trip schedule.", "rel": "procedure" }, { "from": "antalya", "type": "hub", "name": "Antalya", "as": "A dental course that fits the length of a resort stay.", "rel": "procedure" }, { "from": "budapest", "type": "hub", "name": "Budapest", "as": "The full-arch form sold here, and the one whose quote hides the most variables.", "rel": "procedure" }, { "from": "cancun", "type": "hub", "name": "Cancún", "as": "Sold here by the arch on the same list the border towns use.", "rel": "performs" }, { "from": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "Sold here by the arch, which is the word that decides whether a quote is half a mouth or a whole one.", "rel": "performs" }, { "from": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "What four of these become when a whole jaw is rebuilt on them.", "rel": "whole" }, { "from": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "The commonest single answer for one jaw, and the trademark the price lists sort by.", "rel": "part" }, { "from": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "Where the excluded item is the other half of the mouth.", "rel": "procedure" } ] }, { "schema": 1, "id": "angioplasty-stent", "type": "procedure", "names": { "name": "Coronary angioplasty and stent", "aliases": [ "PCI", "percutaneous coronary intervention", "balloon angioplasty", "stenting" ], "said": "Cardiologists say PCI. Package pages say angioplasty and put the angiogram in front of it, because the diagnostic catheter and the treatment are usually sold as one admission." }, "etymology": { "root": "angioplasty: Greek angeion, a vessel, plus plastos, moulded — a vessel remoulded. Stent is said to come from the surname of the nineteenth-century dentist Charles Stent, whose moulding compound gave its name to a support; percutaneous is Latin per cutem, through the skin.", "tier": "tradition", "note": "Transradial means the catheter goes in at the wrist, transfemoral at the groin. Thai package pages price the two differently, the wrist slightly higher." }, "region": [ "global" ], "facets": { "family": "cardiac", "setting": "inpatient", "anaesthesia": "sedation" }, "text": { "what": "A catheter is threaded from the wrist or the groin to the heart, dye shows where a coronary artery is narrowed, a balloon opens it and a metal mesh tube is left behind to hold it open. Two nights in hospital on the Bangkok packages read for this record. The stent itself is a manufactured device and is priced as one.", "story": "The device is the story, as it is with the knee implant.\n\nBangkok Heart Hospital publishes the diagnostic catheter and the treatment as a ladder: coronary angiography alone at 62,100 baht as a day case through the wrist, 66,700 through the groin with a night, 69,000 through the wrist with a night; angiography with percutaneous coronary intervention at 299,000 baht transfemoral or 322,000 transradial, two nights either way. Prices stated valid until 31 October 2026.\n\nThen the exclusion list, which names the thing the patient came for: the package price does not include \"special device used during procedure\". A stent is a special device. So is a second one, and a third, and most of the pressure-wire and imaging equipment a modern intervention uses. The published price buys the room, the team and the nights; the metal is a separate line that the page does not number.\n\n*Trade practice —* the number of stents is not known until the catheter is in, which is the reason hospitals give for pricing them outside the package, and it is also why a quoted price for this operation is a floor rather than a figure.\n\nWhere the device price is regulated, it is regulated separately from the procedure. Medanta in Gurugram publishes an index of its coronary stent prices alongside the relevant notification of India's price regulator, one document per revision going back years — a hospital publishing what the metal costs because the state requires the ceiling to be visible. No figure from those files is carried here: they are linked documents rather than a page this record could read.", "how": "Local anaesthetic at the puncture site, sedation, a catheter to the coronary ostium, contrast, balloon, stent, a plug or pressure at the puncture site, a night or two of monitoring, then dual antiplatelet medication for months — which is a prescription the travelling patient fills at home and no package read here includes.\n\nThe state versions price the doctor, not the device. The Australian Medicare Benefits Schedule sets item 38307 — percutaneous coronary intervention on one coronary vascular territory, including the angiography and \"transluminal insertion of one or more stents\" — at $2,121.75, with a 75% benefit of $1,591.35, and the descriptor excludes aftercare. One territory: a patient with three diseased arteries generates more than one item.", "today": "As of 17 September 2026 the published Thai package price for angiography with intervention is 299,000 baht through the groin and 322,000 through the wrist, two nights, with the stent outside the package as a special device. The Australian schedule fee for the cardiologist's service on one artery is $2,121.75. Ireland's own admitted-patient price for a percutaneous cardiac intervention at minor complexity is EUR 9,887, and EUR 42,060 at major complexity.", "notes": "This page describes a procedure and the prices published for it. It is not medical advice." }, "metrics": { "stay_days": 2, "days_before_flying": 10, "recovery_weeks": 1, "note": "Two nights is the stay named in the Bangkok Heart Hospital angiography-with-intervention packages read for this record; the diagnostic catheter alone is sold as a day case or one night on the same page. The ten-day figure is the CDC's guidance not to fly for ten days after chest surgery, applied here to a chest procedure; a groin or wrist puncture is not a sternotomy and cardiologists' advice varies, which is why this row is hedged. One week is the span usually quoted for return to ordinary activity after an uncomplicated intervention.", "as_of": "2026-09-17", "source": "s:cdc-yellowbook-medical-tourism", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" }, "prices": [ { "procedure": "angioplasty-stent", "country": "TH", "city": "Bangkok", "facility": "bangkok-hospital", "amount": 299000, "currency": "THB", "as_of": "2026-09-17", "kind": "package", "includes": [ "coronary angiography and percutaneous coronary intervention, transfemoral", "operating room and recovery room", "specified medical supplies and medications used during the procedure", "the medical team and anaesthesiologist for the specified procedure", "2 nights, including the critical care unit and standard inpatient room as specified", "hospital fee, meals and related equipment during the stay" ], "excludes": [ "special device used during the procedure — which is what a stent is", "pre-assessment and medical clearance before the procedure", "other specialists' consultations", "further laboratory tests or investigations", "additional nights in critical care or on the ward", "home medications, including the antiplatelet drugs this procedure commits a patient to" ], "source": "s:bangkokhospital-heart-packages", "url": "https://www.bangkokhospital.com/en/bangkok-heart/package/heart-catheterization-surgery", "note": "the transradial version of the same package is 322,000 THB, also 2 nights. Diagnostic angiography alone runs 62,100 THB as a day case to 69,000 with a night. Prices stated valid until 31 October 2026. The exclusion of the special device is the line that decides what this costs.", "tier": "cited", "usd": 8980.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "angioplasty-stent", "country": "TH", "city": "Bangkok", "facility": "bangkok-hospital", "amount": 322000, "currency": "THB", "as_of": "2026-09-17", "kind": "package", "includes": [ "coronary angiography and percutaneous coronary intervention, transradial", "2 nights", "theatre, team and anaesthesiologist as specified" ], "excludes": [ "special device used during the procedure", "pre-assessment", "other specialists", "extra nights", "home medications" ], "source": "s:bangkokhospital-heart-packages", "url": "https://www.bangkokhospital.com/en/bangkok-heart/package/heart-catheterization-surgery", "note": "23,000 baht more than the same operation through the groin. The wrist route is generally the safer one for bleeding, and on this page it is the dearer one.", "tier": "cited", "usd": 9671.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "angioplasty-stent", "country": "AU", "amount": 2121.75, "currency": "AUD", "as_of": "2026-09-17", "kind": "tariff", "includes": [ "item 38307: percutaneous coronary intervention on one coronary vascular territory, including selective coronary angiography and all associated imaging, catheter and contrast, and either or both angioplasty and transluminal insertion of one or more stents" ], "excludes": [ "aftercare, excluded in the descriptor itself", "the hospital, the ward and the device", "further territories, which fall under their own items" ], "source": "s:mbs-38307", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=38307&qt=item", "note": "the Medicare Benefits Schedule fee, 75% benefit $1,591.35, read on 17 September 2026. Unlike the Thai package, the item includes the stents in the service it describes and excludes the aftercare; unlike the Thai package, it is a fee for a doctor rather than a bill for an admission.", "tier": "cited", "usd": 1512.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "angioplasty-stent", "country": "IE", "amount": 9887, "currency": "EUR", "as_of": "2026-09-17", "kind": "tariff", "includes": [ "DRG F19B TRNS-VSCLR PERC CRDC INTERVTN, MINC — transvascular percutaneous cardiac intervention at minor complexity, as an inlier inpatient episode" ], "excludes": [ "stays outside the length-of-stay boundaries, which are paid at a per-diem rate above the high boundary", "travel and accommodation" ], "source": "s:hse-abf-2024-inpatient", "url": "https://assets.hse.ie/media/documents/ABF_2024_Admitted_Patient_Price_List_-_Inpatient_Only.pdf", "note": "the Irish public system's own price for the admission, and the ceiling on what it repays a patient treated abroad. The major-complexity version of the same group, F19A, is EUR 42,060 — a fourfold spread inside one procedure, which is what a complexity-weighted tariff looks like beside a fixed package price.", "tier": "cited", "usd": 11408.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "cabg", "as": "The open operation this one competes with, at four times the price on the same hospital's page.", "rel": "contrast" }, { "to": "heart-valve-replacement", "as": "The other cardiac package on the same Thai list, sold by level and by nights.", "rel": "kin" }, { "to": "bangkok-hospital", "as": "Publishes the angiography and intervention packages this page reads, special device excluded.", "rel": "performed-at" }, { "to": "medanta", "as": "Publishes an index of its coronary stent prices beside the price regulator's notifications.", "rel": "performed-at" }, { "to": "implant-excluded", "as": "The trap by its own name: the stent is the special device the package leaves out.", "rel": "risk" }, { "to": "thailand", "as": "Where the wrist route costs 23,000 baht more than the groin.", "rel": "destination" }, { "to": "india", "as": "Where the state caps what a stent may be sold for and hospitals publish the ceiling.", "rel": "destination" }, { "to": "australia", "as": "Where the schedule pays for one coronary territory at a time.", "rel": "destination" }, { "to": "reading-the-exclusions", "as": "The step at which a stent turns out not to be in the stent package.", "rel": "step" }, { "to": "counterfeit-medicines", "as": "The neighbouring worry about what is in the box, here about devices rather than drugs.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Who prescribes and monitors the antiplatelet drugs after the flight home.", "rel": "risk" }, { "to": "tariff", "as": "What the Australian figure on this page is, and why it is not a bill.", "rel": "term" } ], "confusable_with": [ { "id": "cabg", "tell": "Angioplasty opens an artery from inside through a puncture; bypass sews a new route around it through an opened chest. Hospital pages sell both under heart treatment." } ], "links": [ { "label": "Bangkok Heart Hospital — angiography and intervention packages", "url": "https://www.bangkokhospital.com/en/bangkok-heart/package/heart-catheterization-surgery" }, { "label": "MBS item 38307", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=38307&qt=item" } ], "sources": [ "s:bangkokhospital-heart-packages", "s:mbs-38307", "s:medanta-policy-forms", "s:cdc-yellowbook-medical-tourism", "s:hse-abf-2024-inpatient" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:bangkokhospital-heart-packages", "note": "package figures and the exclusion wording read off the hospital's own page on 17 September 2026; the stretch on why devices sit outside the package is marked as trade practice; the Medanta paragraph names the index page without carrying a figure from the linked files" }, "text.how": { "tier": "tradition", "note": "standard procedural description; the Australian item descriptor is cited" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:cdc-yellowbook-medical-tourism" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Coronary angioplasty balloon inflated.png", "File:Stent4 fcm.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "A catheter is threaded from the wrist or the groin to the heart, dye shows where a coronary artery is narrowed, a balloon opens it and a metal mesh tube is left behind to hold it open.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The open operation this one competes with, at four times the price on the same hospital's page.", "rel": "contrast" }, { "to": "heart-valve-replacement", "type": "procedure", "name": "Heart valve replacement", "as": "The other cardiac package on the same Thai list, sold by level and by nights.", "rel": "kin" }, { "to": "bangkok-hospital", "type": "facility", "name": "Bangkok Hospital", "as": "Publishes the angiography and intervention packages this page reads, special device excluded.", "rel": "performed-at" }, { "to": "medanta", "type": "facility", "name": "Medanta — The Medicity, Gurugram", "as": "Publishes an index of its coronary stent prices beside the price regulator's notifications.", "rel": "performed-at" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The trap by its own name: the stent is the special device the package leaves out.", "rel": "risk" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the wrist route costs 23,000 baht more than the groin.", "rel": "destination" }, { "to": "india", "type": "destination", "name": "India", "as": "Where the state caps what a stent may be sold for and hospitals publish the ceiling.", "rel": "destination" }, { "to": "australia", "type": "destination", "name": "Australia", "as": "Where the schedule pays for one coronary territory at a time.", "rel": "destination" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step at which a stent turns out not to be in the stent package.", "rel": "step" }, { "to": "counterfeit-medicines", "type": "risk", "name": "Substandard and falsified medicines", "as": "The neighbouring worry about what is in the box, here about devices rather than drugs.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who prescribes and monitors the antiplatelet drugs after the flight home.", "rel": "risk" }, { "to": "tariff", "type": "term", "name": "Tariff", "as": "What the Australian figure on this page is, and why it is not a bill.", "rel": "term" } ], "source_list": [ { "id": "s:bangkokhospital-heart-packages", "kind": "web", "title": "Coronary artery angiography / percutaneous coronary intervention and Cardiovascular Surgery — package list", "publisher": "Bangkok Heart Hospital, Bangkok Hospital", "url": "https://www.bangkokhospital.com/en/bangkok-heart/package/heart-catheterization-surgery", "accessed": "2026-09-17", "note": "read with the browser on 17 September 2026, prices stated valid until 31 October 2026: CABG Level 1 1,173,000 THB and Level 2 1,437,500 THB, 8 nights each; MICS CABG 1,500,000 THB, 7 nights; valve replacement or repair Level 1 966,000 THB and Level 2 1,196,000 THB, 8 nights; totally 3D endoscopic valve replacement or repair 1,400,000 THB, 7 nights; CAG and PCI transfemoral 299,000 THB and transradial 322,000 THB, 2 nights; CAG alone 62,100 to 69,000 THB. Exclusions name pre-assessment, other specialists' consultations, 'special device used during procedure', extra ICU or ward nights and home medications." }, { "id": "s:mbs-38307", "kind": "gov", "title": "MBS item 38307 — percutaneous coronary intervention, one coronary vascular territory", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=38307&qt=item", "accessed": "2026-09-17", "note": "schedule fee $2,121.75, 75% benefit $1,591.35; descriptor covers angioplasty and 'transluminal insertion of one or more stents' on one territory and excludes aftercare" }, { "id": "s:medanta-policy-forms", "kind": "web", "title": "Policies & Forms — MRP of coronary stents and orthopaedic knee systems", "publisher": "Medanta", "url": "https://www.medanta.org/policy-and-forms", "accessed": "2026-09-16", "note": "the index names the price documents; the figures themselves sit in linked files" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:hse-abf-2024-inpatient", "kind": "gov", "title": "ABF 2024 Admitted Patient Price List — Inpatient Only", "publisher": "Health Service Executive (Ireland)", "url": "https://assets.hse.ie/media/documents/ABF_2024_Admitted_Patient_Price_List_-_Inpatient_Only.pdf", "accessed": "2026-09-17", "note": "the activity-based-funding inlier inpatient price per diagnosis-related group, linked from the HSE's Northern Ireland Planned Healthcare Scheme claim page and the list behind the CBD and NIPHS repayments. Rows read on 17 September 2026: F06C CRNRY BYPSS-INV INVES MINC EUR 30,040, F06B EUR 34,430, F06A EUR 50,579; F05B CRNRY BYPSS+INV INVES MINC EUR 45,093; F04C CRD VLV INTERVTN+PMP-INV INVES MINC EUR 40,253, F04B EUR 50,628, F04A EUR 80,201; F19B TRNS-VSCLR PERC CRDC INTERVTN MINC EUR 9,887, F19A EUR 42,060; F10B INTERVENTIONAL CRNRY PR + AMI MINC EUR 8,857; M01B MAJOR MALE PELVIC INTERVTNS MINC EUR 19,899, M01A EUR 26,820; M02B TRANSURTH PROSTMY MINC EUR 8,363; N04B HYSTERECTOMY FOR N-MAL MINC EUR 13,282; G10B HERNIA INTERVENTIONS MINC EUR 9,046, G10A MAJC EUR 15,366; H08B LAP CHOLECYSTECTOMY MINC EUR 9,867, H07C OPEN CHOLECYSTECTOMY MINC EUR 16,206. An inlier price assumes a length of stay between the low and high boundaries printed beside it." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:bangkokhospital-heart-packages", "note": "package figures and the exclusion wording read off the hospital's own page on 17 September 2026; the stretch on why devices sit outside the package is marked as trade practice; the Medanta paragraph names the index page without carrying a figure from the linked files" }, "text.how": { "tier": "tradition", "note": "standard procedural description; the Australian item descriptor is cited" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:cdc-yellowbook-medical-tourism" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The catheter alternative, a tenth of the price on the same hospital's page and a different argument about who needs which.", "rel": "contrast" }, { "from": "heart-valve-replacement", "type": "procedure", "name": "Heart valve replacement", "as": "The catheter procedure whose package carries the same five-word device exclusion.", "rel": "kin" } ] }, { "schema": 1, "id": "assisted-dying", "type": "procedure", "names": { "name": "Assisted dying", "aliases": [ "assisted suicide", "accompanied suicide", "voluntary assisted dying", "VAD", "physician-assisted death" ], "said": "The two Swiss associations read for this record use their own terms: one says accompanied suicide, the other voluntary assisted dying. Statutes elsewhere say assisted dying, medical assistance in dying, or nothing at all, because they do not provide for it. Euthanasia, where a doctor administers, is a different act from assisted suicide, where the person does; a country can permit one and prosecute the other." }, "etymology": { "root": "euthanasia: Greek eu, well, plus thanatos, death — a good death, and in its first English uses in the seventeenth century it meant an easy natural one, not an assisted one. The modern distinction the law turns on is grammatical before it is ethical: who is the subject of the verb.", "tier": "tradition", "note": "Assisted suicide: the person takes the drug themselves. Euthanasia: someone else administers it. Swiss practice, and the route non-residents use, is the first." }, "region": [ "global", "europe-west" ], "facets": { "family": "end-of-life", "setting": "staged", "anaesthesia": "none" }, "text": { "what": "A person who wishes to end their life is prescribed a lethal drug by a doctor and takes it themselves, with an organisation present. The steps are administrative for months and medical at the end: joining an association, submitting a medical history and documents, obtaining a doctor's provisional agreement to write a prescription, attending two consultations with that doctor in the country, and then an appointment. Nothing about it is a procedure in the surgical sense, and the only part that happens in a clinical setting is the consultation.", "story": "This is the one journey in this directory with a single destination. Switzerland is where the associations that accept non-residents are, and the Swiss provision under which they work is Article 115 of the Criminal Code; the country-by-country reading, and the several jurisdictions that now provide for assisted dying for their own residents only, sit on this directory's assisted dying law page.\n\nWhat is unusual here is that the money is published in full, itemised, by the organisations themselves. Dignitas, at Forch near Zurich, sets out five figures. Preparation up to what it calls the \"provisional green light\" — a doctor's agreement in principle to prescribe, reserving the final decision until a consultation — is an additional contribution of 4,000 Swiss francs, payable in advance, and the page states that \"no guarantee of an accompanied suicide can be linked to this payment\". Two extended consultations with the Swiss doctor and the related administration are 1,000. Completion, covering the escort and a contribution towards the apartment, is 2,500. The funeral director and cremation, including the charges of the Swiss authorities and the despatch of the urn, are 2,500. Official procedures after the death, if the association handles them, are 1,000. The totals are stated: 11,000 Swiss francs with everything, 7,500 without the funeral and administrative arrangements, VAT excluded, and all of it \"subject to change\". Membership is separate: a one-off joining fee of 220 francs and an annual subscription of at least 80. The statutes provide for reduction or exemption for members in modest circumstances, agreed beforehand.\n\nPegasos, in Basel, publishes one number instead of five: approximately 10,000 Swiss francs, stated to cover paperwork, consultations, the appointment including drugs, cremation and the couriering of ashes, paid in two instalments. Its refund policy is published too — a full refund of the deposit if the application is not approved, and 1,500 francs retained if the applicant withdraws.\n\n*Inference —* the itemisation is worth more than the total. Two of the five Dignitas lines are for a death, not for a dying: the funeral director and the paperwork with the Swiss authorities. Somebody who dies away from home leaves an administrative estate in the country they died in, and here it has a price on it.\n\nThe journey is long before it is short. Membership, a medical file assembled by doctors at home, a provisional agreement, then travel, two consultations on separate days, and an appointment. The three things that stop it are refusal of the provisional agreement, deterioration that makes travel impossible, and the requirement that the person act for themselves at the end.", "how": "Administratively, in stages, each with its own payment. Medically, it is two consultations and a prescription. The association arranges the room, the escort and, where asked, the funeral director and the registry work; both organisations read for this record state that costs are settled in advance. What no page publishes is a count: neither organisation's fee pages state how many people apply, how many are approved, or how many travel and then do not go through with it.", "today": "As of 17 September 2026 the published prices read for this record are all Swiss and all from associations rather than hospitals: 7,500 or 11,000 francs from one, approximately 10,000 from the other, plus membership. No other country's provider page carrying a price for a non-resident was found, and that is not a gap in the reporting — it is the shape of the law.", "notes": "This page describes a process and reports published prices and published statements. It is not medical advice and it is not legal advice, it recommends nothing, and it takes no position for or against." }, "metrics": { "stay_days": null, "days_before_flying": null, "recovery_weeks": null, "note": "None of these apply and none is published. The one interval that matters — from first application to appointment — is not stated as a number by either association read here; both describe a sequence of approvals instead, and one states that no payment guarantees an outcome.", "as_of": "2026-09-17", "source": "s:dignitas-costs", "url": "https://www.dignitas.ch/en/accompanied-suicide/information-on-the-costs/" }, "prices": [ { "procedure": "assisted-dying", "country": "CH", "amount": 7500, "currency": "CHF", "as_of": "2026-09-17", "kind": "list", "includes": [ "preparation to the provisional green light, 4,000", "two extended consultations with a Swiss doctor and related administration, 1,000", "completion, covering the escort and a contribution towards the apartment, 2,500" ], "excludes": [ "the funeral director and cremation, 2,500", "official procedures after the death, 1,000", "VAT", "membership, travel and accommodation" ], "source": "s:dignitas-costs", "url": "https://www.dignitas.ch/en/accompanied-suicide/information-on-the-costs/", "note": "the association's stated total where it is not asked to handle the funeral or the official affairs; 11,000 francs where it is. Payment is normally required in advance, and the page states that no guarantee of an accompanied suicide is linked to the first 4,000. All costs are stated to be subject to change.", "tier": "cited", "usd": 9158.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "assisted-dying", "country": "CH", "amount": 300, "currency": "CHF", "as_of": "2026-09-17", "kind": "list", "includes": [ "a one-off joining fee of 220 francs", "the first annual subscription, at the stated minimum of 80" ], "excludes": [ "everything in the row above", "subsequent years" ], "source": "s:dignitas-membership", "url": "https://www.dignitas.ch/en/become-a-member/membership/", "note": "membership is the precondition, and it is open to adults who are neither resident in Switzerland nor Swiss citizens; the association states it can only act within Swiss territory. The subscription is at each member's discretion but at least 80 francs, with reduction or exemption available to members in modest circumstances by prior agreement.", "tier": "cited", "usd": 366.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "assisted-dying", "country": "CH", "city": "Basel", "amount": 10000, "currency": "CHF", "as_of": "2026-09-17", "kind": "estimate", "includes": [ "paperwork", "consultations", "the appointment, including drugs", "cremation", "couriering of the ashes" ], "excludes": [ "travel and accommodation", "any variation the association attributes to the level of external medical review needed" ], "source": "s:pegasos-faqs", "url": "https://pegasos-association.com/faqs/", "note": "the association's own figure, stated as approximate and paid in two instalments, a deposit at application and the balance at scheduling. Its published refund policy returns the full deposit if an application is not approved and retains 1,500 francs on withdrawal.", "tier": "cited", "usd": 12211.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "assisted-dying-law", "as": "Where the country-by-country reading sits, including the jurisdictions that provide for residents only.", "rel": "governed-by" }, { "to": "switzerland", "as": "The one destination, and the only country with associations that accept non-residents.", "rel": "destination" }, { "to": "circumvention-travel", "as": "The word for crossing a border to do lawfully what cannot be done at home.", "rel": "term" }, { "to": "repatriation", "as": "Two of the five published Swiss lines are for what happens to the body and the paperwork afterwards.", "rel": "term" }, { "to": "the-companion", "as": "Nobody makes this journey alone, and the escort is a published line on the bill.", "rel": "step" }, { "to": "the-deposit", "as": "The first 4,000 francs buys an assessment, and the page says so.", "rel": "step" }, { "to": "deposit-and-refund", "as": "One association publishes what is returned when an application is refused and what is kept when it is withdrawn.", "rel": "risk" }, { "to": "getting-your-records", "as": "The medical file assembled at home is what the Swiss doctor decides on.", "rel": "step" }, { "to": "deciding-whether", "as": "The step this record is entirely composed of.", "rel": "step" }, { "to": "informed-consent", "as": "The requirement that the person act for themselves at the end is a consent rule before it is a clinical one.", "rel": "term" } ], "confusable_with": [ { "id": "addiction-rehab", "tell": "Both are long-stay, non-surgical and sold by membership or programme rather than by procedure; nothing else about them is comparable." } ], "links": [ { "label": "DIGNITAS — costs of an accompanied suicide", "url": "https://www.dignitas.ch/en/accompanied-suicide/information-on-the-costs/" }, { "label": "DIGNITAS — membership", "url": "https://www.dignitas.ch/en/become-a-member/membership/" }, { "label": "Pegasos Swiss Association — FAQs", "url": "https://pegasos-association.com/faqs/" } ], "sources": [ "s:dignitas-costs", "s:dignitas-membership", "s:pegasos-faqs", "s:ch-criminal-code" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:dignitas-costs", "note": "every figure and quotation is read off the association's own page; the paragraph about what the itemisation shows is marked Inference" }, "text.how": { "tier": "cited", "source": "s:pegasos-faqs" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:dignitas-costs" }, "metrics": { "tier": "cited", "source": "s:dignitas-costs" } } }, "x_commons_files": [ "File:Flag of Switzerland.svg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "A person who wishes to end their life is prescribed a lethal drug by a doctor and takes it themselves, with an organisation present.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "assisted-dying-law", "type": "rule", "name": "Assisted dying, and who may cross a border for it", "as": "Where the country-by-country reading sits, including the jurisdictions that provide for residents only.", "rel": "governed-by" }, { "to": "switzerland", "type": "destination", "name": "Switzerland", "as": "The one destination, and the only country with associations that accept non-residents.", "rel": "destination" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The word for crossing a border to do lawfully what cannot be done at home.", "rel": "term" }, { "to": "repatriation", "type": "term", "name": "Repatriation", "as": "Two of the five published Swiss lines are for what happens to the body and the paperwork afterwards.", "rel": "term" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "Nobody makes this journey alone, and the escort is a published line on the bill.", "rel": "step" }, { "to": "the-deposit", "type": "pathway", "name": "The deposit", "as": "The first 4,000 francs buys an assessment, and the page says so.", "rel": "step" }, { "to": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "One association publishes what is returned when an application is refused and what is kept when it is withdrawn.", "rel": "risk" }, { "to": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "The medical file assembled at home is what the Swiss doctor decides on.", "rel": "step" }, { "to": "deciding-whether", "type": "pathway", "name": "Deciding whether to go", "as": "The step this record is entirely composed of.", "rel": "step" }, { "to": "informed-consent", "type": "term", "name": "Informed consent", "as": "The requirement that the person act for themselves at the end is a consent rule before it is a clinical one.", "rel": "term" } ], "source_list": [ { "id": "s:dignitas-costs", "kind": "org", "title": "Costs of an accompanied suicide", "publisher": "DIGNITAS, Forch, Switzerland", "url": "https://www.dignitas.ch/en/accompanied-suicide/information-on-the-costs/", "accessed": "2026-09-16" }, { "id": "s:dignitas-membership", "kind": "org", "title": "Membership", "publisher": "DIGNITAS, Forch, Switzerland", "url": "https://www.dignitas.ch/en/become-a-member/membership/", "accessed": "2026-09-16" }, { "id": "s:pegasos-faqs", "kind": "org", "title": "FAQs — cost, refund policy and who may apply", "publisher": "Pegasos Swiss Association, Basel", "url": "https://pegasos-association.com/faqs/", "accessed": "2026-09-17", "note": "the answers are inside collapsed panels and were read out of the page text with the browser tools. States a cost of approximately CHF 10,000 covering paperwork, consultations, the appointment including drugs, cremation and couriering of ashes, paid in two instalments, with CHF 1,500 retained on withdrawal." }, { "id": "s:ch-criminal-code", "kind": "statute", "title": "Swiss Criminal Code (SR 311.0), Article 115 — Inciting and assisting suicide (English translation)", "publisher": "Fedlex, the Swiss federal law portal", "url": "https://www.fedlex.admin.ch/filestore/fedlex.data.admin.ch/eli/cc/54/757_781_799/20250101/en/html/fedlex-data-admin-ch-eli-cc-54-757_781_799-20250101-en-html.html", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:dignitas-costs", "note": "every figure and quotation is read off the association's own page; the paragraph about what the itemisation shows is marked Inference" }, "text.how": { "tier": "cited", "source": "s:pegasos-faqs" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:dignitas-costs" }, "metrics": { "tier": "cited", "source": "s:dignitas-costs" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "assisted-dying-law", "type": "rule", "name": "Assisted dying, and who may cross a border for it", "as": "The procedure these instruments govern.", "rel": "procedure" } ] }, { "schema": 1, "id": "bbl", "type": "procedure", "names": { "name": "Gluteal fat grafting", "aliases": [ "BBL", "Brazilian butt lift", "buttock augmentation with fat grafting", "gluteal lipofilling", "fat transfer to the buttocks" ], "said": "Surgeons write gluteal fat grafting or gluteal lipofilling. Clinics and price pages write BBL, and the marketing name travels better than the operation's own." }, "etymology": { "root": "lipofilling: Greek lipos, fat, plus filling. The trade name Brazilian butt lift attaches a nationality to a technique and a lift to an operation that lifts nothing - it adds volume; the lifting operation is a separate procedure that removes skin.", "tier": "tradition", "note": "graft here means the patient's own aspirated fat, washed or decanted and re-injected. A graft survives only if it lands where blood can reach it, which is why the plane of injection is the argument in this operation." }, "region": [ "global" ], "facets": { "family": "cosmetic", "setting": "day-case", "anaesthesia": "general" }, "text": { "what": "Fat is taken by liposuction from the abdomen, flanks or back, processed, and injected into the buttocks to add volume and change shape. Some of the graft is reabsorbed over months, which is why surgeons overfill and why a second session is common. The reported danger is specific and mechanical: fat entering a torn gluteal vein travels to the lungs as a pulmonary fat embolism.", "story": "In 2017 the Aesthetic Surgery Education and Research Foundation put a task force on this operation and published what its survey found. Six hundred and ninety-two surgeons responded out of 4,843 members of two international societies contacted, a 14.3 per cent response rate. They reported 32 fatal pulmonary fat emboli across 198,857 career cases, a career rate of 1 in 6,214, and five fatal emboli in 17,519 cases over the previous twelve months, an annual rate of 1 in 3,448. The same paper reported 103 non-fatal pulmonary fat emboli.\n\nThe task force's recommendation was about the plane. Deep intramuscular injection was associated with significantly increased risk; injection into the mid and superficial planes was protective, and the authors urged surgeons to avoid deep muscle injections. The paper's own words about the rate were that it is unacceptably high and that the approach to the procedure must be improved.\n\n*Inference --* those rates are what surgeons reported about themselves, in a survey answered by one in seven of the members contacted, and they count deaths known to the operating surgeon. A patient who flies home and dies there is not necessarily in the numerator; a clinic that does not belong to either society is not in the denominator. The figure is the best published one, and it is a floor rather than a measurement of the whole trade.\n\nThe operation travels heavily all the same, and the price pages are short. Premier Clinic in Prague prices fat transfer to breasts or buttocks with liposuction of one area from 62,800 koruna. RP Clinic in Warsaw prices a BBL from 25,000 zloty and states the figure covers the whole procedure including post-operative care. The American society publishes 7,264 US dollars as an average surgeon's fee, excluding anaesthesia and the operating room. Yanhee in Bangkok, whose plastic surgery table runs to hundreds of lines, prices buttock implants and a buttock lift and does not list fat grafting at all.", "how": "General anaesthesia. The harvest is a liposuction, and the volumes are large enough that fluid balance matters. Injection is made with a blunt cannula into the subcutaneous plane above the muscle, under direct control of the tip; the 2017 task force recommendation is against injecting deep to the gluteal muscle. Sitting is restricted for weeks and specialised cushions are sold for the flight home. Graft take is partial and unpredictable, and clinics quote a second session accordingly.", "today": "Three published prices sit on this record, from Czechia, Poland and the United States, alongside one published mortality figure from 2017 that the profession itself produced. No national register counts this operation across clinics, so the count of how many are performed each year and where is a gap on this site rather than a number.", "notes": "This page describes an operation and reports the published figures on its mortality. It is not advice about having one, or about where." }, "metrics": { "mortality_per_1000": 0.29, "note": "0.29 deaths per 1,000 cases is the ASERF task force's annual figure of 1 fatal pulmonary fat embolism per 3,448 cases, from 5 deaths in 17,519 gluteal fat grafting cases reported for the twelve months before the 2017 survey. The population is self-reported by 692 surgeons who answered out of 4,843 members of ISAPS and ASAPS contacted - a 14.3 per cent response rate - so it measures deaths known to responding society members, not deaths in the trade at large. The same survey gives a career rate of 1 in 6,214 across 198,857 cases, which is 0.16 per 1,000, and 103 non-fatal pulmonary fat emboli.", "as_of": "2017", "source": "s:aserf-gluteal-fat-grafting-2017", "url": "https://academic.oup.com/asj/article/37/7/796/3075249" }, "prices": [ { "procedure": "bbl", "country": "CZ", "city": "Prague", "amount": 62800, "amount_high": 74800, "currency": "CZK", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [ "fat transfer to breasts or buttocks with liposuction of one area, at the bottom of the range", "liposuction of two areas at the top" ], "excludes": [ "not stated on the page" ], "source": "s:premier-clinic-prague-prices", "url": "https://www.premier-clinic.cz/en/price-list-plastic-surgery/", "note": "the clinic prices the harvest with the graft, which is the shape that makes a buttock price and a liposuction price impossible to add together", "tier": "cited", "usd": 2982.0, "usd_high": 3552.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "bbl", "country": "PL", "city": "Warsaw", "amount": 25000, "currency": "PLN", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [ "the whole procedure including post-operative care: consultations, follow-ups, dressing changes and suture removal, in the clinic's own words" ], "excludes": [ "not stated on the page" ], "source": "s:rpclinic-posladki-cennik", "url": "https://www.rpclinic.pl/cenniki/cennik-chirurgia-plastyczna/cennik-zabiegi-posladkow/", "note": "listed as 'from', gross, in zloty. The same list prices buttock implants from 27,000 PLN and a hybrid of implants with fat transfer and liposuction from 32,000 PLN.", "tier": "cited", "usd": 6643.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "bbl", "country": "US", "amount": 7264, "currency": "USD", "as_of": "2026-09-16", "kind": "survey", "includes": [ "surgeon fee only, buttock augmentation with fat grafting" ], "excludes": [ "anesthesia", "operating room facilities", "other related expenses" ], "source": "s:asps-cost-buttock", "url": "https://www.plasticsurgery.org/cosmetic-procedures/buttock-enhancement/cost", "note": "the same page gives 7,964 USD for buttock implants and 7,062 USD for a buttock lift. No year is named on the page.", "tier": "cited", "usd": 7264.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "bbl-mortality", "as": "The risk this operation carries, with the task-force figure and the argument over what it counts.", "rel": "risk" }, { "to": "liposuction", "as": "The first half of this operation, and the reason its price cannot be added to a liposuction price.", "rel": "part" }, { "to": "breast-augmentation", "as": "The other place harvested fat is injected, with a different risk profile.", "rel": "contrast" }, { "to": "isaps", "as": "One of the two societies whose members answered the mortality survey.", "rel": "org" }, { "to": "flying-after-surgery", "as": "Sitting restrictions and the clot risk of the flight collide in this operation more than any other cosmetic one.", "rel": "risk" }, { "to": "dvt-pe", "as": "A different embolism from the fat one, and the one the flight home adds.", "rel": "risk" }, { "to": "turkiye", "as": "A destination where the operation is sold in packages alongside hair surgery.", "rel": "destination" }, { "to": "poland", "as": "Where a clinic publishes a price stated to cover post-operative care.", "rel": "destination" }, { "to": "united-states", "as": "The source market whose society published the mortality survey.", "rel": "destination" }, { "to": "malpractice-recourse", "as": "What a family can do, and where, when the death happens abroad.", "rel": "risk" }, { "to": "revision-at-home", "as": "Who treats the complication after the flight, and who pays.", "rel": "risk" } ], "confusable_with": [ { "id": "liposuction", "tell": "A BBL is a liposuction plus a graft. A price for one is not a price for the other, and a package that names only the liposuction has priced half the operation." } ], "links": [ { "label": "ASERF task force report, Aesthetic Surgery Journal 2017", "url": "https://academic.oup.com/asj/article/37/7/796/3075249" }, { "label": "ASPS average surgeon fee, buttock enhancement", "url": "https://www.plasticsurgery.org/cosmetic-procedures/buttock-enhancement/cost" } ], "sources": [ "s:aserf-gluteal-fat-grafting-2017", "s:premier-clinic-prague-prices", "s:rpclinic-posladki-cennik", "s:asps-cost-buttock", "s:yanhee-plastic-prices" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:aserf-gluteal-fat-grafting-2017", "note": "the mortality paragraphs are the published task-force figures; the paragraph on what the denominator misses is marked as inference inline" }, "text.how": { "tier": "cited", "source": "s:aserf-gluteal-fat-grafting-2017", "note": "the plane-of-injection recommendation is the task force's; the rest is standard operative description" }, "metrics": { "tier": "cited", "source": "s:aserf-gluteal-fat-grafting-2017" }, "etymology": { "tier": "tradition" } } }, "x_commons_files": [ "File:Gluteal augmentation.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "Fat is taken by liposuction from the abdomen, flanks or back, processed, and injected into the buttocks to add volume and change shape.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "bbl-mortality", "type": "risk", "name": "Death from gluteal fat grafting", "as": "The risk this operation carries, with the task-force figure and the argument over what it counts.", "rel": "risk" }, { "to": "liposuction", "type": "procedure", "name": "Liposuction", "as": "The first half of this operation, and the reason its price cannot be added to a liposuction price.", "rel": "part" }, { "to": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "The other place harvested fat is injected, with a different risk profile.", "rel": "contrast" }, { "to": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "One of the two societies whose members answered the mortality survey.", "rel": "org" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "Sitting restrictions and the clot risk of the flight collide in this operation more than any other cosmetic one.", "rel": "risk" }, { "to": "dvt-pe", "type": "risk", "name": "Deep vein thrombosis and pulmonary embolism", "as": "A different embolism from the fat one, and the one the flight home adds.", "rel": "risk" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "A destination where the operation is sold in packages alongside hair surgery.", "rel": "destination" }, { "to": "poland", "type": "destination", "name": "Poland", "as": "Where a clinic publishes a price stated to cover post-operative care.", "rel": "destination" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The source market whose society published the mortality survey.", "rel": "destination" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "What a family can do, and where, when the death happens abroad.", "rel": "risk" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who treats the complication after the flight, and who pays.", "rel": "risk" } ], "source_list": [ { "id": "s:aserf-gluteal-fat-grafting-2017", "kind": "paper", "title": "Report on Mortality from Gluteal Fat Grafting: Recommendations from the ASERF Task Force", "publisher": "Aesthetic Surgery Journal 37(7), July-August 2017; Mofid, Teitelbaum, Suissa, Ramirez-Montanana, Astarita, Mendieta, Singer", "url": "https://academic.oup.com/asj/article/37/7/796/3075249", "accessed": "2026-09-16", "note": "survey of ISAPS and ASAPS members; 692 responses from 4,843 surveyed, a 14.3% response rate" }, { "id": "s:premier-clinic-prague-prices", "kind": "web", "title": "Price List - Plastic Surgery", "publisher": "Premier Clinic, Prague", "url": "https://www.premier-clinic.cz/en/price-list-plastic-surgery/", "accessed": "2026-09-16", "note": "clinic's own English price list, every line prefixed 'from', in Czech koruna" }, { "id": "s:rpclinic-posladki-cennik", "kind": "web", "title": "Cennik - zabiegi posladkow", "publisher": "RP Clinic, Warsaw", "url": "https://www.rpclinic.pl/cenniki/cennik-chirurgia-plastyczna/cennik-zabiegi-posladkow/", "accessed": "2026-09-16", "note": "buttock price list in zloty, gross, stated to cover the whole procedure including post-operative care" }, { "id": "s:asps-cost-buttock", "kind": "org", "title": "Buttock Enhancement Cost", "publisher": "American Society of Plastic Surgeons", "url": "https://www.plasticsurgery.org/cosmetic-procedures/buttock-enhancement/cost", "accessed": "2026-09-16", "note": "society's average surgeon fee; the page says it excludes anaesthesia, operating room facilities and other related expenses, and names no year" }, { "id": "s:yanhee-plastic-prices", "kind": "web", "title": "Plastic Surgery Prices", "publisher": "Yanhee Hospital, Bangkok", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "accessed": "2026-09-16", "note": "hospital's own price table: procedure, nights, price in Thai baht. The page carries no validity date and no inclusion list." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:aserf-gluteal-fat-grafting-2017", "note": "the mortality paragraphs are the published task-force figures; the paragraph on what the denominator misses is marked as inference inline" }, "text.how": { "tier": "cited", "source": "s:aserf-gluteal-fat-grafting-2017", "note": "the plane-of-injection recommendation is the task force's; the rest is standard operative description" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:aserf-gluteal-fat-grafting-2017" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "brazil", "type": "destination", "name": "Brazil", "as": "The buttock operation whose technique argument is partly Brazilian.", "rel": "procedure" }, { "from": "colombia", "type": "destination", "name": "Colombia", "as": "The operation most argued over here, and the one with a published mortality literature.", "rel": "procedure" }, { "from": "dominican-republic", "type": "destination", "name": "Dominican Republic", "as": "The body operation the trade here is currently known for.", "rel": "procedure" }, { "from": "medellin", "type": "hub", "name": "Medellín", "as": "The operation this city is best known abroad for, and the one this directory keeps a separate mortality record on.", "rel": "performs" }, { "from": "santo-domingo", "type": "hub", "name": "Santo Domingo", "as": "Among the operations sold here, and the one with its own mortality record in this directory.", "rel": "performs" }, { "from": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "The other fat-grafting operation, and the one with a published mortality figure attached to it.", "rel": "contrast" }, { "from": "liposuction", "type": "procedure", "name": "Liposuction", "as": "The operation that begins with this one, and then injects what it harvested.", "rel": "part" }, { "from": "clinica-las-americas", "type": "facility", "name": "Clínica Las Américas", "as": "Medellín's cosmetic trade runs beside this clinic and not through it, which is the distinction a reader of a city page needs.", "rel": "contrast" }, { "from": "bbl-mortality", "type": "risk", "name": "Death from gluteal fat grafting", "as": "The procedure this is the mortality of.", "rel": "procedure" }, { "from": "nontuberculous-mycobacteria", "type": "risk", "name": "Nontuberculous mycobacteria", "as": "Among the cosmetic procedures the case-patients had travelled for.", "rel": "procedure" }, { "from": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Gluteal augmentation was the commonest procedure and the source of every major complication in two of the series.", "rel": "procedure" }, { "from": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "The operation its members answered a mortality survey about, which is where this directory's death rate for it comes from.", "rel": "procedure" }, { "from": "dominican-republic-ntm-outbreak", "type": "event", "name": "The Dominican mycobacterial outbreaks, 2013–14 and 2017", "as": "The body operation the Dominican trade is now known for.", "rel": "procedure" }, { "from": "the-follow-up-nobody-books", "type": "story", "name": "The follow-up nobody books", "as": "Gluteal augmentation was the commonest procedure and the source of every major complication in two series.", "rel": "procedure" } ] }, { "schema": 1, "id": "bone-marrow-transplant", "type": "procedure", "names": { "name": "Bone marrow transplant", "aliases": [ "haematopoietic stem cell transplant", "HSCT", "stem cell transplant", "BMT" ], "said": "Haematologists say transplant and then say autologous or allogeneic, because the two are different operations with different prices, different stays and different risks. Registries say haematopoietic cell transplantation. Families say bone marrow, even when the cells came out of a vein." }, "etymology": { "root": "marrow: Old English mearg, the soft interior of a bone. Transplant: Latin transplantare, to plant across. Autologous, from Greek autos, self; allogeneic, from allos, other, and genos, kind — the whole distinction the field turns on sits in those two prefixes.", "tier": "tradition", "note": "graft-versus-host disease names the direction of the attack: in this one transplant the tissue can reject the patient." }, "region": [ "global" ], "facets": { "family": "transplant", "setting": "inpatient", "anaesthesia": "varies" }, "text": { "what": "The blood-forming system is destroyed by chemotherapy, with or without radiation, and replaced with stem cells — the patient's own, harvested and stored beforehand, or another person's. Milliman's terms are the usable ones: autologous, \"where the donor is the recipient\", and allogeneic, \"where the donor may be related or unrelated to the recipient\". The cells are given through a drip, not implanted. What follows is weeks of no immune system, and, in the allogeneic case, a lifetime of watching for the graft attacking the patient.", "story": "This treatment travels for a reason no other page in this directory carries: the thing that is scarce is a person.\n\nAn allogeneic transplant needs a tissue-matched donor. About a quarter to a third of patients have a matched sibling; the rest are searched for in the international registries, which are federated and queried as one. The World Marrow Donor Association's front-page counter gave 44,206,627 volunteer donors and cord blood units in the global database when it was read on 16 September 2026 — a count of registrations, not of people who will answer the phone.\n\nThe registries are not evenly composed, and that is the second scarcity. Modelling the US registry for 21 racial and ethnic groups, Gragert and colleagues found in the New England Journal of Medicine in 2014 that \"the likelihood of finding an optimal adult donor varies among racial and ethnic groups, with the highest probability among whites of European descent, at 75%, and the lowest probability among blacks of South or Central American descent, at 16%\". A patient's ancestry, in other words, sets the odds that the world's donor pool contains them. Cord blood closes part of the gap: units mismatched at one or two loci \"are available for almost all patients younger than 20 years of age and for more than 80% of patients 20 years of age or older, regardless of racial and ethnic background\".\n\n*Trade practice —* the workaround that changed the map is the half-matched, or haploidentical, transplant from a parent or child, which needs no registry at all. Units in India and Türkiye built large haploidentical programmes, and patients from countries with no transplant unit travel to them.\n\n*Inference —* a search that crosses borders is ordinary here in a way it is nowhere else in this directory: the patient may stay put while the graft flies. Cells are couriered between registries under time limits, and the courier is the part of the journey nobody writes a package price for.", "how": "Conditioning chemotherapy first, for days; then the infusion; then the wait for the new marrow to start making blood, during which the patient has almost no immune defence and is nursed in isolation. Milliman's 2025 estimate of the average US hospital stay is 33.3 days for an allogeneic transplant and 20.3 for an autologous one. *Trade practice —* transplant units commonly ask allogeneic patients to remain close to the centre for roughly the first hundred days after discharge, with a full-time carer, which is the sentence that decides whether a transplant abroad is possible at all. Graft-versus-host disease, infection and the immunosuppression that follows are managed for months to years afterwards.", "today": "The only publicly readable price for this record is an actuarial estimate of what American hospitals bill. Milliman's February 2025 report puts average 2025 billed charges at 1,261,800 US dollars for an allogeneic transplant and 577,000 for an autologous one, covering 30 days before admission to 180 days after discharge. The report is explicit that this is not what anyone pays: \"billed charges are unlikely to equal the actual amount paid for the transplant services due to the presence of negotiated reimbursement arrangements such as case rates, prescribed fee schedules, discounts, or other agreements in place.\" No hospital price list for a self-paying foreign patient was read for this record on 16 September 2026.", "notes": "This page describes a treatment. It is not advice about whether to have one, or where." }, "metrics": { "stay_days": 33.3, "days_before_flying": null, "recovery_weeks": null, "note": "Milliman's estimated 2025 US average hospital length of stay for an allogeneic transplant; the autologous figure is 20.3 days. It is an estimate from claims data, not a protocol. No published wait before flying was found for this treatment, and the constraint that matters is the months near the centre rather than the flight itself.", "as_of": "2025", "source": "s:milliman-transplant-2025", "url": "https://www.milliman.com/en/insight/2025-us-organ-and-tissue-transplants-costs-utilization" }, "prices": [ { "procedure": "bone-marrow-transplant", "country": "US", "amount": 1261800, "currency": "USD", "as_of": "2025", "kind": "estimate", "includes": [ "30 days pretransplant, $94,300", "procurement, $97,400", "hospital transplant admission, $669,300", "physician services during the admission, $18,900", "180 days posttransplant discharge, $314,200", "outpatient immunosuppressants and other prescriptions, $67,700" ], "excludes": [ "anything outside the window of 30 days before admission to 180 days after discharge", "the difference between a billed charge and a negotiated rate" ], "source": "s:milliman-transplant-2025", "url": "https://www.milliman.com/en/insight/2025-us-organ-and-tissue-transplants-costs-utilization", "note": "allogeneic. An actuarial estimate of average US billed charges, not a quoted price; the six component figures are the report's own breakdown and are given here because the admission is barely half of the total.", "tier": "cited", "usd": 1261800.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "bone-marrow-transplant", "country": "US", "amount": 577000, "currency": "USD", "as_of": "2025", "kind": "estimate", "includes": [ "30 days pretransplant, $77,900", "procurement, $36,100", "hospital transplant admission, $275,500", "physician services during the admission, $11,500", "180 days posttransplant discharge, $129,800", "outpatient immunosuppressants and other prescriptions, $46,200" ], "excludes": [ "anything outside the window of 30 days before admission to 180 days after discharge" ], "source": "s:milliman-transplant-2025", "url": "https://www.milliman.com/en/insight/2025-us-organ-and-tissue-transplants-costs-utilization", "note": "autologous — the patient's own cells, so the procurement line is a third of the allogeneic one and there is no donor to find.", "tier": "cited", "usd": 577000.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "car-t", "as": "Grew out of these units and is still given in them; the accreditation that qualifies a centre for one qualifies it for the other.", "rel": "descendant" }, { "to": "kidney-transplant", "as": "The other transplant in this directory where a second person carries the risk.", "rel": "kin" }, { "to": "india", "as": "Built large half-matched transplant programmes that take patients from countries with no unit.", "rel": "destination" }, { "to": "turkiye", "as": "Runs transplant units that treat foreign patients, and publishes a licensing regime for them.", "rel": "destination" }, { "to": "blood-supply-safety", "as": "The transfusions that carry a patient through the weeks without marrow.", "rel": "risk" }, { "to": "antimicrobial-resistance", "as": "What an infection means in a patient with no immune system, and what a patient can carry home.", "rel": "risk" }, { "to": "the-escort-burden", "as": "A hundred days near the centre with a full-time carer, which no package price covers.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Graft-versus-host disease declares itself months later, in another country.", "rel": "risk" }, { "to": "who", "as": "Sets the framework under which donated cells and tissues move between countries.", "rel": "org" } ], "confusable_with": [ { "id": "stem-cell-unproven", "tell": "A haematopoietic transplant is a licensed treatment with registries, matching and published outcomes. Clinics selling stem cells for arthritis or autism are selling something else under a borrowed word." } ], "links": [ { "label": "World Marrow Donor Association", "url": "https://wmda.info/" }, { "label": "Milliman 2025 US organ and tissue transplants", "url": "https://www.milliman.com/en/insight/2025-us-organ-and-tissue-transplants-costs-utilization" } ], "sources": [ "s:milliman-transplant-2025", "s:wmda-global-database", "s:gragert-nejm-2014" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:gragert-nejm-2014", "note": "registry and match figures cited; the haploidentical paragraph is marked Trade practice and the closing paragraph Inference" }, "text.how": { "tier": "cited", "source": "s:milliman-transplant-2025", "note": "length of stay cited; the hundred-day convention is marked Trade practice" }, "prices": { "tier": "cited", "source": "s:milliman-transplant-2025" }, "etymology": { "tier": "tradition" } } }, "x_commons_files": [ "File:Bone marrow harvest.jpg", "File:Hematopoietic stem cell transplantation.svg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "The blood-forming system is destroyed by chemotherapy, with or without radiation, and replaced with stem cells — the patient's own, harvested and stored beforehand, or another person's.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "Grew out of these units and is still given in them; the accreditation that qualifies a centre for one qualifies it for the other.", "rel": "descendant" }, { "to": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "The other transplant in this directory where a second person carries the risk.", "rel": "kin" }, { "to": "india", "type": "destination", "name": "India", "as": "Built large half-matched transplant programmes that take patients from countries with no unit.", "rel": "destination" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "Runs transplant units that treat foreign patients, and publishes a licensing regime for them.", "rel": "destination" }, { "to": "blood-supply-safety", "type": "risk", "name": "Blood supply safety", "as": "The transfusions that carry a patient through the weeks without marrow.", "rel": "risk" }, { "to": "antimicrobial-resistance", "type": "risk", "name": "Antimicrobial resistance acquired abroad", "as": "What an infection means in a patient with no immune system, and what a patient can carry home.", "rel": "risk" }, { "to": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "A hundred days near the centre with a full-time carer, which no package price covers.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Graft-versus-host disease declares itself months later, in another country.", "rel": "risk" }, { "to": "who", "type": "org", "name": "World Health Organization", "as": "Sets the framework under which donated cells and tissues move between countries.", "rel": "org" } ], "source_list": [ { "id": "s:milliman-transplant-2025", "kind": "report", "title": "2025 U.S. organ and tissue transplants: Estimated costs and utilization, emerging issues, and solutions", "publisher": "Nick Ortner and Hanna Holzer, Milliman, February 2025", "url": "https://www.milliman.com/en/insight/2025-us-organ-and-tissue-transplants-costs-utilization", "accessed": "2026-09-16", "note": "estimated US average billed charges per transplant for the window 30 days before admission to 180 days after discharge, broken into six components; the report states that billed charges are unlikely to equal the amount actually paid" }, { "id": "s:wmda-global-database", "kind": "org", "title": "World Marrow Donor Association — global database counter", "publisher": "World Marrow Donor Association, Leiden", "url": "https://wmda.info/", "accessed": "2026-09-16", "note": "the counter on the association's front page gives the number of volunteer donors and cord blood products in the global database; it counts registrations, not people available to donate on a given day" }, { "id": "s:gragert-nejm-2014", "kind": "paper", "title": "HLA match likelihoods for hematopoietic stem-cell grafts in the U.S. registry", "publisher": "New England Journal of Medicine, 2014, doi:10.1056/NEJMsa1311707, PMID 25054717", "url": "https://doi.org/10.1056/NEJMsa1311707", "accessed": "2026-09-16", "note": "models the probability of finding an optimally matched adult unrelated donor for 21 US racial and ethnic groups" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:gragert-nejm-2014", "note": "registry and match figures cited; the haploidentical paragraph is marked Trade practice and the closing paragraph Inference" }, "text.how": { "tier": "cited", "source": "s:milliman-transplant-2025", "note": "length of stay cited; the hundred-day convention is marked Trade practice" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:milliman-transplant-2025" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "amman", "type": "hub", "name": "Amman", "as": "The kind of work a regional referral centre is built to take.", "rel": "procedure" }, { "from": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "Referred here from across South and Central Asia, by the trade's account.", "rel": "procedure" }, { "from": "mumbai", "type": "hub", "name": "Mumbai", "as": "The work that brings patients to Parel from outside India.", "rel": "procedure" }, { "from": "singapore-city", "type": "hub", "name": "Singapore", "as": "The complex work that stayed when the routine work left.", "rel": "procedure" }, { "from": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "The older cell therapy whose accredited units became the centres allowed to give this one.", "rel": "origin" }, { "from": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "The other transplant here where a healthy second person takes the risk.", "rel": "kin" }, { "from": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "The other graft here that needs a second healthy person to agree to something.", "rel": "kin" }, { "from": "anadolu-medical-center", "type": "facility", "name": "Anadolu Medical Center", "as": "The programme the hospital was built around, with capacity stated for 22 simultaneous stem cell transplants.", "rel": "performs" }, { "from": "fortis-gurgaon", "type": "facility", "name": "Fortis Memorial Research Institute, Gurugram", "as": "One of the referral programmes the group runs here.", "rel": "performs" }, { "from": "hadassah", "type": "facility", "name": "Hadassah Medical Center", "as": "Among the programmes that draw regional and diaspora referrals.", "rel": "performs" }, { "from": "king-hussein-cancer-center", "type": "facility", "name": "King Hussein Cancer Center", "as": "Among the programmes that bring children across borders to Amman.", "rel": "performs" }, { "from": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "The stem cell case the CDC folds into the same category.", "rel": "procedure" } ] }, { "schema": 1, "id": "breast-augmentation", "type": "procedure", "names": { "name": "Breast augmentation", "aliases": [ "augmentation mammoplasty", "boob job", "breast enlargement", "fat transfer to the breast" ], "said": "Clinics say augmentation when an implant goes in and fat transfer when the patient's own fat does. Price pages in Bangkok say the brand: Mentor, Motiva, Sebbin, Silimed. The brand is the price." }, "etymology": { "root": "mammoplasty: Latin mamma, a breast, plus Greek plastos, moulded. Augmentation from Latin augere, to increase - the same root as augment and as augur, who read increase in the flight of birds.", "tier": "tradition", "note": "cc means cubic centimetres of implant volume, and it is the unit that moves a Bangkok price: the same shell over 400 cc costs 10,000 to 20,000 baht more on the same table." }, "region": [ "global" ], "facets": { "family": "cosmetic", "setting": "day-case", "anaesthesia": "general" }, "text": { "what": "A silicone shell filled with cohesive gel or saline is placed behind the breast tissue or behind the chest muscle, through a cut in the fold under the breast, around the areola or in the armpit. The alternative operation takes fat by liposuction from elsewhere on the body and injects it into the breast, which adds less volume and holds it less predictably. An implant is a device with a serial number, a manufacturer and a register, and it is not permanent.", "story": "Breast augmentation is the operation that taught the trade to price by component. A Bangkok price table for one hospital runs to eighteen lines, and every line is a shell: round Mentor under 400 cc at 125,000 baht, Motiva Ergonomix at 217,000, Ergonomix II Zen at 289,000, each with one night on the ward. The operation barely changes across those lines. The device does, and so does the margin.\n\nEuropean lists are shorter and quieter about the device. Premier Clinic in Prague prices breast augmentation alone from 55,000 koruna; Artplastica in Poland prices augmentation with round implants at 25,500 zloty and lists the ward day separately at 800 zloty. The American Society of Plastic Surgeons publishes 4,875 US dollars for augmentation with implants and 5,719 for augmentation with fat grafting, and says that figure is a surgeon's fee with no anaesthesia and no operating room in it.\n\n*Inference --* the implant is where a cross-border comparison usually breaks. A patient who cannot name the manufacturer, the volume, the shell texture and the lot number of what was put in cannot be followed up properly at home, cannot be matched if one side fails, and cannot be found by a manufacturer's recall. The implant card is the document that carries those numbers, and asking for it is a step in the journey rather than a clinical courtesy.", "how": "General anaesthesia; most published packages name one night. Drains, where used, come out in days. Clinics commonly restrict overhead lifting for several weeks and a supportive garment is worn for longer. Implants are followed for life: rupture, capsular contracture and change of taste all produce revision operations, and every register that measures them counts device removals as well as insertions. Where a price is quoted per breast rather than per operation, the table usually says so in small type.", "today": "Prices on this record run from 25,500 zloty in Poland to 289,000 baht for a named gel implant in Bangkok, with a published American surgeon's fee of 4,875 US dollars that excludes the theatre it is performed in. Each row names its date and what it covers. None of them include the follow-up scan that most manufacturers and several regulators recommend for the years after.", "notes": "This page describes an operation and the devices used in it. It is not advice about either." }, "metrics": { "stay_days": 1, "note": "One night is the stay printed beside every implant line on the Yanhee table read for this record, not a clinical standard; day-case augmentation is routine elsewhere. No implant survival or revision rate is carried here: the national breast implant registries that measure those publish by device and by year, which is a dataset record rather than a number for this page.", "as_of": "2026-09-16", "source": "s:yanhee-plastic-prices", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/" }, "prices": [ { "procedure": "breast-augmentation", "country": "TH", "city": "Bangkok", "amount": 125000, "amount_high": 305000, "currency": "THB", "as_of": "2026-09-16", "kind": "list", "includes": [ "the implant, named by brand and shell", "one night on the ward" ], "excludes": [ "not stated on the page" ], "source": "s:yanhee-plastic-prices", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "note": "the range across eighteen published lines: round Mentor under 400 cc at 125,000 THB at the bottom, Motiva Ergonomix II Zen over 400 cc at 305,000 THB at the top. Unlike most joint packages, the device is inside the price here and the brand is what moves it.", "tier": "cited", "usd": 3754.0, "usd_high": 9161.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "breast-augmentation", "country": "CZ", "city": "Prague", "amount": 55000, "currency": "CZK", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [ "breast augmentation alone" ], "excludes": [ "not stated on the page" ], "source": "s:premier-clinic-prague-prices", "url": "https://www.premier-clinic.cz/en/price-list-plastic-surgery/", "note": "listed as 'from'. The same list prices augmentation by the clinic's Preserve method from 93,000 CZK and breast lift with augmentation from 88,000 CZK.", "tier": "cited", "usd": 2612.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "breast-augmentation", "country": "PL", "city": "Szczecin", "amount": 25500, "currency": "PLN", "as_of": "2026-09-16", "kind": "list", "includes": [ "augmentation with round implants" ], "excludes": [ "hospitalisation, listed separately at 800 PLN a day" ], "source": "s:artplastica-cennik", "url": "https://www.artplastica.pl/cennik-zabiegi-operacje-plastyczne/", "note": "the clinic states its listed prices are indicative and may change at consultation", "tier": "cited", "usd": 6776.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "breast-augmentation", "country": "US", "amount": 4875, "currency": "USD", "as_of": "2026-09-16", "kind": "survey", "includes": [ "surgeon fee only, augmentation with implants" ], "excludes": [ "anesthesia", "operating room facilities", "other related expenses", "the implants themselves are not itemised on the page" ], "source": "s:asps-cost-breast-augmentation", "url": "https://www.plasticsurgery.org/cosmetic-procedures/breast-augmentation/cost", "note": "the same page gives 5,719 USD for augmentation with fat grafting. No year is named on the page for either figure.", "tier": "cited", "usd": 4875.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "bbl", "as": "The other fat-grafting operation, and the one with a published mortality figure attached to it.", "rel": "contrast" }, { "to": "liposuction", "as": "Where the fat comes from when the augmentation is done without an implant.", "rel": "part" }, { "to": "thailand", "as": "Where the price is published one implant brand at a time.", "rel": "destination" }, { "to": "czechia", "as": "A European price list for the same operation, in koruna.", "rel": "destination" }, { "to": "poland", "as": "Where the ward day is priced separately from the operation.", "rel": "destination" }, { "to": "implant-excluded", "as": "The line item that decides whether a published price is half a bill; here the device is usually inside it, which is the exception.", "rel": "risk" }, { "to": "revision", "as": "Implants are removed and replaced; the first price covers none of that.", "rel": "term" }, { "to": "follow-up-gap", "as": "Who holds the implant card, and who scans the breast in five years.", "rel": "risk" }, { "to": "isaps", "as": "The society whose global survey counts this operation across countries.", "rel": "org" }, { "to": "reading-the-exclusions", "as": "The step where the brand, the volume and the ward night are separated from the headline.", "rel": "step" } ], "confusable_with": [ { "id": "bbl", "tell": "Both may be sold as fat transfer. Fat to the breast and fat to the buttock are different operations with different risks, and only one of them has a task-force mortality figure." } ], "links": [ { "label": "Yanhee implant price table", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/" } ], "sources": [ "s:yanhee-plastic-prices", "s:premier-clinic-prague-prices", "s:artplastica-cennik", "s:asps-cost-breast-augmentation" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "price paragraphs read off the four named pages; the implant-card paragraph is marked as inference inline" }, "text.how": { "tier": "tradition" }, "etymology": { "tier": "tradition" } } }, "x_commons_files": [ "File:Breast implant.jpg", "File:Breast augmentation diagram.png" ], "confidence": "high", "updated": "2026-09-16", "blurb": "A silicone shell filled with cohesive gel or saline is placed behind the breast tissue or behind the chest muscle, through a cut in the fold under the breast, around the areola or in the armpit.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "The other fat-grafting operation, and the one with a published mortality figure attached to it.", "rel": "contrast" }, { "to": "liposuction", "type": "procedure", "name": "Liposuction", "as": "Where the fat comes from when the augmentation is done without an implant.", "rel": "part" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the price is published one implant brand at a time.", "rel": "destination" }, { "to": "czechia", "type": "destination", "name": "Czechia", "as": "A European price list for the same operation, in koruna.", "rel": "destination" }, { "to": "poland", "type": "destination", "name": "Poland", "as": "Where the ward day is priced separately from the operation.", "rel": "destination" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The line item that decides whether a published price is half a bill; here the device is usually inside it, which is the exception.", "rel": "risk" }, { "to": "revision", "type": "term", "name": "Revision", "as": "Implants are removed and replaced; the first price covers none of that.", "rel": "term" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who holds the implant card, and who scans the breast in five years.", "rel": "risk" }, { "to": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "The society whose global survey counts this operation across countries.", "rel": "org" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step where the brand, the volume and the ward night are separated from the headline.", "rel": "step" } ], "source_list": [ { "id": "s:yanhee-plastic-prices", "kind": "web", "title": "Plastic Surgery Prices", "publisher": "Yanhee Hospital, Bangkok", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "accessed": "2026-09-16", "note": "hospital's own price table: procedure, nights, price in Thai baht. The page carries no validity date and no inclusion list." }, { "id": "s:premier-clinic-prague-prices", "kind": "web", "title": "Price List - Plastic Surgery", "publisher": "Premier Clinic, Prague", "url": "https://www.premier-clinic.cz/en/price-list-plastic-surgery/", "accessed": "2026-09-16", "note": "clinic's own English price list, every line prefixed 'from', in Czech koruna" }, { "id": "s:artplastica-cennik", "kind": "web", "title": "Cennik zabiegow i operacji plastycznych", "publisher": "Beauty Group - Artplastica, Szczecin", "url": "https://www.artplastica.pl/cennik-zabiegi-operacje-plastyczne/", "accessed": "2026-09-16", "note": "clinic's own price list in zloty; the page states the prices are indicative and may change at consultation, and lists hospitalisation at 800 PLN a day separately" }, { "id": "s:asps-cost-breast-augmentation", "kind": "org", "title": "Breast Augmentation Cost", "publisher": "American Society of Plastic Surgeons", "url": "https://www.plasticsurgery.org/cosmetic-procedures/breast-augmentation/cost", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "price paragraphs read off the four named pages; the implant-card paragraph is marked as inference inline" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "argentina", "type": "destination", "name": "Argentina", "as": "A staple of the surgical half of the country's count.", "rel": "procedure" }, { "from": "south-africa", "type": "destination", "name": "South Africa", "as": "One of the operations the European end of this trade is built on.", "rel": "procedure" }, { "from": "phuket", "type": "hub", "name": "Phuket", "as": "Sold here on the same recovery-in-a-resort footing.", "rel": "procedure" }, { "from": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "The other place harvested fat is injected, with a different risk profile.", "rel": "contrast" }, { "from": "liposuction", "type": "procedure", "name": "Liposuction", "as": "Where the harvested fat goes when no implant is used.", "rel": "contrast" }, { "from": "top-surgery", "type": "procedure", "name": "Top surgery", "as": "The mirror operation, priced by implant on the same tables.", "rel": "contrast" }, { "from": "prince-court", "type": "facility", "name": "Prince Court Medical Centre", "as": "Sold here at a fixed price with two named implant brands and a top-up between them.", "rel": "performs" }, { "from": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The commonest procedure in the Manchester breast unit series.", "rel": "procedure" }, { "from": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "Third on that ranking, and one of the operations its survey counts by country.", "rel": "procedure" } ] }, { "schema": 1, "id": "cabg", "type": "procedure", "names": { "name": "Coronary artery bypass grafting", "aliases": [ "CABG", "heart bypass", "coronary bypass", "open heart surgery" ], "said": "Surgeons say cabbage, spelling it CABG. Price pages say heart bypass. Neither says how many grafts, and the graft count is part of the price everywhere it is published." }, "etymology": { "root": "coronary: Latin corona, a crown — the arteries wreathe the heart. Graft is Old French greffe, a shoot for planting, from Greek graphion, a stylus, which the cutting resembled. Bypass is plain English engineering, borrowed by cardiac surgery in the 1960s for a road around a blockage.", "tier": "tradition", "note": "Off-pump means the heart keeps beating; on-pump means a machine takes over circulation. Package pages price the two together, and MICS — minimally invasive cardiac surgery, through a small incision between the ribs — as a tier above both." }, "region": [ "global" ], "facets": { "family": "cardiac", "setting": "inpatient", "anaesthesia": "general" }, "text": { "what": "A length of vein from the leg or artery from the chest wall is sewn around a blocked coronary artery so blood reaches the muscle beyond it. Several grafts in one operation is usual. Eight nights in hospital on the Bangkok packages read for this record, seven for the minimally invasive version, and weeks before a long flight.", "story": "This is the operation that taught the world to argue about medical prices, and the argument rests on one pair of numbers from 2013.\n\nBloomberg reported that year that Narayana Health had brought coronary bypass surgery to 95,000 rupees, about 1,583 US dollars at the time, and set the same operation at the Cleveland Clinic in Ohio at 106,385 dollars. Devi Shetty, who founded the group, said then that he meant to reach 800 dollars within a decade. The pair has been reprinted ever since, usually without its date and usually without the fact that the Indian figure is an Indian patient's bill at an Indian hospital rather than a package sold to somebody who flew in. It is carried here as what it is: two figures published in 2013, thirteen years before this record was written.\n\nWhat a foreign patient can read off a page today is narrower and duller. Bangkok Heart Hospital, part of Bangkok Hospital, publishes its cardiovascular surgery packages with the nights inside them: off-pump or on-pump bypass at Level 1, 1,173,000 baht for eight nights; Level 2, 1,437,500 baht for the same eight; the minimally invasive version at 1,500,000 baht against a struck-through 1,725,000, for seven. Prices stated valid until 31 October 2026.\n\nThe exclusion list is where the money moves. The package covers theatre, the surgical and anaesthetic team, the critical care unit and the stated nights. It does not cover pre-assessment and medical clearance, other specialists' consultations, \"special device used during procedure\", extra nights in intensive care or on the ward, or medication taken home. A bypass that stays eight nights costs what the page says; one that needs a tenth night does not.\n\n*Inference —* Level 1 and Level 2 are the page's own way of pricing the difficulty of the case without describing it. A reader cannot tell from the page which level their heart is.", "how": "General anaesthesia, the chest opened through the breastbone or, for the minimally invasive version, between the ribs, grafts taken from the leg, forearm or chest wall, the heart stopped and supported by a bypass machine or left beating, the grafts sewn on, the chest closed. Intensive care for a day or two, then the ward.\n\nWhere a state pays rather than a patient, the number looks nothing like a package. The Australian Medicare Benefits Schedule sets the surgeon's fee for item 38502 — coronary artery bypass including cardiopulmonary bypass — at $2,819.90, with a 75% benefit of $2,114.95. That is a fee for one doctor's service, not the admission: the hospital, the theatre, the intensive care and the anaesthetist are billed separately. Comparing it with a Bangkok package price compares a line with a bill.", "today": "As of 17 September 2026 the published Thai package prices for this operation run 1,173,000 to 1,500,000 baht with seven or eight nights inside them and the special device outside. The Indian figure the subject is famous for, 95,000 rupees, was published in 2013 against 106,385 US dollars at the Cleveland Clinic in the same report, and neither end has been restated in a source read here since.", "notes": "This page describes an operation and the prices published for it. It is not medical advice. Narayana Health's own figure for this operation sits on that hospital's record rather than being repeated here; it appears on this page's chart all the same, because the chart gathers every price carrying this procedure's id." }, "metrics": { "stay_days": 8, "days_before_flying": 10, "recovery_weeks": 12, "mortality_per_1000": null, "note": "Eight nights is the ward and critical-care stay named in the Bangkok Heart Hospital bypass packages read for this record, seven for the minimally invasive version; it is those packages' figure, not a clinical standard. The ten-day figure is the CDC's guidance not to fly for ten days after chest surgery. The twelve weeks is the span usually quoted for return to ordinary activity and varies widely. No registry read for this record publishes mortality for the hospitals named on this page, so that field stays empty.", "as_of": "2026-09-17", "source": "s:cdc-yellowbook-medical-tourism", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" }, "prices": [ { "procedure": "cabg", "country": "TH", "city": "Bangkok", "facility": "bangkok-hospital", "amount": 1173000, "currency": "THB", "as_of": "2026-09-17", "kind": "package", "includes": [ "operating room and recovery room", "specified medical supplies and medications used during the procedure", "surgeon team and anaesthesiologist fees for the specified procedure", "intermediate critical care unit and critical care unit", "standard inpatient room for the stated 8 nights", "hospital fee, meals and related medical equipment during hospitalisation" ], "excludes": [ "pre-assessment and medical clearance before the procedure", "consultation fees where other specialists are required", "special device used during the procedure", "medical expense arising from the patient's underlying conditions", "additional nights in the critical care unit or beyond the stated stay", "rooms other than standard", "home medications" ], "source": "s:bangkokhospital-heart-packages", "url": "https://www.bangkokhospital.com/en/bangkok-heart/package/heart-catheterization-surgery", "note": "off-pump or on-pump CABG Level 1, 8 nights. Level 2 is 1,437,500 THB for the same 8 nights. Prices stated valid until 31 October 2026. The levels are not defined on the page.", "tier": "cited", "usd": 35231.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "cabg", "country": "TH", "city": "Bangkok", "facility": "bangkok-hospital", "amount": 1500000, "currency": "THB", "as_of": "2026-09-17", "kind": "package", "includes": [ "minimally invasive cardiac surgery bypass (MICS CABG)", "7 nights in hospital", "theatre, surgical team and anaesthesiologist as for the other cardiac packages" ], "excludes": [ "as the other cardiac packages: pre-assessment, other specialists, special device used during the procedure, extra nights, home medications" ], "source": "s:bangkokhospital-heart-packages", "url": "https://www.bangkokhospital.com/en/bangkok-heart/package/heart-catheterization-surgery", "note": "listed at 1,500,000 THB against a struck-through 1,725,000 THB, marked New, 7 nights — one night fewer than the open operation at a higher price. Valid until 31 October 2026.", "tier": "cited", "usd": 45053.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "cabg", "country": "US", "city": "Cleveland", "amount": 106385, "currency": "USD", "as_of": "2013", "kind": "estimate", "includes": [ "coronary bypass surgery, as reported" ], "excludes": [ "unstated — the report names no inclusion list" ], "source": "s:wp-devi-shetty", "url": "https://en.wikipedia.org/wiki/Devi_Shetty", "note": "the other end of the same 2013 Bloomberg comparison: the same operation at the Cleveland Clinic in Ohio at 106,385 US dollars. Carried here only because the Indian figure is carried; one without the other is half a sentence.", "tier": "cited", "usd": 106385.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "cabg", "country": "AU", "amount": 2819.9, "currency": "AUD", "as_of": "2026-09-17", "kind": "tariff", "includes": [ "the surgeon's service for item 38502: coronary artery bypass including cardiopulmonary bypass, with harvesting of the left internal mammary artery or vein graft material" ], "excludes": [ "the hospital, the theatre, the anaesthetist, the intensive care and the ward — all billed under their own items or by the hospital", "aftercare" ], "source": "s:mbs-38502", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=38502&qt=item", "note": "the Medicare Benefits Schedule fee, with a 75% benefit of $2,114.95, read on 17 September 2026. A schedule fee is what the state reckons one doctor's service is worth, not what a bypass costs; the Bangkok package beside it is a whole admission.", "tier": "cited", "usd": 2010.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "angioplasty-stent", "as": "The catheter alternative, a tenth of the price on the same hospital's page and a different argument about who needs which.", "rel": "contrast" }, { "to": "heart-valve-replacement", "as": "The other open-heart operation, priced below this one on the same Bangkok list.", "rel": "kin" }, { "to": "narayana-health", "as": "The group whose 2013 figure made this operation the subject's standard comparison.", "rel": "performed-at" }, { "to": "bangkok-hospital", "as": "Publishes the bypass packages this page reads, special device excluded.", "rel": "performed-at" }, { "to": "india", "as": "Where the volume argument about this operation was made.", "rel": "destination" }, { "to": "thailand", "as": "Where the operation is sold as a package with the nights counted.", "rel": "destination" }, { "to": "united-states", "as": "The other end of the 2013 comparison, and the market it was aimed at.", "rel": "destination" }, { "to": "australia", "as": "Where the state prices the surgeon's service rather than the admission.", "rel": "destination" }, { "to": "bengaluru", "as": "The city outside which the cheap-bypass argument was built.", "rel": "place" }, { "to": "tariff", "as": "What a schedule fee is, and why it cannot be read against a package price.", "rel": "term" }, { "to": "flying-after-surgery", "as": "The rule that keeps a chest-surgery patient on the ground for ten days.", "rel": "risk" }, { "to": "repatriation-cost", "as": "What it costs to bring home a patient whose bypass went wrong abroad.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Who reads the echocardiogram at three months, and where.", "rel": "risk" } ], "confusable_with": [ { "id": "angioplasty-stent", "tell": "A bypass reroutes blood around a blockage with sewn grafts and opens the chest; a stent props the artery open from inside through a wrist or groin puncture. Both are sold as heart treatment and they differ by a factor of four on the same hospital's price page." } ], "links": [ { "label": "Bangkok Heart Hospital — cardiovascular surgery packages", "url": "https://www.bangkokhospital.com/en/bangkok-heart/package/heart-catheterization-surgery" }, { "label": "MBS item 38502", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=38502&qt=item" } ], "sources": [ "s:bangkokhospital-heart-packages", "s:wp-devi-shetty", "s:mbs-38502", "s:cdc-yellowbook-medical-tourism", "s:wp-narayana-health" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:bangkokhospital-heart-packages", "note": "the package figures and exclusions read off the hospital's own page on 17 September 2026; the 2013 pair is cited to the report as reproduced in the named source; the closing stretch is this project's reasoning and is marked" }, "text.how": { "tier": "tradition", "note": "standard operative description; the Australian schedule fee is cited to the item page" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:cdc-yellowbook-medical-tourism" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Coronary artery bypass surgery Image 657C-PH.jpg", "File:Heart saphenous coronary grafts.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "A length of vein from the leg or artery from the chest wall is sewn around a blocked coronary artery so blood reaches the muscle beyond it. Several grafts in one operation is usual.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "angioplasty-stent", "type": "procedure", "name": "Coronary angioplasty and stent", "as": "The catheter alternative, a tenth of the price on the same hospital's page and a different argument about who needs which.", "rel": "contrast" }, { "to": "heart-valve-replacement", "type": "procedure", "name": "Heart valve replacement", "as": "The other open-heart operation, priced below this one on the same Bangkok list.", "rel": "kin" }, { "to": "narayana-health", "type": "facility", "name": "Narayana Health", "as": "The group whose 2013 figure made this operation the subject's standard comparison.", "rel": "performed-at" }, { "to": "bangkok-hospital", "type": "facility", "name": "Bangkok Hospital", "as": "Publishes the bypass packages this page reads, special device excluded.", "rel": "performed-at" }, { "to": "india", "type": "destination", "name": "India", "as": "Where the volume argument about this operation was made.", "rel": "destination" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the operation is sold as a package with the nights counted.", "rel": "destination" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The other end of the 2013 comparison, and the market it was aimed at.", "rel": "destination" }, { "to": "australia", "type": "destination", "name": "Australia", "as": "Where the state prices the surgeon's service rather than the admission.", "rel": "destination" }, { "to": "bengaluru", "type": "hub", "name": "Bengaluru", "as": "The city outside which the cheap-bypass argument was built.", "rel": "place" }, { "to": "tariff", "type": "term", "name": "Tariff", "as": "What a schedule fee is, and why it cannot be read against a package price.", "rel": "term" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The rule that keeps a chest-surgery patient on the ground for ten days.", "rel": "risk" }, { "to": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "What it costs to bring home a patient whose bypass went wrong abroad.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who reads the echocardiogram at three months, and where.", "rel": "risk" } ], "source_list": [ { "id": "s:bangkokhospital-heart-packages", "kind": "web", "title": "Coronary artery angiography / percutaneous coronary intervention and Cardiovascular Surgery — package list", "publisher": "Bangkok Heart Hospital, Bangkok Hospital", "url": "https://www.bangkokhospital.com/en/bangkok-heart/package/heart-catheterization-surgery", "accessed": "2026-09-17", "note": "read with the browser on 17 September 2026, prices stated valid until 31 October 2026: CABG Level 1 1,173,000 THB and Level 2 1,437,500 THB, 8 nights each; MICS CABG 1,500,000 THB, 7 nights; valve replacement or repair Level 1 966,000 THB and Level 2 1,196,000 THB, 8 nights; totally 3D endoscopic valve replacement or repair 1,400,000 THB, 7 nights; CAG and PCI transfemoral 299,000 THB and transradial 322,000 THB, 2 nights; CAG alone 62,100 to 69,000 THB. Exclusions name pre-assessment, other specialists' consultations, 'special device used during procedure', extra ICU or ward nights and home medications." }, { "id": "s:wp-devi-shetty", "kind": "web", "title": "Devi Shetty", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Devi_Shetty", "accessed": "2026-09-16", "note": "carries the Bloomberg 2013 bypass figure of 95,000 rupees and the Cleveland Clinic comparison" }, { "id": "s:mbs-38502", "kind": "gov", "title": "MBS item 38502 — coronary artery bypass, including cardiopulmonary bypass", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=38502&qt=item", "accessed": "2026-09-17", "note": "schedule fee $2,819.90, 75% benefit $2,114.95; the item covers the surgeon's service, not the admission" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:wp-narayana-health", "kind": "wikipedia", "title": "Narayana Health", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Narayana_Health", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:bangkokhospital-heart-packages", "note": "the package figures and exclusions read off the hospital's own page on 17 September 2026; the 2013 pair is cited to the report as reproduced in the named source; the closing stretch is this project's reasoning and is marked" }, "text.how": { "tier": "tradition", "note": "standard operative description; the Australian schedule fee is cited to the item page" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:cdc-yellowbook-medical-tourism" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "india", "type": "destination", "name": "India", "as": "The operation most often named in this country's inbound cardiac work.", "rel": "procedure" }, { "from": "amman", "type": "hub", "name": "Amman", "as": "Among the operations the 2007 and 2008 referral counts were made of.", "rel": "procedure" }, { "from": "bengaluru", "type": "hub", "name": "Bengaluru", "as": "The operation the southern campus was built to do at volume.", "rel": "procedure" }, { "from": "bogota", "type": "hub", "name": "Bogotá", "as": "The kind of work that brings a patient to Bogotá rather than to a coast.", "rel": "performs" }, { "from": "chennai", "type": "hub", "name": "Chennai", "as": "The operation the cluster is built around, and the one its surgeons taught to the rest of India.", "rel": "procedure" }, { "from": "colombo", "type": "hub", "name": "Colombo", "as": "The cardiac work Maldivian patients have long been referred here for, by the trade's account.", "rel": "procedure" }, { "from": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "The operation the Gurugram towers were built around.", "rel": "procedure" }, { "from": "johannesburg", "type": "hub", "name": "Johannesburg", "as": "The work a referral from central Africa most often arrives for.", "rel": "procedure" }, { "from": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "The national heart institute on Jalan Tun Razak takes regional referrals for it.", "rel": "procedure" }, { "from": "monterrey", "type": "hub", "name": "Monterrey", "as": "Cardiac surgery is among the work the city's hospitals sell across the border.", "rel": "performs" }, { "from": "mumbai", "type": "hub", "name": "Mumbai", "as": "Sold in the private towers of the western suburbs on the usual estimate.", "rel": "procedure" }, { "from": "penang", "type": "hub", "name": "Penang", "as": "The cardiac work-up that often follows the screening.", "rel": "procedure" }, { "from": "singapore-city", "type": "hub", "name": "Singapore", "as": "One of the three specialties the 2003 policy was written around.", "rel": "procedure" }, { "from": "angioplasty-stent", "type": "procedure", "name": "Coronary angioplasty and stent", "as": "The open operation this one competes with, at four times the price on the same hospital's page.", "rel": "contrast" }, { "from": "heart-valve-replacement", "type": "procedure", "name": "Heart valve replacement", "as": "The other open-heart operation, priced above this one on the same Bangkok list.", "rel": "kin" }, { "from": "apollo-chennai", "type": "facility", "name": "Apollo Hospitals, Greams Road, Chennai", "as": "The operation the Chennai cardiac trade was built on.", "rel": "performs" }, { "from": "mount-elizabeth", "type": "facility", "name": "Mount Elizabeth Hospital", "as": "The first private hospital in Singapore to do open-heart surgery, and still known for the cardiac work.", "rel": "performs" }, { "from": "narayana-health", "type": "facility", "name": "Narayana Health", "as": "The operation the group is known for, and the one the 2013 figure describes.", "rel": "performs" }, { "from": "blood-supply-safety", "type": "risk", "name": "Blood supply safety", "as": "The operation on this site most likely to need blood.", "rel": "procedure" }, { "from": "devi-shetty", "type": "person", "name": "Devi Prasad Shetty", "as": "The operation his cost argument was made about.", "rel": "procedure" }, { "from": "prathap-reddy", "type": "person", "name": "Prathap C. Reddy", "as": "The cardiac work the group was built around and still sells abroad.", "rel": "procedure" } ] }, { "schema": 1, "id": "car-t", "type": "procedure", "names": { "name": "CAR T-cell therapy", "aliases": [ "chimeric antigen receptor T-cell therapy", "CAR-T", "tisagenlecleucel", "axicabtagene ciloleucel" ], "said": "Haematologists say CAR-T and then name the product, because the products are not interchangeable: Kymriah, Yescarta, Tecartus, Breyanzi, Abecma, Carvykti, and in India NexCAR19. A price or an approval attaches to one of them, never to the class." }, "etymology": { "root": "chimeric, from Greek khimaira, the composite beast of lion, goat and serpent: the receptor is spliced together from an antibody's target-recognising end and a T-cell's signalling tail, so the cell recognises a tumour marker the way an antibody would. Antigen: a body that generates a response. T cell: for the thymus, where it matures.", "tier": "tradition", "note": "autologous means the cells are the patient's own, shipped out and shipped back. That is why this is a manufacturing schedule as much as a treatment." }, "region": [ "global" ], "facets": { "family": "oncology", "setting": "inpatient", "anaesthesia": "none" }, "text": { "what": "A patient's own T cells are collected from the blood, genetically modified in a factory to carry a receptor for a marker on their cancer, grown up, frozen, shipped back and infused after a short course of chemotherapy that clears room for them. The Kymriah label describes cells \"obtained via a standard leukapheresis procedure\", enriched, \"transduced with the lentiviral vector containing the anti-CD19 CAR transgene\", expanded, washed and cryopreserved. It is given once. The dangerous part is what the cells do in the fortnight after they go in.", "story": "CAR-T travels because of who is allowed to give it and where those places are, and the rules moved recently enough that most secondary accounts are out of date.\n\nIn the United States the products were dispensed only by hospitals specially certified under a Risk Evaluation and Mitigation Strategy, holding tocilizumab on site. On 26 June 2025 the Food and Drug Administration eliminated that scheme for all six autologous CAR-T products, removing \"the requirement that hospitals and their associated clinics that dispense the above products are specially certified and have on-site, immediate access to tocilizumab\". The Kymriah label's own change table records \"KYMRIAH REMS (5.3) Removed 6/2025\". A 2025 paper in Cancers records what the old rule required: \"Patients were also required to remain within a two-hour radius of the treatment center for four weeks following infusion and to avoid driving for eight weeks. These logistical demands often necessitated temporary relocation, particularly for patients living in rural areas.\"\n\nEurope did not follow. A survey of the thirty EEA countries and the United Kingdom, published in HemaSphere with a status date of August 2024, found that \"in August 2024, 26% of the 31 countries had no CAR‐T products commercially available\", that \"the median number of qualified CAR‐T centers per 10 million population per country was 5.0\", and that in 55% of the countries \"centers were required to be transplant/JACIE‐accredited\". Its centre table runs from 45 in Germany, 37 in Italy, 35 in France, 32 in Spain and 23 in the United Kingdom down to one apiece in Croatia, Hungary, Luxembourg, Norway, Slovakia and Slovenia — and none at all in Bulgaria, Cyprus, Estonia, Iceland, Latvia, Liechtenstein, Lithuania and Malta. Time from marketing authorisation to access ranged from a median of nought months in France and Germany to 53 in Slovakia.\n\nSo patients cross borders, and some health systems send them. The same paper: \"some of these countries, including Latvia, Luxembourg, Iceland, and Malta, can send patients abroad to receive CAR‐T treatment.\" Its authors attach the caution this directory would attach anyway — that cross-border care \"requires well‐structured cross‐border collaboration and that patients are able to travel abroad for a certain period, which may be logistically, physically, and/or emotionally burdensome.\"\n\nDistance bites inside a country too. In one US institutional cohort of adults with large B-cell lymphoma, \"52% of patients traveled more than 30 miles, 40% more than 60 miles, and 29% over 120 miles to reach treatment.\"", "how": "Apheresis first: the Kymriah medication guide says it \"takes 3 to 6 hours and may need to be repeated\". Manufacturing is quoted at \"about 3-4 weeks from the time your cells are received at the manufacturing site and shipped back\" — but the label's own trial reports a median 113 days, range 47 to 196, from apheresis to infusion in diffuse large B-cell lymphoma. Manufacture can fail: \"this has been reported in up to 9% of manufacturing attempts\". Lymphodepletion follows, on the Yescarta label \"cyclophosphamide 500 mg/m2 intravenously and fludarabine 30 mg/m2 intravenously on the fifth, fourth, and third day before infusion\". Then one infusion, and the watch: cytokine release syndrome \"occurred in 90% (379/422) of patients with non-Hodgkin lymphoma\", grade 3 or worse in 9%, median onset 2 days; neurologic toxicity in 78%, grade 3 or worse in 25%, median onset 4 days and median duration 17. The label instructs clinicians to \"monitor patients at least daily for 7 days following infusion\", to \"instruct patients to remain within proximity of a healthcare facility for at least 2 weeks following infusion\", and to advise against driving for the same two weeks. No distance appears anywhere in the current labels: proximity is left undefined.", "today": "Prices are published per product and per country, and they are not the cost of the episode. Novartis set the first list price at 475,000 US dollars in August 2017. Acquisition costs since have risen rather than fallen: a 2023 paper in Blood Advances records axicabtagene ciloleucel going \"from $399 000 in 2022 to $424 000 in 2023 and liso-cel from $410 300 to $447 227 over the same period\". The National Institute for Health and Care Excellence publishes the UK list price at £280,451 per single infusion bag and states that the discount the NHS actually pays \"is commercial in confidence\". Against those drug prices, US Medicare paid an average of 498,723 dollars for an inpatient CAR-T claim in 2021–2022, and 587,908 dollars across the whole episode of care. India approved its own product, NexCAR19, in October 2023; a 2024 paper reports it \"is expected to cost 50,000 USD\", which is an expectation in a journal and not a list price.", "notes": "This page describes a treatment and the rules that govern where it may be given. It is not medical advice and it is not legal advice." }, "metrics": { "stay_days": 13, "days_before_flying": 14, "recovery_weeks": null, "note": "Thirteen days is the median inpatient stay in a US Medicare claims study of diffuse large B-cell lymphoma, 2021–2022; the mean was 16.81 and the range 3 to 132, and 21% of treatments were given as outpatients. The fourteen days is not a flight clearance: it is the label's instruction to stay within proximity of a healthcare facility for at least two weeks after infusion, with no distance given. Before June 2025 the US rule was a two-hour radius for four weeks.", "as_of": "2026-09-16", "source": "s:yescarta-pi", "url": "https://www.gilead.com/-/media/files/pdfs/medicines/oncology/yescarta/yescarta-pi.pdf" }, "prices": [ { "procedure": "car-t", "country": "US", "amount": 475000, "currency": "USD", "as_of": "2017", "kind": "list", "source": "s:statnews-kymriah-price", "url": "https://www.statnews.com/2017/08/31/475000-price-tag-new-cancer-drug-crazy-meh/", "note": "Kymriah at US approval in August 2017, for paediatric and young adult acute lymphoblastic leukaemia. This is the price of the cell product alone: apheresis, lymphodepleting chemotherapy, the admission and the management of cytokine release syndrome are all billed separately.", "tier": "cited", "usd": 475000.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "car-t", "country": "US", "amount": 424000, "currency": "USD", "as_of": "2023", "kind": "list", "source": "s:bloodadv-cart-costs", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10837180/", "note": "axicabtagene ciloleucel acquisition cost, reported as rising from $399,000 in 2022. The same paper puts lisocabtagene maraleucel at $447,227 in 2023, up from $410,300.", "tier": "cited", "usd": 424000.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "car-t", "country": "GB", "amount": 280451, "currency": "GBP", "as_of": "2023-02-28", "kind": "list", "source": "s:nice-ta872", "url": "https://www.nice.org.uk/guidance/ta872", "note": "axicabtagene ciloleucel, \"per single infusion bag (approximately 68 ml, company submission)\". NICE states that a commercial arrangement makes it available to the NHS at a discount and that \"the size of the discount is commercial in confidence\" — so the published number is the one nobody pays.", "tier": "cited", "usd": 377950.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "car-t", "country": "US", "amount": 498723, "amount_high": 587908, "currency": "USD", "as_of": "2022", "kind": "reimbursement", "source": "s:advther-cart-medicare", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11263250/", "note": "US Medicare fee-for-service, claims 2021–2022, diffuse large B-cell lymphoma. The lower figure is the average paid on an inpatient CAR-T claim, range $276,138 to $1,066,524; the higher is the total for the whole episode, counting the claim plus three-month and six-month per-patient-per-month spending. Outpatient CAR-T averaged $414,393 on the claim and $529,188 over the episode.", "tier": "cited", "usd": 498723.0, "usd_high": 587908.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "car-t", "country": "IN", "amount": 50000, "currency": "USD", "as_of": "2024", "kind": "estimate", "source": "s:bct-nexcar19", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11620990/", "note": "NexCAR19, approved in India in October 2023. The journal's words are that it \"is expected to cost 50,000 USD, which is almost one-tenth the cost of approved CAR-T cell products in the United States\". An expectation reported in a paper, not a price read off a price list; the rupee figures in circulation could not be read on a page for this record.", "tier": "cited", "usd": 50000.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "bone-marrow-transplant", "as": "The older cell therapy whose accredited units became the centres allowed to give this one.", "rel": "origin" }, { "to": "proton-therapy", "as": "The same scarcity told in concrete rather than in licences.", "rel": "kin" }, { "to": "gamma-knife", "as": "Another treatment a patient reaches by travelling to the equipment.", "rel": "kin" }, { "to": "s2-route", "as": "The EU form under which a health service can send a patient across a border for treatment it cannot give at home.", "rel": "governed-by" }, { "to": "germany", "as": "Holds more qualified centres than any other European country, and reached access the month the product was authorised.", "rel": "destination" }, { "to": "india", "as": "Approved a domestically made CD19 product in October 2023 at a fraction of the US price.", "rel": "destination" }, { "to": "alone-after-discharge", "as": "Two weeks near the centre with a carer, which is the part no price list carries.", "rel": "risk" }, { "to": "the-companion", "as": "The label assumes someone is watching the patient daily; somebody has to be that person, in another country.", "rel": "step" }, { "to": "insurance-exclusions", "as": "Where a published list price and what a payer actually pays stop being the same number.", "rel": "rule" } ], "links": [ { "label": "FDA — elimination of REMS for autologous CAR T-cell immunotherapies", "url": "https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/fda-eliminates-risk-evaluation-and-mitigation-strategies-rems-autologous-chimeric-antigen-receptor" }, { "label": "The European CAR-T map (HemaSphere)", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12961523/" } ], "sources": [ "s:fda-kymriah-label", "s:yescarta-pi", "s:fda-cart-rems-removal", "s:hemasphere-cart-map", "s:cancers-cart-rems", "s:advther-cart-medicare", "s:nice-ta872", "s:bloodadv-cart-costs", "s:statnews-kymriah-price", "s:bct-nexcar19" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:hemasphere-cart-map" }, "text.how": { "tier": "cited", "source": "s:yescarta-pi" }, "prices": { "tier": "cited" }, "etymology": { "tier": "tradition" } } }, "x_commons_files": [ "File:CAR T-cell therapy.svg", "File:Leukapheresis.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "A patient's own T cells are collected from the blood, genetically modified in a factory to carry a receptor for a marker on their cancer, grown up, frozen, shipped back and infused after a short course of chemotherapy…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "The older cell therapy whose accredited units became the centres allowed to give this one.", "rel": "origin" }, { "to": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "The same scarcity told in concrete rather than in licences.", "rel": "kin" }, { "to": "gamma-knife", "type": "procedure", "name": "Gamma knife radiosurgery", "as": "Another treatment a patient reaches by travelling to the equipment.", "rel": "kin" }, { "to": "s2-route", "type": "rule", "name": "The S2 route", "as": "The EU form under which a health service can send a patient across a border for treatment it cannot give at home.", "rel": "governed-by" }, { "to": "germany", "type": "destination", "name": "Germany", "as": "Holds more qualified centres than any other European country, and reached access the month the product was authorised.", "rel": "destination" }, { "to": "india", "type": "destination", "name": "India", "as": "Approved a domestically made CD19 product in October 2023 at a fraction of the US price.", "rel": "destination" }, { "to": "alone-after-discharge", "type": "risk", "name": "Discharged alone", "as": "Two weeks near the centre with a carer, which is the part no price list carries.", "rel": "risk" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "The label assumes someone is watching the patient daily; somebody has to be that person, in another country.", "rel": "step" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "Where a published list price and what a payer actually pays stop being the same number.", "rel": "rule" } ], "source_list": [ { "id": "s:fda-kymriah-label", "kind": "regulation", "title": "KYMRIAH (tisagenlecleucel) suspension for intravenous infusion — US prescribing information", "publisher": "US Food and Drug Administration / Novartis, label revised June 2025", "url": "https://www.fda.gov/media/107296/download", "accessed": "2026-09-16" }, { "id": "s:yescarta-pi", "kind": "regulation", "title": "YESCARTA (axicabtagene ciloleucel) suspension for intravenous infusion — US prescribing information", "publisher": "Kite Pharma / Gilead, label revised August 2026", "url": "https://www.gilead.com/-/media/files/pdfs/medicines/oncology/yescarta/yescarta-pi.pdf", "accessed": "2026-09-16" }, { "id": "s:fda-cart-rems-removal", "kind": "regulation", "title": "FDA Eliminates Risk Evaluation and Mitigation Strategies (REMS) for Autologous Chimeric Antigen Receptor (CAR) T-cell Immunotherapies", "publisher": "US Food and Drug Administration, 26 June 2025", "url": "https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/fda-eliminates-risk-evaluation-and-mitigation-strategies-rems-autologous-chimeric-antigen-receptor", "accessed": "2026-09-16" }, { "id": "s:hemasphere-cart-map", "kind": "paper", "title": "The European CAR-T map — Current status and future directions to improve access to CAR T-cell therapy for hematologic malignancies", "publisher": "HemaSphere, PMCID PMC12961523", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12961523/", "accessed": "2026-09-16", "note": "survey of the 30 EEA countries plus the United Kingdom, status as of August 2024; counts centres qualified by at least one marketing authorisation holder" }, { "id": "s:cancers-cart-rems", "kind": "paper", "title": "Eliminating REMS for CAR T-Cell Therapies: An Opportunity to Improve Access", "publisher": "Cancers (Basel) 2025;17(19):3216, doi:10.3390/cancers17193216, PMID 41097742", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12523345/", "accessed": "2026-09-16", "note": "records the proximity and driving restrictions that applied before June 2025 and the distances US patients travel" }, { "id": "s:advther-cart-medicare", "kind": "paper", "title": "Medicare Utilization and Cost Trends for CAR T Cell Therapies Across Settings of Care in the Treatment of Diffuse Large B-Cell Lymphoma", "publisher": "Advances in Therapy 41(8):3232–3246, 25 June 2024, doi:10.1007/s12325-024-02917-7", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11263250/", "accessed": "2026-09-16", "note": "US Medicare fee-for-service claims 2021–2022; counts what Medicare paid, not what was charged" }, { "id": "s:nice-ta872", "kind": "gov", "title": "Axicabtagene ciloleucel for treating diffuse large B-cell lymphoma and primary mediastinal large B-cell lymphoma after 2 or more systemic therapies (TA872)", "publisher": "National Institute for Health and Care Excellence, 28 February 2023", "url": "https://www.nice.org.uk/guidance/ta872", "accessed": "2026-09-16", "note": "publishes the list price and states that the size of the commercial discount is confidential" }, { "id": "s:bloodadv-cart-costs", "kind": "paper", "title": "Financial toxicity and CAR T-cell therapy acquisition costs", "publisher": "Blood Advances 8(2):484–496, 17 December 2023, doi:10.1182/bloodadvances.2023011793", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10837180/", "accessed": "2026-09-16", "note": "gives dated US acquisition costs for axicabtagene ciloleucel and lisocabtagene maraleucel for 2022 and 2023" }, { "id": "s:statnews-kymriah-price", "kind": "news", "title": "The $475,000 price tag for a new cancer drug: crazy or meh?", "publisher": "Anna Kaltenboeck and Peter B. Bach, STAT News, 31 August 2017", "url": "https://www.statnews.com/2017/08/31/475000-price-tag-new-cancer-drug-crazy-meh/", "accessed": "2026-09-16", "note": "the first CAR-T list price, reported the day after approval" }, { "id": "s:bct-nexcar19", "kind": "paper", "title": "A Discount on the Cost of Cancer: India's Homegrown CAR-T Cell Therapy", "publisher": "Blood Cell Therapy 7(4):121–123, 1 November 2024, doi:10.31547/bct-2024-008", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11620990/", "accessed": "2026-09-16", "note": "gives NexCAR19's expected cost rather than a published list price, and says so" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:hemasphere-cart-map" }, "text.how": { "tier": "cited", "source": "s:yescarta-pi" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "china", "type": "destination", "name": "China", "as": "Cell therapy pulled onshore through the Hainan exception.", "rel": "procedure" }, { "from": "japan", "type": "destination", "name": "Japan", "as": "Cell therapy available here, and priced for it.", "rel": "procedure" }, { "from": "singapore", "type": "destination", "name": "Singapore", "as": "Cell therapy sold to the region at the top of the price range.", "rel": "procedure" }, { "from": "united-states", "type": "destination", "name": "United States", "as": "Cell therapy is the inbound end of this market.", "rel": "procedure" }, { "from": "tel-aviv", "type": "hub", "name": "Tel Aviv", "as": "The kind of work a large public teaching hospital takes and a clinic strip cannot.", "rel": "procedure" }, { "from": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "Grew out of these units and is still given in them; the accreditation that qualifies a centre for one qualifies it for the other.", "rel": "descendant" }, { "from": "gamma-knife", "type": "procedure", "name": "Gamma knife radiosurgery", "as": "Scarcity of a different kind: there, the restriction is who may give the treatment, not who owns the hardware.", "rel": "kin" }, { "from": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "The same shape of scarcity in a vial rather than a building: a treatment you travel to because only certain centres may give it.", "rel": "kin" }, { "from": "stem-cell-unproven", "type": "procedure", "name": "Unapproved stem cell treatment", "as": "The approved cell therapy, with a licensed indication, a named manufacturer and a price in the same order of magnitude times ten.", "rel": "contrast" }, { "from": "charite-international", "type": "facility", "name": "Charité International Patients", "as": "Among the therapies a patient crosses a border for because it is unavailable at home rather than cheaper.", "rel": "performs" }, { "from": "sheba", "type": "facility", "name": "Sheba Medical Center", "as": "Among the cell therapies its international department leads with — a treatment travelled for because it is unavailable at home, not because it is cheap.", "rel": "performs" } ] }, { "schema": 1, "id": "cataract-surgery", "type": "procedure", "names": { "name": "Cataract surgery", "aliases": [ "phacoemulsification", "phaco", "lens extraction with intraocular lens", "IOL surgery" ], "said": "Surgeons say phaco. Package pages say cataract surgery and then name a lens set, because the lens is the tier and the tier is the price." }, "etymology": { "root": "cataract: Greek katarraktēs, a waterfall or portcullis — something falling across the view — by way of Latin cataracta. Phacoemulsification is Greek phakos, a lentil and so a lens, plus Latin emulsus, milked out: the clouded lens broken up by ultrasound and drawn away through a two-millimetre wound.", "tier": "tradition", "note": "The operation removes the eye's own lens; a manufactured one replaces it. Monofocal, toric, multifocal and extended-depth lenses are separate products at separate prices, and the word cataract on a price page rarely says which." }, "region": [ "global" ], "facets": { "family": "ophthalmic", "setting": "day-case", "anaesthesia": "local" }, "text": { "what": "The clouded natural lens is broken up by ultrasound and removed through a small wound, and an artificial lens is folded into the empty capsule. Fifteen or twenty minutes under drops or a local block, one eye at a time, no admission on any page read for this record. *Trade practice —* it is generally counted the highest-volume operation in the world, which is what makes it the one procedure where state tariffs, hospital packages and clinic lists can all be read against each other.", "story": "The lens is the knee implant of the eye, and every page read for this record handles it differently.\n\nBumrungrad in Bangkok sells phacoemulsification for one eye with a monofocal lens at 85,400 baht, package IPDEYE40+IPDEYE4005, prices stated valid until 31 December 2026. Its inclusion list names the surgeon, the hospital and nursing fees for the surgery only, and \"Medical device, such as, monofocal lens (only the types specified in the package)\". The lens is in — that lens, from that list, in that set. The package is called Set 1.\n\nRutnin Eye Hospital, a specialist eye hospital in the same city, publishes the terms without a price in its page text and states the rule plainly: \"If the ophthalmologist recommends the use of lenses other than those specified in the package, additional charges will apply.\" Its package also excludes doctor fees, consultation fees and pre-operative evaluation.\n\nThe payer versions split it the other way. Ireland's Health Service Executive repays cross-border cataract treatment at the day-case price for DRG C16Z, LENS INTERVENTIONS — €1,171 — a group defined as phacoemulsification or other extraction of the crystalline lens and capsulotomy, with glaucoma procedures excluded from it. Australia's Medicare Benefits Schedule pays item 42702, \"Lens extraction and insertion of intraocular lens\", at a schedule fee of $910.35, the lens named inside the item and the hospital billed outside it.\n\n*Inference —* three ways of writing one operation: a Thai package that includes a named lens and excludes the consultation, an Irish reimbursement that names the technique and not the device, and an Australian fee that names both and pays for neither the theatre nor the bed. The comparison a reader wants — what does a cataract cost — has no single answer on any of them, and the lens is where the difference hides.", "how": "Drops, a small wound at the edge of the cornea, an opening in the front of the lens capsule, ultrasound to break the lens, aspiration, the folded implant injected into the capsule where it unfolds. Drops for several weeks afterwards, and a check the next day. Second eye usually weeks later, which for a patient who flew in means either two trips or a longer stay; none of the pages read here prices the pair.\n\nThe lens tier is the variable that moves the price. A monofocal implant corrects distance and leaves reading glasses; toric lenses correct astigmatism and multifocal or extended-depth lenses aim to reduce glasses altogether, at higher prices. The Australian item descriptor also draws the line that matters for the rest of this batch: it excludes \"surgery performed to correct a refractive error\", which is how a state that pays for a cataract lens declines to pay for laser vision correction.", "today": "As of 17 September 2026 one eye with a monofocal lens is published at 85,400 baht in Bangkok; Ireland repays cross-border cataract treatment at a day-case DRG price of €1,171; and the Australian schedule fee for lens extraction with an intraocular lens is $910.35. Each of those numbers counts a different set of things.", "notes": "This page describes an operation and the prices published for it. It is not medical advice." }, "metrics": { "stay_days": 0, "days_before_flying": null, "recovery_weeks": 4, "wait_days_home": 84, "note": "A day case on every page read for this record. The eighty-four days is the median wait of 12.0 weeks across all pathways waiting to start treatment in England at the end of July 2026, published by NHS England — an all-specialty median for the English market, not a cataract figure, and it is carried here only because it is the queue a British patient reads a foreign price against. Four weeks is the span usually quoted for drops and healing. No published guidance read for this record sets a wait before flying after a cataract, so that field stays empty.", "as_of": "2026-07-31", "source": "s:nhs-rtt-july-2026", "url": "https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Jul26-RTT-statistical-press-notice-PDF-578K-97ylx5.pdf" }, "prices": [ { "procedure": "cataract-surgery", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 85400, "currency": "THB", "as_of": "2026-09-17", "kind": "package", "includes": [ "surgeon fees for the surgery only", "hospital fees and nursing fees for the surgery only", "medical device, such as monofocal lens — only the types specified in the package" ], "excludes": [ "physician's fees and any fees for consultations or pre-surgical screening", "medication, medical supplies and any other examinations or tests performed", "the second eye", "lenses other than the types specified" ], "source": "s:bumrungrad-phaco-monofocal", "url": "https://www.bumrungrad.com/en/packages/monofocal-lens-for-phacoemulsification-single-eye-set-1", "note": "package IPDEYE40+IPDEYE4005, one eye, prices stated valid until 31 December 2026. The lens is inside the package and the consultation that decides whether the patient needs it is outside. The package's name — Set 1 — is the page admitting there are other sets.", "tier": "cited", "usd": 2565.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "cataract-surgery", "country": "IE", "amount": 1171, "currency": "EUR", "as_of": "2026-09-17", "kind": "reimbursement", "includes": [ "DRG C16Z LENS INTERVENTIONS, day case: phacoemulsification of the crystalline lens, other extraction of the crystalline lens, capsulotomy of the lens" ], "excludes": [ "insertion or removal of an aqueous shunt, goniotomy, iridotomy, iridoplasty, iridectomy, trabeculectomy and trabeculoplasty, which fall in the glaucoma group", "travel and accommodation", "anything above the DRG price, which the patient bears" ], "source": "s:hse-cbd-niphs-drg-guide", "url": "https://assets.hse.ie/media/documents/CBD-NIPHS-Most-Common-Procedures-DRG-Guide.pdf", "note": "what Ireland repays a patient treated abroad under the Cross Border Directive and the Northern Ireland Planned Healthcare Scheme, not what the operation costs. The guide states the prices are for inpatient or day-case care, whichever is standard in Ireland, and that an inlier price assumes a stay within the length-of-stay boundaries of the 2024 activity-based-funding price list.", "tier": "cited", "usd": 1351.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "cataract-surgery", "country": "AU", "amount": 910.35, "currency": "AUD", "as_of": "2026-09-17", "kind": "tariff", "includes": [ "item 42702: lens extraction and insertion of intraocular lens" ], "excludes": [ "surgery performed to correct a refractive error, other than anisometropia exceeding 3 dioptres developing after removal of the cataract in the first eye — excluded in the descriptor itself", "the hospital, the theatre and the anaesthetist" ], "source": "s:mbs-42702", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=42702&qt=item", "note": "the Medicare Benefits Schedule fee, 75% benefit $682.80, the fee shown as applying from 1 July 2026. The item bundles the lens into the service it describes; the refractive exclusion in its own descriptor is the same state declining to fund laser vision correction.", "tier": "cited", "usd": 649.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "lasik", "as": "The refractive operation the same Australian item explicitly refuses to pay for.", "rel": "contrast" }, { "to": "icl", "as": "The implanted lens that sits in front of the natural one rather than replacing it.", "rel": "contrast" }, { "to": "knee-replacement", "as": "The other operation whose price page turns on which implant is in the package.", "rel": "contrast" }, { "to": "bumrungrad", "as": "Publishes the phacoemulsification package this page reads, monofocal lens included and the consultation excluded.", "rel": "performed-at" }, { "to": "thailand", "as": "Where the lens is inside the package and the screening is outside it.", "rel": "destination" }, { "to": "australia", "as": "Where the state pays for the cataract lens and names the refractive exclusion in the same sentence.", "rel": "destination" }, { "to": "eu-directive-2011-24", "as": "The route under which Ireland repays a cataract done in another member state at its own DRG price.", "rel": "rule" }, { "to": "implant-excluded", "as": "The trap this operation mostly avoids by naming the lens — and reopens by naming only some lenses.", "rel": "risk" }, { "to": "reading-the-exclusions", "as": "The step at which Set 1 turns out to mean one kind of lens.", "rel": "step" }, { "to": "follow-up-gap", "as": "Who checks the eye the day after, and who sees it at six weeks.", "rel": "risk" }, { "to": "tariff", "as": "What the Irish and Australian figures on this page are, and why they are not bills.", "rel": "term" }, { "to": "oecd-waiting-times", "as": "The series that counts how long a public patient waits for this operation.", "rel": "measured-by" } ], "confusable_with": [ { "id": "icl", "tell": "Cataract surgery takes the natural lens out and puts an implant in its place; an ICL leaves the natural lens alone and adds a second one in front of it." }, { "id": "lasik", "tell": "Both change how the eye focuses, but one treats a clouded lens and the other reshapes a clear cornea; state schedules pay for the first and decline the second." } ], "links": [ { "label": "Bumrungrad — phacoemulsification with monofocal lens, Set 1", "url": "https://www.bumrungrad.com/en/packages/monofocal-lens-for-phacoemulsification-single-eye-set-1" }, { "label": "HSE — CBD / NIPHS most common procedures DRG guide", "url": "https://assets.hse.ie/media/documents/CBD-NIPHS-Most-Common-Procedures-DRG-Guide.pdf" } ], "sources": [ "s:bumrungrad-phaco-monofocal", "s:bumrungrad-eye-packages", "s:rutnin-cataract-package", "s:hse-cbd-niphs-drg-guide", "s:mbs-42702", "s:nhs-rtt-july-2026" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:bumrungrad-phaco-monofocal", "note": "the volume claim is marked as trade practice and carries no count" }, "text.story": { "tier": "cited", "source": "s:rutnin-cataract-package", "note": "each figure and each quoted term read off the named page on 17 September 2026; the closing comparison is this project's reasoning and is marked" }, "text.how": { "tier": "tradition", "note": "standard operative description; the refractive exclusion is cited to the Australian item descriptor" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:nhs-rtt-july-2026" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Cataract surgery phacoemulsification.jpg", "File:Intraocular lens.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "The clouded natural lens is broken up by ultrasound and removed through a small wound, and an artificial lens is folded into the empty capsule.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "lasik", "type": "procedure", "name": "LASIK", "as": "The refractive operation the same Australian item explicitly refuses to pay for.", "rel": "contrast" }, { "to": "icl", "type": "procedure", "name": "Implantable collamer lens", "as": "The implanted lens that sits in front of the natural one rather than replacing it.", "rel": "contrast" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The other operation whose price page turns on which implant is in the package.", "rel": "contrast" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Publishes the phacoemulsification package this page reads, monofocal lens included and the consultation excluded.", "rel": "performed-at" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the lens is inside the package and the screening is outside it.", "rel": "destination" }, { "to": "australia", "type": "destination", "name": "Australia", "as": "Where the state pays for the cataract lens and names the refractive exclusion in the same sentence.", "rel": "destination" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route under which Ireland repays a cataract done in another member state at its own DRG price.", "rel": "rule" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The trap this operation mostly avoids by naming the lens — and reopens by naming only some lenses.", "rel": "risk" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step at which Set 1 turns out to mean one kind of lens.", "rel": "step" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who checks the eye the day after, and who sees it at six weeks.", "rel": "risk" }, { "to": "tariff", "type": "term", "name": "Tariff", "as": "What the Irish and Australian figures on this page are, and why they are not bills.", "rel": "term" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The series that counts how long a public patient waits for this operation.", "rel": "measured-by" } ], "source_list": [ { "id": "s:bumrungrad-phaco-monofocal", "kind": "web", "title": "Phacoemulsification Single Eye with Monofocal Lens for Phacoemulsification Single Eye Set 1 — package IPDEYE40+IPDEYE4005", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/monofocal-lens-for-phacoemulsification-single-eye-set-1", "accessed": "2026-09-17", "note": "85,400 THB, prices stated valid until 31 December 2026. Inclusions name the monofocal lens, 'only the types specified in the package'; exclusions name physician's fees, consultations, pre-surgical screening, medication, supplies and other tests." }, { "id": "s:bumrungrad-eye-packages", "kind": "web", "title": "Eye Center — package list", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/packages-center/eye-center", "accessed": "2026-09-17", "note": "read with the browser on 17 September 2026: ReLEx SMILE both eyes 102,000 THB; ICL single eye 129,000 THB; Toric ICL single eye 161,000 THB; phacoemulsification single eye with monofocal lens, Set 1, 85,400 THB; eye screening 4,100 THB" }, { "id": "s:rutnin-cataract-package", "kind": "web", "title": "CATARACT Surgery Package", "publisher": "Rutnin Eye Hospital, Bangkok", "url": "https://www.rutnin.com/en/promotion/detail.315.1.html", "accessed": "2026-09-17", "note": "the page carries the package terms and no price in text, stated updated 2 October 2023 and valid until 31 December 2026. Term 3 reads: 'If the ophthalmologist recommends the use of lenses other than those specified in the package, additional charges will apply.' Term 4 excludes doctor fees, consultation fees and pre-operative evaluation." }, { "id": "s:hse-cbd-niphs-drg-guide", "kind": "gov", "title": "CBD / NIPHS Most Common Procedures DRG Guide", "publisher": "Health Service Executive (Ireland)", "url": "https://assets.hse.ie/media/documents/CBD-NIPHS-Most-Common-Procedures-DRG-Guide.pdf", "accessed": "2026-09-16", "note": "the tariff behind both the Cross Border Directive scheme and the Northern Ireland Planned Healthcare Scheme. Cataract procedures map to DRG C16Z LENS INTERVENTIONS at a day-case price of EUR 1,171, covering phacoemulsification or other extraction of the crystalline lens and capsulotomy; colonoscopy G48B EUR 1,001; gastroscopy G47C EUR 726. Same figure as the HSE's 2024 activity-based-funding day-case price list." }, { "id": "s:mbs-42702", "kind": "gov", "title": "MBS item 42702 — lens extraction and insertion of intraocular lens", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=42702&qt=item", "accessed": "2026-09-17", "note": "schedule fee $910.35, 75% benefit $682.80, fee shown as applying from 01-Jul-2026. The descriptor excludes 'surgery performed to correct a refractive error, other than anisometropia that exceeds 3 dioptres and develops after the removal of cataract in the first eye'." }, { "id": "s:nhs-rtt-july-2026", "kind": "gov", "title": "Statistical Press Notice — NHS referral to treatment (RTT) waiting times data, July 2026", "publisher": "NHS England", "url": "https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Jul26-RTT-statistical-press-notice-PDF-578K-97ylx5.pdf", "accessed": "2026-09-16", "note": "published Thursday 10 September 2026. 7.3 million RTT pathways waiting to start treatment at the end of July 2026, an estimated 6.2 million unique patients; 111,379 waiting over 52 weeks, 9,095 over 65 weeks, 235 over 104 weeks; 65.4% waiting up to 18 weeks against a 92% standard; median wait 12.0 weeks. Figures include estimates for three trusts and one independent provider that did not submit." } ], "tiers": { "text.what": { "tier": "cited", "source": "s:bumrungrad-phaco-monofocal", "note": "the volume claim is marked as trade practice and carries no count" }, "text.story": { "tier": "cited", "source": "s:rutnin-cataract-package", "note": "each figure and each quoted term read off the named page on 17 September 2026; the closing comparison is this project's reasoning and is marked" }, "text.how": { "tier": "tradition", "note": "standard operative description; the refractive exclusion is cited to the Australian item descriptor" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:nhs-rtt-july-2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "canada", "type": "destination", "name": "Canada", "as": "69% inside 112 days in 2024, on its own shorter benchmark.", "rel": "procedure" }, { "from": "ireland", "type": "destination", "name": "Ireland", "as": "The operation behind the most-quoted number in the whole scheme: €1,171 repaid as a day case.", "rel": "procedure" }, { "from": "cairo", "type": "hub", "name": "Cairo", "as": "High-volume day work a large private sector is built to do.", "rel": "procedure" }, { "from": "colombo", "type": "hub", "name": "Colombo", "as": "Short-stay volume work, the kind a regional patient can fly in and out for.", "rel": "procedure" }, { "from": "havana", "type": "hub", "name": "Havana", "as": "The operation Cuba exported by aircraft under Operación Milagro, free, in the opposite direction to the paying trade.", "rel": "performs" }, { "from": "penang", "type": "hub", "name": "Penang", "as": "High-volume, short-stay work suited to a patient who can come back.", "rel": "procedure" }, { "from": "taipei", "type": "hub", "name": "Taipei", "as": "High-volume short-stay work quoted at a published self-pay rate.", "rel": "procedure" }, { "from": "icl", "type": "procedure", "name": "Implantable collamer lens", "as": "The operation that removes the natural lens; this one leaves it, and is taken out when that day comes.", "rel": "contrast" }, { "from": "lasik", "type": "procedure", "name": "LASIK", "as": "The lens operation the Australian schedule funds, in the same descriptor that refuses this one.", "rel": "contrast" }, { "from": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The shortest queue in the series and the commonest operation in it.", "rel": "procedure" }, { "from": "waiting-lists", "type": "story", "name": "The queue is the product", "as": "The highest-volume operation in the world, and a queue in most systems that fund it.", "rel": "procedure" } ] }, { "schema": 1, "id": "cochlear-implant", "type": "procedure", "names": { "name": "Cochlear implant", "aliases": [ "CI", "cochlear implantation", "auditory prosthesis" ], "said": "Audiologists say the implant for the part inside the head and the processor for the part outside, and the distinction is the whole economics of the device: the implant is bought once, the processor is bought again and again." }, "etymology": { "root": "cochlea: Latin, from Greek kokhlias, a snail with a spiral shell — the spiral bone of the inner ear the electrode array is threaded into. Implant: Latin in- plus plantare, to plant in.", "tier": "tradition", "note": "mapping, or programming, is the audiologist's word for setting the current level on each electrode. It is not a repair and it is not optional; a map drifts, and a child's changes as they grow." }, "region": [ "global" ], "facets": { "family": "neurological", "setting": "day-case", "anaesthesia": "general" }, "text": { "what": "An electronic device that bypasses the damaged inner ear and stimulates the hearing nerve directly. The US National Institute on Deafness and Other Communication Disorders describes four parts: a microphone, a speech processor, \"a transmitter and receiver/stimulator, which receive signals from the speech processor and convert them into electric impulses\", and \"an electrode array, which is a group of electrodes that collects the impulses from the stimulator and sends them to different regions of the auditory nerve\". The receiver-stimulator and the array are surgical and permanent. The microphone and processor are worn, replaceable, and priced separately. As of December 2019 the institute counts \"approximately 736,900 registered devices\" implanted worldwide.", "story": "The operation travels easily. The aftercare does not, and this is the clearest case in the directory of an operation whose price is the smaller half of the transaction.\n\nNothing about implantation itself resists being sold as a package: a couple of hours under general anaesthetic, a short stay, a wound that heals. What follows does resist. The device is switched on weeks after surgery, not in theatre, and is then programmed repeatedly — often, at first, and then for life. The institute puts the demand plainly: \"use of a cochlear implant requires both a surgical procedure and significant therapy to learn or relearn the sense of hearing\", with speech-language pathologists and audiologists involved throughout. A Finnish cost-effectiveness study published in 2025 says the same from the payer's side: an implant \"requires life-long aftercare including regular check-ups, software and sound processor upgrades and sometimes a device replacement\".\n\nThe processor is the trap inside the trap. Its warranty runs three years. Its modelled mean life before upgrade is 106 months — about nine years, on a range of 29 to 232 — sourced in that Finnish model to a manufacturer's own database. And when a model goes out of production the problem is not fashion: \"access to spare parts is reduced for obsolete sound processors that are no longer manufactured, reducing the ability to service and repair sound processors, leaving recipients without a functioning CI system and no functional hearing\". An implanted ear with a dead processor is a deaf ear.\n\nAustralia has measured what that costs. The CUSP study upgraded 340 processors in 304 adults aged 65 and over between May 2021 and April 2023, all of them with obsolete processors and no funding to replace them; its authors describe the position as \"an increasing public health challenge in Australia and worldwide\", and found the economic value of upgrading came \"from preventing device failures, rather than from access to newer technology features\".\n\n*Inference —* every one of those facts lands harder on a patient implanted in another country. Programming is done by an audiologist on the manufacturer's software with the patient's own map; a clinic at home that never implanted the device may not hold the map, may not stock the parts, and may not take the patient on.", "how": "General anaesthesia; the array is threaded into the cochlea and the receiver seated in a well drilled in the bone behind the ear. *Trade practice —* the operation runs a couple of hours and is commonly a day case or a single night, and the two ears are sometimes done in one sitting. Switch-on comes weeks later, once the wound has settled, and is followed by a run of mapping appointments — frequent in the first year, then periodic for life. Rehabilitation is the long part: the brain has to learn to read the signal. The published failure figures are for the internal device: a Finnish model uses a 2.8% probability of internal device failure, an Australian model 4.8% over thirty years, with reimplantation — another operation — costed at 39,519 Australian dollars.", "today": "The published prices that matter here are for the parts, not the operation. At the time of the Australian CUSP study the out-of-pocket cost of a replacement processor was 7,648 Australian dollars for a Nucleus 5, 8,114 for a Kanso 2 and 9,078 for a Nucleus 7, which the authors say \"limits CI users' ability to upgrade sound processors without public subsidy\". The Finnish model puts the whole lifetime cost of a unilateral implant, care included, at 43,905 euros. No hospital price list for implantation for a self-paying foreign patient was read for this record on 16 September 2026.", "notes": "This page describes a device and what maintaining it involves. It is not advice about whether to have one, or where." }, "metrics": { "stay_days": null, "days_before_flying": null, "recovery_weeks": null, "note": "No published ward stay, flight interval or recovery span was read for this record on 16 September 2026, so all three print as gaps. The interval that governs this device is a different one: a three-year processor warranty, a modelled mean of 106 months before a processor is upgraded, and programming appointments for life.", "as_of": "2026-09-16", "source": "s:eur-arch-ci-finland", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12605616/" }, "prices": [ { "procedure": "cochlear-implant", "country": "AU", "amount": 7648, "amount_high": 9078, "currency": "AUD", "as_of": "2022", "kind": "list", "includes": [ "one replacement external sound processor" ], "excludes": [ "the implant", "the operation", "programming appointments", "repairs outside the three-year warranty" ], "source": "s:pharmacoecon-ci-upgrade", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13110226/", "note": "the range covers three models priced at the time of the CUSP study: Nucleus 5 at A$7,648, Kanso 2 at A$8,114 and Nucleus 7 at A$9,078. This is the accessory, bought perhaps three or four times in a recipient's life, and it is the line that decides whether an implant keeps working.", "tier": "cited", "usd": 5451.0, "usd_high": 6470.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "cochlear-implant", "country": "AU", "amount": 39519, "currency": "AUD", "as_of": "2022", "kind": "estimate", "includes": [ "reimplantation after internal device failure" ], "source": "s:pharmacoecon-ci-upgrade", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13110226/", "note": "the cost used in an Australian microsimulation for replacing a failed internal device, alongside a 4.8% risk of internal failure over thirty years and three months with the device inactive.", "tier": "cited", "usd": 28165.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "cochlear-implant", "country": "FI", "amount": 43905, "currency": "EUR", "as_of": "2025", "kind": "estimate", "includes": [ "assessment", "the device", "surgery", "lifetime aftercare, check-ups, software and processor upgrades, and device replacement where modelled" ], "excludes": [ "anything a health system does not pay for" ], "source": "s:eur-arch-ci-finland", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12605616/", "note": "the modelled lifetime cost of one unilateral implant to the Finnish health system, from a published cost-utility analysis. A modelled lifetime, not an invoice — but it is the only figure read for this record that counts the follow-up as part of the price.", "tier": "cited", "usd": 50657.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "follow-up-gap", "as": "The exact shape of this device's problem: an operation that crosses a border easily and a programming appointment that does not.", "rel": "risk" }, { "to": "aftercare-at-home", "as": "Where the map, the spare parts and the audiologist have to be, for the rest of the patient's life.", "rel": "step" }, { "to": "revision-at-home", "as": "Who reimplants a failed internal device, and on whose bill.", "rel": "risk" }, { "to": "implant-excluded", "as": "The same trick in another trade: a price for the operation that is not a price for the hardware.", "rel": "risk" }, { "to": "the-discharge-summary", "as": "The paper a patient carries home, which for this device has to include the implant model and the map.", "rel": "step" }, { "to": "india", "as": "Runs implant programmes and a state subsidy scheme, and takes patients from neighbouring countries with none.", "rel": "destination" }, { "to": "turkiye", "as": "Implants at scale under a licensing regime for foreign patients.", "rel": "destination" }, { "to": "australia", "as": "Where the shortfall in replacement processors has been measured and published.", "rel": "place" }, { "to": "insurance-exclusions", "as": "Where a payer funds the implant and declines the processor nine years later.", "rel": "rule" } ], "links": [ { "label": "NIDCD — Cochlear Implants", "url": "https://www.nidcd.nih.gov/health/cochlear-implants" }, { "label": "Cost effectiveness of upgrading cochlear implant sound processors in Australia", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13110226/" } ], "sources": [ "s:nidcd-cochlear", "s:pharmacoecon-ci-upgrade", "s:jcm-cusp-upgrade", "s:eur-arch-ci-finland" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:pharmacoecon-ci-upgrade", "note": "device, warranty and upgrade figures cited; the closing paragraph about an implant recipient in another country is marked Inference" }, "text.how": { "tier": "cited", "source": "s:eur-arch-ci-finland", "note": "failure and reimplantation figures cited; the operating time and day-case pattern are marked Trade practice" }, "prices": { "tier": "cited" }, "etymology": { "tier": "tradition" } } }, "x_commons_files": [ "File:Cochlear implant.jpg", "File:Cochlear implant diagram.svg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "An electronic device that bypasses the damaged inner ear and stimulates the hearing nerve directly.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The exact shape of this device's problem: an operation that crosses a border easily and a programming appointment that does not.", "rel": "risk" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "Where the map, the spare parts and the audiologist have to be, for the rest of the patient's life.", "rel": "step" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who reimplants a failed internal device, and on whose bill.", "rel": "risk" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The same trick in another trade: a price for the operation that is not a price for the hardware.", "rel": "risk" }, { "to": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "The paper a patient carries home, which for this device has to include the implant model and the map.", "rel": "step" }, { "to": "india", "type": "destination", "name": "India", "as": "Runs implant programmes and a state subsidy scheme, and takes patients from neighbouring countries with none.", "rel": "destination" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "Implants at scale under a licensing regime for foreign patients.", "rel": "destination" }, { "to": "australia", "type": "destination", "name": "Australia", "as": "Where the shortfall in replacement processors has been measured and published.", "rel": "place" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "Where a payer funds the implant and declines the processor nine years later.", "rel": "rule" } ], "source_list": [ { "id": "s:nidcd-cochlear", "kind": "gov", "title": "Cochlear Implants", "publisher": "National Institute on Deafness and Other Communication Disorders, US National Institutes of Health; page updated 13 June 2024", "url": "https://www.nidcd.nih.gov/health/cochlear-implants", "accessed": "2026-09-16" }, { "id": "s:pharmacoecon-ci-upgrade", "kind": "paper", "title": "The Cost Effectiveness of Upgrading Cochlear Implant Sound Processors in Australia: A Novel Application of Individual-Level Microsimulation Models", "publisher": "PharmacoEconomics, 2026, doi:10.1007/s40273-026-01588-2", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13110226/", "accessed": "2026-09-16", "note": "carries the out-of-pocket sound processor prices current at the time of the CUSP study, in 2022 Australian dollars, and the modelled cost of reimplantation" }, { "id": "s:jcm-cusp-upgrade", "kind": "paper", "title": "Evaluating the Clinical- and Cost-Effectiveness of Cochlear Implant Sound Processor Upgrades in Older Adults: Outcomes from a Large Australian Multicenter Study", "publisher": "Journal of Clinical Medicine 14(11):3765, 2025, doi:10.3390/jcm14113765", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12155704/", "accessed": "2026-09-16", "note": "the CUSP study; 340 sound processors upgraded in 304 adults between May 2021 and April 2023" }, { "id": "s:eur-arch-ci-finland", "kind": "paper", "title": "The cost-effectiveness of unilateral cochlear implantation in the Finnish health care", "publisher": "European Archives of Oto-Rhino-Laryngology, 2025, doi:10.1007/s00405-025-09468-9", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12605616/", "accessed": "2026-09-16", "note": "its model parameter table gives a mean time to sound processor upgrade sourced to a manufacturer's internal database" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:pharmacoecon-ci-upgrade", "note": "device, warranty and upgrade figures cited; the closing paragraph about an implant recipient in another country is marked Inference" }, "text.how": { "tier": "cited", "source": "s:eur-arch-ci-finland", "note": "failure and reimplantation figures cited; the operating time and day-case pattern are marked Trade practice" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "Where the external processor is a separate purchase from the operation.", "rel": "procedure" } ] }, { "schema": 1, "id": "dental-crown", "type": "procedure", "names": { "name": "Dental crown", "aliases": [ "cap", "porcelain fused to metal crown", "zirconia crown", "e.max crown" ], "said": "Patients say cap. Price lists say crown and then name a material, because the material is the price." }, "etymology": { "root": "crown: Latin corona, a wreath or circlet, used in anatomy for the part of a tooth above the gum long before it named the thing fitted over it. Zirconia is from zircon, the mineral, by way of Persian zargun, gold-coloured; e.max is a brand of lithium disilicate glass-ceramic.", "tier": "tradition", "note": "A crown fitted to a natural tooth and a crown fitted to an implant are the same object with different prices; the implant crown usually carries the abutment's price beside it." }, "region": [ "global" ], "facets": { "family": "dental", "setting": "day-case", "anaesthesia": "local" }, "text": { "what": "A tooth is reduced to a stump, an impression or scan is taken, a laboratory makes a cover in metal, porcelain-fused-to-metal, lithium disilicate or zirconia, and it is cemented or screwed on. Two visits usually, or one where the clinic mills the crown on site. It is the commonest single line on a dental travel bill because almost every other treatment ends with one.", "story": "Four price lists, four ways of writing the same tooth.\n\nBangkok International Dental Center runs by material: porcelain fused to non-precious alloy 13,000 baht, to palladium 20,000, to gold 25,000, all-ceramic e.max 19,500 for one to five teeth and 18,500 for six or more, zirconia 21,000 and 20,000 on the same sliding scale, a one-day all-ceramic crown 25,000. The discount for the sixth tooth is the page telling a reader what kind of patient it is written for.\n\nMedicare Dental Clinic in Budapest prints two numbers per crown and means their sum: porcelain fused to metal €202 plus €134 of laboratory fee, zirconia €226 plus €152, full porcelain €237 plus €157.\n\nSani Dental Group in Los Algodones runs from an all-metal crown at $120 to porcelain-fused-to-gold at $600, with a \"US COST\" column beside each — $400 against the metal crown, $1,700 against the gold — which is the seller's own comparison and names no source.\n\nIndex Medica in Kraków does the same thing in the opposite direction, printing what it calls an average UK price beside its own: £900 against its £355 for a metal-based porcelain crown, £1,200 against its £429 for full-ceramic zirconia.\n\n*Inference —* three of the four pages sell the crown against a number from the patient's home country that the clinic itself supplies. The one state tariff read for this record — the English NHS band 3 charge of £332.10, which covers a crown along with dentures, bridges and orthodontics — is the only figure on this page whose author is not also the seller.", "how": "Priced by material first and by count second. Where a clinic prices implants, the implant crown appears as its own line: 25,000 baht in Bangkok on every implant row, $720 in Los Algodones including the abutment. Where a clinic prices laboratory work separately, as Budapest does, the crown's real price is two lines added together.\n\nIn England the patient's share is not a price at all but a band: a flat £332.10 for band 3 treatment, one charge however many crowns the course contains, with the rest met by the health service. A private crown in the same country is quoted per tooth and is not on that scale.", "today": "As of 17 September 2026 a single crown is published at 13,000 to 25,000 baht in Bangkok, €336 to €394 including laboratory fee in Budapest, $120 to $600 in Los Algodones and £355 to £429 in Kraków, against an English NHS band 3 patient charge of £332.10 for a course of treatment that may contain several.", "notes": "This page describes a dental procedure and the prices published for it. It is not dental advice." }, "metrics": { "stay_days": 0, "days_before_flying": null, "recovery_weeks": null, "note": "A clinic appointment, not an admission. The number a travelling patient needs — how many days between preparation and fitting — is stated on none of the four price pages read for this record, though one of them sells a crown milled in a single day.", "as_of": "2026-09-17", "source": "s:bidc-fees", "url": "https://bangkokdentalcenter.com/fees/" }, "prices": [ { "procedure": "dental-crown", "country": "TH", "city": "Bangkok", "amount": 13000, "amount_high": 25000, "currency": "THB", "as_of": "2026-09-17", "kind": "list", "includes": [ "the crown itself, by material" ], "excludes": [ "x-rays, medications, sterilisation, nursing fees and clinic service fees, charged separately", "sterilisation at 150 to 250 baht per visit", "root canal treatment where the tooth needs it first" ], "source": "s:bidc-fees", "url": "https://bangkokdentalcenter.com/fees/", "note": "the range runs porcelain fused to non-precious alloy 13,000, palladium 20,000, gold 25,000, e.max 19,500 for one to five teeth and 18,500 for six or more, zirconia 21,000 and 20,000, one-day all-ceramic 25,000. Several rows are printed against struck-through figures of 22,000. Package rates stated applicable till 30 September 2026.", "tier": "cited", "usd": 390.0, "usd_high": 751.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "dental-crown", "country": "HU", "city": "Budapest", "amount": 378, "currency": "EUR", "as_of": "2026-09-17", "kind": "list", "includes": [ "zirconia crown: €226 treatment plus €152 fabrication" ], "excludes": [ "nothing stated beyond the split; the post and core, if the tooth needs one, is a separate line" ], "source": "s:mdental-budapest-prices", "url": "https://www.mdentalclinic.eu/prices", "note": "porcelain fused to metal is €202 plus €134 for €336, full porcelain €237 plus €157 for €394. The clinic's note above the table states that many treatments carry both a treatment price and a separate fabrication or laboratory fee.", "tier": "cited", "usd": 436.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "dental-crown", "country": "MX", "city": "Los Algodones", "amount": 120, "amount_high": 600, "currency": "USD", "as_of": "2026-09-17", "kind": "list", "includes": [ "the crown, by material" ], "excludes": [ "the implant or abutment where the crown sits on one — the implant crown including abutment is its own line at $720" ], "source": "s:sani-dental-prices", "url": "https://sanidentalgroup.com/price-list", "note": "all-metal $120, porcelain fused to metal $230, e.max $395, zirconia $490, porcelain fused to gold $600, temporary crown $30, each with a peso figure beside it. The page prints a US comparison column — $400, $1,250, $1,500, $1,600, $1,700 — that carries no source, and states that all prices are a base or starting price.", "tier": "cited", "usd": 120.0, "usd_high": 600.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "dental-crown", "country": "PL", "city": "Kraków", "amount": 355, "amount_high": 429, "currency": "GBP", "as_of": "2026-09-17", "kind": "list", "includes": [ "the crown; the page lists examination, x-rays and local anaesthetic as free" ], "excludes": [ "nothing stated for the crown itself" ], "source": "s:indexmedica-prices", "url": "https://www.indexmedica.com/prices/", "note": "metal-based porcelain £355 against a column the clinic labels average UK price at £900; full-ceramic zirconoxide £429 against £1,200. The euro table gives €389 and €469 against Irish comparisons of €1,110 and €1,430. A deposit of 80% of each stage is due on signing the treatment plan.", "tier": "cited", "usd": 478.0, "usd_high": 578.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "dental-crown", "country": "GB", "amount": 332.1, "currency": "GBP", "as_of": "2026-09-17", "kind": "tariff", "includes": [ "band 3: a crown, and everything in bands 1 and 2 in the same course of treatment", "dentures, bridges and orthodontic treatment fall in the same band" ], "excludes": [ "private treatment", "cosmetic work the service does not provide" ], "source": "s:nhs-dental-charges", "url": "https://www.nhs.uk/nhs-services/dentists/dental-costs/understanding-nhs-dental-charges/", "note": "the patient's charge in England, not the cost of the work: one band 3 charge of £332.10 covers a course of treatment however many crowns it contains, against £27.90 for band 1 and £76.60 for band 2. The page states it was last reviewed on 13 March 2025 and does not state when the amounts took effect.", "tier": "cited", "usd": 448.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "dental-implant", "as": "The root this crown is often screwed to, and the line it is billed apart from.", "rel": "part" }, { "to": "root-canal", "as": "What usually comes first, on the same bill and the same trip.", "rel": "kin" }, { "to": "veneers", "as": "The thinner cousin, covering the front of a tooth rather than the whole of it.", "rel": "contrast" }, { "to": "full-mouth-restoration", "as": "The job that counts these in tens.", "rel": "whole" }, { "to": "thailand", "as": "Where the price falls when the sixth tooth is crowned.", "rel": "destination" }, { "to": "hungary", "as": "Where the laboratory fee is a line of its own beside every crown.", "rel": "destination" }, { "to": "poland", "as": "Where the clinic prints an average UK price beside its own.", "rel": "destination" }, { "to": "united-kingdom", "as": "The source market whose band 3 charge of £332.10 is the number these lists are written against.", "rel": "destination" }, { "to": "budapest", "as": "The city that made dental travel a European industry.", "rel": "place" }, { "to": "los-algodones", "as": "The border town where a crown is quoted against a US figure the clinic supplies itself.", "rel": "place" }, { "to": "getting-a-quote", "as": "The step where a crown quote turns out to exclude the laboratory fee.", "rel": "step" }, { "to": "revision-at-home", "as": "Who recements a crown that comes off at home, and what they charge.", "rel": "risk" } ], "confusable_with": [ { "id": "veneers", "tell": "A crown covers the whole tooth and needs most of it cut away; a veneer covers the front face only." } ], "links": [ { "label": "NHS dental charges — bands 1, 2 and 3", "url": "https://www.nhs.uk/nhs-services/dentists/dental-costs/understanding-nhs-dental-charges/" }, { "label": "BIDC dental fees", "url": "https://bangkokdentalcenter.com/fees/" } ], "sources": [ "s:bidc-fees", "s:mdental-budapest-prices", "s:sani-dental-prices", "s:indexmedica-prices", "s:nhs-dental-charges" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:bidc-fees", "note": "every figure read off the named page on the accessed date; the closing stretch is this project's reasoning and is marked" }, "text.how": { "tier": "cited", "source": "s:nhs-dental-charges" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:bidc-fees" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Dental crown.jpg", "File:Zirconia crown.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "A tooth is reduced to a stump, an impression or scan is taken, a laboratory makes a cover in metal, porcelain-fused-to-metal, lithium disilicate or zirconia, and it is cemented or screwed on.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The root this crown is often screwed to, and the line it is billed apart from.", "rel": "part" }, { "to": "root-canal", "type": "procedure", "name": "Root canal treatment", "as": "What usually comes first, on the same bill and the same trip.", "rel": "kin" }, { "to": "veneers", "type": "procedure", "name": "Dental veneers", "as": "The thinner cousin, covering the front of a tooth rather than the whole of it.", "rel": "contrast" }, { "to": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "The job that counts these in tens.", "rel": "whole" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the price falls when the sixth tooth is crowned.", "rel": "destination" }, { "to": "hungary", "type": "destination", "name": "Hungary", "as": "Where the laboratory fee is a line of its own beside every crown.", "rel": "destination" }, { "to": "poland", "type": "destination", "name": "Poland", "as": "Where the clinic prints an average UK price beside its own.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The source market whose band 3 charge of £332.10 is the number these lists are written against.", "rel": "destination" }, { "to": "budapest", "type": "hub", "name": "Budapest", "as": "The city that made dental travel a European industry.", "rel": "place" }, { "to": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "The border town where a crown is quoted against a US figure the clinic supplies itself.", "rel": "place" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step where a crown quote turns out to exclude the laboratory fee.", "rel": "step" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who recements a crown that comes off at home, and what they charge.", "rel": "risk" } ], "source_list": [ { "id": "s:bidc-fees", "kind": "web", "title": "Dental Fees — standardised treatment fees", "publisher": "Bangkok International Dental Center", "url": "https://bangkokdentalcenter.com/fees/", "accessed": "2026-09-16", "note": "implant fixture and implant crown priced in separate columns; page states package rates applicable till 30 September 2026" }, { "id": "s:mdental-budapest-prices", "kind": "web", "title": "Treatment Prices", "publisher": "Medicare Dental Clinic, Budapest", "url": "https://www.mdentalclinic.eu/prices", "accessed": "2026-09-16", "note": "treatment price and lab fee shown as separate lines; packages name accommodation and transfers" }, { "id": "s:sani-dental-prices", "kind": "web", "title": "Dental Price List in Mexico", "publisher": "Sani Dental Group, Los Algodones", "url": "https://sanidentalgroup.com/price-list", "accessed": "2026-09-16", "note": "prices in US dollars with a Mexican peso figure beside each; the page states every price is a base or starting price" }, { "id": "s:indexmedica-prices", "kind": "web", "title": "Prices — dental treatment in Kraków", "publisher": "Index Medica, Kraków", "url": "https://www.indexmedica.com/prices/", "accessed": "2026-09-16", "note": "two tables, one in sterling against a column the clinic labels average UK price, one in euro against average Irish price. Read 16 September 2026: complete implant including screw, healing ring, individual abutment and full-ceramic zirconia crown GBP 1,450 or EUR 1,552; implant screw alone GBP 575; full-ceramic zirconia crown GBP 429 or EUR 469; root canal on a front tooth GBP 120. Examination, x-rays and local anaesthetic are listed free. A deposit of 80% of each stage is due on signing the treatment plan; American Express and Diners Club are not accepted." }, { "id": "s:nhs-dental-charges", "kind": "gov", "title": "Understanding NHS dental charges — bands 1, 2 and 3", "publisher": "NHS (England)", "url": "https://www.nhs.uk/nhs-services/dentists/dental-costs/understanding-nhs-dental-charges/", "accessed": "2026-09-16", "note": "band amounts read on the accessed date; the page does not state the date the amounts took effect" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:bidc-fees", "note": "every figure read off the named page on the accessed date; the closing stretch is this project's reasoning and is marked" }, "text.how": { "tier": "cited", "source": "s:nhs-dental-charges" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:bidc-fees" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "Priced by material on the open lists in the windows.", "rel": "performs" }, { "from": "nuevo-progreso", "type": "hub", "name": "Nuevo Progreso", "as": "Ordinary restorative work, done at a fraction of the price across the river.", "rel": "performs" }, { "from": "sopron", "type": "hub", "name": "Sopron", "as": "The unit most of this town's traffic is actually booked for.", "rel": "procedure" }, { "from": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "The single-tooth version of the same laboratory work, and the line that shows how each clinic splits a bill.", "rel": "contrast" }, { "from": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The part that goes on top, billed separately on every price list read for this page.", "rel": "part" }, { "from": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "The unit the surviving teeth are covered in.", "rel": "part" }, { "from": "root-canal", "type": "procedure", "name": "Root canal treatment", "as": "What the treated tooth usually needs next, on the same list and at several times the price.", "rel": "kin" }, { "from": "veneers", "type": "procedure", "name": "Dental veneers", "as": "The full cover, at much the same laboratory price and with far more tooth cut away.", "rel": "contrast" } ] }, { "schema": 1, "id": "dental-implant", "type": "procedure", "names": { "name": "Dental implant", "aliases": [ "implant fixture", "endosseous implant", "single tooth implant" ], "said": "Clinics say implant and mean one of three things: the screw in the bone, the screw plus the part that sticks through the gum, or the whole tooth. The price list usually means the first." }, "etymology": { "root": "implant: Latin in- plus plantare, to plant. Fixture is the trade's own word for the screw, from Latin figere, to fix. Osseointegration — the bone growing onto titanium, which is what the waiting months are for — is Latin os, bone, plus integrare, to make whole.", "tier": "tradition", "note": "Three parts, three prices: fixture, abutment, crown. A page that quotes one number for an implant is quoting one of the three unless it says otherwise." }, "region": [ "global" ], "facets": { "family": "dental", "setting": "staged", "anaesthesia": "local" }, "text": { "what": "A titanium or ceramic screw is placed in the jaw where a tooth was. Bone grows onto it over months; then an abutment is screwed into it and a crown is cemented or screwed onto that. The surgery is a clinic appointment under local anaesthetic. The waiting is the part that decides how many flights a foreign patient takes.", "story": "The implant is the dental version of the knee implant trap, and the price pages say so plainly enough that nobody has to be caught.\n\nBangkok International Dental Center prices the fixture and the crown in two separate columns. On 16 September 2026 a SIC Swiss Invent fixture is 35,000 baht, a Straumann Roxolid SLA 54,000, a Nobel Biocare titanium 55,000 and a Straumann BLX 70,000 — and in every row the implant crown is a further 25,000 baht. The brand of the screw moves the price by a factor of two at one clinic, on one day.\n\nIn Budapest, Medicare Dental Clinic splits it three ways and prints the lab fee as its own line: a NeoDent or Alpha Bio implant at €381 plus €255 lab, a Straumann or Nobel at €594 plus €398 lab, an abutment at €258 for the first pair and €393 for the second, and a zirconia crown at €226 plus €152 lab. Four lines to finish one tooth.\n\nIn Los Algodones, Sani Dental Group lists a titanium implant at $890, with MXN 17,800 beside it, and a standard implant crown including the abutment at $720. Beside each the clinic prints a \"US COST\" column — $1,290 for the implant, $1,650 for the crown — which is the seller's own comparison and carries no source.\n\nIndexmedica in Kraków is the one page read for this batch that resolves the ambiguity in its own wording: an implant screw at £575, and separately an implant \"complete\" at £1,450, described as \"including implant screw, healing ring, individual abutment and full-ceramic zirconoxide crown\".\n\n*Inference —* the £575 and the £1,450 are the same clinic quoting the same tooth twice. Every comparison a reader makes between two countries is only worth the part-count behind each number.", "how": "One visit to place the fixture, a wait of months while bone integrates, a second visit for the abutment and crown. Clinics selling to foreign patients compress this by fitting a temporary and finishing on a second trip, or by loading the implant immediately where the bone allows. Bone grafting and sinus lifting, needed where the ridge is thin, are priced separately — Budapest lists sinus lifting at €409 per quadrant and bone augmentation at €302 plus the cost of the graft material.", "today": "As of 16 September 2026 a single implant fixture is published at 35,000 to 70,000 baht in Bangkok, €381 plus a €255 lab fee in Budapest, $890 in Los Algodones and £575 in Kraków — with the abutment and the crown extra in each case, and only the Kraków page quoting a finished tooth as its own line at £1,450.", "notes": "This page describes a procedure and the prices published for it. It is not dental advice." }, "metrics": { "stay_days": 0, "days_before_flying": null, "recovery_weeks": null, "note": "No hospital stay: every price read for this record is a clinic fee, not an admission. None of the four price pages states how long osseointegration takes or how many trips it needs, which is the figure a travelling patient most needs, so recovery_weeks stays empty.", "as_of": "2026-09-16", "source": "s:bidc-fees", "url": "https://bangkokdentalcenter.com/fees/" }, "prices": [ { "procedure": "dental-implant", "country": "TH", "city": "Bangkok", "amount": 35000, "amount_high": 70000, "currency": "THB", "as_of": "2026-09-16", "kind": "list", "includes": [ "the implant fixture only" ], "excludes": [ "the implant crown, listed at 25,000 THB in every row", "sterilisation and nursing fee of 150 to 250 baht per visit", "x-rays, medications and clinic service fees", "digital surgical guide, 7,000 THB for one to two teeth" ], "source": "s:bidc-fees", "url": "https://bangkokdentalcenter.com/fees/", "note": "the clinic's own fee table runs SIC Swiss Invent at 35,000, Straumann Roxolid SLA at 54,000, Nobel Biocare titanium at 55,000, Straumann Roxolid SLActive at 60,000, Straumann BLX at 70,000 and a Zi all-ceramic at 70,000, each against a struck-through higher figure. The page states package rates are applicable till 30 September 2026. Consultation is free, but the page adds that this is \"not inclusive of x-rays, medications, sterilization, nursing fees and clinic service fees that are charged separately\".", "tier": "cited", "usd": 1051.0, "usd_high": 2102.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "dental-implant", "country": "HU", "city": "Budapest", "amount": 381, "currency": "EUR", "as_of": "2026-09-16", "kind": "list", "includes": [ "the implant fixture: NeoDent or Alpha Bio" ], "excludes": [ "the lab fee of €255 printed as a separate line", "the abutment, €258 for these brands and €393 for Straumann or Nobel", "the crown, €226 plus €152 lab for zirconia", "sinus lifting at €409 per quadrant and bone augmentation at €302 plus the graft" ], "source": "s:mdental-budapest-prices", "url": "https://www.mdentalclinic.eu/prices", "note": "the premium brands are listed at €594 plus €398 lab. The clinic's own note above the table reads: \"Please note that many treatments include both the treatment price and a separate fabrication/lab fee.\" Finishing one tooth takes four of its price lines.", "tier": "cited", "usd": 440.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "dental-implant", "country": "MX", "city": "Los Algodones", "amount": 890, "currency": "USD", "as_of": "2026-09-16", "kind": "list", "includes": [ "titanium dental implant, implant only" ], "excludes": [ "the standard implant crown including abutment, listed at $720" ], "source": "s:sani-dental-prices", "url": "https://sanidentalgroup.com/price-list", "note": "listed as $890 with MXN $17,800 beside it, and a Straumann BLX implant-only line at $1,350. The page states \"All prices on this website are Base Price or Starting At price\" and prints a US comparison column — $1,290 against this implant — which is the clinic's own figure with no source attached.", "tier": "cited", "usd": 890.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "dental-implant", "country": "PL", "city": "Kraków", "amount": 575, "currency": "GBP", "as_of": "2026-09-16", "kind": "list", "includes": [ "implant (screw)" ], "excludes": [ "the healing ring, the individual abutment and the crown, which the same page bundles into a separate line" ], "source": "s:indexmedica-prices", "url": "https://www.indexmedica.com/prices/", "note": "the same price list carries an implant \"complete\" at £1,450, described as \"including implant screw, healing ring, individual abutment and full-ceramic zirconoxide crown\", and gives €1,552 for the same item. One clinic, one tooth, two published numbers two and a half times apart, and the wording is what separates them.", "tier": "cited", "usd": 775.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "dental-crown", "as": "The part that goes on top, billed separately on every price list read for this page.", "rel": "part" }, { "to": "all-on-four", "as": "What four of these become when a whole jaw is rebuilt on them.", "rel": "whole" }, { "to": "full-mouth-restoration", "as": "The larger job single implants are counted into.", "rel": "whole" }, { "to": "thailand", "as": "Where the fixture-and-crown split is printed as two columns.", "rel": "destination" }, { "to": "hungary", "as": "Where the lab fee is printed as its own line beside every implant.", "rel": "destination" }, { "to": "mexico", "as": "Where the border clinics price the implant against a US comparison of their own.", "rel": "destination" }, { "to": "poland", "as": "Where one page quotes both the screw alone and the finished tooth.", "rel": "destination" }, { "to": "los-algodones", "as": "The border town whose dental surgeries this page's Mexican price comes from.", "rel": "place" }, { "to": "budapest", "as": "The city whose clinics price implants in parts and sell the parts as packages.", "rel": "place" }, { "to": "implant-excluded", "as": "The same trap as the joint implant, written smaller and more often.", "rel": "risk" }, { "to": "reading-the-exclusions", "as": "The step that decides whether a quoted implant is a screw or a tooth.", "rel": "step" }, { "to": "follow-up-gap", "as": "Who sees the implant at the six-month check, and who fixes a failed one.", "rel": "risk" } ], "confusable_with": [ { "id": "dental-crown", "tell": "The crown is the visible tooth and the implant is the root it sits on; a quoted implant price usually excludes the crown, and a crown price assumes something to fix it to." } ], "links": [ { "label": "BIDC dental fees", "url": "https://bangkokdentalcenter.com/fees/" }, { "label": "Indexmedica price list", "url": "https://www.indexmedica.com/prices/" } ], "sources": [ "s:bidc-fees", "s:mdental-budapest-prices", "s:sani-dental-prices", "s:indexmedica-prices" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "every figure read off the clinic's own fee page on the accessed date; the closing stretch is this project's reasoning" }, "text.how": { "tier": "tradition", "note": "standard staging; the graft and sinus lift prices are cited to the Budapest list" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:bidc-fees" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Dental implant.jpg", "File:Implant dentaire.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "A titanium or ceramic screw is placed in the jaw where a tooth was. Bone grows onto it over months; then an abutment is screwed into it and a crown is cemented or screwed onto that.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "The part that goes on top, billed separately on every price list read for this page.", "rel": "part" }, { "to": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "What four of these become when a whole jaw is rebuilt on them.", "rel": "whole" }, { "to": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "The larger job single implants are counted into.", "rel": "whole" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the fixture-and-crown split is printed as two columns.", "rel": "destination" }, { "to": "hungary", "type": "destination", "name": "Hungary", "as": "Where the lab fee is printed as its own line beside every implant.", "rel": "destination" }, { "to": "mexico", "type": "destination", "name": "Mexico", "as": "Where the border clinics price the implant against a US comparison of their own.", "rel": "destination" }, { "to": "poland", "type": "destination", "name": "Poland", "as": "Where one page quotes both the screw alone and the finished tooth.", "rel": "destination" }, { "to": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "The border town whose dental surgeries this page's Mexican price comes from.", "rel": "place" }, { "to": "budapest", "type": "hub", "name": "Budapest", "as": "The city whose clinics price implants in parts and sell the parts as packages.", "rel": "place" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The same trap as the joint implant, written smaller and more often.", "rel": "risk" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step that decides whether a quoted implant is a screw or a tooth.", "rel": "step" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who sees the implant at the six-month check, and who fixes a failed one.", "rel": "risk" } ], "source_list": [ { "id": "s:bidc-fees", "kind": "web", "title": "Dental Fees — standardised treatment fees", "publisher": "Bangkok International Dental Center", "url": "https://bangkokdentalcenter.com/fees/", "accessed": "2026-09-16", "note": "implant fixture and implant crown priced in separate columns; page states package rates applicable till 30 September 2026" }, { "id": "s:mdental-budapest-prices", "kind": "web", "title": "Treatment Prices", "publisher": "Medicare Dental Clinic, Budapest", "url": "https://www.mdentalclinic.eu/prices", "accessed": "2026-09-16", "note": "treatment price and lab fee shown as separate lines; packages name accommodation and transfers" }, { "id": "s:sani-dental-prices", "kind": "web", "title": "Dental Price List in Mexico", "publisher": "Sani Dental Group, Los Algodones", "url": "https://sanidentalgroup.com/price-list", "accessed": "2026-09-16", "note": "prices in US dollars with a Mexican peso figure beside each; the page states every price is a base or starting price" }, { "id": "s:indexmedica-prices", "kind": "web", "title": "Prices — dental treatment in Kraków", "publisher": "Index Medica, Kraków", "url": "https://www.indexmedica.com/prices/", "accessed": "2026-09-16", "note": "two tables, one in sterling against a column the clinic labels average UK price, one in euro against average Irish price. Read 16 September 2026: complete implant including screw, healing ring, individual abutment and full-ceramic zirconia crown GBP 1,450 or EUR 1,552; implant screw alone GBP 575; full-ceramic zirconia crown GBP 429 or EUR 469; root canal on a front tooth GBP 120. Examination, x-rays and local anaesthetic are listed free. A deposit of 80% of each stage is due on signing the treatment plan; American Express and Diners Club are not accepted." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "every figure read off the clinic's own fee page on the accessed date; the closing stretch is this project's reasoning" }, "text.how": { "tier": "tradition", "note": "standard staging; the graft and sinus lift prices are cited to the Budapest list" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:bidc-fees" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "argentina", "type": "destination", "name": "Argentina", "as": "The work that brings patients across the land borders, and that no survey here counts.", "rel": "procedure" }, { "from": "australia", "type": "destination", "name": "Australia", "as": "The other half of the Australian outflow, and the one that rarely reaches a hospital.", "rel": "procedure" }, { "from": "costa-rica", "type": "destination", "name": "Costa Rica", "as": "The item that brings most patients here.", "rel": "procedure" }, { "from": "croatia", "type": "destination", "name": "Croatia", "as": "The item the Istrian practices are built on.", "rel": "procedure" }, { "from": "egypt", "type": "destination", "name": "Egypt", "as": "One of the things the inbound trade here is built on.", "rel": "procedure" }, { "from": "hungary", "type": "destination", "name": "Hungary", "as": "The item at the centre of every treatment plan sold here.", "rel": "procedure" }, { "from": "lithuania", "type": "destination", "name": "Lithuania", "as": "The commonest reason a foreign patient books a flight here.", "rel": "procedure" }, { "from": "mexico", "type": "destination", "name": "Mexico", "as": "The item the border clinics sell most, priced per tooth.", "rel": "procedure" }, { "from": "morocco", "type": "destination", "name": "Morocco", "as": "The other half of the European end of this trade.", "rel": "procedure" }, { "from": "philippines", "type": "destination", "name": "Philippines", "as": "One of the few procedures sold here to visitors at a published price.", "rel": "procedure" }, { "from": "poland", "type": "destination", "name": "Poland", "as": "The line item its price lists are built around.", "rel": "procedure" }, { "from": "romania", "type": "destination", "name": "Romania", "as": "The item its clinics sell to the diaspora and to their neighbours.", "rel": "procedure" }, { "from": "vietnam", "type": "destination", "name": "Vietnam", "as": "The operation the Ho Chi Minh City trade is built on.", "rel": "procedure" }, { "from": "budapest", "type": "hub", "name": "Budapest", "as": "The operation the capital's clinics are booked for, priced per implant.", "rel": "procedure" }, { "from": "cairo", "type": "hub", "name": "Cairo", "as": "The commonest advertised booking here.", "rel": "procedure" }, { "from": "cancun", "type": "hub", "name": "Cancún", "as": "The commonest reason a foreign patient sees a Cancún surgery rather than a Cancún beach.", "rel": "performs" }, { "from": "chiang-mai", "type": "hub", "name": "Chiang Mai", "as": "A course of dental work is the commonest reason a visitor stays a month here.", "rel": "procedure" }, { "from": "izmir", "type": "hub", "name": "İzmir", "as": "The commonest reason somebody flies to this city rather than the capital.", "rel": "procedure" }, { "from": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "The operation the town is built on, priced here as a fixture with the crown billed separately.", "rel": "performs" }, { "from": "nuevo-progreso", "type": "hub", "name": "Nuevo Progreso", "as": "The largest single item on the street, sold across two visits.", "rel": "performs" }, { "from": "panama-city", "type": "hub", "name": "Panama City", "as": "The everyday work of the cluster, bought as often by a resident as by a visitor.", "rel": "performs" }, { "from": "phuket", "type": "hub", "name": "Phuket", "as": "The shopfront trade strung along the roads into Phuket Town.", "rel": "procedure" }, { "from": "san-jose-cr", "type": "hub", "name": "San José, Costa Rica", "as": "The single commonest reason a North American books a flight to this valley.", "rel": "performs" }, { "from": "sopron", "type": "hub", "name": "Sopron", "as": "The work that brings a second visit, and the reason a day trip becomes two.", "rel": "procedure" }, { "from": "taipei", "type": "hub", "name": "Taipei", "as": "The shopfront trade along Zhongxiao East Road rather than on the hospital campuses.", "rel": "procedure" }, { "from": "vilnius", "type": "hub", "name": "Vilnius", "as": "The short-stay work that fills the rest of the schedule.", "rel": "procedure" }, { "from": "warsaw", "type": "hub", "name": "Warsaw", "as": "The commonest booking, priced per implant.", "rel": "procedure" }, { "from": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "The single screw this technique uses four of, priced one at a time on the same lists.", "rel": "part" }, { "from": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "The root this crown is often screwed to, and the line it is billed apart from.", "rel": "part" }, { "from": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "The screws this work is counted in, priced one at a time on the same lists.", "rel": "part" }, { "from": "root-canal", "type": "procedure", "name": "Root canal treatment", "as": "The alternative when the tooth cannot be saved, at ten to twenty times the cost.", "rel": "contrast" }, { "from": "veneers", "type": "procedure", "name": "Dental veneers", "as": "The other half of a dental travel bill, and the one that needs months rather than days.", "rel": "kin" }, { "from": "clinica-biblica", "type": "facility", "name": "Hospital Clínica Bíblica", "as": "The other short chain, and the one that brings back the same patient in stages.", "rel": "performs" }, { "from": "bloodborne-virus", "type": "risk", "name": "Bloodborne virus from treatment abroad", "as": "Dental care is the commonest reason US residents travel, and instrument reprocessing is the whole of the exposure.", "rel": "procedure" }, { "from": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "Priced per fixture, with the abutment and crown on their own lines.", "rel": "procedure" }, { "from": "dha-dubai", "type": "org", "name": "Dubai Health Authority", "as": "Dentistry is 29 per cent of what the emirate's own count says its visitors came for.", "rel": "procedure" }, { "from": "promed", "type": "org", "name": "PROMED", "as": "The work that brings most of Costa Rica's international patients in.", "rel": "procedure" }, { "from": "co-payment", "type": "term", "name": "Co-payment", "as": "A treatment where the patient contribution at home is what makes the fare abroad arithmetic.", "rel": "procedure" }, { "from": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "Four price lines to finish one tooth, on a page that says so.", "rel": "procedure" } ] }, { "schema": 1, "id": "dhi-hair-transplant", "type": "procedure", "names": { "name": "Direct hair implantation (DHI)", "aliases": [ "DHI", "implanter pen technique", "Choi implanter technique", "direct hair transplantation" ], "said": "DHI is a trade name belonging to DHI Global Medical Group, and clinics outside it sell the same technique as the implanter pen or the Choi pen. On a price page DHI usually denotes a tier above FUE rather than a different operation." }, "etymology": { "root": "implant: Latin in plus plantare, to plant - the same verb used of setting a seedling in ground. Direct in the trade name marks the step it removes: the follicular unit goes from the punch into the scalp without a slit being cut first.", "tier": "tradition", "note": "the technique is named after its instrument. A hollow needle loaded with a single follicular unit makes the channel and delivers the graft in one movement, which is why the method is described as implanting rather than placing." }, "region": [ "global" ], "facets": { "family": "hair", "setting": "day-case", "anaesthesia": "local" }, "text": { "what": "Follicular units are harvested as in follicular unit extraction, then loaded one at a time into a hollow implanter pen that both makes the recipient channel and delivers the graft in a single movement, rather than the two-stage method of cutting slits first and placing grafts into them. The harvest, the anaesthetic, the day and the donor limits are the same as FUE. What changes is the instrument, the number of staff hours, and the price tier.", "story": "DHI is a brand-linked technique rather than a separate operation, and the record says so because the price pages do not. DHI Medical Group's own Dubai page describes a patented implanter pen that allows surgeons to directly implant hair follicles without the need for creating incisions beforehand, and claims more precise control over the depth, direction and angle of each implanted follicle, a no-shave option, and a higher survival rate of grafts because follicles spend less time outside the body. Those are the seller's claims, published by the seller.\n\nThe pricing is where the distinction shows. Estenove in Istanbul quotes the same package prices - 3,395, 4,595 and 6,595 euro - for FUE and DHI alike, which is one clinic's answer to whether the pen is a different product. DHI Medical Group in Dubai publishes a ladder instead: about 9,999 dirham for minor procedures with fewer grafts, 12,000 to 18,000 for moderate hair loss, and 35,000 or more for extensive work.\n\n*Trade practice --* the argument between the two techniques is conducted almost entirely in clinic marketing. Whether the pen improves graft survival, and by how much, is not settled by any trial that this record could find published; what is documented is that it changes how many staff are needed and how long the session takes, and therefore what the session costs.\n\nThe question the International Society of Hair Restoration Surgery raises about hair surgery generally applies here with particular force, because the pen is often the part of the operation handed to technicians. Its position statement holds that donor hair harvesting, hairline design and recipient site creation should be done by a properly trained and licensed physician or physician extender; in the pen technique, recipient site creation and graft placement are the same movement.", "how": "Local anaesthetic, a full day, no ward. The scalp may be left unshaved, which is the feature most often sold with the technique and the one that lengthens the session. Loading pens is slow, so a DHI session usually involves more assistants than an FUE session of the same size, or fewer grafts in the same time. Aftercare, shedding and the twelve-to-eighteen-month judgement date are identical to FUE.", "today": "Two published prices sit on this record, from Turkiye and the United Arab Emirates, read in September 2026. One clinic prices the pen the same as the punch; the other prices by extent of hair loss. Neither publishes a graft count with the price.", "notes": "This page describes a technique and the claims made for it by those who sell it. It is not advice about having one." }, "metrics": { "stay_days": 0, "note": "Day case, as with FUE. No graft-survival figure is carried on this record: the higher survival claimed for the implanter pen is the seller's claim on the seller's page, and no independent measurement with a defined population was found for it.", "as_of": "2026-09-16", "source": "s:dhi-dubai-cost", "url": "https://www.dhiinternational.com/cost-of-hair-transplant-in-dubai-dhi-medical-group/" }, "prices": [ { "procedure": "dhi-hair-transplant", "country": "TR", "city": "Istanbul", "amount": 3395, "amount_high": 6595, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "a fixed session, the clinic quoting the same three package prices for FUE and DHI", "MD participation in extraction and incision", "PRP session", "hotel accommodation three to four nights", "VIP transfer", "aftercare kit", "18 months aftercare support" ], "excludes": [ "flights" ], "source": "s:estenove-cost", "url": "https://www.estenove.com/hair-transplant-cost-istanbul-turkey/", "note": "the clinic states its prices are quoted for FUE and DHI at the same rate, which is itself a statement about whether the pen is a different operation", "tier": "cited", "usd": 3917.0, "usd_high": 7609.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "dhi-hair-transplant", "country": "AE", "city": "Dubai", "amount": 9999, "amount_high": 35000, "currency": "AED", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [ "surgeon fees, anaesthesia, facility charges, graft extraction and implantation, post-operative care including medications and follow-up visits, in the group's own words" ], "excludes": [ "not stated on the page" ], "source": "s:dhi-dubai-cost", "url": "https://www.dhiinternational.com/cost-of-hair-transplant-in-dubai-dhi-medical-group/", "note": "the ladder on the brand owner's own page: approximately 9,999 AED for minor procedures with fewer grafts, 12,000 to 18,000 AED for moderate hair loss, 35,000 AED or more for extensive procedures", "tier": "cited", "usd": 2723.0, "usd_high": 9530.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "hair-transplant-fue", "as": "The operation this is a branded variant of, with the same harvest and the same donor limits.", "rel": "origin" }, { "to": "graft", "as": "The unit both techniques are sold in, and which neither of these two prices states.", "rel": "term" }, { "to": "istanbul", "as": "Where the two techniques are sold from the same price list.", "rel": "place" }, { "to": "turkiye", "as": "The destination that sells both at a package price.", "rel": "destination" }, { "to": "uae", "as": "Where the brand owner publishes its own ladder of prices.", "rel": "destination" }, { "to": "dubai", "as": "The hub whose clinics price by extent of hair loss rather than by graft.", "rel": "place" }, { "to": "ishrs", "as": "The society whose statement on who may create recipient sites bears directly on a technique that makes the site and places the graft in one movement.", "rel": "org" }, { "to": "advertising-rules", "as": "Where claims of higher graft survival may be made, and where they may not.", "rel": "governed-by" }, { "to": "getting-a-quote", "as": "The step at which a technique name becomes a price tier.", "rel": "step" } ], "confusable_with": [ { "id": "hair-transplant-fue", "tell": "Same harvest, same donor area, same day. DHI names the instrument that places the graft, and on most price lists it names a tier." } ], "links": [ { "label": "DHI Medical Group, cost of hair transplant in Dubai", "url": "https://www.dhiinternational.com/cost-of-hair-transplant-in-dubai-dhi-medical-group/" } ], "sources": [ "s:dhi-dubai-cost", "s:estenove-cost", "s:ishrs-unlicensed-technicians" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:dhi-dubai-cost", "note": "the technique claims are quoted from the brand owner's page and attributed there; the paragraph on marketing is marked as trade practice inline" }, "text.how": { "tier": "tradition" }, "etymology": { "tier": "tradition" } } }, "x_commons_files": [ "File:Hair transplantation implanter.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "Follicular units are harvested as in follicular unit extraction, then loaded one at a time into a hollow implanter pen that both makes the recipient channel and delivers the graft in a single movement, rather than the…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The operation this is a branded variant of, with the same harvest and the same donor limits.", "rel": "origin" }, { "to": "graft", "type": "term", "name": "Graft", "as": "The unit both techniques are sold in, and which neither of these two prices states.", "rel": "term" }, { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "Where the two techniques are sold from the same price list.", "rel": "place" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The destination that sells both at a package price.", "rel": "destination" }, { "to": "uae", "type": "destination", "name": "United Arab Emirates", "as": "Where the brand owner publishes its own ladder of prices.", "rel": "destination" }, { "to": "dubai", "type": "hub", "name": "Dubai", "as": "The hub whose clinics price by extent of hair loss rather than by graft.", "rel": "place" }, { "to": "ishrs", "type": "org", "name": "International Society of Hair Restoration Surgery", "as": "The society whose statement on who may create recipient sites bears directly on a technique that makes the site and places the graft in one movement.", "rel": "org" }, { "to": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "Where claims of higher graft survival may be made, and where they may not.", "rel": "governed-by" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step at which a technique name becomes a price tier.", "rel": "step" } ], "source_list": [ { "id": "s:dhi-dubai-cost", "kind": "web", "title": "Cost of Hair Transplant in Dubai", "publisher": "DHI Medical Group", "url": "https://www.dhiinternational.com/cost-of-hair-transplant-in-dubai-dhi-medical-group/", "accessed": "2026-09-16", "note": "the group's own page, describing DHI as a patented implanter pen and quoting dirham ranges" }, { "id": "s:estenove-cost", "kind": "web", "title": "Hair Transplant Cost and Prices in Turkey", "publisher": "Estenove, Istanbul", "url": "https://www.estenove.com/hair-transplant-cost-istanbul-turkey/", "accessed": "2026-09-16", "note": "clinic's own package prices in euro, quoted per session rather than per graft" }, { "id": "s:ishrs-unlicensed-technicians", "kind": "org", "title": "Beware of Unlicensed Technicians Performing Hair Restoration Surgery", "publisher": "International Society of Hair Restoration Surgery", "url": "https://ishrs.org/beware-of-unlicensed-technicians-performing-hair-restoration-surgery/", "accessed": "2026-09-16", "note": "position statement dated 10 January 2024, updated from 18 September 2014" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:dhi-dubai-cost", "note": "the technique claims are quoted from the brand owner's page and attributed there; the paragraph on marketing is marked as trade practice inline" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "istanbul", "type": "hub", "name": "Istanbul", "as": "The implanter-pen variant the clinics here price as a tier above.", "rel": "procedure" }, { "from": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The same operation with a branded implanter pen doing the placing, priced as a tier above it.", "rel": "contrast" }, { "from": "ishrs", "type": "org", "name": "International Society of Hair Restoration Surgery", "as": "A technique that makes the recipient site and places the graft in one movement, which is exactly the step the society's statements are about.", "rel": "procedure" }, { "from": "turkiye-hair-boom", "type": "event", "name": "Türkiye's hair transplant boom", "as": "The branded variant the clinics price above it.", "rel": "procedure" }, { "from": "fue", "type": "term", "name": "FUE", "as": "The branded variant sold beside it, with an implanter pen instead of forceps.", "rel": "contrast" }, { "from": "graft", "type": "term", "name": "Graft", "as": "The other technique sold in the same unit, whose prices state it no more clearly.", "rel": "procedure" } ] }, { "schema": 1, "id": "dialysis-holiday", "type": "procedure", "names": { "name": "Dialysis away from home", "aliases": [ "holiday dialysis", "vacation dialysis", "guest dialysis", "transient dialysis", "haemodialysis for travelling patients" ], "said": "Units say holiday dialysis, and chains run departments under that name. Nephrologists say transient or guest patient, which is the word on the booking form. The patient is not seeking treatment abroad; the patient is already having treatment and is trying to go somewhere." }, "etymology": { "root": "dialysis: Greek dialusis, a separating or dissolving — dia, apart, plus luein, to loosen. Thomas Graham took the word for the laboratory process in the 1860s, a century before it was a treatment. Haemodiafiltration adds Latin filtrum, felt, the cloth a liquid was strained through.", "tier": "tradition", "note": "Haemodialysis clears the blood across a membrane; haemodiafiltration adds convection and is priced higher where a unit offers both. A session is the unit of sale on every price page read here, and three a week is the usual prescription, so a fortnight away is six sessions before anything else is counted." }, "region": [ "global", "southeast-asia", "west-asia", "europe-south", "north-america" ], "facets": { "family": "rehabilitation", "setting": "outpatient-course", "anaesthesia": "none" }, "text": { "what": "A person on maintenance haemodialysis books sessions at a unit somewhere else and goes there. The treatment is the one they already have: needles into a fistula or a line, four hours on a machine, three times a week, indefinitely. What travels with them is a prescription — dry weight, dialysate composition, heparin, machine settings — and a set of virology results the receiving unit will want before it agrees to a slot.", "story": "This is the long-stay, non-surgical end of cross-border care and it inverts the usual story. Nobody here is buying an operation that is cheaper abroad. They are buying the ability to leave home for a fortnight, and the price of that is six or eight dialysis sessions bought retail in a country where they are not insured.\n\nWhat gets published is the session. Bangkok Hospital Phuket runs a department called the Holiday Dialysis Center and states its rates: 7,000 baht a session of four hours for conventional haemodialysis, 8,000 for online haemodiafiltration, both excluding medications. Vibhavadi Hospital in Bangkok publishes a domestic figure on the same kind of page: 2,200 baht a session, 3,400 for a first session including the nephrologist, 1,200 to open a dialyser and 4,700 for a session in intensive care, with the same exclusion of medications and any additional diagnosis. *Inference —* the two numbers are not the same product bought at two prices. One is a department built to take booked foreign patients with interpreters and a concierge; the other is a hospital's standard outpatient rate. But a traveller reading only the first has no idea the second exists, and the comparison is the kind a directory can make and a clinic page cannot.\n\nIn Europe the price is frequently not a price at all, because entitlement gets there first: a UK agency page listing Spanish units notes that most accept the European Health Insurance Card or its UK successor. Where they do not, it quotes a private unit in Benidorm at 450 euro a session. The same agency lists Turkish units at roughly 220 to 300 euro a session, some with transport to the resort included and one explicitly cheaper without it. Those are an intermediary's numbers, not a unit's own price list, and they are labelled as such here.\n\nThe largest chain publishes no prices whatsoever. Fresenius Medical Care's NephroCare runs a holiday dialysis service and routes it through the patient's home centre: the booking is made by the unit that already treats them, which is also the arrangement that gets the prescription transmitted correctly.\n\n*Trade practice —* a unit asks for the dialysis prescription, recent hepatitis B, hepatitis C and HIV serology, and confirmation of who pays, before it confirms a slot; isolation machines are limited and a positive result can mean no slot at all rather than a higher price. Sessions in a resort in August are booked out months ahead for the same reason hotel rooms are.", "how": "Booked ahead, session by session, usually through the home unit and sometimes through an agency that holds slots at named units. The receiving unit repeats what it needs: weight, bloods, machine settings, and a signature. Payment is per session and in advance at most private units; within the EU an entitlement card may replace payment entirely, and where it does the transaction leaves no price behind at all. What is not bought in a session is the rest of the care — the medication, the pathology, the access problem that arrives on day three, the admission if it does not resolve.", "today": "As of 17 September 2026 four countries' published per-session figures were read for this record: two Thai hospitals' own pages, an agency's numbers for Spain and Türkiye, and a US federal tariff. They are four different kinds of document. The American one is the only rate in the set set by a payer rather than a seller: the Medicare base rate for one dialysis treatment, 281.71 dollars from 1 January 2026, covering a bundle that includes the drugs the Thai pages exclude.", "notes": "This page describes a treatment and reports published prices. It is not medical advice, and nothing here says whether anybody should travel." }, "metrics": { "stay_days": null, "days_before_flying": null, "recovery_weeks": null, "note": "None of these is the right unit. The number that matters is sessions: the published Thai rates are quoted per four-hour session, and a maintenance prescription is usually three a week, so a two-week trip is six sessions before medication, transport or anything that goes wrong. No source read here publishes a wait before flying, and this is the one record in this batch where the traveller is fit to fly by definition.", "as_of": "2026-09-17", "source": "s:bph-holiday-dialysis", "url": "https://www.bangkokhospital.com/en/phuket/center-clinic/other/phuket-holiday-dialysis-center-bpk/treatments-and-services" }, "prices": [ { "procedure": "dialysis-holiday", "country": "TH", "city": "Phuket", "amount": 7000, "amount_high": 8000, "currency": "THB", "as_of": "2026-09-17", "kind": "list", "includes": [ "one session of four hours" ], "excludes": [ "medications, stated on the page", "laboratory tests", "transport to and from the unit", "any admission" ], "source": "s:bph-holiday-dialysis", "url": "https://www.bangkokhospital.com/en/phuket/center-clinic/other/phuket-holiday-dialysis-center-bpk/treatments-and-services", "note": "the hospital's own rates for its Holiday Dialysis Center: 7,000 baht conventional, 8,000 for online haemodiafiltration. No validity date on the page.", "tier": "cited", "usd": 210.0, "usd_high": 240.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "dialysis-holiday", "country": "TH", "city": "Bangkok", "amount": 2200, "currency": "THB", "as_of": "2026-09-17", "kind": "list", "includes": [ "one haemodialysis session" ], "excludes": [ "medications and any additional diagnosis, stated on the page", "the first session, priced at 3,400 including the nephrologist's fee", "opening a dialyser, 1,200", "a session in intensive care, 4,700" ], "source": "s:vibhavadi-hemodialysis", "url": "https://www.vibhavadi.com/en/department-hemodialysis", "note": "a Bangkok hospital's standard published rate, on its own department page, alongside partial refunds it names for government-officer and social-security patients. Carried here as the domestic figure against which a holiday dialysis rate can be read; it is not the same service and not the same unit.", "tier": "cited", "usd": 66.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "dialysis-holiday", "country": "ES", "city": "Benidorm", "amount": 450, "currency": "EUR", "as_of": "2026-09-17", "kind": "quoted-range", "includes": [ "one session at a named private unit" ], "excludes": [ "everything else; the agency page names no inclusion list" ], "source": "s:freedom-dialysis-spain", "url": "https://www.holidaydialysis.co.uk/spain.php", "note": "an agency's figure, not the unit's own price list, and the only Spanish price on a page that names more than thirty units. The same page states that most Spanish units accept the European Health Insurance Card or its UK successor, in which case no price arises at all.", "tier": "cited", "usd": 519.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "dialysis-holiday", "country": "TR", "amount": 200, "amount_high": 300, "currency": "EUR", "as_of": "2026-09-17", "kind": "quoted-range", "includes": [ "one session; at some named units, transport to the resort area" ], "excludes": [ "transport where it is priced out: one unit is listed at 250 euro with transport and 200 without" ], "source": "s:freedom-dialysis-turkey", "url": "https://www.holidaydialysis.co.uk/turkey.php", "note": "an agency's approximate figures for named units in Aydın, Muğla, the Antalya region and Istanbul; every one is prefixed approx. and the page carries no date. Not a unit's own price list.", "tier": "cited", "usd": 231.0, "usd_high": 346.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "dialysis-holiday", "country": "US", "amount": 281.71, "currency": "USD", "as_of": "2026-01-01", "kind": "tariff", "includes": [ "all renal dialysis services furnished for outpatient maintenance dialysis, including drugs and biological products", "a training add-on adjustment for home and self-dialysis" ], "excludes": [ "adjustment for local wages, which is applied on top with a floor of 0.6000 and a 5% cap on annual decreases", "anything outside the bundle" ], "source": "s:cms-esrd-pps-2026", "url": "https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-end-stage-renal-disease-esrd-prospective-payment-system-final-rule", "note": "the Medicare base rate for one dialysis treatment from 1 January 2026, up from 273.82 dollars in 2025. A payer's price rather than a seller's, and the only figure in this set that includes the drugs the Thai pages exclude.", "tier": "cited", "usd": 282.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "kidney-transplant", "as": "What this treatment is the alternative to, and the operation that ends it.", "rel": "contrast" }, { "to": "liver-transplant", "as": "The other organ in this directory where a traveller is already a patient before the journey starts.", "rel": "kin" }, { "to": "thailand", "as": "Where the only two hospital-published per-session rates read for this record are posted.", "rel": "destination" }, { "to": "phuket", "as": "The resort with a hospital department named for this traffic.", "rel": "hub" }, { "to": "spain", "as": "Where entitlement usually replaces the price, and a private unit's session appears when it does not.", "rel": "destination" }, { "to": "turkiye", "as": "Where an agency quotes sessions by resort, sometimes with the transfer inside the number.", "rel": "destination" }, { "to": "eu-directive-2011-24", "as": "The route by which a European patient's home system may meet the cost of treatment in another member state.", "rel": "governed-by" }, { "to": "insurance-exclusions", "as": "Whether a travel policy covers pre-existing renal failure is the question that decides this trip.", "rel": "rule" }, { "to": "getting-your-records", "as": "The prescription and the serology are what the receiving unit books on.", "rel": "step" }, { "to": "booking-the-flight", "as": "Sessions are booked before the flight here, not after it.", "rel": "step" }, { "to": "bloodborne-virus", "as": "Hepatitis status decides whether a unit has a machine for the patient at all.", "rel": "risk" }, { "to": "follow-up-gap", "as": "The reverse case: the home unit keeps the patient and lends them out for a fortnight.", "rel": "contrast" } ], "confusable_with": [ { "id": "kidney-transplant", "tell": "Dialysis abroad is a booked treatment slot on a trip somebody was going to take anyway. A transplant abroad is an operation on two people, one of whom is not the traveller." } ], "links": [ { "label": "Bangkok Hospital Phuket — Holiday Dialysis Center", "url": "https://www.bangkokhospital.com/en/phuket/center-clinic/other/phuket-holiday-dialysis-center-bpk/treatments-and-services" }, { "label": "Vibhavadi Hospital — haemodialysis department", "url": "https://www.vibhavadi.com/en/department-hemodialysis" }, { "label": "CMS — CY2026 ESRD Prospective Payment System final rule", "url": "https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-end-stage-renal-disease-esrd-prospective-payment-system-final-rule" } ], "sources": [ "s:bph-holiday-dialysis", "s:vibhavadi-hemodialysis", "s:freedom-dialysis-spain", "s:freedom-dialysis-turkey", "s:cms-esrd-pps-2026", "s:nephrocare-holiday-dialysis" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:bph-holiday-dialysis", "note": "the rates are read off the named pages; the comparison between the two Thai figures is marked Inference and the booking conditions are marked Trade practice" }, "text.how": { "tier": "tradition", "note": "the booking sequence is the trade's; the payment and entitlement points are cited to the pages named in the prices" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:bph-holiday-dialysis" }, "metrics": { "tier": "cited", "source": "s:bph-holiday-dialysis" } } }, "x_commons_files": [ "File:Hemodialysis machine.jpg", "File:Dialysis ward.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "A person on maintenance haemodialysis books sessions at a unit somewhere else and goes there.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" }, { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" }, { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "What this treatment is the alternative to, and the operation that ends it.", "rel": "contrast" }, { "to": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "The other organ in this directory where a traveller is already a patient before the journey starts.", "rel": "kin" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the only two hospital-published per-session rates read for this record are posted.", "rel": "destination" }, { "to": "phuket", "type": "hub", "name": "Phuket", "as": "The resort with a hospital department named for this traffic.", "rel": "hub" }, { "to": "spain", "type": "destination", "name": "Spain", "as": "Where entitlement usually replaces the price, and a private unit's session appears when it does not.", "rel": "destination" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "Where an agency quotes sessions by resort, sometimes with the transfer inside the number.", "rel": "destination" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route by which a European patient's home system may meet the cost of treatment in another member state.", "rel": "governed-by" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "Whether a travel policy covers pre-existing renal failure is the question that decides this trip.", "rel": "rule" }, { "to": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "The prescription and the serology are what the receiving unit books on.", "rel": "step" }, { "to": "booking-the-flight", "type": "pathway", "name": "Booking the flight", "as": "Sessions are booked before the flight here, not after it.", "rel": "step" }, { "to": "bloodborne-virus", "type": "risk", "name": "Bloodborne virus from treatment abroad", "as": "Hepatitis status decides whether a unit has a machine for the patient at all.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The reverse case: the home unit keeps the patient and lends them out for a fortnight.", "rel": "contrast" } ], "source_list": [ { "id": "s:bph-holiday-dialysis", "kind": "web", "title": "Holiday Dialysis Center — treatments and services", "publisher": "Bangkok Hospital Phuket", "url": "https://www.bangkokhospital.com/en/phuket/center-clinic/other/phuket-holiday-dialysis-center-bpk/treatments-and-services", "accessed": "2026-09-17", "note": "the hospital's own page: a conventional rate of 7,000 THB a session of four hours and an online haemodiafiltration rate of 8,000 THB, both stated to exclude medications. No validity date." }, { "id": "s:vibhavadi-hemodialysis", "kind": "web", "title": "Department: Hemodialysis", "publisher": "Vibhavadi Hospital, Bangkok", "url": "https://www.vibhavadi.com/en/department-hemodialysis", "accessed": "2026-09-16" }, { "id": "s:freedom-dialysis-spain", "kind": "web", "title": "Spain - dialysis holidays", "publisher": "Freedom, the Dialysis Holiday Specialists, Leicestershire", "url": "https://www.holidaydialysis.co.uk/spain.php", "accessed": "2026-09-16", "note": "an agency page, not a unit's own price list" }, { "id": "s:freedom-dialysis-turkey", "kind": "web", "title": "Dialysis in Turkey — units and approximate session prices", "publisher": "Freedom, the Dialysis Holiday Specialists, Leicestershire", "url": "https://www.holidaydialysis.co.uk/turkey.php", "accessed": "2026-09-17", "note": "an agency page, not a unit's own price list; every figure is prefixed 'approx.' and the page carries no date" }, { "id": "s:cms-esrd-pps-2026", "kind": "org", "title": "Calendar Year 2026 End-Stage Renal Disease Prospective Payment System Final Rule (CMS-1830-F)", "publisher": "US Centers for Medicare and Medicaid Services", "url": "https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-end-stage-renal-disease-esrd-prospective-payment-system-final-rule", "accessed": "2026-09-16" }, { "id": "s:nephrocare-holiday-dialysis", "kind": "web", "title": "Holiday Dialysis", "publisher": "NephroCare, Fresenius Medical Care", "url": "https://www.nephrocare.com/en-gb/patients-home/holiday-dialysis/", "accessed": "2026-09-16", "note": "the chain's own page: booking through the home centre, no prices published" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:bph-holiday-dialysis", "note": "the rates are read off the named pages; the comparison between the two Thai figures is marked Inference and the booking conditions are marked Trade practice" }, "text.how": { "tier": "tradition", "note": "the booking sequence is the trade's; the payment and entitlement points are cited to the pages named in the prices" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:bph-holiday-dialysis" }, "metrics": { "tier": "cited", "source": "s:bph-holiday-dialysis" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The other outpatient course sold to travellers, priced per session rather than per programme.", "rel": "contrast" }, { "from": "bloodborne-virus", "type": "risk", "name": "Bloodborne virus from treatment abroad", "as": "Repeated vascular access in an unfamiliar unit, week after week.", "rel": "procedure" }, { "from": "ndm-1-2010", "type": "event", "name": "NDM-1, 2010", "as": "One of the treatments named among the admissions in the paper.", "rel": "procedure" } ] }, { "schema": 1, "id": "disc-replacement", "type": "procedure", "names": { "name": "Artificial disc replacement", "aliases": [ "total disc replacement", "TDR", "disc arthroplasty", "cervical disc replacement", "CDR", "ADR" ], "said": "Surgeons say cervical or lumbar and then the level. Hospitals selling it say motion-preserving, which is the argument against fusion said as a product name." }, "etymology": { "root": "disc: Greek diskos, a flat plate, by way of Latin discus. Prosthesis is Greek prosthesis, an addition or something put on. Arthroplasty again: arthron, a joint, plastos, moulded — a spinal segment treated as a joint rather than as a beam to be pinned.", "tier": "tradition", "note": "The unit is the motion segment, and every price read for this record is a one-level price." }, "region": [ "global" ], "facets": { "family": "orthopaedic", "setting": "inpatient", "anaesthesia": "general" }, "text": { "what": "The worn disc is removed and replaced with a metal-and-polymer implant that keeps the two vertebrae moving, instead of a cage and screws that lock them together. It is done at one level in the neck or the lower back, for degenerative disc disease with nerve symptoms that has not settled with conservative treatment.", "story": "Disc replacement is fusion's competitor, and the pages that sell one usually sell the other. On Bumrungrad's Spine Institute price list, read on 16 September 2026, a one-level cervical disc replacement is 468,600 baht with one night, sitting directly above a one-level anterior cervical fusion at 420,000 and a one-level lumbar fusion at 576,300. The exclusion on the disc replacement package is one line long and reads: artificial cervical disc.\n\nThat single line is the same trap as the knee implant. The package buys two hours of theatre, a night in a standard single room, the surgeon, the assistant and the anaesthetist — and not the device the operation is named after.\n\nAustralia prices the two rivals identically. Item 51131, cervical artificial intervertebral total disc replacement at one motion segment, pays $1,295.85 as at 1 July 2026, exactly what item 51041 pays for a one-segment fusion. What the item adds instead of money is a gate: five written conditions the patient must meet — no prior surgery at that cervical level, skeletal maturity, symptomatic degenerative disc disease with radiculopathy, no vertebral osteoporosis, and failed conservative therapy.\n\nIn India, Yashoda Hospitals in Hyderabad publishes its own cost page for the operation: a range of Rs. 3,50,000 to Rs. 6,00,000, an average of about Rs. 4,00,000 and a table figure of Rs. 4,20,000, with no date on the page and no statement of what the figure covers.\n\n*Inference —* three publishers, three different objects again: a package with the implant carved out, a payer's fee with an eligibility test attached, and a hospital's own range with neither date nor inclusion list. Only the first can be compared with a bill.", "how": "General anaesthesia. In the neck the surgeon works from the front through a crease incision, removes the disc and the marginal osteophytes — bone spurs at the rim — and seats the prosthesis between the vertebral bodies; Bumrungrad's package books two hours of theatre and one night. Lumbar replacement is done from the front through the abdomen and is the bigger undertaking. Motion at the treated level is kept, which is the whole argument for the device.", "today": "As of 16 September 2026 the published disc replacement prices on this site are 468,600 baht in Bangkok excluding the disc itself, an Australian schedule fee of $1,295.85 with a five-part eligibility test written into the item, and an Indian hospital's own range of Rs. 3,50,000 to Rs. 6,00,000 carrying no date.", "notes": "This page describes an operation, its rivalry with fusion, and the prices published for it. Nothing here is medical advice." }, "metrics": { "stay_days": 1, "days_before_flying": null, "recovery_weeks": null, "note": "One night is the stay named in Bumrungrad's CDR01 package for a one-level cervical disc replacement. No page read for this record states a recovery span or a flying interval, so both stay empty.", "as_of": "2026-09-16", "source": "s:bumrungrad-cdr01", "url": "https://www.bumrungrad.com/en/packages/cervical-disc-replacement" }, "prices": [ { "procedure": "disc-replacement", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 468600, "currency": "THB", "as_of": "2026-09-16", "kind": "package", "includes": [ "operating room charges for 2 hours including OR room, recovery room, scrub nurse and circulating nurse", "accommodation for 1 day in a standard single room", "medical equipment and medical supplies specified in the package", "anaesthesia and medications related to the procedure", "surgeon", "assistant surgeon if necessary", "anaesthesiologist" ], "excludes": [ "artificial cervical disc", "consultation fee for an initial visit and follow-up visits", "inpatient stay more than 1 day, ICU, or stay past the approved discharge day", "internist's and other specialists' consultations", "outpatient fees before admission", "complex cases requiring emergency surgery", "laboratory and diagnostic tests before and after operation, blood transfusion and biopsy", "take-home medications and medical supplies", "pre-operative exercise programme by a physical therapist" ], "source": "s:bumrungrad-cdr01", "url": "https://www.bumrungrad.com/en/packages/cervical-disc-replacement", "note": "package CDR01, one level, price stated valid until 31 December 2026. The first exclusion is the prosthesis the operation is named for.", "tier": "cited", "usd": 14074.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "disc-replacement", "country": "AU", "amount": 1295.85, "currency": "AUD", "as_of": "2026-07-01", "kind": "tariff", "includes": [ "the medical service described in item 51131: cervical artificial intervertebral total disc replacement, at one motion segment only, including removal of disc and marginal osteophytes" ], "excludes": [ "hospital accommodation and theatre", "the prosthesis", "the anaesthetist's own items", "any amount charged above the schedule fee" ], "source": "s:mbs-51131", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=51131&qt=item", "note": "Medicare Benefits Schedule item 51131, fee last updated 1 July 2026; 75% benefit $971.90. The item pays only where the patient has had no prior surgery at the same cervical level, is skeletally mature, has symptomatic degenerative disc disease with radiculopathy, does not have vertebral osteoporosis and has failed conservative therapy. The identical fee is paid for a one-segment fusion under item 51041.", "tier": "cited", "usd": 924.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "disc-replacement", "country": "IN", "city": "Hyderabad", "amount": 350000, "amount_high": 600000, "currency": "INR", "as_of": "2026", "kind": "quoted-range", "includes": [], "excludes": [], "source": "s:yashoda-adr-cost", "url": "https://www.yashodahospitals.com/procedure-cost/artificial-disc-replacement-surgery-cost-in-india/", "note": "the hospital's own cost page gives \"Rs. 3,50,000 to Rs. 6,00,000\", an average of \"approximately Rs. 4,00,000\" and a table line of \"4,20,000/- (Approx.)\". The page carries no publication date and no statement of what the figure covers, so as_of is the year it was read, 16 September 2026, and not a date the hospital published.", "tier": "cited", "usd": 3646.0, "usd_high": 6251.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "spinal-fusion", "as": "The operation this one competes with, 48,600 baht cheaper at the same Bangkok hospital and paid the same fee in Australia.", "rel": "contrast" }, { "to": "bumrungrad", "as": "Publishes the one-level cervical disc replacement package this page reads, prosthesis excluded.", "rel": "performed-at" }, { "to": "thailand", "as": "Where the package price on this page is sold.", "rel": "destination" }, { "to": "india", "as": "Where the hospital's own undated range on this page comes from.", "rel": "destination" }, { "to": "australia", "as": "Whose schedule attaches a five-part eligibility test to the fee.", "rel": "destination" }, { "to": "implant-excluded", "as": "The exclusion that removes the device the operation is named after.", "rel": "risk" }, { "to": "reading-the-exclusions", "as": "The step on which this package's headline figure turns.", "rel": "step" }, { "to": "prior-authorisation", "as": "What five written eligibility conditions amount to when a payer applies them.", "rel": "term" }, { "to": "tariff", "as": "What the Australian figure is, and why it is not a bill.", "rel": "term" }, { "to": "the-price-that-isnt", "as": "A headline price with the prosthesis taken out of it.", "rel": "story" } ], "confusable_with": [ { "id": "spinal-fusion", "tell": "Both clear the disc space; fusion locks the segment with a cage and screws, replacement keeps it moving with a prosthesis, and both exclude the hardware from the package price." } ], "links": [ { "label": "Bumrungrad package CDR01", "url": "https://www.bumrungrad.com/en/packages/cervical-disc-replacement" }, { "label": "MBS item 51131", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=51131&qt=item" } ], "sources": [ "s:bumrungrad-cdr01", "s:bumrungrad-spine-packages", "s:mbs-51131", "s:yashoda-adr-cost" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "prices, exclusions and item conditions read off named pages; the closing stretch is this project's reasoning" }, "text.how": { "tier": "tradition", "note": "standard operative description; theatre time and nights cited to the package page" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:bumrungrad-cdr01" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Cervical disc prosthesis.jpg", "File:Artificial disc replacement X-ray.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "The worn disc is removed and replaced with a metal-and-polymer implant that keeps the two vertebrae moving, instead of a cage and screws that lock them together.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "spinal-fusion", "type": "procedure", "name": "Spinal fusion", "as": "The operation this one competes with, 48,600 baht cheaper at the same Bangkok hospital and paid the same fee in Australia.", "rel": "contrast" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Publishes the one-level cervical disc replacement package this page reads, prosthesis excluded.", "rel": "performed-at" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the package price on this page is sold.", "rel": "destination" }, { "to": "india", "type": "destination", "name": "India", "as": "Where the hospital's own undated range on this page comes from.", "rel": "destination" }, { "to": "australia", "type": "destination", "name": "Australia", "as": "Whose schedule attaches a five-part eligibility test to the fee.", "rel": "destination" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The exclusion that removes the device the operation is named after.", "rel": "risk" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step on which this package's headline figure turns.", "rel": "step" }, { "to": "prior-authorisation", "type": "term", "name": "Prior authorisation", "as": "What five written eligibility conditions amount to when a payer applies them.", "rel": "term" }, { "to": "tariff", "type": "term", "name": "Tariff", "as": "What the Australian figure is, and why it is not a bill.", "rel": "term" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "A headline price with the prosthesis taken out of it.", "rel": "story" } ], "source_list": [ { "id": "s:bumrungrad-cdr01", "kind": "web", "title": "Cervical Disc Replacement (CDR) — package CDR01", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/cervical-disc-replacement", "accessed": "2026-09-16", "note": "468,600 THB, one night, the artificial cervical disc itself excluded" }, { "id": "s:bumrungrad-spine-packages", "kind": "web", "title": "Spine Surgery — Spine Institute package list", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/packages-center/spine-specialists-center", "accessed": "2026-09-16", "note": "endoscopic discectomy, ACDF, cervical disc replacement and TLIF prices" }, { "id": "s:mbs-51131", "kind": "gov", "title": "MBS item 51131 — cervical artificial intervertebral total disc replacement, one motion segment", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=51131&qt=item", "accessed": "2026-09-16", "note": "schedule fee $1,295.85, fee last updated 01-Jul-2026; the item carries five written eligibility conditions" }, { "id": "s:yashoda-adr-cost", "kind": "web", "title": "Artificial disc replacement surgery cost in India", "publisher": "Yashoda Hospitals, Hyderabad", "url": "https://www.yashodahospitals.com/procedure-cost/artificial-disc-replacement-surgery-cost-in-india/", "accessed": "2026-09-16", "note": "the hospital's own cost page; it carries a range and an approximate figure, and no date" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "prices, exclusions and item conditions read off named pages; the closing stretch is this project's reasoning" }, "text.how": { "tier": "tradition", "note": "standard operative description; theatre time and nights cited to the package page" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:bumrungrad-cdr01" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "spinal-fusion", "type": "procedure", "name": "Spinal fusion", "as": "The motion-preserving alternative argued against this one, and 48,600 baht dearer at the same neck level on the same Bangkok page.", "rel": "contrast" }, { "from": "wooridul", "type": "facility", "name": "Wooridul Spine Hospital", "as": "The motion-preserving alternative to fusion; the Gulf centre staffed from this hospital lists it, and the Seoul pages read for this record do not.", "rel": "performs" }, { "from": "prior-authorisation", "type": "term", "name": "Prior authorisation", "as": "Five written eligibility conditions, which is what this gate looks like in a fee schedule.", "rel": "procedure" } ] }, { "schema": 1, "id": "egg-donation", "type": "procedure", "names": { "name": "Egg donation", "aliases": [ "oocyte donation", "donor egg IVF", "DIVF", "OD", "ovodonación" ], "said": "Clinics write DIVF or OD on a price list. Registers write donor oocyte. The recipient's paperwork says recipient; the donor's says compensation, and how large that word is allowed to be is the whole legal argument." }, "etymology": { "root": "oocyte: Greek ōion, an egg, plus kytos, a vessel — the egg cell. Donation carries Latin donare, to give, which is the word every jurisdiction keeps even where a fixed sum changes hands and the sum is printed on the clinic's own price list.", "tier": "tradition", "note": "fresh means the donor is stimulated for this recipient and the eggs are used within days; frozen means they come from a bank and are thawed. The two words sit next to each other on price lists at a difference of several thousand euro, and only one of them includes the eggs." }, "region": [ "global" ], "facets": { "family": "fertility", "setting": "outpatient-course", "anaesthesia": "sedation" }, "text": { "what": "A donor is screened and stimulated, her eggs are collected, and they are fertilised with the recipient's partner's sperm or with donor sperm; the resulting embryo goes into the recipient, whose own cycle is timed to match or suppressed and replaced with hormones. The recipient has no egg collection and needs no sedation of her own. What is bought is a stranger's ovarian reserve, and what varies across borders is whether that stranger may be paid, whether she stays anonymous, and how old the recipient is allowed to be.", "story": "Egg donation is where the price gap and the law gap point the same way, which is why it is the most travelled fertility treatment in Europe. The ESHRE taskforce that surveyed six destination countries found legal barriers leading the reasons patients gave for crossing a border at all, ahead of cost.\n\nThe pricing is unusually legible because the clinics are selling to people who are comparing across jurisdictions. Reprofit's price list, valid from 1 January 2026, puts \"selection + STANDARD stimulation and compensation of the donor\" inside a 5,525 EUR cycle — the donor's payment is a printed line item in a published Czech price, not an inference. The UK regulator sets the other kind of number: a cap. An egg donor in the UK may receive up to 985 pounds per donation cycle, raised from 750 pounds on 1 October 2024, and may not be paid more.\n\n*Trade practice —* the clinics advertising to British, German and Nordic patients advertise anonymity, guaranteed blastocyst counts and short waiting lists, in that order. Which countries actually provide donor anonymity, under which instrument and on what date, belongs on the rule record rather than here, because it changes.\n\n*Inference —* a guarantee of two blastocysts is a pricing device as much as a clinical one: it moves the risk of a poor cycle from the patient to the clinic and prices it, which is why the guaranteed packages cost roughly double the unguaranteed ones on the same list.", "how": "Three legal facts set the price and the destination. Whether the donor may be paid, and how much: a published cycle price that names donor compensation among its inclusions is a price from a jurisdiction that allows it, while a capped jurisdiction such as the UK produces a donor shortage rather than a cheaper cycle. Whether the donor stays anonymous: the UK ended anonymity for donations made after 1 April 2005, and a person conceived from such a donation can have the donor's name, date of birth and last known address at 18 — patients who want an unnamed donor cannot buy one at home. And who may be a recipient: statutory age limits and rules on marital status and sexual orientation sit in national law, not clinic policy. The rule records carry the country map with instruments and dates.\n\nOn the bill, the item to find is the eggs. Newlife IVF in Thessaloniki lists frozen donor-egg treatment from an external bank at 3,300 EUR and then names \"donor egg cost\" and the shipment of the eggs to the clinic among the exclusions: the cheapest donor-egg line on the page is the one that does not include the donor eggs. Medication for the recipient is excluded almost everywhere; Fertilab in Barcelona is unusual in stating that the donor's medication is inside its guaranteed-blastocyst price. UK donors are limited to creating children in up to ten families, which is a supply constraint rather than a price.", "today": "As of September 2026 the published donor-egg cycle prices read off clinic pages for this record run from 3,300 EUR in Thessaloniki without the eggs, through 5,525 EUR in Brno with donor compensation inside it, to 7,635 EUR in Barcelona with a blastocyst guarantee and 11,994 US dollars in New York state. A UK donor is capped at 985 pounds for the cycle that produces the eggs in any of those prices that were paid for under UK rules.", "notes": "This page describes a treatment and the published prices and caps attached to it. It is not medical advice and it is not legal advice." }, "metrics": { "success_rate_pct": 51.3, "note": "51.3% is the European mean PREGNANCY rate per embryo transfer after egg donation in 2020, from the ESHRE fact sheet drawing on the EIM registries. It is a pregnancy rate, not a live-birth rate, and it is per embryo transferred, not per cycle started or per patient — the three differ by roughly a factor of two and clinics quote whichever is highest. The comparable ESHRE figures are 33.2% after conventional IVF and 33.0% after ICSI with the patient's own eggs; the gap is the donor's age, not the clinic's skill. The CDC's US national rows for 2022 give 42.2% of transfers using donated embryos ending in a live-birth delivery, on a different denominator again.", "as_of": "2020", "source": "s:eshre-art-factsheet", "url": "https://www.eshre.eu/-/media/sitecore-files/Press-room/ESHRE_ARTFactSheet_v10_2025.pdf" }, "prices": [ { "procedure": "egg-donation", "country": "CZ", "city": "Brno", "amount": 5525, "currency": "EUR", "as_of": "2026-01-01", "kind": "package", "includes": [ "consultation", "treatment plan", "protocol preparation", "selection, standard stimulation and compensation of the donor", "donor's egg retrieval", "sperm analysis and preparation", "male partner's STDs testing", "ICSI", "extended cultivation", "embryotransfer (fresh embryo)" ], "excludes": [ "MFSS / MACS", "PICSI", "EmbryoGlue", "TimeLaps cultivation", "cryopreservation" ], "source": "s:reprofit-pricelist-2026", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "note": "line \"IVF cycle with donated eggs (DIVF, OD)\", valid from 1 January 2026. Compensation of the donor is a named inclusion. Nothing on the five-page list names stimulation medication for the recipient.", "tier": "cited", "usd": 6375.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "egg-donation", "country": "CZ", "city": "Brno", "amount": 11110, "currency": "EUR", "as_of": "2026-01-01", "kind": "package", "includes": [ "donor selection, standard stimulation and compensation", "donor's egg retrieval", "ICSI", "extended cultivation", "up to 4 transfers", "cryopreservation of all embryos and 1 year of storage" ], "excludes": [ "MFSS / MACS", "PICSI", "EmbryoGlue", "TimeLaps cultivation" ], "source": "s:reprofit-pricelist-2026", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "note": "line \"IVF cycle with donated eggs Baby Guarantee Program\" — twice the standard cycle for up to four transfers. The list does not state on its face what the programme returns if no baby follows.", "tier": "cited", "usd": 12819.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "egg-donation", "country": "GR", "city": "Thessaloniki", "amount": 3300, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "treatment with frozen donor oocytes from an external bank" ], "excludes": [ "donor egg cost", "shipment of the eggs from the bank to the clinic", "preliminary tests", "medications" ], "source": "s:newlife-ivf-costs", "url": "https://www.newlife-ivf.co.uk/ivf-costs", "note": "the cheapest donor-egg line on the page excludes the donor eggs. This is the fertility version of a joint-replacement package that excludes the implant. Read on 16 September 2026.", "tier": "cited", "usd": 3808.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "egg-donation", "country": "GR", "city": "Thessaloniki", "amount": 7350, "amount_high": 10550, "currency": "EUR", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [ "fresh oocyte donation", "standard package guarantees 2 top-quality blastocysts", "advanced package guarantees 4" ], "excludes": [ "preliminary obligatory investigations for both partners", "medications", "embryo storage" ], "source": "s:newlife-ivf-costs", "url": "https://www.newlife-ivf.co.uk/ivf-costs", "note": "7,350 EUR standard, 10,550 EUR advanced; the difference is two more guaranteed blastocysts. Read on 16 September 2026.", "tier": "cited", "usd": 8480.0, "usd_high": 12172.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "egg-donation", "country": "ES", "city": "Barcelona", "amount": 7635, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "donor selection", "donor's medication", "genetic testing", "EmbryoScope+", "blastocyst culture", "first transfer" ], "excludes": [], "source": "s:fertilab-pricing", "url": "https://fertilab.com/en/pricing/", "note": "listed as from 7,635 EUR under a guaranteed-blastocysts programme. The donor's medication is named as included, which is rare enough on these lists to be worth reading twice; the recipient's is not mentioned either way. Read on 16 September 2026.", "tier": "cited", "usd": 8809.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "egg-donation", "country": "US", "city": "Syracuse", "amount": 11994, "currency": "USD", "as_of": "2026-07-07", "kind": "package", "includes": [ "4 fresh donor eggs", "ICSI", "assisted hatching", "cryopreservation", "frozen embryo transfer" ], "excludes": [ "medications" ], "source": "s:cny-ivf-cost", "url": "https://www.cnyfertility.com/ivf-cost/", "note": "the clinic's in-house donor egg package, page dated 7 July 2026. Four eggs is a count, not a cycle: the unit being sold differs from the European cycle prices above.", "tier": "cited", "usd": 11994.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "egg-donation", "country": "GB", "amount": 985, "currency": "GBP", "as_of": "2024-10-01", "kind": "tariff", "includes": [ "the maximum compensation a UK egg donor may receive per donation cycle" ], "excludes": [ "travel, accommodation and childcare, which may be claimed as expenses on top" ], "source": "s:hfea-donating-eggs", "url": "https://www.hfea.gov.uk/donation/donors/donating-your-eggs/", "note": "a regulator's cap, not a treatment price: it is what the donor receives, not what the recipient pays. Raised from 750 pounds on 1 October 2024. UK egg donors are aged 18 to 35, and a person conceived from their donation may have the donor's name, date of birth and address at 18.", "tier": "cited", "usd": 1327.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "ivf", "as": "The cycle this is a version of, run on somebody else's eggs.", "rel": "whole" }, { "to": "donor-anonymity-law", "as": "The rule that decides whether the donor can stay unnamed, and so which country the cycle is bought in.", "rel": "governed-by" }, { "to": "sperm-donation", "as": "The same bargain on the other side of the dish, with a different cap and a different queue.", "rel": "contrast" }, { "to": "egg-freezing", "as": "Where the frozen eggs in a donor bank come from, and the same laboratory step.", "rel": "kin" }, { "to": "circumvention-travel", "as": "What this traffic is called when the reason for it is a prohibition at home.", "rel": "term" }, { "to": "reproductive-exile", "as": "The word offered for the patient who must leave to be treated.", "rel": "term" }, { "to": "hfea", "as": "Sets the UK compensation cap and the ten-family limit this record quotes.", "rel": "governs" }, { "to": "eshre", "as": "Publishes the European pregnancy rate per transfer after egg donation.", "rel": "measures" }, { "to": "reading-the-exclusions", "as": "The step where a donor-egg package that excludes the donor eggs is found.", "rel": "step" }, { "to": "czechia", "as": "Where a published cycle price names the donor's compensation among its inclusions.", "rel": "destination" }, { "to": "greece", "as": "Where the guaranteed-blastocyst packages on this page are sold.", "rel": "destination" }, { "to": "spain", "as": "The largest European destination for this treatment by cycle count in the ESHRE registries.", "rel": "destination" } ], "confusable_with": [ { "id": "egg-freezing", "tell": "Egg freezing banks a patient's own eggs for herself; egg donation banks or transfers another woman's for someone else. The laboratory step is the same and the consent forms are not." }, { "id": "surrogacy", "tell": "Egg donation moves a gamete; surrogacy moves a pregnancy. A donor-egg cycle can be lawful in a country where surrogacy is not." } ], "links": [ { "label": "Newlife IVF costs, Thessaloniki", "url": "https://www.newlife-ivf.co.uk/ivf-costs" }, { "label": "HFEA — donating your eggs", "url": "https://www.hfea.gov.uk/donation/donors/donating-your-eggs/" } ], "sources": [ "s:eshre-art-factsheet", "s:shenfield-2010", "s:reprofit-pricelist-2026", "s:newlife-ivf-costs", "s:fertilab-pricing", "s:cny-ivf-cost", "s:hfea-donating-eggs", "s:hfea-donating-sperm", "s:hfea-2023-trends", "s:cdc-art-2022-summary" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:reprofit-pricelist-2026", "note": "the compensation line and the UK cap are cited; the paragraph on what clinics advertise is marked Trade practice and the reading of blastocyst guarantees is marked Inference" }, "text.how": { "tier": "cited", "source": "s:newlife-ivf-costs" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:eshre-art-factsheet" }, "prices": { "tier": "cited", "source": "s:reprofit-pricelist-2026" } } }, "x_commons_files": [ "File:Oocyte.jpg", "File:Human oocyte with corona radiata.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "A donor is screened and stimulated, her eggs are collected, and they are fertilised with the recipient's partner's sperm or with donor sperm; the resulting embryo goes into the recipient, whose own cycle is timed to…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The cycle this is a version of, run on somebody else's eggs.", "rel": "whole" }, { "to": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The rule that decides whether the donor can stay unnamed, and so which country the cycle is bought in.", "rel": "governed-by" }, { "to": "sperm-donation", "type": "procedure", "name": "Sperm donation", "as": "The same bargain on the other side of the dish, with a different cap and a different queue.", "rel": "contrast" }, { "to": "egg-freezing", "type": "procedure", "name": "Egg freezing", "as": "Where the frozen eggs in a donor bank come from, and the same laboratory step.", "rel": "kin" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "What this traffic is called when the reason for it is a prohibition at home.", "rel": "term" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The word offered for the patient who must leave to be treated.", "rel": "term" }, { "to": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "Sets the UK compensation cap and the ten-family limit this record quotes.", "rel": "governs" }, { "to": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "Publishes the European pregnancy rate per transfer after egg donation.", "rel": "measures" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step where a donor-egg package that excludes the donor eggs is found.", "rel": "step" }, { "to": "czechia", "type": "destination", "name": "Czechia", "as": "Where a published cycle price names the donor's compensation among its inclusions.", "rel": "destination" }, { "to": "greece", "type": "destination", "name": "Greece", "as": "Where the guaranteed-blastocyst packages on this page are sold.", "rel": "destination" }, { "to": "spain", "type": "destination", "name": "Spain", "as": "The largest European destination for this treatment by cycle count in the ESHRE registries.", "rel": "destination" } ], "source_list": [ { "id": "s:eshre-art-factsheet", "kind": "org", "title": "ART fact sheet (v10, 2025)", "publisher": "European Society of Human Reproduction and Embryology", "url": "https://www.eshre.eu/-/media/sitecore-files/Press-room/ESHRE_ARTFactSheet_v10_2025.pdf", "accessed": "2026-09-16", "note": "European and world figures for 2020, drawn from the EIM consortium and ICMART" }, { "id": "s:shenfield-2010", "kind": "paper", "title": "Cross border reproductive care in six European countries", "publisher": "Human Reproduction 25(6):1361-1368, ESHRE Taskforce on Cross Border Reproductive Care", "url": "https://academic.oup.com/humrep/article/25/6/1361/2915759", "accessed": "2026-09-16" }, { "id": "s:reprofit-pricelist-2026", "kind": "web", "title": "Pricelist — Assisted Reproduction, valid from 01.01.2026 (document 0331.26ENG)", "publisher": "Reprofit International s.r.o., Brno", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "accessed": "2026-09-16", "note": "the clinic's own self-payer price list, five pages, each line naming its inclusions and its exclusions" }, { "id": "s:newlife-ivf-costs", "kind": "web", "title": "IVF costs, egg donation costs", "publisher": "Newlife IVF, Thessaloniki", "url": "https://www.newlife-ivf.co.uk/ivf-costs", "accessed": "2026-09-16" }, { "id": "s:fertilab-pricing", "kind": "web", "title": "Price list — fertility treatments", "publisher": "Fertilab Barcelona", "url": "https://fertilab.com/en/pricing/", "accessed": "2026-09-16" }, { "id": "s:cny-ivf-cost", "kind": "web", "title": "IVF Cost 2026: breakdown of prices, add-ons", "publisher": "CNY Fertility", "url": "https://www.cnyfertility.com/ivf-cost/", "accessed": "2026-09-16", "note": "page dated 7 July 2026; carries the clinic's own list prices and unattributed national ranges" }, { "id": "s:hfea-donating-eggs", "kind": "org", "title": "Donating your eggs", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/donation/donors/donating-your-eggs/", "accessed": "2026-09-16" }, { "id": "s:hfea-donating-sperm", "kind": "org", "title": "Donating your sperm", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/donation/donors/donating-your-sperm/", "accessed": "2026-09-16" }, { "id": "s:hfea-2023-trends", "kind": "org", "title": "Fertility treatment 2023: trends and figures", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2023-trends-and-figures/", "accessed": "2026-09-16", "note": "the UK regulator's annual register report; birth rates marked preliminary and not yet validated" }, { "id": "s:cdc-art-2022-summary", "kind": "dataset", "title": "2022 Final Assisted Reproductive Technology (ART) Summary", "publisher": "US Centers for Disease Control and Prevention", "url": "https://data.cdc.gov/Assisted-Reproductive-Technology-ART-/2022-Final-Assisted-Reproductive-Technology-ART-Su/9tjt-seye", "accessed": "2026-09-16", "note": "clinic-level and national rows; the national rows carry locationabbr NA. Queried through the Socrata endpoint https://data.cdc.gov/resource/9tjt-seye.json" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:reprofit-pricelist-2026", "note": "the compensation line and the UK cap are cited; the paragraph on what clinics advertise is marked Trade practice and the reading of blastocyst guarantees is marked Inference" }, "text.how": { "tier": "cited", "source": "s:newlife-ivf-costs" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:reprofit-pricelist-2026" }, "metrics": { "tier": "cited", "source": "s:eshre-art-factsheet" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "belgium", "type": "destination", "name": "Belgium", "as": "One of the reasons a French or Italian patient books a Brussels clinic.", "rel": "procedure" }, { "from": "cyprus", "type": "destination", "name": "Cyprus", "as": "The programme patients compare across the island's line.", "rel": "procedure" }, { "from": "czechia", "type": "destination", "name": "Czechia", "as": "The treatment this country is known for across Europe.", "rel": "procedure" }, { "from": "greece", "type": "destination", "name": "Greece", "as": "The programme priced against Spain's.", "rel": "procedure" }, { "from": "north-cyprus", "type": "destination", "name": "Northern Cyprus", "as": "The programme patients cross the line for.", "rel": "procedure" }, { "from": "portugal", "type": "destination", "name": "Portugal", "as": "The programme whose donor pool the ruling emptied.", "rel": "procedure" }, { "from": "spain", "type": "destination", "name": "Spain", "as": "More than half of every cycle it runs for a patient from abroad.", "rel": "procedure" }, { "from": "barcelona", "type": "hub", "name": "Barcelona", "as": "The treatment this city is flown to for, and the one Spain reports the most of in Europe.", "rel": "procedure" }, { "from": "nicosia", "type": "hub", "name": "Nicosia", "as": "Sold here into the same European shortage that feeds Barcelona and Prague.", "rel": "procedure" }, { "from": "prague", "type": "hub", "name": "Prague", "as": "The treatment this city is known for, and the one its registry volume is built on.", "rel": "procedure" }, { "from": "tbilisi", "type": "hub", "name": "Tbilisi", "as": "Sold alongside, into the same European shortage.", "rel": "procedure" }, { "from": "egg-freezing", "type": "procedure", "name": "Egg freezing", "as": "Where frozen donor eggs in a bank come from, and the same laboratory step for someone else's benefit.", "rel": "kin" }, { "from": "icsi", "type": "procedure", "name": "Intracytoplasmic sperm injection", "as": "The other half of the cycle that can be bought from a stranger.", "rel": "kin" }, { "from": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The same cycle with someone else's eggs — and the version most often crossing a border.", "rel": "contrast" }, { "from": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "Frequently tested as well, and the packages that guarantee blastocysts price the two together.", "rel": "kin" }, { "from": "sperm-donation", "type": "procedure", "name": "Sperm donation", "as": "The same bargain on the other side of the dish, with a larger price and a longer queue.", "rel": "contrast" }, { "from": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "Frequently the other purchase in the same arrangement, and excluded from the programme price alongside the IVF.", "rel": "kin" }, { "from": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The procedure this question follows.", "rel": "procedure" }, { "from": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "The treatment that moves the most patients across European borders, and the hardest to count.", "rel": "procedure" }, { "from": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "Sets the compensation cap and the ten-family limit that British donors are recruited under.", "rel": "procedure" }, { "from": "icmart", "type": "org", "name": "International Committee for Monitoring Assisted Reproductive Technologies", "as": "The cycles that cross a border, and that no national registry counts from both ends.", "rel": "procedure" }, { "from": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The treatment where an anonymity or payment rule most often forces the crossing.", "rel": "procedure" }, { "from": "cdc-art-results", "type": "dataset", "name": "CDC assisted reproductive technology results", "as": "Reported separately in the clinic tables, because donor cycles carry different rates.", "rel": "procedure" }, { "from": "circumvention", "type": "story", "name": "Circumvention", "as": "The treatment whose destination is chosen by a rule about the donor rather than by a price.", "rel": "procedure" }, { "from": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "Where the cheapest donor-egg line on the page excludes the donor eggs.", "rel": "procedure" } ] }, { "schema": 1, "id": "egg-freezing", "type": "procedure", "names": { "name": "Egg freezing", "aliases": [ "oocyte cryopreservation", "oocyte vitrification", "social freezing", "fertility preservation" ], "said": "Clinics write social freezing when there is no medical reason and fertility preservation when there is; the laboratory step is identical and the insurance answer is not. Price lists say from, and the storage bill arrives yearly afterwards." }, "etymology": { "root": "vitrification: Latin vitrum, glass, plus facere, to make — to turn to glass. Cooling fast enough that the water inside the egg sets as glass instead of ice, because ice crystals cut the cell apart. The same vitrum sits inside in vitro, so the field's two central words are both about glass.", "tier": "tradition", "note": "an egg frozen is not a baby banked. The bill has two halves separated by years: the collection and freeze, then the thaw, fertilisation and transfer, priced again at the prices of that later year." }, "region": [ "global" ], "facets": { "family": "fertility", "setting": "day-case", "anaesthesia": "sedation" }, "text": { "what": "The first half of an IVF cycle, stopped after the eggs are collected. Drugs stimulate the ovaries, the eggs are collected under sedation or general anaesthetic, a cryoprotectant is applied, and the eggs are vitrified and held in liquid nitrogen. Nothing is fertilised. Years later the eggs are thawed, injected with sperm and cultured, and that second treatment is bought again at the prices of the later year. The storage is invoiced annually in between.", "story": "Egg freezing is the fertility treatment whose price is most often quoted as a single number and least often paid as one. The UK regulator publishes the shape plainly: an average of 3,350 pounds to have eggs collected and frozen, medication a further 500 to 1,500 pounds, and storage on top at between 125 and 350 pounds a year. A ten-year store at the upper end doubles the headline.\n\nIt is also the treatment whose law changed most recently in a way that moved patients. Until 1 July 2022 most people in the UK could store eggs, sperm or embryos for ten years, with exceptions for premature infertility or fertility-damaging treatment; since that date the limit is up to 55 years from the date of first storage. Before it, a storage clock running out was a reason to move gametes across a border.\n\n*Trade practice —* the marketing is age-shaped and the arithmetic is age-shaped, and they point opposite ways: the eggs worth freezing are the ones a patient is least likely to think she needs. The CDC's national rows put 9.2% of all US ART cycles in 2022 down to fertility preservation, and 11.5% among patients aged 35 to 37 — the band where the decision is usually taken late.\n\n*Inference —* the denominator that would answer the question is not a success rate at all but a use rate, which no register in this batch publishes: how many people who froze eggs came back, thawed them, and had a child.", "how": "Bought in two instalments and usually in two countries' worth of price lists. The collection-and-freeze end is cheap relative to a full cycle — 2,190 EUR in Brno including a year of storage, from 2,480 EUR in Thessaloniki, 2,570 EUR in Barcelona with three years of storage folded in. The thaw end is the second bill: Reprofit prices IVF with the patient's own frozen eggs at 1,925 EUR, with screening, sperm-selection add-ons and refreezing outside it, and thawing of eggs alone at 340 EUR.\n\nTwo legal facts move this treatment across borders rather than the price. First, how long storage may lawfully run, and what happens at the end of it: the UK's shift from ten years to 55 years on 1 July 2022 removed the commonest reason British patients moved gametes abroad. Second, what the eggs may later be used for and by whom — the rules on donor use, posthumous use and export are national and sit with the rule records, not here. A store is a contract with a jurisdiction as much as with a clinic.", "today": "As of September 2026 the published collection-and-freeze prices read off pages for this record run from 2,190 EUR in Brno to 3,350 pounds as the UK regulator's own stated average, with stimulation drugs outside every one of them and storage invoiced yearly. The UK regulator's page for this treatment publishes no success rate and points readers to individual clinics for figures at their own age.", "notes": "This page describes a treatment and the published prices and storage limits attached to it. It is not medical advice and it is not legal advice." }, "metrics": { "success_rate_pct": 45.2, "note": "45.2% is the CDC's 2022 US national figure for the percentage of TRANSFERS of fresh embryos created from FROZEN EGGS that resulted in a live-birth delivery. It is per transfer — not per egg frozen, not per patient who froze eggs, and not per cycle started — and it counts only patients who came back, thawed and reached a transfer, which is the smallest and most favourable population in the series. The comparable CDC figure for fresh embryos from fresh eggs is 52.0%, and for frozen embryos 45.1%. No register read for this record publishes a live birth per egg frozen, or the share of patients who ever return to use a store; the HFEA's own egg-freezing page publishes no success rate and refers readers to clinics.", "as_of": "2022", "source": "s:cdc-art-2022-summary", "url": "https://data.cdc.gov/Assisted-Reproductive-Technology-ART-/2022-Final-Assisted-Reproductive-Technology-ART-Su/9tjt-seye" }, "prices": [ { "procedure": "egg-freezing", "country": "CZ", "city": "Brno", "amount": 2190, "currency": "EUR", "as_of": "2026-01-01", "kind": "package", "includes": [ "consultation", "treatment protocol", "stimulation", "egg retrieval in general anesthesia", "cryopreservation of the eggs and 1 year of storage" ], "excludes": [ "STDs testing" ], "source": "s:reprofit-pricelist-2026", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "note": "line \"Social freezing (eggs collection and freezing)\", valid from 1 January 2026. Storage past the first year is priced separately on the same list: 205 EUR for one year, 580 EUR for five. The later thaw-and-transfer treatment is another 1,925 EUR.", "tier": "cited", "usd": 2527.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "egg-freezing", "country": "ES", "city": "Barcelona", "amount": 2570, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "egg retrieval", "vitrification", "3 years of storage", "option to upgrade to 5 years" ], "excludes": [], "source": "s:fertilab-pricing", "url": "https://fertilab.com/en/pricing/", "note": "the page also sells two collections as a pack at 4,195 EUR, which is the clinic pricing the fact that one collection often yields too few eggs. Special prices stated to hold for reservations until 30 September 2026; read on 16 September 2026.", "tier": "cited", "usd": 2965.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "egg-freezing", "country": "GR", "city": "Thessaloniki", "amount": 2480, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "egg freezing, listed as from this price" ], "excludes": [ "preliminary investigations", "medications", "storage" ], "source": "s:newlife-ivf-costs", "url": "https://www.newlife-ivf.co.uk/ivf-costs", "note": "a from price; the page's standing exclusion list covers medications and storage for every line on it. Read on 16 September 2026.", "tier": "cited", "usd": 2861.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "egg-freezing", "country": "GB", "amount": 3350, "currency": "GBP", "as_of": "2026-09-16", "kind": "estimate", "includes": [ "collection and freezing of eggs, as an average across UK clinics" ], "excludes": [ "medication, stated at 500 to 1,500 pounds", "storage, stated at 125 to 350 pounds a year" ], "source": "s:hfea-egg-freezing", "url": "https://www.hfea.gov.uk/treatments/fertility-preservation/egg-freezing/", "note": "the regulator's own stated average cost, read on 16 September 2026. The page names the figure as an average without naming the method behind it or the year it was drawn from, so it is carried as an estimate and not as a list price.", "tier": "cited", "usd": 4515.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "ivf", "as": "The cycle this is the first half of, and the treatment the frozen eggs come back to.", "rel": "part" }, { "to": "egg-donation", "as": "Where frozen donor eggs in a bank come from, and the same laboratory step for someone else's benefit.", "rel": "kin" }, { "to": "icsi", "as": "How a thawed egg is fertilised, because its outer coat hardens in freezing.", "rel": "kin" }, { "to": "pgt", "as": "The next optional charge on embryos made from these eggs.", "rel": "kin" }, { "to": "hfea", "as": "Sets the UK storage limit and publishes the average UK price this record quotes.", "rel": "governs" }, { "to": "cdc-art-results", "as": "The US series behind the per-transfer figure for embryos from frozen eggs.", "rel": "measured-by" }, { "to": "deposit-and-refund", "as": "The yearly storage invoice, and what happens to a store when it stops being paid.", "rel": "risk" }, { "to": "the-price-that-isnt", "as": "A headline price with a drug bill outside it and a storage bill after it.", "rel": "story" }, { "to": "out-of-pocket", "as": "How this treatment is paid for almost everywhere, since few payers cover it without a medical indication.", "rel": "term" } ], "confusable_with": [ { "id": "egg-donation", "tell": "Freezing banks a patient's own eggs for herself; donation moves another woman's to a recipient. Same vitrification, different consent and different law." }, { "id": "ivf", "tell": "A freeze cycle stops at collection and is charged again on the thaw; an IVF cycle runs through to a transfer in one bill." } ], "links": [ { "label": "HFEA — egg freezing", "url": "https://www.hfea.gov.uk/treatments/fertility-preservation/egg-freezing/" }, { "label": "Reprofit price list, valid from 1 January 2026", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf" } ], "sources": [ "s:hfea-egg-freezing", "s:cdc-art-2022-summary", "s:reprofit-pricelist-2026", "s:fertilab-pricing", "s:newlife-ivf-costs", "s:eshre-art-factsheet" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:hfea-egg-freezing", "note": "the prices, the storage limit and the preservation share are cited; the paragraph on age-shaped marketing is marked Trade practice and the point about the missing use rate is marked Inference" }, "text.how": { "tier": "cited", "source": "s:reprofit-pricelist-2026" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:cdc-art-2022-summary" }, "prices": { "tier": "cited", "source": "s:hfea-egg-freezing" } } }, "x_commons_files": [ "File:Cryopreservation straws.jpg", "File:Liquid nitrogen storage dewar.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "The first half of an IVF cycle, stopped after the eggs are collected.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The cycle this is the first half of, and the treatment the frozen eggs come back to.", "rel": "part" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "Where frozen donor eggs in a bank come from, and the same laboratory step for someone else's benefit.", "rel": "kin" }, { "to": "icsi", "type": "procedure", "name": "Intracytoplasmic sperm injection", "as": "How a thawed egg is fertilised, because its outer coat hardens in freezing.", "rel": "kin" }, { "to": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "The next optional charge on embryos made from these eggs.", "rel": "kin" }, { "to": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "Sets the UK storage limit and publishes the average UK price this record quotes.", "rel": "governs" }, { "to": "cdc-art-results", "type": "dataset", "name": "CDC assisted reproductive technology results", "as": "The US series behind the per-transfer figure for embryos from frozen eggs.", "rel": "measured-by" }, { "to": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "The yearly storage invoice, and what happens to a store when it stops being paid.", "rel": "risk" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "A headline price with a drug bill outside it and a storage bill after it.", "rel": "story" }, { "to": "out-of-pocket", "type": "term", "name": "Out-of-pocket", "as": "How this treatment is paid for almost everywhere, since few payers cover it without a medical indication.", "rel": "term" } ], "source_list": [ { "id": "s:hfea-egg-freezing", "kind": "org", "title": "Egg freezing", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/treatments/fertility-preservation/egg-freezing/", "accessed": "2026-09-16", "note": "carries the 55-year storage limit and the regulator's own average UK cost" }, { "id": "s:cdc-art-2022-summary", "kind": "dataset", "title": "2022 Final Assisted Reproductive Technology (ART) Summary", "publisher": "US Centers for Disease Control and Prevention", "url": "https://data.cdc.gov/Assisted-Reproductive-Technology-ART-/2022-Final-Assisted-Reproductive-Technology-ART-Su/9tjt-seye", "accessed": "2026-09-16", "note": "clinic-level and national rows; the national rows carry locationabbr NA. Queried through the Socrata endpoint https://data.cdc.gov/resource/9tjt-seye.json" }, { "id": "s:reprofit-pricelist-2026", "kind": "web", "title": "Pricelist — Assisted Reproduction, valid from 01.01.2026 (document 0331.26ENG)", "publisher": "Reprofit International s.r.o., Brno", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "accessed": "2026-09-16", "note": "the clinic's own self-payer price list, five pages, each line naming its inclusions and its exclusions" }, { "id": "s:fertilab-pricing", "kind": "web", "title": "Price list — fertility treatments", "publisher": "Fertilab Barcelona", "url": "https://fertilab.com/en/pricing/", "accessed": "2026-09-16" }, { "id": "s:newlife-ivf-costs", "kind": "web", "title": "IVF costs, egg donation costs", "publisher": "Newlife IVF, Thessaloniki", "url": "https://www.newlife-ivf.co.uk/ivf-costs", "accessed": "2026-09-16" }, { "id": "s:eshre-art-factsheet", "kind": "org", "title": "ART fact sheet (v10, 2025)", "publisher": "European Society of Human Reproduction and Embryology", "url": "https://www.eshre.eu/-/media/sitecore-files/Press-room/ESHRE_ARTFactSheet_v10_2025.pdf", "accessed": "2026-09-16", "note": "European and world figures for 2020, drawn from the EIM consortium and ICMART" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:hfea-egg-freezing", "note": "the prices, the storage limit and the preservation share are cited; the paragraph on age-shaped marketing is marked Trade practice and the point about the missing use rate is marked Inference" }, "text.how": { "tier": "cited", "source": "s:reprofit-pricelist-2026" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:hfea-egg-freezing" }, "metrics": { "tier": "cited", "source": "s:cdc-art-2022-summary" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "barcelona", "type": "hub", "name": "Barcelona", "as": "The other reason a patient books a retrieval here rather than at home.", "rel": "procedure" }, { "from": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "Where the frozen eggs in a donor bank come from, and the same laboratory step.", "rel": "kin" }, { "from": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The first half of this cycle, stopped after collection and resumed years later.", "rel": "kin" }, { "from": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "Sets the storage limit, and publishes the average price a British cycle is quoted at.", "rel": "procedure" }, { "from": "cycle", "type": "term", "name": "Cycle", "as": "Where the cycle ends at collection and the storage bill begins.", "rel": "procedure" } ] }, { "schema": 1, "id": "executive-health-screening", "type": "procedure", "names": { "name": "Executive health screening", "aliases": [ "executive check-up", "health screening package", "comprehensive medical check-up", "annual physical" ], "said": "Asian hospitals say check-up and grade the packages by age, sex and price: essential, executive, comprehensive, premier. Executive is a price tier, not a clinical category." }, "etymology": { "root": "screening: from the sieve. A screening test is applied to people without symptoms to sort them into two piles, and its value depends entirely on what happens to the pile that is sorted wrongly. Check-up is twentieth-century commercial English, arriving with the periodic health examination sold to corporate employees.", "tier": "tradition", "note": "an executive package differs from a basic one by the number of tests in it, not by the evidence behind them. Several national screening committees recommend against some tests that appear in the larger packages; the packages are sold in markets where that recommendation does not run." }, "region": [ "global", "southeast-asia", "east-asia" ], "facets": { "family": "diagnostic", "setting": "outpatient-course", "anaesthesia": "none" }, "text": { "what": "A fixed bundle of tests run in half a day: history and examination, bloods, urine and stool, an electrocardiogram, a chest X-ray, an abdominal ultrasound, with imaging, endoscopy and cardiac stress testing added in the larger tiers. The result is a printed report and a consultation. It is bought, not prescribed, and the buyer is usually well.", "story": "*Inference --* The check-up package is the first purchase in cross-border care. It is cheap enough to buy on impulse, it needs no referral, it fits into a working trip, and it introduces a hospital to a patient who may come back for something larger. Bangkok, Kuala Lumpur, Singapore and Seoul all sell it, and hospitals publish these prices when they publish nothing else.\n\nBumrungrad in Bangkok prices its Executive Program Health Check-up Package, CKUP1701, at 16,300 baht, states the price is valid until 31 December 2026, states that it includes the doctor's fee and is per person in Thai currency, and lists the contents test by test: complete blood count, fasting sugar, HbA1c, lipids, uric acid, kidney and liver panels, urine, stool with occult blood, ECG, chest X-ray, whole abdominal ultrasound, hepatitis B surface antigen and antibody. It says the programme takes approximately three to four hours. The same terms and conditions carry a line that belongs to this trade and to no other: tourism activity price is not included in the procedure package price.\n\nPrince Court Medical Centre in Kuala Lumpur publishes a Vibrant Male package for men under 40 at 900 ringgit, with much the same panel plus hepatitis A, C and HIV screening and an abdominal ultrasound. Raffles Medical in Singapore publishes women's screening packages at 361.31 and 563.16 Singapore dollars.\n\n*Inference --* what none of the packages price is the consequence. A screening test in a hospital eight time zones from home produces findings that need repeating, and the second scan, the follow-up bloods and the anxious six weeks are billed at home to a doctor who did not order the first test and cannot see the images.", "how": "Fasting from the night before, half a day in a dedicated screening centre, results the same day or the next, a consultation with a physician to read them. Hospitals sell the packages online with a cart and a price, which is why this is one of the few procedures where a price comparison across countries is straightforward. Reports travel as PDFs; images usually do not, unless asked for on a disc before departure.", "today": "Three published prices on this record, from Thailand, Malaysia and Singapore, each read off the hospital's own page in September 2026. The Thai price names its validity date and its exclusions; the other two name their contents but not their dates.", "notes": "This page describes a product sold by hospitals. Nothing here says which tests a reader should have, which is a question for a doctor who knows them." }, "metrics": { "stay_days": 0, "note": "Bumrungrad states its executive programme takes approximately three to four hours, with no overnight stay. Nothing on this record measures yield: no hospital read for it publishes how many of its screening patients were found to have disease, which is the number that would say what the package buys.", "as_of": "2026-09-16", "source": "s:bumrungrad-executive-checkup", "url": "https://www.bumrungrad.com/en/packages/executive-health-check-male" }, "prices": [ { "procedure": "executive-health-screening", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 16300, "currency": "THB", "as_of": "2026-09-16", "kind": "package", "includes": [ "doctor's fee", "vital signs and physical examination", "complete blood count", "fasting blood sugar and HbA1c", "lipid profile", "uric acid", "kidney function panel", "liver function panel", "urine examination", "stool examination with occult blood", "electrocardiogram", "chest X-ray", "ultrasound whole abdomen", "HBsAg and HBsAb" ], "excludes": [ "tourism activity price, in the hospital's own terms", "any discount: the hospital states no discount of any kind may be applied to package prices", "settlement other than directly to the hospital" ], "source": "s:bumrungrad-executive-checkup", "url": "https://www.bumrungrad.com/en/packages/executive-health-check-male", "note": "package CKUP1701, price stated valid until 31 December 2026 and per person in Thai currency; the service is available 365 days from purchase. The same hospital lists an Executive Program (Female) at 20,700 THB and a Comprehensive Program (Male) at 34,900 THB.", "tier": "cited", "usd": 490.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "executive-health-screening", "country": "MY", "city": "Kuala Lumpur", "amount": 900, "currency": "MYR", "as_of": "2026-09-16", "kind": "package", "includes": [ "consultation and physical examination by doctor", "vital signs, vision, hearing, body composition", "glucose, kidney and liver function, lipid profile, thyroid, full blood count", "hepatitis A, B and C and HIV screening", "resting ECG", "chest X-ray with radiologist report", "abdominal ultrasound" ], "excludes": [ "not stated on the page" ], "source": "s:princecourt-health-screening", "url": "https://princecourt.com/health-screening", "note": "the Vibrant Male package for men below 40. The hospital grades its packages by age and sex, so the price is a function of the buyer rather than of the test.", "tier": "cited", "usd": 220.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "executive-health-screening", "country": "SG", "city": "Singapore", "amount": 361.31, "amount_high": 563.16, "currency": "SGD", "as_of": "2026-09-16", "kind": "package", "includes": [ "gynaecologist consultation, cervical smear and transvaginal pelvic ultrasound at the lower price", "screening mammogram and breast ultrasound added at the higher price" ], "excludes": [ "the general medical panel: these two are women's screening packages, not whole-body executive panels", "whether GST is included is not stated on the page" ], "source": "s:raffles-screening-ladies", "url": "https://www.rafflesmedicalgroup.com/health-screening/health-screening-packages/", "note": "carried here as the Singapore price point because the provider publishes it with its contents; the group's general packages are named on the site but priced only inside its online store", "tier": "cited", "usd": 284.0, "usd_high": 442.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "bumrungrad", "as": "Publishes the executive package this record reads, with its validity date and its exclusions.", "rel": "performed-at" }, { "to": "thailand", "as": "Where the check-up is sold with a shopping cart and a price valid to a stated date.", "rel": "destination" }, { "to": "malaysia", "as": "Where the package is graded by the buyer's age and sex.", "rel": "destination" }, { "to": "singapore", "as": "The third published price on this record, and the most specific in what it covers.", "rel": "destination" }, { "to": "bangkok", "as": "The hub whose hospitals sell screening as the first purchase.", "rel": "place" }, { "to": "wellness-travel", "as": "The neighbouring trade, and the one screening packages are sold beside in hotel and spa bundles.", "rel": "term" }, { "to": "package-price", "as": "The pricing form this product is native to.", "rel": "term" }, { "to": "follow-up-gap", "as": "What happens to an abnormal result eight time zones from the doctor who will act on it.", "rel": "risk" }, { "to": "getting-your-records", "as": "The report travels as a PDF; the images usually need asking for before departure.", "rel": "step" }, { "to": "dialysis-holiday", "as": "The other outpatient course sold to travellers, priced per session rather than per programme.", "rel": "contrast" } ], "confusable_with": [ { "id": "dialysis-holiday", "tell": "Both are outpatient courses sold to travellers; screening is bought by the well, dialysis abroad is bought by people who cannot travel without it." } ], "links": [ { "label": "Bumrungrad package CKUP1701", "url": "https://www.bumrungrad.com/en/packages/executive-health-check-male" }, { "label": "Prince Court health screening", "url": "https://princecourt.com/health-screening" } ], "sources": [ "s:bumrungrad-executive-checkup", "s:princecourt-health-screening", "s:raffles-screening-ladies" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:bumrungrad-executive-checkup", "note": "package contents and terms quoted from the hospitals' own pages; the closing paragraph is marked as inference inline" }, "text.how": { "tier": "tradition" }, "etymology": { "tier": "tradition" } } }, "x_commons_files": [ "File:Health check up.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "A fixed bundle of tests run in half a day: history and examination, bloods, urine and stool, an electrocardiogram, a chest X-ray, an abdominal ultrasound, with imaging, endoscopy and cardiac stress testing added in the…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" }, { "key": "east-asia", "name": "East Asia", "note": "South Korea, Japan, Taiwan, China" } ], "kin_out": [ { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Publishes the executive package this record reads, with its validity date and its exclusions.", "rel": "performed-at" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the check-up is sold with a shopping cart and a price valid to a stated date.", "rel": "destination" }, { "to": "malaysia", "type": "destination", "name": "Malaysia", "as": "Where the package is graded by the buyer's age and sex.", "rel": "destination" }, { "to": "singapore", "type": "destination", "name": "Singapore", "as": "The third published price on this record, and the most specific in what it covers.", "rel": "destination" }, { "to": "bangkok", "type": "hub", "name": "Bangkok", "as": "The hub whose hospitals sell screening as the first purchase.", "rel": "place" }, { "to": "wellness-travel", "type": "term", "name": "Wellness travel", "as": "The neighbouring trade, and the one screening packages are sold beside in hotel and spa bundles.", "rel": "term" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The pricing form this product is native to.", "rel": "term" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "What happens to an abnormal result eight time zones from the doctor who will act on it.", "rel": "risk" }, { "to": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "The report travels as a PDF; the images usually need asking for before departure.", "rel": "step" }, { "to": "dialysis-holiday", "type": "procedure", "name": "Dialysis away from home", "as": "The other outpatient course sold to travellers, priced per session rather than per programme.", "rel": "contrast" } ], "source_list": [ { "id": "s:bumrungrad-executive-checkup", "kind": "web", "title": "Executive Program Health Check-up Package, CKUP1701", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/executive-health-check-male", "accessed": "2026-09-16", "note": "price stated valid until 31 December 2026, inclusive of the doctor's fee, per person, in Thai currency" }, { "id": "s:princecourt-health-screening", "kind": "web", "title": "Medical Check-Up and Health Screening Packages", "publisher": "Prince Court Medical Centre, Kuala Lumpur", "url": "https://princecourt.com/health-screening", "accessed": "2026-09-16" }, { "id": "s:raffles-screening-ladies", "kind": "web", "title": "Health Screening Packages", "publisher": "Raffles Medical Group, Singapore", "url": "https://www.rafflesmedicalgroup.com/health-screening/health-screening-packages/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:bumrungrad-executive-checkup", "note": "package contents and terms quoted from the hospitals' own pages; the closing paragraph is marked as inference inline" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "indonesia", "type": "destination", "name": "Indonesia", "as": "The check-up that starts most of these journeys and sometimes is the whole of it.", "rel": "procedure" }, { "from": "japan", "type": "destination", "name": "Japan", "as": "The short admission — the ningen dock — that most foreign visitors to Japanese medicine actually buy.", "rel": "procedure" }, { "from": "malaysia", "type": "destination", "name": "Malaysia", "as": "The package that fills the appointment book between operations.", "rel": "procedure" }, { "from": "panama", "type": "destination", "name": "Panama", "as": "The product a hub airport and a dollar economy sell well.", "rel": "procedure" }, { "from": "switzerland", "type": "destination", "name": "Switzerland", "as": "The course of tests sold here to people who fly in for a week.", "rel": "procedure" }, { "from": "bangkok", "type": "hub", "name": "Bangkok", "as": "The day-long screening package that fills the quiet end of these hospitals' order books.", "rel": "procedure" }, { "from": "dubai", "type": "hub", "name": "Dubai", "as": "The programme this city sells most, priced as a day.", "rel": "procedure" }, { "from": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "The screening package the private groups sell across the strait.", "rel": "procedure" }, { "from": "monterrey", "type": "hub", "name": "Monterrey", "as": "The screening package a hospital sells to a corporate market on its doorstep.", "rel": "performs" }, { "from": "panama-city", "type": "hub", "name": "Panama City", "as": "What a hub airport and a dollar economy sell well: fly in, be measured, fly out.", "rel": "performs" }, { "from": "penang", "type": "hub", "name": "Penang", "as": "The bundled screening that is most of what crosses the strait for.", "rel": "procedure" }, { "from": "seoul", "type": "hub", "name": "Seoul", "as": "The one-day screening the university hospitals sell to the region.", "rel": "procedure" }, { "from": "singapore-city", "type": "hub", "name": "Singapore", "as": "The regional screening trade, now competed for by Penang and Bangkok.", "rel": "procedure" }, { "from": "taipei", "type": "hub", "name": "Taipei", "as": "The package the island is best known for selling across the strait and to Japan.", "rel": "procedure" }, { "from": "panchakarma", "type": "procedure", "name": "Panchakarma", "as": "The short diagnostic product sold alongside it in the same brochures.", "rel": "contrast" }, { "from": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "Sold in graded tiers whose contents are published and whose prices are not.", "rel": "performs" }, { "from": "albert-einstein-sao-paulo", "type": "facility", "name": "Hospital Israelita Albert Einstein", "as": "Sold here as a referral product rather than a published package.", "rel": "performs" }, { "from": "clinica-las-americas", "type": "facility", "name": "Clínica Las Américas", "as": "Heads its own service list, ahead of any operation.", "rel": "performs" }, { "from": "island-hospital-penang", "type": "facility", "name": "Island Hospital", "as": "Sold here off an online store, priced, itemised and dated.", "rel": "performs" }, { "from": "liv-hospital", "type": "facility", "name": "Liv Hospital", "as": "Sold here in fifteen graded packages with published starting prices, which is rare enough in this directory to be the reason the record exists.", "rel": "performs" }, { "from": "medanta", "type": "facility", "name": "Medanta — The Medicity, Gurugram", "as": "Sold here off a public list at a stated rupee price.", "rel": "performs" }, { "from": "raffles-hospital", "type": "facility", "name": "Raffles Hospital", "as": "Sold across a counter at a published price, which almost nothing else in this directory is.", "rel": "performs" }, { "from": "samitivej", "type": "facility", "name": "Samitivej Sukhumvit Hospital", "as": "Priced here in fifteen versions, split by sex and by decade of life.", "rel": "performs" }, { "from": "wellness-travel", "type": "term", "name": "Wellness travel", "as": "The other product sold to people who are not ill.", "rel": "procedure" } ] }, { "schema": 1, "id": "facelift", "type": "procedure", "names": { "name": "Facelift", "aliases": [ "rhytidectomy", "SMAS facelift", "deep plane facelift", "mid-facelift", "neck lift" ], "said": "Surgeons say rhytidectomy in an operation note and SMAS or deep plane in a consultation, naming which layer is lifted. Price lists say facelift, and rarely say which layer they mean." }, "etymology": { "root": "rhytidectomy: Greek rhytis, a wrinkle, plus ektome, a cutting out - a wrinkle excised. SMAS is an acronym, not a word: the superficial musculoaponeurotic system, the fibrous sheet under the skin of the cheek that modern techniques lift rather than simply pulling the skin.", "tier": "tradition", "note": "skin-only lifts, SMAS lifts and deep plane lifts are different operations with the same name on a price page; the layer decides the durability, the swelling and the price." }, "region": [ "global" ], "facets": { "family": "cosmetic", "setting": "inpatient", "anaesthesia": "general" }, "text": { "what": "Incisions are made in front of and behind the ear and into the hairline, the skin is lifted, the fibrous layer beneath it is repositioned or tightened, excess skin is trimmed and the wound closed along the lines where the scars can hide. Neck lifts and brow lifts are separate operations sold alongside. The facial nerve runs through the field, and injury to a branch of it is the complication surgeons describe first.", "story": "Facelift is the most expensive of the standard cosmetic operations in every market read for this record, and the widest spread between them. Yanhee in Bangkok prices a mid-facelift at 165,000 baht with two nights, a secondary facelift at 171,000 and an endoscopic facelift at 250,000. Premier Clinic in Prague prices a SMAS facelift from 84,000 koruna. Artplastica in Poland prices a facelift from 25,000 zloty with the ward day separate. The American society publishes an average surgeon fee of 11,395 US dollars and says it excludes anaesthesia and the theatre.\n\n*Inference --* the reason those numbers do not line up is that the word covers several operations. A skin-only lift and a deep plane lift take different times, different anaesthetics and different skill, and only a consultation note says which one a price bought. The published figure that is easiest to compare across borders is the least informative one.\n\n*Trade practice --* recovery is the constraint that makes this operation travel awkwardly. Bruising and swelling are visible for two to three weeks, sutures come out in stages over ten days, and a patient who has flown a long way is usually asked to stay locally until the first review. The accommodation, not the theatre, is what a two-week facelift trip is mostly buying.", "how": "General anaesthesia in most published packages, one to two nights, drains sometimes, a head dressing overnight. Sutures come out between five and twelve days depending on the site, which sets the earliest flight home. Numbness in front of the ear lasts months. Smoking is the contraindication surgeons enforce hardest, because the skin flap depends on a blood supply that nicotine narrows.", "today": "Four published prices from four countries, read in September 2026, ranging from 25,000 zloty in Poland to 250,000 baht for an endoscopic lift in Bangkok, with an American surgeon's fee of 11,395 dollars that does not include the operating room. None of the four pages says which layer of the face its price lifts.", "notes": "This page describes an operation. It gives no advice about having one." }, "metrics": { "stay_days": 2, "note": "Two nights is the stay printed beside the mid-facelift and endoscopic facelift lines on the Yanhee table read for this record; the neck lift and forehead lift on the same table show one night. No figure for nerve injury or revision is carried here because no source read for this record published one with a defined denominator.", "as_of": "2026-09-16", "source": "s:yanhee-plastic-prices", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/" }, "prices": [ { "procedure": "facelift", "country": "TH", "city": "Bangkok", "amount": 136000, "amount_high": 250000, "currency": "THB", "as_of": "2026-09-16", "kind": "list", "includes": [ "the named operation", "one to two nights on the ward, as printed per line" ], "excludes": [ "not stated on the page" ], "source": "s:yanhee-plastic-prices", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "note": "neck lift 136,000 THB with one night; forehead lift 146,000 with one night; mid-facelift 165,000 with two; secondary facelift 171,000 with two; facelift with endoscope 250,000 with two", "tier": "cited", "usd": 4085.0, "usd_high": 7509.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "facelift", "country": "CZ", "city": "Prague", "amount": 84000, "currency": "CZK", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [ "SMAS facelift" ], "excludes": [ "not stated on the page" ], "source": "s:premier-clinic-prague-prices", "url": "https://www.premier-clinic.cz/en/price-list-plastic-surgery/", "note": "listed as 'from'. This is the only one of the four prices on this record that names the layer it lifts.", "tier": "cited", "usd": 3989.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "facelift", "country": "PL", "city": "Szczecin", "amount": 25000, "currency": "PLN", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [ "facelift" ], "excludes": [ "hospitalisation, listed separately at 800 PLN a day" ], "source": "s:artplastica-cennik", "url": "https://www.artplastica.pl/cennik-zabiegi-operacje-plastyczne/", "note": "listed as 'from', with the clinic's statement that prices are indicative", "tier": "cited", "usd": 6643.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "facelift", "country": "US", "amount": 11395, "currency": "USD", "as_of": "2026-09-16", "kind": "survey", "includes": [ "surgeon fee only, rhytidectomy" ], "excludes": [ "anesthesia", "operating room facilities", "other related expenses" ], "source": "s:asps-cost-facelift", "url": "https://www.plasticsurgery.org/cosmetic-procedures/facelift/cost", "note": "no year named on the page; the highest average surgeon fee of the six cosmetic operations read from this society's cost pages", "tier": "cited", "usd": 11395.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "rhinoplasty", "as": "The other face operation on the same price lists, at roughly half the price.", "rel": "contrast" }, { "to": "south-korea", "as": "A destination that built a face-surgery trade on technique rather than on discount.", "rel": "destination" }, { "to": "thailand", "as": "Where the same word is priced as five different operations with their ward nights printed.", "rel": "destination" }, { "to": "czechia", "as": "Where the price names the layer of the face it lifts.", "rel": "destination" }, { "to": "united-states", "as": "The source market whose published figure is a surgeon's fee alone.", "rel": "destination" }, { "to": "the-companion", "as": "Two weeks of visible bruising, and somebody has to be in the room.", "rel": "step" }, { "to": "aftercare-at-home", "as": "Sutures out in stages, and the last of them often after the flight.", "rel": "step" }, { "to": "package-price", "as": "The form that bundles hotel nights with theatre time, and which this operation depends on most.", "rel": "term" }, { "to": "informed-consent", "as": "The facial nerve is the risk that consent conversations turn on, and language is part of that conversation.", "rel": "term" } ], "confusable_with": [ { "id": "rhinoplasty", "tell": "Both are face surgery sold by the same clinics; a facelift repositions skin and the layer beneath it, a rhinoplasty reshapes bone and cartilage." } ], "links": [ { "label": "ASPS average surgeon fee, facelift", "url": "https://www.plasticsurgery.org/cosmetic-procedures/facelift/cost" } ], "sources": [ "s:yanhee-plastic-prices", "s:premier-clinic-prague-prices", "s:artplastica-cennik", "s:asps-cost-facelift" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "prices read off the four named pages; the two closing paragraphs are marked inference and trade practice inline" }, "text.how": { "tier": "tradition" }, "etymology": { "tier": "tradition" } } }, "x_commons_files": [ "File:Facelift incision.png" ], "confidence": "high", "updated": "2026-09-16", "blurb": "Incisions are made in front of and behind the ear and into the hairline, the skin is lifted, the fibrous layer beneath it is repositioned or tightened, excess skin is trimmed and the wound closed along the lines where…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "The other face operation on the same price lists, at roughly half the price.", "rel": "contrast" }, { "to": "south-korea", "type": "destination", "name": "South Korea", "as": "A destination that built a face-surgery trade on technique rather than on discount.", "rel": "destination" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the same word is priced as five different operations with their ward nights printed.", "rel": "destination" }, { "to": "czechia", "type": "destination", "name": "Czechia", "as": "Where the price names the layer of the face it lifts.", "rel": "destination" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The source market whose published figure is a surgeon's fee alone.", "rel": "destination" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "Two weeks of visible bruising, and somebody has to be in the room.", "rel": "step" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "Sutures out in stages, and the last of them often after the flight.", "rel": "step" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The form that bundles hotel nights with theatre time, and which this operation depends on most.", "rel": "term" }, { "to": "informed-consent", "type": "term", "name": "Informed consent", "as": "The facial nerve is the risk that consent conversations turn on, and language is part of that conversation.", "rel": "term" } ], "source_list": [ { "id": "s:yanhee-plastic-prices", "kind": "web", "title": "Plastic Surgery Prices", "publisher": "Yanhee Hospital, Bangkok", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "accessed": "2026-09-16", "note": "hospital's own price table: procedure, nights, price in Thai baht. The page carries no validity date and no inclusion list." }, { "id": "s:premier-clinic-prague-prices", "kind": "web", "title": "Price List - Plastic Surgery", "publisher": "Premier Clinic, Prague", "url": "https://www.premier-clinic.cz/en/price-list-plastic-surgery/", "accessed": "2026-09-16", "note": "clinic's own English price list, every line prefixed 'from', in Czech koruna" }, { "id": "s:artplastica-cennik", "kind": "web", "title": "Cennik zabiegow i operacji plastycznych", "publisher": "Beauty Group - Artplastica, Szczecin", "url": "https://www.artplastica.pl/cennik-zabiegi-operacje-plastyczne/", "accessed": "2026-09-16", "note": "clinic's own price list in zloty; the page states the prices are indicative and may change at consultation, and lists hospitalisation at 800 PLN a day separately" }, { "id": "s:asps-cost-facelift", "kind": "org", "title": "Facelift Cost", "publisher": "American Society of Plastic Surgeons", "url": "https://www.plasticsurgery.org/cosmetic-procedures/facelift/cost", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "prices read off the four named pages; the two closing paragraphs are marked inference and trade practice inline" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "The other face operation sold by the same clinics, at roughly twice the price.", "rel": "contrast" } ] }, { "schema": 1, "id": "full-mouth-restoration", "type": "procedure", "names": { "name": "Full mouth restoration", "aliases": [ "full mouth rehabilitation", "full mouth reconstruction", "smile makeover", "full arch reconstruction" ], "said": "The trade's phrase for a plan, not a procedure. What it contains is whatever the mouth needs, which is why the number at the bottom of the quote is the only part two clinics ever agree on the meaning of." }, "etymology": { "root": "restoration: Latin restaurare, to rebuild or renew, used in dentistry since the nineteenth century for anything put back into a tooth — a filling is a restoration. Full mouth is the trade's escalation of the same word to the whole dentition. Rehabilitation, the other term on these lists, is Latin habilitare, to make fit again.", "tier": "tradition", "note": "No regulator defines the phrase. It is a quotation heading, and the contents vary by clinic: implants, crowns, veneers, bridges, extractions, grafts, or all of them." }, "region": [ "global" ], "facets": { "family": "dental", "setting": "staged", "anaesthesia": "varies" }, "text": { "what": "Rebuilding both jaws: extractions where teeth cannot be kept, implants or bridges where they cannot be replaced otherwise, crowns on what remains, and often a raising of the bite. It runs over months and two or more trips, and it is the largest single bill in dental travel. No price page read for this record publishes one number for it.", "story": "What the price lists publish instead is the parts, and the parts are priced per arch.\n\nSani Dental Group in Los Algodones runs a full ladder for one jaw: an implant-supported overdenture on two implants at $3,270, on three at $4,520, an All-on-4 acrylic hybrid at $8,110 marked per arch, All-on-6 on MIS implants at $11,450, three-on-six at $11,190, All-on-6 on Nobel at $13,310. Underneath it, the conventional answer: a full acrylic denture, upper or lower, at $320. Bone graft $420 a unit, sinus lift $700.\n\nBangkok International Dental Center publishes the same choice as two sums: dental implants plus removable dentures from 70,000 plus 85,000 baht, dental implants plus fixed bridges from 140,000 plus 250,000, and All-on-4 or ProArch hybrid bridges from 290,000.\n\nMedicare Dental Clinic in Budapest prices its full-arch work in the two-line form it uses for everything — All-on-6 zirconium at €2,622 of treatment plus €1,748 of laboratory, €4,370 the arch.\n\n*Inference —* every one of those figures is half a mouth. A reader adding two arches, the grafts the pages price separately, and the second flight is doing arithmetic no seller has done on the page.\n\nThe state comparison is stranger still. In England the patient's share of a course of treatment containing crowns, dentures and bridges is a single band 3 charge of £332.10, however many teeth it covers. Two public systems, two different objects: one prices the mouth, the other prices the visit.", "how": "Assessment, imaging, a treatment plan, then staged work: extractions and implants first, healing for months, then the fixed work. Clinics selling to foreign patients compress it into two trips with temporaries in between, and the price pages read for this record do not say how long the gap is.\n\nWhat consistently sits outside the headline: the second arch, bone grafting and sinus lifting, the laboratory fee where the clinic prints it separately, and the clinic charges Bangkok lists — x-rays, medications, sterilisation, nursing and service fees — that its own page states are charged separately from every treatment on it.", "today": "As of 17 September 2026 the published per-arch prices for rebuilding one jaw run from $320 for a conventional denture and $3,270 for a two-implant overdenture to $13,310 for All-on-6 in Los Algodones; from 155,000 baht for implants with a removable denture to 390,000 for implants with a fixed bridge in Bangkok; and €4,370 for All-on-6 in Budapest. A mouth is two of those.", "notes": "This page describes a class of dental work and the prices published for its parts. It is not dental advice." }, "metrics": { "stay_days": 0, "days_before_flying": null, "recovery_weeks": null, "note": "No admission: these are clinic fees. The months of healing between stages, and therefore the number of trips, are the figures that decide what this work actually costs a travelling patient, and none of the three price pages read for this record states either.", "as_of": "2026-09-17", "source": "s:sani-dental-prices", "url": "https://sanidentalgroup.com/price-list" }, "prices": [ { "procedure": "full-mouth-restoration", "country": "MX", "city": "Los Algodones", "amount": 3270, "amount_high": 13310, "currency": "USD", "as_of": "2026-09-17", "kind": "list", "includes": [ "one arch, by method: implant-supported overdenture on two implants $3,270 or three implants $4,520; All-on-4 acrylic hybrid $8,110; three-on-six $11,190; All-on-6 MIS $11,450; All-on-6 Nobel $13,310" ], "excludes": [ "the second arch", "bone graft at $420 per unit", "sinus lift at $700", "extractions" ], "source": "s:sani-dental-prices", "url": "https://sanidentalgroup.com/price-list", "note": "the acrylic hybrid row is marked upper or lower arch, which is the page saying per arch out loud. A conventional full denture, upper or lower, is $320 on the same list — the cheapest full-arch answer by a factor of ten. The page states all prices are a base or starting price and that the estimate is not an official price until diagnosis.", "tier": "cited", "usd": 3270.0, "usd_high": 13310.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "full-mouth-restoration", "country": "TH", "city": "Bangkok", "amount": 155000, "amount_high": 390000, "currency": "THB", "as_of": "2026-09-17", "kind": "quoted-range", "includes": [ "one jaw, as two lines: implants from 70,000 plus removable dentures from 85,000; or implants from 140,000 plus fixed bridges from 250,000" ], "excludes": [ "the second arch", "x-rays, medications, sterilisation, nursing fees and clinic service fees, charged separately", "grafting" ], "source": "s:bidc-fees", "url": "https://bangkokdentalcenter.com/fees/", "note": "the low and high are this record's addition of the clinic's own two-part quotes, both stated as from prices; the same page lists All-on-4 and ProArch hybrid bridges from 290,000 baht as a third route. Package rates stated applicable till 30 September 2026.", "tier": "cited", "usd": 4655.0, "usd_high": 11714.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "full-mouth-restoration", "country": "HU", "city": "Budapest", "amount": 4370, "currency": "EUR", "as_of": "2026-09-17", "kind": "list", "includes": [ "All-on-6 zirconium denture for one arch: €2,622 treatment plus €1,748 fabrication" ], "excludes": [ "the second arch", "sinus lifting at €409 per quadrant and bone augmentation at €302 plus graft material, listed separately" ], "source": "s:mdental-budapest-prices", "url": "https://www.mdentalclinic.eu/prices", "note": "the metal-ceramic version is €2,384 plus €1,589 for €3,973. The clinic's note states that many treatments carry both a treatment price and a separate fabrication fee, which is what makes its arch prices look half the size of the Mexican ones until the second line is added.", "tier": "cited", "usd": 5042.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "full-mouth-restoration", "country": "GB", "amount": 332.1, "currency": "GBP", "as_of": "2026-09-17", "kind": "tariff", "includes": [ "band 3: crowns, dentures and bridges, and everything in bands 1 and 2, for one course of treatment" ], "excludes": [ "implants, which the health service provides only in limited circumstances", "private treatment", "cosmetic work" ], "source": "s:nhs-dental-charges", "url": "https://www.nhs.uk/nhs-services/dentists/dental-costs/understanding-nhs-dental-charges/", "note": "the patient's share in England for a whole course of treatment, whatever it contains — the one figure on this page that does not scale with the number of teeth. The page states it was last reviewed on 13 March 2025 and gives no date for when the amounts took effect.", "tier": "cited", "usd": 448.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "all-on-four", "as": "The commonest single answer for one jaw, and the trademark the price lists sort by.", "rel": "part" }, { "to": "dental-implant", "as": "The screws this work is counted in, priced one at a time on the same lists.", "rel": "part" }, { "to": "dental-crown", "as": "The unit the surviving teeth are covered in.", "rel": "part" }, { "to": "veneers", "as": "The cosmetic half of the same quotation, when the back teeth are sound.", "rel": "kin" }, { "to": "mexico", "as": "Where the whole ladder from a $320 denture to $13,310 of All-on-6 is printed on one page.", "rel": "destination" }, { "to": "thailand", "as": "Where the same choice is published as two sums to be added.", "rel": "destination" }, { "to": "hungary", "as": "Where the arch price is a treatment line plus a laboratory line.", "rel": "destination" }, { "to": "united-kingdom", "as": "The source market where one band 3 charge covers a course however many teeth it holds.", "rel": "destination" }, { "to": "los-algodones", "as": "The border town this work is bought in by the arch.", "rel": "place" }, { "to": "budapest", "as": "The European city that built its dental trade on jobs this size.", "rel": "place" }, { "to": "reading-the-exclusions", "as": "The step at which per-arch becomes per-mouth.", "rel": "step" }, { "to": "the-deposit", "as": "Where a job this size meets a clinic's staged deposit terms.", "rel": "step" }, { "to": "follow-up-gap", "as": "Who checks a rebuilt bite at six months, and where.", "rel": "risk" } ], "confusable_with": [ { "id": "all-on-four", "tell": "All-on-4 is one arch on four implants; full mouth work is both arches and usually a mixture of methods." } ], "links": [ { "label": "Sani Dental Group price list", "url": "https://sanidentalgroup.com/price-list" }, { "label": "BIDC dental fees", "url": "https://bangkokdentalcenter.com/fees/" } ], "sources": [ "s:sani-dental-prices", "s:bidc-fees", "s:mdental-budapest-prices", "s:nhs-dental-charges" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:sani-dental-prices", "note": "every figure read off the named clinic's own page on the accessed date; the arithmetic stretch is marked as this project's" }, "text.how": { "tier": "tradition", "note": "standard staging of full-arch work; the exclusions are cited to the three price pages" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:sani-dental-prices" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Full mouth rehabilitation.jpg", "File:Dental prosthesis.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "Rebuilding both jaws: extractions where teeth cannot be kept, implants or bridges where they cannot be replaced otherwise, crowns on what remains, and often a raising of the bite.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "The commonest single answer for one jaw, and the trademark the price lists sort by.", "rel": "part" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The screws this work is counted in, priced one at a time on the same lists.", "rel": "part" }, { "to": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "The unit the surviving teeth are covered in.", "rel": "part" }, { "to": "veneers", "type": "procedure", "name": "Dental veneers", "as": "The cosmetic half of the same quotation, when the back teeth are sound.", "rel": "kin" }, { "to": "mexico", "type": "destination", "name": "Mexico", "as": "Where the whole ladder from a $320 denture to $13,310 of All-on-6 is printed on one page.", "rel": "destination" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the same choice is published as two sums to be added.", "rel": "destination" }, { "to": "hungary", "type": "destination", "name": "Hungary", "as": "Where the arch price is a treatment line plus a laboratory line.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The source market where one band 3 charge covers a course however many teeth it holds.", "rel": "destination" }, { "to": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "The border town this work is bought in by the arch.", "rel": "place" }, { "to": "budapest", "type": "hub", "name": "Budapest", "as": "The European city that built its dental trade on jobs this size.", "rel": "place" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step at which per-arch becomes per-mouth.", "rel": "step" }, { "to": "the-deposit", "type": "pathway", "name": "The deposit", "as": "Where a job this size meets a clinic's staged deposit terms.", "rel": "step" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who checks a rebuilt bite at six months, and where.", "rel": "risk" } ], "source_list": [ { "id": "s:sani-dental-prices", "kind": "web", "title": "Dental Price List in Mexico", "publisher": "Sani Dental Group, Los Algodones", "url": "https://sanidentalgroup.com/price-list", "accessed": "2026-09-16", "note": "prices in US dollars with a Mexican peso figure beside each; the page states every price is a base or starting price" }, { "id": "s:bidc-fees", "kind": "web", "title": "Dental Fees — standardised treatment fees", "publisher": "Bangkok International Dental Center", "url": "https://bangkokdentalcenter.com/fees/", "accessed": "2026-09-16", "note": "implant fixture and implant crown priced in separate columns; page states package rates applicable till 30 September 2026" }, { "id": "s:mdental-budapest-prices", "kind": "web", "title": "Treatment Prices", "publisher": "Medicare Dental Clinic, Budapest", "url": "https://www.mdentalclinic.eu/prices", "accessed": "2026-09-16", "note": "treatment price and lab fee shown as separate lines; packages name accommodation and transfers" }, { "id": "s:nhs-dental-charges", "kind": "gov", "title": "Understanding NHS dental charges — bands 1, 2 and 3", "publisher": "NHS (England)", "url": "https://www.nhs.uk/nhs-services/dentists/dental-costs/understanding-nhs-dental-charges/", "accessed": "2026-09-16", "note": "band amounts read on the accessed date; the page does not state the date the amounts took effect" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:sani-dental-prices", "note": "every figure read off the named clinic's own page on the accessed date; the arithmetic stretch is marked as this project's" }, "text.how": { "tier": "tradition", "note": "standard staging of full-arch work; the exclusions are cited to the three price pages" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:sani-dental-prices" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "budapest", "type": "hub", "name": "Budapest", "as": "The long course this city's two-visit model is built around.", "rel": "procedure" }, { "from": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "What two of these arches add up to, and the price nobody prints as one number.", "rel": "whole" }, { "from": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "The job that counts these in tens.", "rel": "whole" }, { "from": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The larger job single implants are counted into.", "rel": "whole" }, { "from": "root-canal", "type": "procedure", "name": "Root canal treatment", "as": "The larger job that counts root canals among its lines.", "rel": "whole" }, { "from": "veneers", "type": "procedure", "name": "Dental veneers", "as": "What a set of these becomes when the back teeth are included.", "rel": "whole" } ] }, { "schema": 1, "id": "gallbladder-removal", "type": "procedure", "names": { "name": "Gallbladder removal", "aliases": [ "cholecystectomy", "laparoscopic cholecystectomy", "lap chole", "keyhole gallbladder surgery" ], "said": "Surgeons say lap chole. Payer schedules say cholecystectomy and then split open from laparoscopic, because the two carry different prices and different stays." }, "etymology": { "root": "cholecystectomy: Greek cholē, bile, plus kystis, a bladder, plus ektomē, a cutting out — the bile bladder cut out. Laparoscopic is Greek lapara, the flank or soft part of the body, plus skopein, to look.", "tier": "tradition", "note": "Open and laparoscopic are separate diagnosis-related groups, separate price rows and separate recoveries; the Irish schedule prices the open operation at about 1.6 times the keyhole one." }, "region": [ "global" ], "facets": { "family": "general-surgery", "setting": "day-case", "anaesthesia": "general" }, "text": { "what": "The gallbladder is removed through four small incisions with a camera, or through a larger cut where the keyhole route fails. Done for gallstones — hardened deposits of digestive fluid, in the hospital page's own words — and for the pain and inflammation they cause. One night on the Bangkok package read for this record; a day case on the Irish tariff, which pays the same figure either way.", "story": "This is the operation where the two ways of writing a price line up most neatly, and they still disagree by a factor of three.\n\nBumrungrad in Bangkok lists laparoscopic cholecystectomy at 240,930 baht against a struck-through 267,700 under a label that reads Special Campaign Discount Common Procedures, package SUR04, prices stated valid until 31 December 2026. It buys an hour and a half of theatre, one night in a single room, the supplies and equipment used during surgery, the anaesthesia, the surgeon, assistant and anaesthetist, one day of ward rounds and the discharge summary. Robotic-assisted cholecystectomy on the same list is 349,500 baht, which is 45% more for the same organ. Bangkok Hospital publishes a robotic cholecystectomy package of its own.\n\nIreland prices the group rather than the technique: DRG H08B, laparoscopic cholecystectomy at minor complexity, EUR 9,867 — the same figure as an inpatient stay and as a day case, the guide excluding open cholecystectomy from that group and pricing it separately at EUR 16,206 as an inpatient and EUR 10,466 as a day case.\n\nAustralia pays the surgeon $768.90 under item 30443, cholecystectomy by any approach without cholangiogram, with a 75% benefit of $576.70.\n\n*Inference —* a hospital charges for the route because the route costs it money; a health service pays for the outcome because it is buying a treated patient. The robot appears in the first kind of price list and not the second, and a reader comparing the two is watching two different accounting systems, not two different operations.\n\nThe queue is why any of it is read. Ireland's National Treatment Purchase Fund counted 115,450 people waiting for an inpatient or day-case appointment at the end of May 2026; NHS England's median wait across all pathways at the end of July 2026 was 12.0 weeks.", "how": "General anaesthesia, the abdomen inflated with carbon dioxide, four ports, the cystic duct and artery clipped and divided, the gallbladder freed from the liver bed and drawn out through a port. An hour and a half of theatre on the package read for this record. Home the next day, back to desk work within a week or two, no lifting for a month.\n\nWhere the keyhole route has to be abandoned mid-operation, the bill changes category: the Irish schedule prices the open operation as a different group at two-thirds more, and the Thai package excludes \"complex cases requiring emergency surgery or other conditions requiring equipment in excess of package\". A conversion on the table is the commonest way a fixed price stops being fixed.", "today": "As of 17 September 2026 the published Thai package price for a keyhole gallbladder removal is 240,930 baht with one night, and 349,500 baht with the robot. Ireland's own price is EUR 9,867 for the keyhole operation, day case or inpatient alike, and EUR 16,206 for the open one as an inpatient. The Australian schedule fee for the surgeon's service is $768.90.", "notes": "This page describes an operation and the prices published for it. It is not medical advice." }, "metrics": { "stay_days": 1, "days_before_flying": 10, "recovery_weeks": 2, "wait_days_home": 84, "note": "One night is the stay named in the Bumrungrad laparoscopic cholecystectomy package read for this record; Ireland's tariff prices the same group as a day case at the same figure as an inpatient stay, whose average length is 2.7 days. The eighty-four days is the median wait of 12.0 weeks across all pathways waiting to start treatment in England at the end of July 2026, published by NHS England — an all-specialty median for the English market, not a gallbladder figure. The ten-day figure is the CDC's guidance not to fly for ten days after abdominal surgery. Two weeks is the span usually quoted for return to desk work.", "as_of": "2026-07-31", "source": "s:nhs-rtt-july-2026", "url": "https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Jul26-RTT-statistical-press-notice-PDF-578K-97ylx5.pdf" }, "prices": [ { "procedure": "gallbladder-removal", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 240930, "currency": "THB", "as_of": "2026-09-17", "kind": "package", "includes": [ "operating room for 1.5 hours including theatre, nurse assisting surgeon and operating team", "single room for 1 night including nursing service and regular menu meals", "medical supplies and equipment used during surgery under the physician's consideration, specific model", "anaesthesia and necessary medication during the procedure", "doctor fees: surgeon, assistant surgeon, anaesthesiologist", "admission physician fees, one day of daily round physician fees and the discharge summary fee" ], "excludes": [ "expenses at the outpatient unit or before the operation", "inpatient stays beyond one day, intensive care, or nights past the day discharge was approved", "consultations with other specialists", "complex cases requiring emergency surgery or other conditions requiring equipment in excess of package", "blood transfusion, laboratory tests and other diagnostic tests before and after, such as blood testing, x-ray, ECG and biopsy charges", "items of a personal nature", "take-home medication and supplies" ], "source": "s:bumrungrad-sur04", "url": "https://www.bumrungrad.com/en/packages/laparoscopic-cholecystectomy", "note": "package SUR04, listed at 240,930 THB against a struck-through 267,700 under a Special Campaign Discount Common Procedures label, prices stated valid until 31 December 2026. The exclusion for complex or converted cases is the sentence that decides whether the price holds.", "tier": "cited", "usd": 7236.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "gallbladder-removal", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 349500, "currency": "THB", "as_of": "2026-09-17", "kind": "package", "includes": [ "robotic-assisted cholecystectomy, as listed on the surgical clinic's package page" ], "excludes": [ "not itemised on the list page read for this record" ], "source": "s:bumrungrad-surgical-packages", "url": "https://www.bumrungrad.com/en/packages/packages-center/surgical-clinics", "note": "45% more than the same hospital's keyhole package for the same organ, read off the package list on 17 September 2026. Bangkok Hospital publishes a robotic cholecystectomy package of its own at a level of its own.", "tier": "cited", "usd": 10497.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "gallbladder-removal", "country": "IE", "amount": 9867, "currency": "EUR", "as_of": "2026-09-17", "kind": "reimbursement", "includes": [ "DRG H08B LAP CHOLECYSTECTOMY, MINC — the whole episode, priced at EUR 9,867 both as an inpatient inlier stay and as a day case" ], "excludes": [ "open cholecystectomy procedures, excluded from the group by name and priced separately at EUR 16,206 as an inpatient and EUR 10,466 as a day case", "stays beyond the high boundary, paid per diem on top", "travel and accommodation" ], "source": "s:hse-cbd-niphs-drg-guide", "url": "https://assets.hse.ie/media/documents/CBD-NIPHS-Most-Common-Procedures-DRG-Guide.pdf", "note": "what Ireland repays a patient treated abroad under the Cross Border Directive or the Northern Ireland Planned Healthcare Scheme, and its own price for the admission. The same figure for a day case and for an overnight stay, which is a schedule saying the bed is not what it is paying for.", "tier": "cited", "usd": 11384.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "gallbladder-removal", "country": "AU", "amount": 768.9, "currency": "AUD", "as_of": "2026-09-17", "kind": "tariff", "includes": [ "item 30443: cholecystectomy, by any approach, without cholangiogram" ], "excludes": [ "the hospital, the theatre, the ward and the anaesthetist", "cholangiogram, which falls under a different item" ], "source": "s:mbs-30443", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=30443&qt=item", "note": "the Medicare Benefits Schedule fee, 75% benefit $576.70, the fee shown as applying from 1 July 2026. By any approach: the robot that adds 108,570 baht in Bangkok adds nothing here.", "tier": "cited", "usd": 548.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "hernia-repair", "as": "The other keyhole operation on the same Bangkok list and the same Irish tariff, priced a little lower.", "rel": "kin" }, { "to": "hysterectomy", "as": "The other abdominal operation that travels on a queue rather than a price.", "rel": "kin" }, { "to": "bumrungrad", "as": "Publishes the cholecystectomy packages this page reads, keyhole and robotic.", "rel": "performed-at" }, { "to": "bangkok-hospital", "as": "Publishes a robotic cholecystectomy package of its own.", "rel": "performed-at" }, { "to": "thailand", "as": "Where the robot adds 45% to the price of the same organ.", "rel": "destination" }, { "to": "australia", "as": "Where one fee covers the operation by any approach.", "rel": "destination" }, { "to": "united-kingdom", "as": "The source market whose queue makes a foreign price legible.", "rel": "destination" }, { "to": "eu-directive-2011-24", "as": "The route under which an Irish patient is repaid at the Irish price for this operation done abroad.", "rel": "rule" }, { "to": "reading-the-exclusions", "as": "The step at which a converted operation stops being covered by the fixed price.", "rel": "step" }, { "to": "flying-after-surgery", "as": "The clot risk that sets how long after abdominal surgery a patient can board.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Who sees the wounds at two weeks, and who investigates the pain that did not go away.", "rel": "risk" }, { "to": "oecd-waiting-times", "as": "The series that counts the queue for exactly this kind of operation.", "rel": "measured-by" } ], "confusable_with": [ { "id": "hernia-repair", "tell": "Both are short keyhole operations sold as one-night packages at the same hospitals; one removes an organ and one closes a wall." } ], "links": [ { "label": "Bumrungrad — laparoscopic cholecystectomy package", "url": "https://www.bumrungrad.com/en/packages/laparoscopic-cholecystectomy" }, { "label": "MBS item 30443", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=30443&qt=item" } ], "sources": [ "s:bumrungrad-sur04", "s:bumrungrad-surgical-packages", "s:bangkokhospital-cholecystectomy", "s:hse-cbd-niphs-drg-guide", "s:hse-abf-2024-inpatient", "s:mbs-30443", "s:nhs-rtt-july-2026", "s:ntpf-may-2026", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:bumrungrad-sur04", "note": "package terms and both Thai prices read off the hospital's own pages on 17 September 2026; tariff figures read off the Irish guide and the Australian item page; the paragraph contrasting the two accounting systems is this project's reasoning and is marked" }, "text.how": { "tier": "tradition", "note": "standard operative description; the conversion point is cited to the Irish group definitions and the Thai exclusion list" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:nhs-rtt-july-2026" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Laparoscopic cholecystectomy.jpg", "File:Gallbladder removed.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "The gallbladder is removed through four small incisions with a camera, or through a larger cut where the keyhole route fails.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "hernia-repair", "type": "procedure", "name": "Hernia repair", "as": "The other keyhole operation on the same Bangkok list and the same Irish tariff, priced a little lower.", "rel": "kin" }, { "to": "hysterectomy", "type": "procedure", "name": "Hysterectomy", "as": "The other abdominal operation that travels on a queue rather than a price.", "rel": "kin" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Publishes the cholecystectomy packages this page reads, keyhole and robotic.", "rel": "performed-at" }, { "to": "bangkok-hospital", "type": "facility", "name": "Bangkok Hospital", "as": "Publishes a robotic cholecystectomy package of its own.", "rel": "performed-at" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the robot adds 45% to the price of the same organ.", "rel": "destination" }, { "to": "australia", "type": "destination", "name": "Australia", "as": "Where one fee covers the operation by any approach.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The source market whose queue makes a foreign price legible.", "rel": "destination" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route under which an Irish patient is repaid at the Irish price for this operation done abroad.", "rel": "rule" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step at which a converted operation stops being covered by the fixed price.", "rel": "step" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The clot risk that sets how long after abdominal surgery a patient can board.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who sees the wounds at two weeks, and who investigates the pain that did not go away.", "rel": "risk" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The series that counts the queue for exactly this kind of operation.", "rel": "measured-by" } ], "source_list": [ { "id": "s:bumrungrad-sur04", "kind": "web", "title": "Laparoscopic Cholecystectomy — package SUR04", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/laparoscopic-cholecystectomy", "accessed": "2026-09-17", "note": "240,930 THB against a struck-through 267,700 THB under a 'Special Campaign Discount Common Procedures' label; prices stated valid until 31 December 2026; 1.5 hours of theatre and one night in a single room" }, { "id": "s:bumrungrad-surgical-packages", "kind": "web", "title": "Surgical Clinic — package list", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/packages-center/surgical-clinics", "accessed": "2026-09-17", "note": "read with the browser on 17 September 2026: laparoscopic cholecystectomy 240,930 THB against 267,700; robotic-assisted cholecystectomy 349,500; open inguinal hernia repair one side 199,600 and both sides 304,700; laparoscopic inguinal hernia repair one side 243,500 and both sides 382,000; robotic inguinal hernia repair one side 350,000 and both 430,000; robotic umbilical hernia repair 420,000" }, { "id": "s:bangkokhospital-cholecystectomy", "kind": "web", "title": "Robotic-Assisted Cholecystectomy Level 2 — package page", "publisher": "Bangkok Hospital", "url": "https://www.bangkokhospital.com/en/bangkok/package/robotic-assisted-cholecystectomy-level-2-en", "accessed": "2026-09-16" }, { "id": "s:hse-cbd-niphs-drg-guide", "kind": "gov", "title": "CBD / NIPHS Most Common Procedures DRG Guide", "publisher": "Health Service Executive (Ireland)", "url": "https://assets.hse.ie/media/documents/CBD-NIPHS-Most-Common-Procedures-DRG-Guide.pdf", "accessed": "2026-09-16", "note": "the tariff behind both the Cross Border Directive scheme and the Northern Ireland Planned Healthcare Scheme. Cataract procedures map to DRG C16Z LENS INTERVENTIONS at a day-case price of EUR 1,171, covering phacoemulsification or other extraction of the crystalline lens and capsulotomy; colonoscopy G48B EUR 1,001; gastroscopy G47C EUR 726. Same figure as the HSE's 2024 activity-based-funding day-case price list." }, { "id": "s:hse-abf-2024-inpatient", "kind": "gov", "title": "ABF 2024 Admitted Patient Price List — Inpatient Only", "publisher": "Health Service Executive (Ireland)", "url": "https://assets.hse.ie/media/documents/ABF_2024_Admitted_Patient_Price_List_-_Inpatient_Only.pdf", "accessed": "2026-09-17", "note": "the activity-based-funding inlier inpatient price per diagnosis-related group, linked from the HSE's Northern Ireland Planned Healthcare Scheme claim page and the list behind the CBD and NIPHS repayments. Rows read on 17 September 2026: F06C CRNRY BYPSS-INV INVES MINC EUR 30,040, F06B EUR 34,430, F06A EUR 50,579; F05B CRNRY BYPSS+INV INVES MINC EUR 45,093; F04C CRD VLV INTERVTN+PMP-INV INVES MINC EUR 40,253, F04B EUR 50,628, F04A EUR 80,201; F19B TRNS-VSCLR PERC CRDC INTERVTN MINC EUR 9,887, F19A EUR 42,060; F10B INTERVENTIONAL CRNRY PR + AMI MINC EUR 8,857; M01B MAJOR MALE PELVIC INTERVTNS MINC EUR 19,899, M01A EUR 26,820; M02B TRANSURTH PROSTMY MINC EUR 8,363; N04B HYSTERECTOMY FOR N-MAL MINC EUR 13,282; G10B HERNIA INTERVENTIONS MINC EUR 9,046, G10A MAJC EUR 15,366; H08B LAP CHOLECYSTECTOMY MINC EUR 9,867, H07C OPEN CHOLECYSTECTOMY MINC EUR 16,206. An inlier price assumes a length of stay between the low and high boundaries printed beside it." }, { "id": "s:mbs-30443", "kind": "gov", "title": "MBS item 30443 — cholecystectomy, by any approach, without cholangiogram", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=30443&qt=item", "accessed": "2026-09-17", "note": "schedule fee $768.90, 75% benefit $576.70, fee shown as applying from 01-Jul-2026" }, { "id": "s:nhs-rtt-july-2026", "kind": "gov", "title": "Statistical Press Notice — NHS referral to treatment (RTT) waiting times data, July 2026", "publisher": "NHS England", "url": "https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Jul26-RTT-statistical-press-notice-PDF-578K-97ylx5.pdf", "accessed": "2026-09-16", "note": "published Thursday 10 September 2026. 7.3 million RTT pathways waiting to start treatment at the end of July 2026, an estimated 6.2 million unique patients; 111,379 waiting over 52 weeks, 9,095 over 65 weeks, 235 over 104 weeks; 65.4% waiting up to 18 weeks against a 92% standard; median wait 12.0 weeks. Figures include estimates for three trusts and one independent provider that did not submit." }, { "id": "s:ntpf-may-2026", "kind": "gov", "title": "NTPF Publishes May 2026 National Public Hospital Waiting List Data", "publisher": "National Treatment Purchase Fund (Ireland)", "url": "https://www.ntpf.ie/news_and_events/ntpf-publishes-may-2026-national-public-hospital-waiting-list-data/", "accessed": "2026-09-16", "note": "at the end of May 2026: 669,506 waiting for a first outpatient consultation, 115,450 for an inpatient or day-case appointment, 40,986 for a GI endoscopy, 34,049 suspended, 111,643 on the planned-procedure list" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:bumrungrad-sur04", "note": "package terms and both Thai prices read off the hospital's own pages on 17 September 2026; tariff figures read off the Irish guide and the Australian item page; the paragraph contrasting the two accounting systems is this project's reasoning and is marked" }, "text.how": { "tier": "tradition", "note": "standard operative description; the conversion point is cited to the Irish group definitions and the Thai exclusion list" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:nhs-rtt-july-2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "hernia-repair", "type": "procedure", "name": "Hernia repair", "as": "The other keyhole operation on the same Bangkok package list and the same Irish tariff.", "rel": "kin" }, { "from": "hysterectomy", "type": "procedure", "name": "Hysterectomy", "as": "The other keyhole operation that travels on a queue rather than on a price.", "rel": "kin" }, { "from": "bangkok-hospital", "type": "facility", "name": "Bangkok Hospital", "as": "Sold here as a robotic package at a fixed price with one ward night.", "rel": "performs" } ] }, { "schema": 1, "id": "gamma-knife", "type": "procedure", "names": { "name": "Gamma knife radiosurgery", "aliases": [ "Leksell Gamma Knife", "stereotactic radiosurgery", "SRS", "gamma knife surgery" ], "said": "Neurosurgeons say SRS and mean any machine that does it, including a linear accelerator. Gamma Knife is one manufacturer's trademark, and the two words are used interchangeably on hospital pages that own the branded machine." }, "etymology": { "root": "gamma: the third letter of the Greek alphabet, applied to the third kind of radiation described after alpha and beta. Knife is a metaphor and nothing is cut; the term radiosurgery was coined by the Swedish neurosurgeon Lars Leksell, whose name the machine carries.", "tier": "tradition", "note": "the word surgery in radiosurgery survives from an argument about who owns the patient — the neurosurgeon or the radiation oncologist — rather than from anything that happens in the room." }, "region": [ "global" ], "facets": { "family": "neurological", "setting": "day-case", "anaesthesia": "local" }, "text": { "what": "A high dose of radiation delivered to a target inside the skull from many directions at once, so that the beams meet at the lesion and each individual path through healthy brain carries little dose. The head is held still, by a frame pinned to the skull under local anaesthetic or by a moulded mask on newer machines, and the whole treatment is given in one session. It is used for small brain tumours, for metastases, for arteriovenous malformations and for trigeminal neuralgia. There is no incision and no general anaesthetic.", "story": "Gamma knife travels for the reason proton therapy travels: the machine is where it is. Elekta, which makes it, said on its own fiftieth-anniversary page in January 2018 that \"today, 330 clinical Gamma Knife units across 54 countries treat a combined 80,000 new patients each year\", and that over fifty years \"1.1 million people around the world have received the therapy\". That figure was eight years old when it was read for this record on 16 September 2026, and no newer installed-base count appears on the manufacturer's current product pages. Fifty-four countries out of roughly two hundred is the fact that moves patients.\n\n*Trade practice —* the beams come from cobalt-60 sources arranged around a helmet; the sources decay and are reloaded on a cycle, which is one of the reasons a unit is a standing commitment rather than a purchase.\n\nWhat is published about volume is published about literature rather than about treatment. A 2025 systematic review in Cancer Medicine screened 5,424 articles, included 538, and counted \"120,756 patients treated with SRS for brain cancer and tumors since 2000\" in them. That counts patients who appear in papers. It does not count patients.\n\n*Inference —* the comparison a reader is usually making here is not between countries but between operations: a craniotomy with a ward stay and a recovery against an afternoon in a machine. The published argument over which is right for which lesion is a clinical one, and this directory reports that it is argued rather than settling it.", "how": "A single session in one day. The London Gamma Knife Centre, a private unit whose own description this record reads, puts it as: \"Unlike conventional radiation therapy, which requires treatment over multiple days or weeks, Leksell Gamma Knife delivers a high dose of radiation to one or more brain tumours during a single treatment session, in one day\", and, where the target is too large, \"it is also possible to stage the treatment in three fractions at 2 weekly intervals.\" It is \"a single day outpatient visit\" and \"does not require a general anaesthetic\"; with a frame, the patient feels \"some discomfort from the local anaesthetic, and pressure from the pins when tightened\", and the treatment itself is painless. Most patients \"return to their normal activities the following day\". Newer machines offer \"the option of using a standard radiotherapy mask\" instead of the frame.", "today": "No published price for a gamma knife session was found on any provider page read for this record on 16 September 2026, including the UK centre quoted above, whose self-pay link redirects to a hospital page carrying no figure. That is a statement about the pages read, not about the world: units in India, Türkiye, Thailand and Japan may publish, and no figure from them has been read here. What the scarcity does produce is a referral pattern rather than a price list — the patient is sent to the machine.", "notes": "This page describes a treatment. It is not advice about whether to have one, or where." }, "metrics": { "stay_days": 0, "days_before_flying": null, "recovery_weeks": null, "note": "A day case: the centre read for this record describes a single-day outpatient visit with a return to normal activities the following day. No provider page read on 16 September 2026 gave a wait before flying, so that figure stays a gap rather than a guess.", "as_of": "2026-09-16", "source": "s:london-gamma-knife", "url": "https://www.thegammaknifecentre.co.uk/" }, "kin": [ { "to": "proton-therapy", "as": "The other machine people cross a border to reach, and the one that takes weeks rather than an afternoon.", "rel": "contrast" }, { "to": "car-t", "as": "Scarcity of a different kind: there, the restriction is who may give the treatment, not who owns the hardware.", "rel": "kin" }, { "to": "second-opinion", "as": "The step where a patient learns that the machine exists at all, and in which country.", "rel": "step" }, { "to": "getting-your-records", "as": "The imaging a distant unit needs before it will accept a referral.", "rel": "step" }, { "to": "follow-up-gap", "as": "The scan at six months, back home, that nobody booked.", "rel": "risk" }, { "to": "insurance-exclusions", "as": "Where a payer decides a branded machine is a different thing from the linear accelerator down the road.", "rel": "rule" }, { "to": "medical-travel", "as": "The plain name this directory uses for what a patient does to reach a machine in another country.", "rel": "term" } ], "confusable_with": [ { "id": "proton-therapy", "tell": "Both get called precise radiation. Gamma knife treats inside the skull in one session; proton therapy treats tumours anywhere in the body over weeks of daily fractions." } ], "links": [ { "label": "Elekta — fifty years of Gamma Knife", "url": "https://www.elekta.com/focus/celebrating-50-years-of-iconic-brain-care/" }, { "label": "The London Gamma Knife Centre", "url": "https://www.thegammaknifecentre.co.uk/" } ], "sources": [ "s:elekta-50-years", "s:london-gamma-knife", "s:srs-two-decades" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:elekta-50-years", "note": "installed base and patient counts cited to the manufacturer and dated 2018; the cobalt-60 sentence is marked Trade practice and the closing paragraph Inference" }, "text.how": { "tier": "cited", "source": "s:london-gamma-knife", "note": "quoted from a private provider's own page, which is what it is" }, "etymology": { "tier": "tradition" } } }, "x_commons_files": [ "File:Leksell Gamma Knife Perfexion.jpg", "File:Stereotactic frame.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "A high dose of radiation delivered to a target inside the skull from many directions at once, so that the beams meet at the lesion and each individual path through healthy brain carries little dose.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "The other machine people cross a border to reach, and the one that takes weeks rather than an afternoon.", "rel": "contrast" }, { "to": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "Scarcity of a different kind: there, the restriction is who may give the treatment, not who owns the hardware.", "rel": "kin" }, { "to": "second-opinion", "type": "pathway", "name": "The second opinion", "as": "The step where a patient learns that the machine exists at all, and in which country.", "rel": "step" }, { "to": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "The imaging a distant unit needs before it will accept a referral.", "rel": "step" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The scan at six months, back home, that nobody booked.", "rel": "risk" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "Where a payer decides a branded machine is a different thing from the linear accelerator down the road.", "rel": "rule" }, { "to": "medical-travel", "type": "term", "name": "Medical travel", "as": "The plain name this directory uses for what a patient does to reach a machine in another country.", "rel": "term" } ], "source_list": [ { "id": "s:elekta-50-years", "kind": "web", "title": "Celebrating 50 years of iconic brain care", "publisher": "Elekta, 31 January 2018", "url": "https://www.elekta.com/focus/celebrating-50-years-of-iconic-brain-care/", "accessed": "2026-09-16", "note": "the manufacturer's own installed-base figure, eight years old on the access date and not superseded by anything current on its product pages" }, { "id": "s:london-gamma-knife", "kind": "web", "title": "The London Gamma Knife Centre at St Bartholomew's Hospital", "publisher": "HCA Healthcare UK", "url": "https://www.thegammaknifecentre.co.uk/", "accessed": "2026-09-16", "note": "a private provider's own description of the single-session treatment, the frame and the mask; not an independent body" }, { "id": "s:srs-two-decades", "kind": "paper", "title": "Transforming Brain Tumor Care: The Global Impact of Radiosurgery in Multidisciplinary Treatment Over Two Decades", "publisher": "Cancer Medicine, 2025, doi:10.1002/cam4.70673", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11909010/", "accessed": "2026-09-16", "note": "systematic review counting 120,756 patients reported in 538 peer-reviewed publications since 2000; it counts published patients, not treated patients" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:elekta-50-years", "note": "installed base and patient counts cited to the manufacturer and dated 2018; the cobalt-60 sentence is marked Trade practice and the closing paragraph Inference" }, "text.how": { "tier": "cited", "source": "s:london-gamma-knife", "note": "quoted from a private provider's own page, which is what it is" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "Another treatment a patient reaches by travelling to the equipment.", "rel": "kin" }, { "from": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "The other machine people cross borders to reach, and the one that does its work in a single day.", "rel": "contrast" }, { "from": "hadassah", "type": "facility", "name": "Hadassah Medical Center", "as": "Among the neurosurgical work its foreign referrals come for.", "rel": "performs" }, { "from": "kokilaben", "type": "facility", "name": "Kokilaben Dhirubhai Ambani Hospital", "as": "Its radiosurgery programme is the kind of work its equipment list is built around.", "rel": "performs" } ] }, { "schema": 1, "id": "gastric-balloon", "type": "procedure", "names": { "name": "Gastric balloon", "aliases": [ "intragastric balloon", "Orbera", "Allurion", "swallowable balloon", "weight loss balloon" ], "said": "The trade sells it beside operations and prices it like one. It is a device left in a stomach for a few months and then taken out, and the FDA's own wording for the limit is a maximum placement period." }, "etymology": { "root": "balloon: Italian pallone, a large ball, by way of French ballon. Intragastric is Latin intra, within, plus Greek gaster, the stomach — inside the stomach, which is the whole of what it does. Nothing is cut, stapled or removed, and no part of the word implies surgery.", "tier": "tradition", "note": "liquid-filled and gas-filled balloons are different devices with different regulatory histories; swallowable capsule balloons are different again, and one type dissolves rather than being retrieved. A price page saying gastric balloon has not said which." }, "region": [ "global" ], "facets": { "family": "bariatric", "setting": "day-case", "anaesthesia": "sedation" }, "text": { "what": "A soft balloon is placed in the stomach and filled, so the stomach holds less and fullness comes sooner. It is a temporary device, not an operation: nothing is cut, stapled or removed, and it comes out again. In the NHS description a camera goes down first, then the empty balloon is swallowed with a thin tube attached that fills it with salt water once in place; the whole thing takes around 20 minutes. The FDA states the maximum placement period for the two liquid-filled brands it wrote to providers about as six months.", "story": "The balloon is the cheapest line on a bariatric price column and the one most likely to be misread as the cheap version of the operations above it. On a Tijuana page it sits at 1,880 US dollars, a sleeve at 4,580 and a bypass at 5,980. It is not a cheaper sleeve. It is a rental.\n\nThe price paid is therefore for months, and the comparison that matters is not against an operation but against the same months without a device. *Inference —* a package whose purchase and removal happen in different countries has a problem the operations do not: the removal is a second appointment, months later, and the price that covered the insertion was paid to a clinic on another continent. A US clinic page read for this record prices the balloon with removal folded in, and names early removal for intolerance among the things the price does not cover — the single commonest reason a balloon comes out ahead of schedule.\n\nThe regulator has written to clinicians about this device twice. The FDA's letter of 9 February 2017, updated in August 2017 and April 2020, concerns the liquid-filled Orbera and ReShape systems and names two problems: spontaneous hyperinflation of the balloon, reported as early as nine days after placement, and acute pancreatitis developing within three days of it. The letter asks providers to keep both in mind when a patient presents with severe abdominal pain, distension or difficulty breathing.\n\n*Trade practice —* balloons are sold alongside operations by clinics whose surgical packages need a lower entry price, and to patients whose weight is below the thresholds a surgical programme would accept.", "how": "Placed endoscopically under sedation, or swallowed as a capsule in the newer designs, as a day case with no ward stay. The removal is the part that determines where it can sensibly be bought: a retrieved balloon needs a second endoscopy at the end of its placement period, while a self-dissolving design passes on its own — one US page read for this record puts that type's life at about four months. A device bought abroad and retrieved at home is two providers and one shared responsibility.\n\nThe published prices split the same way. The US page prices Orbera at 6,000 to 8,500 dollars and Allurion at 6,000 to 9,000, stating that the price covers the device, the insertion, anaesthesia, facility costs, removal at six months, the pre-procedure consultation, follow-up visits and nutritionist support — and that it does not cover pre-procedure medical clearance, anti-nausea medication, treatment of complications, early removal if the patient cannot tolerate it, post-removal support, or food and supplements. A Tijuana page prices the same category of device at 1,880 dollars without publishing an inclusion list at all.\n\nNo national regulator read for this record publishes outcome figures for this device. The FDA's published material on it is about adverse events, not effectiveness.", "today": "As of September 2026 the published prices read off pages for this record are from 1,880 US dollars in Tijuana and 6,000 to 9,000 US dollars in the United States, with the FDA's six-month maximum placement period unchanged for the liquid-filled brands it named. A price is for a device that will be removed, and any page that lists it beside permanent operations is listing two different kinds of thing in one column.", "notes": "This page describes a temporary device and reports what its regulator and published price pages say about it. It is not medical advice." }, "metrics": { "stay_days": 0, "success_rate_pct": null, "note": "A day case with no ward stay: the NHS puts the placement at around 20 minutes. The governing number for this device is not a success rate but a limit — the FDA states the maximum placement period for the two liquid-filled brands in its 2017 letter to providers as six months, and one US clinic page read for this record puts a self-dissolving design's life at about four months. No regulator read for this record publishes weight loss or complication rates for the device; the FDA's published material concerns adverse events, and this record carries the two named in the letter — spontaneous hyperinflation, reported as early as nine days after placement, and acute pancreatitis within three days of it — rather than a rate for either.", "as_of": "2020-04-27", "source": "s:fda-intragastric-balloon", "url": "https://www.fda.gov/medical-devices/letters-health-care-providers/fda-alerts-health-care-providers-about-potential-risks-liquid-filled-intragastric-balloons" }, "prices": [ { "procedure": "gastric-balloon", "country": "MX", "city": "Tijuana", "amount": 1880, "currency": "USD", "as_of": "2026-09-16", "kind": "package", "includes": [ "stated as an all-inclusive starting price; the page publishes no itemised inclusion list for this line" ], "excludes": [ "airfare", "additional hotel nights", "extra medications", "financing fees", "services not listed in the personalized quote" ], "source": "s:tijuana-bariatric-center-cost", "url": "https://tijuanabariatriccenter.com/about/financing/bariatric-surgery-tijuana-cost/", "note": "the cheapest line in a column of eight bariatric prices, and the only one that is not an operation. The page does not state whether removal at the end of the placement period is inside the price. Read on 16 September 2026.", "tier": "cited", "usd": 1880.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "gastric-balloon", "country": "US", "amount": 6000, "amount_high": 8500, "currency": "USD", "as_of": "2026-05-06", "kind": "quoted-range", "includes": [ "the balloon device", "insertion procedure", "anaesthesia", "facility costs", "removal after 6 months", "pre-procedure consultation", "follow-up visits", "nutritionist support" ], "excludes": [ "pre-procedure medical clearance", "anti-nausea medication", "treatment of complications", "early removal if the patient cannot tolerate the device", "post-removal support", "food and supplement costs" ], "source": "s:bodevolve-balloon-cost", "url": "https://bodevolvebariatric.com/gastric-balloon-cost/", "note": "the Orbera range on a page dated 6 May 2026. Removal at six months is inside the price and early removal for intolerance is outside it, which prices the device's commonest failure against the patient.", "tier": "cited", "usd": 6000.0, "usd_high": 8500.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "gastric-balloon", "country": "US", "amount": 6000, "amount_high": 9000, "currency": "USD", "as_of": "2026-05-06", "kind": "quoted-range", "includes": [ "the balloon device", "placement", "follow-up visits", "nutritionist support" ], "excludes": [ "pre-procedure medical clearance", "anti-nausea medication", "treatment of complications", "post-removal support", "food and supplement costs" ], "source": "s:bodevolve-balloon-cost", "url": "https://bodevolvebariatric.com/gastric-balloon-cost/", "note": "the Allurion range on the same page; this design is stated to dissolve on its own after about four months, so no removal procedure is priced. A shorter placement period at the same price is a different purchase.", "tier": "cited", "usd": 6000.0, "usd_high": 9000.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "gastric-sleeve", "as": "The permanent operation on the same price column, at more than twice the price and a different kind of purchase.", "rel": "contrast" }, { "to": "gastric-bypass", "as": "The other permanent operation sold beside it, where this device is not.", "rel": "contrast" }, { "to": "mexico", "as": "Where the cheapest published price for this device was read.", "rel": "destination" }, { "to": "united-states", "as": "Where the device's regulator published the placement limit and the adverse events this record quotes.", "rel": "place" }, { "to": "follow-up-gap", "as": "Who takes the balloon out, months later, in the country the patient went home to.", "rel": "risk" }, { "to": "reading-the-exclusions", "as": "Where early removal for intolerance is found outside the price that included removal.", "rel": "step" }, { "to": "deposit-and-refund", "as": "What is owed when a device comes out early and the months it was bought for did not happen.", "rel": "risk" }, { "to": "package-price", "as": "The pricing form that puts a rented device in a column of permanent operations.", "rel": "term" } ], "confusable_with": [ { "id": "gastric-sleeve", "tell": "The sleeve removes four-fifths of the stomach and cannot be undone; the balloon sits inside it for months and is then taken out or dissolves." } ], "links": [ { "label": "FDA letter — liquid-filled intragastric balloons", "url": "https://www.fda.gov/medical-devices/letters-health-care-providers/fda-alerts-health-care-providers-about-potential-risks-liquid-filled-intragastric-balloons" }, { "label": "NHS — weight loss surgery, how it's done", "url": "https://www.nhs.uk/conditions/weight-loss-surgery/how-its-done/" } ], "sources": [ "s:fda-intragastric-balloon", "s:nhs-weight-loss-surgery-how", "s:nhs-weight-loss-surgery", "s:tijuana-bariatric-center-cost", "s:bodevolve-balloon-cost" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:nhs-weight-loss-surgery-how" }, "text.story": { "tier": "cited", "source": "s:fda-intragastric-balloon", "note": "the FDA letter and the price column are cited; the paragraph on cross-border removal is marked Inference and the paragraph on who the device is sold to is marked Trade practice" }, "text.how": { "tier": "cited", "source": "s:bodevolve-balloon-cost" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:fda-intragastric-balloon" }, "prices": { "tier": "cited", "source": "s:bodevolve-balloon-cost" } } }, "x_commons_files": [ "File:Intragastric balloon.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "A soft balloon is placed in the stomach and filled, so the stomach holds less and fullness comes sooner. It is a temporary device, not an operation: nothing is cut, stapled or removed, and it comes out again.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "The permanent operation on the same price column, at more than twice the price and a different kind of purchase.", "rel": "contrast" }, { "to": "gastric-bypass", "type": "procedure", "name": "Gastric bypass", "as": "The other permanent operation sold beside it, where this device is not.", "rel": "contrast" }, { "to": "mexico", "type": "destination", "name": "Mexico", "as": "Where the cheapest published price for this device was read.", "rel": "destination" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "Where the device's regulator published the placement limit and the adverse events this record quotes.", "rel": "place" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who takes the balloon out, months later, in the country the patient went home to.", "rel": "risk" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "Where early removal for intolerance is found outside the price that included removal.", "rel": "step" }, { "to": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "What is owed when a device comes out early and the months it was bought for did not happen.", "rel": "risk" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The pricing form that puts a rented device in a column of permanent operations.", "rel": "term" } ], "source_list": [ { "id": "s:fda-intragastric-balloon", "kind": "org", "title": "The FDA alerts health care providers about potential risks with liquid-filled intragastric balloons", "publisher": "US Food and Drug Administration", "url": "https://www.fda.gov/medical-devices/letters-health-care-providers/fda-alerts-health-care-providers-about-potential-risks-liquid-filled-intragastric-balloons", "accessed": "2026-09-16", "note": "letter dated 9 February 2017, updated 10 August 2017 and 27 April 2020" }, { "id": "s:nhs-weight-loss-surgery-how", "kind": "org", "title": "Weight loss surgery — how it's done", "publisher": "National Health Service (United Kingdom)", "url": "https://www.nhs.uk/conditions/weight-loss-surgery/how-its-done/", "accessed": "2026-09-16", "note": "page last reviewed 5 February 2024" }, { "id": "s:nhs-weight-loss-surgery", "kind": "org", "title": "Weight loss surgery", "publisher": "National Health Service (United Kingdom)", "url": "https://www.nhs.uk/conditions/weight-loss-surgery/", "accessed": "2026-09-16", "note": "page last reviewed 5 February 2024" }, { "id": "s:tijuana-bariatric-center-cost", "kind": "web", "title": "Bariatric surgery Tijuana cost and what affects pricing", "publisher": "Tijuana Bariatric Center", "url": "https://tijuanabariatriccenter.com/about/financing/bariatric-surgery-tijuana-cost/", "accessed": "2026-09-16", "note": "the page carries no date of its own; prices read on the accessed date" }, { "id": "s:bodevolve-balloon-cost", "kind": "web", "title": "Gastric balloon cost 2026", "publisher": "BodEvolve Bariatric Surgery Center", "url": "https://bodevolvebariatric.com/gastric-balloon-cost/", "accessed": "2026-09-16", "note": "page dated 6 May 2026" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:nhs-weight-loss-surgery-how" }, "text.story": { "tier": "cited", "source": "s:fda-intragastric-balloon", "note": "the FDA letter and the price column are cited; the paragraph on cross-border removal is marked Inference and the paragraph on who the device is sold to is marked Trade practice" }, "text.how": { "tier": "cited", "source": "s:bodevolve-balloon-cost" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:bodevolve-balloon-cost" }, "metrics": { "tier": "cited", "source": "s:fda-intragastric-balloon" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "gastric-bypass", "type": "procedure", "name": "Gastric bypass", "as": "The temporary device at a third of the price on the same page, and not an operation at all.", "rel": "contrast" }, { "from": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "The temporary device sold from the same pages at a third of the price, and not an operation.", "rel": "contrast" } ] }, { "schema": 1, "id": "gastric-bypass", "type": "procedure", "names": { "name": "Gastric bypass", "aliases": [ "Roux-en-Y gastric bypass", "RYGB", "mini gastric bypass", "one-anastomosis gastric bypass", "OAGB" ], "said": "Surgeons say Roux-en-Y, or mini bypass for the single-join version. Price lists put them 200 US dollars apart and do not always say which one the number belongs to." }, "etymology": { "root": "bypass is plain English for a road built around a town, borrowed into surgery for a gut built around itself. Roux-en-Y names the shape of the join — two limbs of bowel meeting a third, drawn as a Y — after the Swiss surgeon César Roux, who described the reconstruction in the nineteenth century.", "tier": "tradition", "note": "the mini or one-anastomosis bypass makes one join instead of two. It is a different operation with a different revision profile, and on a price list it looks like a discount." }, "region": [ "global" ], "facets": { "family": "bariatric", "setting": "inpatient", "anaesthesia": "general" }, "text": { "what": "The stomach is divided with staples to leave a small pouch at the top, and that pouch is joined to the lower part of the small intestine, so food passes most of the stomach and the first stretch of bowel without meeting them. The NHS puts the operation at around two hours. It restricts what can be eaten and reduces what is absorbed, and the second half of that sentence is what makes lifelong supplementation and blood monitoring a condition of having had it rather than an optional extra.", "story": "The bypass is the sleeve's more expensive neighbour on every package price list read for this record, and the destination of a sleeve that did not work. On one Tijuana page the two sit in a column with six other operations: a balloon at 1,880 US dollars, a sleeve at 4,580, a mini bypass at 5,780, a bypass at 5,980, a duodenal switch at 7,500. A patient reads that column as a menu of prices. It is a menu of different amounts of malabsorption.\n\n*Trade practice —* the operation that reroutes the gut is the one whose aftercare cannot be skipped. Iron, B12, calcium, vitamin D and annual bloods are the standing requirement, and the deficiency that follows from missing them arrives years later, in a different country from the surgeon.\n\n*Inference —* that timing is what makes the bypass the hardest bariatric operation to buy abroad well. The package is bought for a week; the operation's failure mode is measured in years; and none of the pages read for this record prices the correction of either a nutritional failure or a mechanical one.", "how": "Priced and bundled exactly like the sleeve — surgeon, theatre, anaesthetist, one to two nights on a ward, a hotel either side, transfers, a coordinator — and sold from the same pages, roughly 1,400 US dollars above it in Tijuana. What sits outside is also the same: flights, the companion, extra nights, take-home medication, lifelong vitamins, and any complication that declares itself after the flight home.\n\nThe legal and administrative facts attached to this operation are not prohibitions but payment rules. Whether a home insurer or a public system will pay for a complication of an operation it did not authorise, and whether it will fund a revision, is an insurance question rather than a criminal one, and it decides who bears the cost of the years the package does not cover. Those sit on the rule and risk records.\n\nNo regulator read for this record publishes national outcome figures for this operation. The numbers on the clinic pages are the clinics' own, and this record carries none of them.", "today": "As of September 2026 the published package prices read off pages for this record are from 5,900 US dollars and 5,980 US dollars in Tijuana, with a one-join mini bypass at 5,780 on the same page. No Türkiye clinic page read for this batch published a bypass price, though all three published a sleeve price — a gap in what is advertised rather than in what is done.", "notes": "This page describes an operation and reads the published package prices attached to it. It is not medical advice." }, "metrics": { "stay_days": null, "days_before_flying": 10, "success_rate_pct": null, "note": "The ten-day figure is the CDC's guidance not to fly for ten days after abdominal surgery. Hospital stay is left null because the pages that publish a bypass price for this record name their ward nights against the sleeve rather than the bypass, and a number read off the wrong line is not a number. No national regulator read for this record publishes weight loss, complication or mortality figures for this operation, so those fields print as gaps.", "as_of": "2026-09-16", "source": "s:cdc-yellowbook-medical-tourism", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" }, "prices": [ { "procedure": "gastric-bypass", "country": "MX", "city": "Tijuana", "amount": 5900, "currency": "USD", "as_of": "2026-09-16", "kind": "package", "includes": [ "pre-op consultations and medical evaluation", "pre-op blood work in Mexico", "the operation by a board-certified surgeon", "anaesthesia and anaesthesiologist fees", "hospital stay in a private room", "post-op hotel recovery", "airport, hotel and hospital transfers", "post-op medications", "bilingual coordinator", "nutrition support and follow-up calls" ], "excludes": [ "round-trip flights", "travel companion's hotel and meals", "pre-op blood work done in the home country", "lifetime daily multivitamins", "optional travel-complication insurance", "body-contouring surgery", "travel insurance for trip cancellation" ], "source": "s:alo-bariatrics-cost", "url": "https://www.alobariatrics.com/gastric-sleeve-cost/", "note": "listed as from 5,900 USD beside the same clinic's sleeve at from 4,500 USD, on a page read on 16 September 2026. The inclusion and exclusion lists are the page's own and are stated for the packages together; lifetime daily multivitamins are excluded by name from an operation that makes them compulsory.", "tier": "cited", "usd": 5900.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "gastric-bypass", "country": "MX", "city": "Tijuana", "amount": 5980, "currency": "USD", "as_of": "2026-09-16", "kind": "package", "includes": [ "hospital and surgical team", "San Diego to Tijuana transportation", "hotel recovery stay", "anaesthesiologist fees", "one companion free" ], "excludes": [ "airfare", "additional hotel nights", "extra medications", "financing fees", "services not listed in the personalized quote" ], "source": "s:tijuana-bariatric-center-cost", "url": "https://tijuanabariatriccenter.com/about/financing/bariatric-surgery-tijuana-cost/", "note": "a starting price. The same column lists a mini gastric bypass at 5,780 USD, a SADI-S at 6,480 USD and a duodenal switch at 7,500 USD: four operations that differ in how much bowel is bypassed, sold 1,700 USD apart. Read on 16 September 2026.", "tier": "cited", "usd": 5980.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "gastric-sleeve", "as": "The cheaper operation on the same price lists, and the one a bypass is often a revision of.", "rel": "contrast" }, { "to": "gastric-balloon", "as": "The temporary device at a third of the price on the same page, and not an operation at all.", "rel": "contrast" }, { "to": "mexico", "as": "Where both published prices on this page are sold, a short drive from the border.", "rel": "destination" }, { "to": "tijuana", "as": "The city that prices eight bariatric operations in one column.", "rel": "place" }, { "to": "follow-up-gap", "as": "Who orders the annual bloods this operation makes compulsory, once the coordinator's calls stop.", "rel": "risk" }, { "to": "revision-at-home", "as": "Who operates when a join leaks or a pouch fails, in a country that did not do the first operation.", "rel": "risk" }, { "to": "insurance-exclusions", "as": "Whether a home payer covers a complication of an operation it did not authorise.", "rel": "governed-by" }, { "to": "flying-after-surgery", "as": "The clot risk that sets how long after this abdominal operation a patient can board.", "rel": "risk" }, { "to": "package-price", "as": "The pricing form this operation is sold in, and what the week-long bundle leaves out.", "rel": "term" } ], "confusable_with": [ { "id": "gastric-sleeve", "tell": "The sleeve removes stomach and leaves the bowel alone; the bypass reroutes the bowel. Only the second is malabsorptive, and only the second makes supplementation compulsory rather than advisable." } ], "links": [ { "label": "NHS — weight loss surgery, how it's done", "url": "https://www.nhs.uk/conditions/weight-loss-surgery/how-its-done/" }, { "label": "Tijuana Bariatric Center — prices", "url": "https://tijuanabariatriccenter.com/about/financing/bariatric-surgery-tijuana-cost/" } ], "sources": [ "s:nhs-weight-loss-surgery", "s:nhs-weight-loss-surgery-how", "s:alo-bariatrics-cost", "s:tijuana-bariatric-center-cost", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:nhs-weight-loss-surgery-how" }, "text.story": { "tier": "cited", "source": "s:tijuana-bariatric-center-cost", "note": "the price column is quoted from the named page; the paragraph on aftercare is marked Trade practice and the paragraph on timing is marked Inference" }, "text.how": { "tier": "cited", "source": "s:alo-bariatrics-cost" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:cdc-yellowbook-medical-tourism" }, "prices": { "tier": "cited", "source": "s:alo-bariatrics-cost" } } }, "x_commons_files": [ "File:Gastric bypass icon.svg", "File:Roux-en-Y gastric bypass.png" ], "confidence": "high", "updated": "2026-09-16", "blurb": "The stomach is divided with staples to leave a small pouch at the top, and that pouch is joined to the lower part of the small intestine, so food passes most of the stomach and the first stretch of bowel without meeting…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "The cheaper operation on the same price lists, and the one a bypass is often a revision of.", "rel": "contrast" }, { "to": "gastric-balloon", "type": "procedure", "name": "Gastric balloon", "as": "The temporary device at a third of the price on the same page, and not an operation at all.", "rel": "contrast" }, { "to": "mexico", "type": "destination", "name": "Mexico", "as": "Where both published prices on this page are sold, a short drive from the border.", "rel": "destination" }, { "to": "tijuana", "type": "hub", "name": "Tijuana", "as": "The city that prices eight bariatric operations in one column.", "rel": "place" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who orders the annual bloods this operation makes compulsory, once the coordinator's calls stop.", "rel": "risk" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who operates when a join leaks or a pouch fails, in a country that did not do the first operation.", "rel": "risk" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "Whether a home payer covers a complication of an operation it did not authorise.", "rel": "governed-by" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The clot risk that sets how long after this abdominal operation a patient can board.", "rel": "risk" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The pricing form this operation is sold in, and what the week-long bundle leaves out.", "rel": "term" } ], "source_list": [ { "id": "s:nhs-weight-loss-surgery", "kind": "org", "title": "Weight loss surgery", "publisher": "National Health Service (United Kingdom)", "url": "https://www.nhs.uk/conditions/weight-loss-surgery/", "accessed": "2026-09-16", "note": "page last reviewed 5 February 2024" }, { "id": "s:nhs-weight-loss-surgery-how", "kind": "org", "title": "Weight loss surgery — how it's done", "publisher": "National Health Service (United Kingdom)", "url": "https://www.nhs.uk/conditions/weight-loss-surgery/how-its-done/", "accessed": "2026-09-16", "note": "page last reviewed 5 February 2024" }, { "id": "s:alo-bariatrics-cost", "kind": "web", "title": "Gastric sleeve cost", "publisher": "ALO Bariatrics, Tijuana", "url": "https://www.alobariatrics.com/gastric-sleeve-cost/", "accessed": "2026-09-16" }, { "id": "s:tijuana-bariatric-center-cost", "kind": "web", "title": "Bariatric surgery Tijuana cost and what affects pricing", "publisher": "Tijuana Bariatric Center", "url": "https://tijuanabariatriccenter.com/about/financing/bariatric-surgery-tijuana-cost/", "accessed": "2026-09-16", "note": "the page carries no date of its own; prices read on the accessed date" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:nhs-weight-loss-surgery-how" }, "text.story": { "tier": "cited", "source": "s:tijuana-bariatric-center-cost", "note": "the price column is quoted from the named page; the paragraph on aftercare is marked Trade practice and the paragraph on timing is marked Inference" }, "text.how": { "tier": "cited", "source": "s:alo-bariatrics-cost" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:alo-bariatrics-cost" }, "metrics": { "tier": "cited", "source": "s:cdc-yellowbook-medical-tourism" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "tijuana", "type": "hub", "name": "Tijuana", "as": "The other weight-loss operation on the package lists here.", "rel": "performs" }, { "from": "gastric-balloon", "type": "procedure", "name": "Gastric balloon", "as": "The other permanent operation sold beside it, where this device is not.", "rel": "contrast" }, { "from": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "The other permanent operation, more expensive on the same price lists, and where a failed sleeve is often converted to.", "rel": "contrast" } ] }, { "schema": 1, "id": "gastric-sleeve", "type": "procedure", "names": { "name": "Sleeve gastrectomy", "aliases": [ "gastric sleeve", "vertical sleeve gastrectomy", "VSG", "sleeve" ], "said": "Surgeons say sleeve gastrectomy. Package pages say gastric sleeve, and put the word all-inclusive in front of it. Nobody's page says irreversible, which is what removing four-fifths of a stomach is." }, "etymology": { "root": "gastrectomy: Greek gaster, the stomach, plus ektomē, a cutting out. Sleeve is the shape of what remains — a narrow tube along the lesser curve, the rest cut away and taken out of the body. The word bariatric comes from Greek baros, weight, plus -iatrikē, medical treatment.", "tier": "tradition", "note": "gastrectomy in general surgery usually means removing stomach for cancer. Here it is removal for size, and the distinction matters because the operative risk and the aftercare are different." }, "region": [ "global" ], "facets": { "family": "bariatric", "setting": "inpatient", "anaesthesia": "general" }, "text": { "what": "Around 80% of the stomach is removed to leave a much smaller, sleeve-shaped tube, under general anaesthetic and normally through keyhole incisions. The NHS puts the operation at one to three hours. The removed stomach does not grow back and the operation is not reversible. It is the highest-volume operation travelling to Türkiye and Mexico, and the one whose package price is easiest to find and hardest to compare.", "story": "The sleeve suits the package model the way knee replacement does: standard steps, predictable theatre time, a ward stay of a few nights, and a patient who is well enough to fly in for it. The published prices are correspondingly plentiful and correspondingly bare.\n\nRead the exclusion lists and one item recurs. ALO Bariatrics in Tijuana lists among the things its all-inclusive package does not cover: round-trip flights, the travel companion's hotel and meals, pre-operative blood work done in the home country, optional travel-complication insurance, body-contouring surgery — and lifetime daily multivitamins. That last line is the operation's actual long-run cost written into the exclusions of the price that advertises itself as covering everything.\n\n*Trade practice —* what the packages sell is the week. What the operation needs is the decade: annual bloods, B12, iron, calcium and vitamin D for life, a dietitian within reach, and someone to look at a patient who cannot keep fluids down in month four. Follow-up in the Türkiye packages read for this record runs to six months of video consultations in one case and a lifetime messaging line in another, which is a different promise from a clinic appointment.\n\n*Inference —* revision is the exclusion nobody prices. A sleeve that leaks, strictures, or is converted to a bypass years later is a second operation, and none of the package pages read for this record states what it costs or who pays for it. The Türkiye clinic that publishes a 0.6% revision rate does not publish a revision price beside it.", "how": "Bought as a week-long bundle with the hotel inside it, which is the shape that distinguishes bariatric travel from orthopaedic travel. The Istanbul packages read for this record name three to four nights in hospital and three to six in a hotel, airport transfers for the patient and a companion, post-operative medication, and a follow-up period; the Tijuana packages name one to two nights in hospital and one to two in a hotel, with ground transport from San Diego.\n\nWhat consistently sits outside: flights, the companion's meals, extra nights if discharge slips, medication taken home, lifelong vitamins, and any treatment of a complication once the patient has left the country. Body-contouring surgery — the skin left behind by a large weight loss — is excluded by name and is a second journey.\n\nNo regulator read for this record publishes national outcomes for this operation the way the fertility regulators publish cycle outcomes, so the success figures on these pages are the clinics' own. That asymmetry is itself the finding: the fertility half of this batch is measured by registers, and the weight half is measured by its sellers.", "today": "As of September 2026 the published package prices read off clinic pages for this record run at 2,500 to 2,600 EUR in Istanbul, 2,300 to 2,800 pounds at another Istanbul clinic, and 4,295 to 4,580 US dollars in Tijuana — in every case with flights outside, and in the Tijuana case with lifetime vitamins named among the exclusions.", "notes": "This page describes an operation and reads the published package prices attached to it. It is not medical advice and it does not say whether anyone should have the operation." }, "metrics": { "stay_days": 2, "days_before_flying": 10, "success_rate_pct": null, "note": "Two nights is the hospital stay named in the Mexico Bariatrics Center package read for this record; it is not a clinical standard, and the packages read here name between one and four nights for the same operation. The ten-day figure is the CDC's guidance not to fly for ten days after abdominal surgery, and a sleeve gastrectomy is abdominal surgery. No national regulator read for this record publishes weight loss, complication or mortality figures for this operation, so those fields stay null and print as gaps; the percentages on clinic pages are the clinics' own and are not carried here.", "as_of": "2026-09-16", "source": "s:cdc-yellowbook-medical-tourism", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" }, "prices": [ { "procedure": "gastric-sleeve", "country": "TR", "city": "Istanbul", "amount": 2600, "currency": "EUR", "as_of": "2026-01-01", "kind": "package", "includes": [ "pre-operative tests", "the surgery", "3 nights hospitalization", "4 nights 5-star hotel", "airport, hotel and hospital transfers", "all medications", "post-operative leak tests", "lifetime nutritionist support", "emergency hotline access" ], "excludes": [ "flights", "treatment of complications after departure", "revision surgery" ], "source": "s:carely-gastric-sleeve", "url": "https://carelyclinic.com/gastric-sleeve-turkey/", "note": "the clinic states the price in three currencies at once — 2,600 EUR, 2,860 USD, 2,210 pounds — which is a page written for three source markets. Last updated January 2026, price stated valid until April 2026. The exclusions listed here are read from what the inclusion list does not contain rather than from a published exclusion list; the page publishes a 0.6% revision rate without publishing a revision price.", "tier": "cited", "usd": 3000.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "gastric-sleeve", "country": "TR", "city": "Istanbul", "amount": 2300, "amount_high": 2800, "currency": "GBP", "as_of": "2025-10-29", "kind": "quoted-range", "includes": [ "pre-operative consultation, blood tests, imaging and endoscopy", "surgeon and anaesthesiologist fees", "operating theatre, recovery room and ward stay", "one to two nights of inpatient care", "post-operative medications and vitamin supplements for the initial weeks", "airport transfers for the patient and one accompanying guest", "three to four nights hotel accommodation", "follow-up consultations by video for six months" ], "excludes": [ "flights", "vitamin supplements beyond the initial weeks", "follow-up past six months" ], "source": "s:hayatmed-gastric-sleeve", "url": "https://www.hayatmed.com/gastric-sleeve-for-weight-loss/", "note": "page states reviewed on 29 October 2025. Six months of video consultations is the follow-up promised; the supplementation this operation requires runs for life.", "tier": "cited", "usd": 3100.0, "usd_high": 3773.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "gastric-sleeve", "country": "TR", "city": "Istanbul", "amount": 2500, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "4 nights in hospital", "personal drivers for each trip", "interpreter in the clinic", "travel insurance" ], "excludes": [ "flights" ], "source": "s:euroistanbul-gastric-sleeve", "url": "https://www.euroistanbul.com/gastric-sleeve-all-inclusive-package/", "note": "listed at 2,500 EUR against a struck-through 2,950 EUR; read on 16 September 2026, the page carrying no date of its own. The inclusion list names the interpreter and the driver and does not name the surgeon's fee, the theatre or the medication either way.", "tier": "cited", "usd": 2884.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "gastric-sleeve", "country": "MX", "city": "Tijuana", "amount": 4500, "currency": "USD", "as_of": "2026-09-16", "kind": "package", "includes": [ "pre-op consultations and medical evaluation", "all required pre-op blood work in Mexico", "vertical sleeve gastrectomy by a board-certified surgeon", "anaesthesia and anaesthesiologist fees", "1 to 2 nights hospital stay in a private room", "2 nights post-op hotel recovery", "airport, hotel and hospital transfers", "post-op medications", "bilingual coordinator", "nutrition support and follow-up calls" ], "excludes": [ "round-trip flights", "travel companion's hotel and meals", "pre-op blood work done in the home country", "lifetime daily multivitamins", "optional travel-complication insurance", "body-contouring surgery", "travel insurance for trip cancellation" ], "source": "s:alo-bariatrics-cost", "url": "https://www.alobariatrics.com/gastric-sleeve-cost/", "note": "listed as from 4,500 USD, read on 16 September 2026. The exclusion list names lifetime daily multivitamins, which is the operation's permanent cost written out in the small print of a price that calls itself all-inclusive.", "tier": "cited", "usd": 4500.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "gastric-sleeve", "country": "MX", "city": "Tijuana", "amount": 4295, "currency": "USD", "as_of": "2026-09-16", "kind": "package", "includes": [ "preoperative blood work, EKG and physical evaluation", "ground transportation", "one night pre-op hotel", "two nights hospital", "one night post-op hotel", "surgeon fee", "anaesthesiologist fee", "antibiotics and pain medicine", "aftercare nurse coordinator" ], "excludes": [], "source": "s:mexico-bariatrics-center-sleeve", "url": "https://mexicobariatricscenter.com/portfolio-items/gastric-sleeve-in-mexico/", "note": "stated as an all-inclusive package starting at 4,295 USD for a limited time; the page publishes an inclusion list and no exclusion list at all, which is a harder page to read than one that names what it leaves out. Read on 16 September 2026.", "tier": "cited", "usd": 4295.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "gastric-sleeve", "country": "MX", "city": "Tijuana", "amount": 4580, "currency": "USD", "as_of": "2026-09-16", "kind": "package", "includes": [ "hospital and surgical team", "San Diego to Tijuana transportation", "hotel recovery stay", "anaesthesiologist fees", "one companion free" ], "excludes": [ "airfare", "additional hotel nights", "extra medications", "financing fees", "services not listed in the personalized quote" ], "source": "s:tijuana-bariatric-center-cost", "url": "https://tijuanabariatriccenter.com/about/financing/bariatric-surgery-tijuana-cost/", "note": "a starting price on a page that lists eight bariatric operations side by side, from a balloon at 1,880 USD to a duodenal switch at 7,500 USD. Read on 16 September 2026; the page carries no date of its own.", "tier": "cited", "usd": 4580.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "gastric-bypass", "as": "The other permanent operation, more expensive on the same price lists, and where a failed sleeve is often converted to.", "rel": "contrast" }, { "to": "gastric-balloon", "as": "The temporary device sold from the same pages at a third of the price, and not an operation.", "rel": "contrast" }, { "to": "turkiye", "as": "Where the cheapest published packages for this operation are sold, hotel and transfers included.", "rel": "destination" }, { "to": "mexico", "as": "The other high-volume destination, reached by road from San Diego rather than by air.", "rel": "destination" }, { "to": "istanbul", "as": "The city whose clinics quote this operation in three currencies on one page.", "rel": "place" }, { "to": "tijuana", "as": "The border city whose packages include the ground transfer from the United States.", "rel": "place" }, { "to": "follow-up-gap", "as": "Who checks the bloods at year three, when the package's six months of video calls have run out.", "rel": "risk" }, { "to": "revision-at-home", "as": "Who operates when a sleeve leaks, strictures or has to become a bypass.", "rel": "risk" }, { "to": "flying-after-surgery", "as": "The clot risk that sets how long after this abdominal operation a patient can board.", "rel": "risk" }, { "to": "reading-the-exclusions", "as": "The step where lifetime multivitamins are found on the exclusion list of an all-inclusive price.", "rel": "step" }, { "to": "package-price", "as": "The pricing form this operation is sold in, hotel and transfers inside, aftercare outside.", "rel": "term" }, { "to": "the-escort-burden", "as": "The companion whose flights and meals the package prices separately or not at all.", "rel": "risk" } ], "confusable_with": [ { "id": "gastric-bypass", "tell": "A sleeve removes stomach and leaves the gut intact; a bypass reroutes the small intestine. Packages price them 1,000 to 1,500 US dollars apart and describe both as weight loss surgery." }, { "id": "gastric-balloon", "tell": "The balloon is a device placed and removed through the mouth and left in for months; the sleeve removes four-fifths of the stomach permanently." } ], "links": [ { "label": "NHS — weight loss surgery, how it's done", "url": "https://www.nhs.uk/conditions/weight-loss-surgery/how-its-done/" }, { "label": "ALO Bariatrics — gastric sleeve cost", "url": "https://www.alobariatrics.com/gastric-sleeve-cost/" } ], "sources": [ "s:nhs-weight-loss-surgery", "s:nhs-weight-loss-surgery-how", "s:carely-gastric-sleeve", "s:hayatmed-gastric-sleeve", "s:euroistanbul-gastric-sleeve", "s:alo-bariatrics-cost", "s:mexico-bariatrics-center-sleeve", "s:tijuana-bariatric-center-cost", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:nhs-weight-loss-surgery-how" }, "text.story": { "tier": "cited", "source": "s:alo-bariatrics-cost", "note": "the exclusion list is quoted from the named page; the paragraph on what the decade needs is marked Trade practice and the paragraph on unpriced revision is marked Inference" }, "text.how": { "tier": "cited", "source": "s:hayatmed-gastric-sleeve" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:cdc-yellowbook-medical-tourism" }, "prices": { "tier": "cited", "source": "s:alo-bariatrics-cost" } } }, "x_commons_files": [ "File:Sleeve gastrectomy.png", "File:Gastric sleeve surgery diagram.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "Around 80% of the stomach is removed to leave a much smaller, sleeve-shaped tube, under general anaesthetic and normally through keyhole incisions. The NHS puts the operation at one to three hours.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "gastric-bypass", "type": "procedure", "name": "Gastric bypass", "as": "The other permanent operation, more expensive on the same price lists, and where a failed sleeve is often converted to.", "rel": "contrast" }, { "to": "gastric-balloon", "type": "procedure", "name": "Gastric balloon", "as": "The temporary device sold from the same pages at a third of the price, and not an operation.", "rel": "contrast" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "Where the cheapest published packages for this operation are sold, hotel and transfers included.", "rel": "destination" }, { "to": "mexico", "type": "destination", "name": "Mexico", "as": "The other high-volume destination, reached by road from San Diego rather than by air.", "rel": "destination" }, { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "The city whose clinics quote this operation in three currencies on one page.", "rel": "place" }, { "to": "tijuana", "type": "hub", "name": "Tijuana", "as": "The border city whose packages include the ground transfer from the United States.", "rel": "place" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who checks the bloods at year three, when the package's six months of video calls have run out.", "rel": "risk" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who operates when a sleeve leaks, strictures or has to become a bypass.", "rel": "risk" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The clot risk that sets how long after this abdominal operation a patient can board.", "rel": "risk" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step where lifetime multivitamins are found on the exclusion list of an all-inclusive price.", "rel": "step" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The pricing form this operation is sold in, hotel and transfers inside, aftercare outside.", "rel": "term" }, { "to": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "The companion whose flights and meals the package prices separately or not at all.", "rel": "risk" } ], "source_list": [ { "id": "s:nhs-weight-loss-surgery", "kind": "org", "title": "Weight loss surgery", "publisher": "National Health Service (United Kingdom)", "url": "https://www.nhs.uk/conditions/weight-loss-surgery/", "accessed": "2026-09-16", "note": "page last reviewed 5 February 2024" }, { "id": "s:nhs-weight-loss-surgery-how", "kind": "org", "title": "Weight loss surgery — how it's done", "publisher": "National Health Service (United Kingdom)", "url": "https://www.nhs.uk/conditions/weight-loss-surgery/how-its-done/", "accessed": "2026-09-16", "note": "page last reviewed 5 February 2024" }, { "id": "s:carely-gastric-sleeve", "kind": "web", "title": "Gastric sleeve Turkey — all-inclusive package", "publisher": "Carely Clinic, Istanbul", "url": "https://carelyclinic.com/gastric-sleeve-turkey/", "accessed": "2026-09-16", "note": "page last updated January 2026, price stated valid until April 2026" }, { "id": "s:hayatmed-gastric-sleeve", "kind": "web", "title": "Gastric sleeve for weight loss — costs and packages", "publisher": "HayatMed Clinic, Istanbul", "url": "https://www.hayatmed.com/gastric-sleeve-for-weight-loss/", "accessed": "2026-09-16", "note": "page states reviewed on 29 October 2025" }, { "id": "s:euroistanbul-gastric-sleeve", "kind": "web", "title": "Gastric sleeve all-inclusive package", "publisher": "Euro Istanbul, Istanbul", "url": "https://www.euroistanbul.com/gastric-sleeve-all-inclusive-package/", "accessed": "2026-09-16" }, { "id": "s:alo-bariatrics-cost", "kind": "web", "title": "Gastric sleeve cost", "publisher": "ALO Bariatrics, Tijuana", "url": "https://www.alobariatrics.com/gastric-sleeve-cost/", "accessed": "2026-09-16" }, { "id": "s:mexico-bariatrics-center-sleeve", "kind": "web", "title": "Gastric sleeve in Mexico", "publisher": "Mexico Bariatrics Center", "url": "https://mexicobariatricscenter.com/portfolio-items/gastric-sleeve-in-mexico/", "accessed": "2026-09-16" }, { "id": "s:tijuana-bariatric-center-cost", "kind": "web", "title": "Bariatric surgery Tijuana cost and what affects pricing", "publisher": "Tijuana Bariatric Center", "url": "https://tijuanabariatriccenter.com/about/financing/bariatric-surgery-tijuana-cost/", "accessed": "2026-09-16", "note": "the page carries no date of its own; prices read on the accessed date" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:nhs-weight-loss-surgery-how" }, "text.story": { "tier": "cited", "source": "s:alo-bariatrics-cost", "note": "the exclusion list is quoted from the named page; the paragraph on what the decade needs is marked Trade practice and the paragraph on unpriced revision is marked Inference" }, "text.how": { "tier": "cited", "source": "s:hayatmed-gastric-sleeve" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:alo-bariatrics-cost" }, "metrics": { "tier": "cited", "source": "s:cdc-yellowbook-medical-tourism" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "mexico", "type": "destination", "name": "Mexico", "as": "The operation behind the Tijuana trade, and behind the complication series at San Diego.", "rel": "procedure" }, { "from": "turkiye", "type": "destination", "name": "Türkiye", "as": "Sold here as a fixed all-inclusive package with the hotel in the price.", "rel": "procedure" }, { "from": "antalya", "type": "hub", "name": "Antalya", "as": "Sold here with the convalescence written into the hotel nights.", "rel": "procedure" }, { "from": "tijuana", "type": "hub", "name": "Tijuana", "as": "The operation this city sells most, and the one named in the 2018–2019 outbreak.", "rel": "performs" }, { "from": "tunis", "type": "hub", "name": "Tunis", "as": "The bariatric line beside the cosmetic one.", "rel": "procedure" }, { "from": "warsaw", "type": "hub", "name": "Warsaw", "as": "Sold here as a package with the nights named.", "rel": "procedure" }, { "from": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "The operation that fills this one's waiting room, and whose patients arrive with skin nobody funded removing.", "rel": "kin" }, { "from": "gastric-balloon", "type": "procedure", "name": "Gastric balloon", "as": "The permanent operation on the same price column, at more than twice the price and a different kind of purchase.", "rel": "contrast" }, { "from": "gastric-bypass", "type": "procedure", "name": "Gastric bypass", "as": "The cheaper operation on the same price lists, and the one a bypass is often a revision of.", "rel": "contrast" }, { "from": "clinica-biblica", "type": "facility", "name": "Hospital Clínica Bíblica", "as": "Among the operations the Costa Rican route is bought for, and one of the shortest chains from enquiry to flight.", "rel": "performs" }, { "from": "hospital-angeles-tijuana", "type": "facility", "name": "Hospital Angeles Tijuana", "as": "The operation the Tijuana market is built on, and the one the CDC's outbreak investigation followed.", "rel": "performs" }, { "from": "dvt-pe", "type": "risk", "name": "Deep vein thrombosis and pulmonary embolism", "as": "Bariatric surgery, where the underlying weight is itself a risk factor for clots.", "rel": "procedure" }, { "from": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "Abdominal surgery sold in packages shorter than the interval the guidance names.", "rel": "procedure" }, { "from": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "Where lifetime daily multivitamins sit in the exclusions of an operation that requires them.", "rel": "procedure" } ] }, { "schema": 1, "id": "hair-transplant-fue", "type": "procedure", "names": { "name": "Follicular unit extraction", "aliases": [ "FUE", "follicular unit excision", "sapphire FUE", "hair transplant" ], "said": "Clinics say FUE. The society that certifies the surgeons renamed it follicular unit excision, because nothing is extracted whole - a punch cuts around each follicular unit and the unit is lifted out. Sapphire FUE names the blade material used to make the recipient sites, not a different operation." }, "etymology": { "root": "follicle: Latin folliculus, a little bag, the diminutive of follis, a bellows or a leather sack. A follicular unit is the natural cluster of one to four hairs with its own gland and muscle; the unit, not the hair, is the thing counted and the thing sold.", "first_attested": "", "tier": "tradition", "note": "graft and follicular unit are used interchangeably on price pages, and a graft may hold one hair or four. A quote of 4,000 grafts therefore describes an unknown number of hairs, which is the first ambiguity in every hair transplant price." }, "region": [ "global" ], "facets": { "family": "hair", "setting": "day-case", "anaesthesia": "local" }, "text": { "what": "Follicular units are cut out of the back and sides of the scalp one at a time with a punch under a millimetre across, sorted under magnification, and placed into slits made in the bald area. The donor area is finite and does not regrow; a transplant moves hair, it does not make more. The operation takes most of a day under local anaesthetic, and the transplanted hairs shed before they grow.", "story": "*Inference --* FUE is the operation that made Istanbul a destination, and the reason is arithmetic. The work is long, repetitive and labour-intensive, it needs no ward, no general anaesthetic and no implant, and its cost is almost entirely staff time. A trade built on staff time relocates to where staff time is cheaper, and it did.\n\nThe pricing unit is the graft, and that is where the comparison fails. Estenove in Istanbul states plainly that it does not price per graft: its packages run at 3,395, 4,595 and 6,595 euro for what the clinic describes as the maximum number of grafts necessary, with hotel nights, transfers, a PRP session and an aftercare kit inside the price. The same page quotes a per-graft range of 0.65 to 0.95 euro across Turkish clinics generally. In London, Wimpole Clinic publishes hair transplant prices from 3,499 pounds with pre-care, surgery and aftercare included and no VAT added.\n\nA per-graft price and a per-session price are two different contracts. Per graft, the number of grafts decides the bill, and the number is set by the seller after the sale. Per session, the bill is fixed and the number of grafts is set by the seller after the sale as well - but in the other direction. Wimpole's own mystery-shopper survey put one photograph of a man with Norwood stage 2-3 hair loss to 104 UK clinics and used the replies of 58: the recommended graft counts for the same head differed by 2,100 grafts, and the clinic's report states that in many cases the number of grafts recommended was inflated and the price per graft reduced to appear more competitive. Their averages: 4,820 pounds for a 1,500 graft procedure, 3.25 pounds per graft, with quotes running from 1,995 to 15,000 pounds.\n\nThe International Society of Hair Restoration Surgery has published a position statement on who does the cutting. In its words a properly trained and licensed physician or physician extender should perform the preoperative diagnostic evaluation and consultation, surgery planning and surgery execution - including donor hair harvesting, hairline design and recipient site creation - and it names three risks when unlicensed technicians do that work: misdiagnosis, failure to diagnose hair disorders and related systemic diseases, and unnecessary or ill-advised surgery. The statement is dated 10 January 2024, updated from September 2014.", "how": "Local anaesthetic, one long day or two, no ward. The donor strip is shaved in most techniques; unshaven variants cost more and take longer. Grafts are counted out loud in some clinics and not in others, and the count on the invoice is the count the clinic states. Transplanted hairs fall out within weeks and regrow from three months; the result is judged at twelve to eighteen months, well after the patient has flown home. Redness and crusting last about ten days, which is what package hotel nights are built around.", "today": "Three published prices sit on this record - a Turkish package, a London 'from' price, and a Dubai range - plus one clinic's published survey of 58 UK clinics quoting on the same photograph. The graft count, not the currency, is what makes them hard to compare.", "notes": "This page describes an operation and how it is sold. It is not advice about having one." }, "metrics": { "stay_days": 0, "note": "Day case: no published package read for this record includes a hospital night, and the hotel nights in Turkish packages are accommodation rather than ward stay. No graft-survival figure is carried here; clinics publish their own, none of the sources read for this record published one measured against a defined population.", "as_of": "2026-09-16", "source": "s:estenove-cost", "url": "https://www.estenove.com/hair-transplant-cost-istanbul-turkey/" }, "prices": [ { "procedure": "hair-transplant-fue", "country": "TR", "city": "Istanbul", "amount": 3395, "amount_high": 6595, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "a fixed session rather than a graft count: in the clinic's words, the maximum number of grafts necessary for the procedure at a fixed price", "MD participation in extraction and incision", "anaesthesia", "a PRP session", "hotel accommodation, three to four nights depending on package", "VIP transfer", "aftercare kit", "18 months of aftercare support" ], "excludes": [ "flights", "anything the clinic bills after the session" ], "source": "s:estenove-cost", "url": "https://www.estenove.com/hair-transplant-cost-istanbul-turkey/", "note": "three packages at 3,395, 4,595 and 6,595 EUR. The same page quotes a general Turkish per-graft range of 0.65 to 0.95 EUR and states that at this clinic the patient does not pay per graft.", "tier": "cited", "usd": 3917.0, "usd_high": 7609.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "hair-transplant-fue", "country": "GB", "city": "London", "amount": 3499, "currency": "GBP", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [ "pre-care, surgery and aftercare, in the clinic's words", "a stimulating laser session" ], "excludes": [ "nothing named: the page states there are no hidden costs, no added VAT and nothing extra for medication" ], "source": "s:wimpole-prices", "url": "https://wimpole.com/prices-how-much-does-hair-transplant-cost/", "note": "listed as 'from'. The same clinic states its average procedure runs between 3,500 and 7,000 GBP.", "tier": "cited", "usd": 4715.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "hair-transplant-fue", "country": "GB", "amount": 4820, "currency": "GBP", "as_of": "2026-09-16", "kind": "survey", "includes": [ "the average quoted for a 1,500 graft procedure across the clinics that replied" ], "excludes": [ "not applicable: this is a survey figure, not a bill" ], "source": "s:wimpole-uk-cost-survey", "url": "https://wimpole.com/blog/hair-transplant-cost-uk-analysis/", "note": "one clinic's own mystery-shopper survey: the same photograph of a Norwood stage 2-3 patient sent to 104 UK clinics, replies used from 58. Average 3.25 GBP per graft, quotes from 1,995 to 15,000 GBP, and a 2,100 graft spread in what the same head was told it needed.", "tier": "cited", "usd": 6496.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "hair-transplant-fue", "country": "AE", "city": "Dubai", "amount": 12000, "amount_high": 35000, "currency": "AED", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [ "surgeon fees, anaesthesia, facility charges, graft extraction and implantation, and post-operative care including medications and follow-up visits, in the group's own words" ], "excludes": [ "not stated on the page" ], "source": "s:dhi-dubai-cost", "url": "https://www.dhiinternational.com/cost-of-hair-transplant-in-dubai-dhi-medical-group/", "note": "the group's stated range for FUE in Dubai; it quotes FUT at 10,000 to 25,000 AED on the same page", "tier": "cited", "usd": 3268.0, "usd_high": 9530.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "dhi-hair-transplant", "as": "The same operation with a branded implanter pen doing the placing, priced as a tier above it.", "rel": "contrast" }, { "to": "fue", "as": "The three letters, and what the society that certifies the surgeons renamed them.", "rel": "term" }, { "to": "graft", "as": "The unit this operation is priced in, and the one that is routinely inflated.", "rel": "term" }, { "to": "istanbul", "as": "The city this operation built, and which built it.", "rel": "place" }, { "to": "turkiye", "as": "The destination whose hair trade is the largest single procedure market in cross-border care.", "rel": "destination" }, { "to": "turkiye-hair-boom", "as": "The years the corridor formed.", "rel": "event" }, { "to": "ishrs", "as": "The society whose position statement names who should be cutting.", "rel": "org" }, { "to": "advertising-rules", "as": "Where before-and-after photography and graft-count claims are regulated, and where they are not.", "rel": "governed-by" }, { "to": "getting-a-quote", "as": "The step where a photograph produces a graft number, and the number produces the price.", "rel": "step" }, { "to": "united-kingdom", "as": "A source market whose own clinics publish what they quote, and what their competitors quote.", "rel": "destination" }, { "to": "uae", "as": "A second destination pricing the same operation in a different currency and a wider range.", "rel": "destination" } ], "confusable_with": [ { "id": "dhi-hair-transplant", "tell": "DHI is a trademarked variant of this operation using an implanter pen, not a separate procedure; clinics price it as an upgrade." } ], "links": [ { "label": "Estenove package prices", "url": "https://www.estenove.com/hair-transplant-cost-istanbul-turkey/" }, { "label": "ISHRS statement on unlicensed technicians", "url": "https://ishrs.org/beware-of-unlicensed-technicians-performing-hair-restoration-surgery/" }, { "label": "Wimpole Clinic UK cost survey", "url": "https://wimpole.com/blog/hair-transplant-cost-uk-analysis/" } ], "sources": [ "s:estenove-cost", "s:wimpole-prices", "s:wimpole-uk-cost-survey", "s:dhi-dubai-cost", "s:ishrs-unlicensed-technicians" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:wimpole-uk-cost-survey", "note": "prices and the survey are read off the named pages; the opening paragraph on why the trade relocated is this project's reading and is marked in the record as such" }, "text.how": { "tier": "tradition", "note": "standard operative description; the ten-day crusting figure is the trade's, and the hotel nights are cited to the package" }, "etymology": { "tier": "tradition" } } }, "x_commons_files": [ "File:Follicular unit extraction.jpg", "File:Hair transplant donor area.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "Follicular units are cut out of the back and sides of the scalp one at a time with a punch under a millimetre across, sorted under magnification, and placed into slits made in the bald area.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "dhi-hair-transplant", "type": "procedure", "name": "Direct hair implantation (DHI)", "as": "The same operation with a branded implanter pen doing the placing, priced as a tier above it.", "rel": "contrast" }, { "to": "fue", "type": "term", "name": "FUE", "as": "The three letters, and what the society that certifies the surgeons renamed them.", "rel": "term" }, { "to": "graft", "type": "term", "name": "Graft", "as": "The unit this operation is priced in, and the one that is routinely inflated.", "rel": "term" }, { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "The city this operation built, and which built it.", "rel": "place" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The destination whose hair trade is the largest single procedure market in cross-border care.", "rel": "destination" }, { "to": "turkiye-hair-boom", "type": "event", "name": "Türkiye's hair transplant boom", "as": "The years the corridor formed.", "rel": "event" }, { "to": "ishrs", "type": "org", "name": "International Society of Hair Restoration Surgery", "as": "The society whose position statement names who should be cutting.", "rel": "org" }, { "to": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "Where before-and-after photography and graft-count claims are regulated, and where they are not.", "rel": "governed-by" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step where a photograph produces a graft number, and the number produces the price.", "rel": "step" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "A source market whose own clinics publish what they quote, and what their competitors quote.", "rel": "destination" }, { "to": "uae", "type": "destination", "name": "United Arab Emirates", "as": "A second destination pricing the same operation in a different currency and a wider range.", "rel": "destination" } ], "source_list": [ { "id": "s:estenove-cost", "kind": "web", "title": "Hair Transplant Cost and Prices in Turkey", "publisher": "Estenove, Istanbul", "url": "https://www.estenove.com/hair-transplant-cost-istanbul-turkey/", "accessed": "2026-09-16", "note": "clinic's own package prices in euro, quoted per session rather than per graft" }, { "id": "s:wimpole-prices", "kind": "web", "title": "Wimpole Clinic Prices", "publisher": "Wimpole Clinic, London", "url": "https://wimpole.com/prices-how-much-does-hair-transplant-cost/", "accessed": "2026-09-16" }, { "id": "s:wimpole-uk-cost-survey", "kind": "web", "title": "UK Hair Transplant Cost: Average Price and Cost Per Graft", "publisher": "Wimpole Clinic, London", "url": "https://wimpole.com/blog/hair-transplant-cost-uk-analysis/", "accessed": "2026-09-16", "note": "a clinic's own mystery-shopper survey: one photograph of a Norwood stage 2-3 patient sent to 104 UK clinics, data used from 58" }, { "id": "s:dhi-dubai-cost", "kind": "web", "title": "Cost of Hair Transplant in Dubai", "publisher": "DHI Medical Group", "url": "https://www.dhiinternational.com/cost-of-hair-transplant-in-dubai-dhi-medical-group/", "accessed": "2026-09-16", "note": "the group's own page, describing DHI as a patented implanter pen and quoting dirham ranges" }, { "id": "s:ishrs-unlicensed-technicians", "kind": "org", "title": "Beware of Unlicensed Technicians Performing Hair Restoration Surgery", "publisher": "International Society of Hair Restoration Surgery", "url": "https://ishrs.org/beware-of-unlicensed-technicians-performing-hair-restoration-surgery/", "accessed": "2026-09-16", "note": "position statement dated 10 January 2024, updated from 18 September 2014" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:wimpole-uk-cost-survey", "note": "prices and the survey are read off the named pages; the opening paragraph on why the trade relocated is this project's reading and is marked in the record as such" }, "text.how": { "tier": "tradition", "note": "standard operative description; the ten-day crusting figure is the trade's, and the hotel nights are cited to the package" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "egypt", "type": "destination", "name": "Egypt", "as": "Sold here against Istanbul, on price and on language.", "rel": "procedure" }, { "from": "iran", "type": "destination", "name": "Iran", "as": "The other cosmetic staple of the Tehran clinics.", "rel": "procedure" }, { "from": "morocco", "type": "destination", "name": "Morocco", "as": "One of the procedures sold here to European buyers.", "rel": "procedure" }, { "from": "turkiye", "type": "destination", "name": "Türkiye", "as": "The operation that made this country's name abroad, and the one its clinics price in euros.", "rel": "procedure" }, { "from": "antalya", "type": "hub", "name": "Antalya", "as": "Sold here as a week that includes the hotel.", "rel": "procedure" }, { "from": "cairo", "type": "hub", "name": "Cairo", "as": "Sold here into the same Gulf market Istanbul sells into, at a shorter flight.", "rel": "procedure" }, { "from": "istanbul", "type": "hub", "name": "Istanbul", "as": "The operation this belt is known for abroad, sold by graft count.", "rel": "procedure" }, { "from": "tbilisi", "type": "hub", "name": "Tbilisi", "as": "The other export, priced against Istanbul at a shorter flight from the north.", "rel": "procedure" }, { "from": "dhi-hair-transplant", "type": "procedure", "name": "Direct hair implantation (DHI)", "as": "The operation this is a branded variant of, with the same harvest and the same donor limits.", "rel": "origin" }, { "from": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "A procedure sold as a two-day trip, with the result judged at twelve months.", "rel": "procedure" }, { "from": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The procedure that built the trade the regulation was written for.", "rel": "procedure" }, { "from": "ishrs", "type": "org", "name": "International Society of Hair Restoration Surgery", "as": "The operation, and the stage of it the society says a technician must not perform.", "rel": "procedure" }, { "from": "turkiye-health-services-directorate", "type": "org", "name": "Türkiye General Directorate of Health Services", "as": "The operation given its own regulation in 2023, down to who may open the channels.", "rel": "procedure" }, { "from": "turkiye-hair-boom", "type": "event", "name": "Türkiye's hair transplant boom", "as": "The operation being sold, and the stage of it the 2023 regulation reserves to a physician.", "rel": "procedure" }, { "from": "fue", "type": "term", "name": "FUE", "as": "The operation these three letters name.", "rel": "procedure" }, { "from": "graft", "type": "term", "name": "Graft", "as": "The operation this unit prices.", "rel": "procedure" } ] }, { "schema": 1, "id": "heart-valve-replacement", "type": "procedure", "names": { "name": "Heart valve replacement", "aliases": [ "valve replacement", "aortic valve replacement", "mitral valve replacement", "AVR", "MVR" ], "said": "Surgeons name the valve and the material — mechanical or tissue. Package pages say valve replacement or repair, price the two as one line, and leave the valve itself to the fine print." }, "etymology": { "root": "valve: Latin valva, a leaf of a folding door, which is what a heart valve is. Prosthesis is Greek prosthesis, an addition. Bioprosthesis names a valve built from animal tissue, usually pig or bovine pericardium; mechanical names one built from pyrolytic carbon, which lasts longer and commits the patient to lifelong anticoagulation.", "tier": "tradition", "note": "Replacement and repair are different operations sold on one line of most package pages. A repaired valve is the patient's own; a replaced one is a purchased device with its own price and its own lifespan." }, "region": [ "global" ], "facets": { "family": "cardiac", "setting": "inpatient", "anaesthesia": "general" }, "text": { "what": "A diseased valve — most often the aortic or the mitral — is cut out and a mechanical or tissue prosthesis is sewn in its place, on cardiopulmonary bypass through an opened chest, or through a smaller incision with an endoscope. Eight nights on the Bangkok packages read for this record, seven for the endoscopic version. The choice of prosthesis decides what happens for the rest of the patient's life: a mechanical valve means warfarin and monthly blood tests, a tissue valve means a second operation in ten to twenty years.", "story": "Bangkok Heart Hospital prices valve work the way it prices bypass: by level, with the nights inside. Valve replacement or repair at Level 1 is 966,000 baht for eight nights; Level 2 is 1,196,000 for the same eight; totally 3D endoscopic valve replacement or repair is 1,400,000 against a struck-through 1,610,500, for seven. Prices stated valid until 31 October 2026.\n\nThe same exclusion list governs all three, and it contains the same five words as the stent package: \"special device used during procedure\". A prosthetic valve is a manufactured device. So the published price of a valve replacement covers the theatre, the team, the intensive care unit and the stated nights, and the valve is quoted separately.\n\n*Inference —* that is the same shape as the knee package that excludes the implant and the stent package that excludes the stent, and it recurs across three unrelated specialties on hospital pages written for foreign patients. The pattern is not deception; it is what happens when a hospital fixes a price for its own work and passes a manufacturer's price straight through. It does mean the headline figure for an implant operation is never the bill.\n\nThe state comparison prices the surgeon alone. The Australian schedule sets item 38484 — aortic or pulmonary valve replacement with bioprosthesis or mechanical prosthesis — at $2,429.60, and item 38499, the mitral or tricuspid equivalent, at the same figure. The valve, the pump, the ward and the anaesthetist are elsewhere.", "how": "Sternotomy or a small right-sided incision, cardiopulmonary bypass, the heart stopped, the diseased valve excised, the prosthesis sutured into the annulus, the heart restarted, the chest closed. A day or two in intensive care and the rest of the stay on the ward. Anticoagulation is started before discharge and, for a mechanical valve, never stopped.\n\nFor a patient who travelled, the anticoagulation is the part no package covers: monitoring a warfarin dose needs a laboratory and a clinician within reach, weekly at first, and every package read for this record ends at the airport.", "today": "As of 17 September 2026 the published Thai package prices for valve replacement or repair are 966,000 and 1,196,000 baht for eight nights and 1,400,000 baht for seven by endoscope, with the prosthesis excluded as a special device. Ireland's own admitted-patient price for a valve intervention with pump runs EUR 40,253 to EUR 80,201 by complexity. The Australian schedule fee for the surgeon's service is $2,429.60.", "notes": "This page describes an operation and the prices published for it. It is not medical advice." }, "metrics": { "stay_days": 8, "days_before_flying": 10, "recovery_weeks": 12, "mortality_per_1000": null, "note": "Eight nights is the stay named in the Bangkok Heart Hospital valve packages read for this record, seven for the endoscopic version; those are the packages' figures, not a clinical standard. The ten-day figure is the CDC's guidance not to fly for ten days after chest surgery. Twelve weeks is the span usually quoted for return to ordinary activity. No registry read for this record publishes valve outcomes for the hospitals named here, so mortality stays empty.", "as_of": "2026-09-17", "source": "s:cdc-yellowbook-medical-tourism", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" }, "prices": [ { "procedure": "heart-valve-replacement", "country": "TH", "city": "Bangkok", "facility": "bangkok-hospital", "amount": 966000, "currency": "THB", "as_of": "2026-09-17", "kind": "package", "includes": [ "valve replacement or repair, Level 1", "operating room and recovery room", "specified medical supplies and medications used during the procedure", "surgeon team and anaesthesiologist fees", "intermediate critical care unit and critical care unit", "standard inpatient room for the stated 8 nights", "hospital fee, meals and related equipment during the stay" ], "excludes": [ "special device used during the procedure — which is what a prosthetic valve is", "pre-assessment and medical clearance", "other specialists' consultations", "expense arising from underlying conditions", "extra nights in critical care or on the ward", "home medications, including the anticoagulant a mechanical valve commits the patient to" ], "source": "s:bangkokhospital-heart-packages", "url": "https://www.bangkokhospital.com/en/bangkok-heart/package/heart-catheterization-surgery", "note": "Level 2 of the same package is 1,196,000 THB for the same 8 nights; the levels are not defined on the page. Prices stated valid until 31 October 2026. Replacement and repair are priced on one line, though only one of them buys a device.", "tier": "cited", "usd": 29014.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "heart-valve-replacement", "country": "TH", "city": "Bangkok", "facility": "bangkok-hospital", "amount": 1400000, "currency": "THB", "as_of": "2026-09-17", "kind": "package", "includes": [ "totally 3D endoscopic valve replacement or repair", "7 nights in hospital", "theatre, surgical team and anaesthesiologist as specified" ], "excludes": [ "special device used during the procedure", "pre-assessment", "other specialists", "extra nights", "home medications" ], "source": "s:bangkokhospital-heart-packages", "url": "https://www.bangkokhospital.com/en/bangkok-heart/package/heart-catheterization-surgery", "note": "listed at 1,400,000 THB against a struck-through 1,610,500 THB, marked New, 7 nights. The endoscopic route costs more than the open one and keeps the patient a night less.", "tier": "cited", "usd": 42049.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "heart-valve-replacement", "country": "AU", "amount": 2429.6, "currency": "AUD", "as_of": "2026-09-17", "kind": "tariff", "includes": [ "item 38484: aortic or pulmonary valve replacement with bioprosthesis or mechanical prosthesis, including retrograde cardioplegia if performed" ], "excludes": [ "the prosthesis", "the hospital, the theatre, the pump, the anaesthetist and the intensive care" ], "source": "s:mbs-38484", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=38484&qt=item", "note": "the Medicare Benefits Schedule fee, 75% benefit $1,822.20, read on 17 September 2026. Item 38499, mitral or tricuspid replacement, carries the same fee — the schedule prices the operation by the work, not by which valve.", "tier": "cited", "usd": 1732.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "heart-valve-replacement", "country": "IE", "amount": 40253, "currency": "EUR", "as_of": "2026-09-17", "kind": "tariff", "includes": [ "DRG F04C CRD VLV INTERVTN+PMP-INV INVES, MINC — cardiac valve intervention with pump, without invasive cardiac investigation, at minor complexity, as an inlier inpatient episode" ], "excludes": [ "stays beyond the high boundary, paid per diem on top", "travel and accommodation" ], "source": "s:hse-abf-2024-inpatient", "url": "https://assets.hse.ie/media/documents/ABF_2024_Admitted_Patient_Price_List_-_Inpatient_Only.pdf", "note": "the same group runs EUR 50,628 at intermediate complexity and EUR 80,201 at major; where the admission also includes invasive cardiac investigation the group is F03, at EUR 52,054 and EUR 70,953. One operation, six prices, sorted by how sick the patient is — the opposite of the Thai page's two undefined levels.", "tier": "cited", "usd": 46443.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "cabg", "as": "The other open-heart operation, priced above this one on the same Bangkok list.", "rel": "kin" }, { "to": "angioplasty-stent", "as": "The catheter procedure whose package carries the same five-word device exclusion.", "rel": "kin" }, { "to": "knee-replacement", "as": "The other implant operation whose package price excludes the implant.", "rel": "contrast" }, { "to": "bangkok-hospital", "as": "Publishes the valve packages this page reads, prosthesis excluded.", "rel": "performed-at" }, { "to": "thailand", "as": "Where valve surgery is sold by level, by nights, and without the valve.", "rel": "destination" }, { "to": "australia", "as": "Where the schedule prices the surgeon's service at a fixed fee whichever valve it is.", "rel": "destination" }, { "to": "implant-excluded", "as": "The line item this operation's headline price leaves out.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Who monitors the anticoagulation a mechanical valve requires, weekly, at home.", "rel": "risk" }, { "to": "revision-at-home", "as": "Who replaces a tissue valve in fifteen years, and where.", "rel": "risk" }, { "to": "flying-after-surgery", "as": "The rule that keeps a chest-surgery patient on the ground.", "rel": "risk" }, { "to": "reading-the-exclusions", "as": "The step at which special device turns out to mean the valve.", "rel": "step" }, { "to": "package-price", "as": "The pricing form this operation is sold in, and the reason its exclusions matter.", "rel": "term" } ], "confusable_with": [ { "id": "cabg", "tell": "Bypass reroutes blood around blocked arteries; valve surgery replaces a door inside the heart. The two are sold on the same package page and are not alternatives to each other." } ], "links": [ { "label": "Bangkok Heart Hospital — cardiovascular surgery packages", "url": "https://www.bangkokhospital.com/en/bangkok-heart/package/heart-catheterization-surgery" }, { "label": "MBS item 38484", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=38484&qt=item" } ], "sources": [ "s:bangkokhospital-heart-packages", "s:mbs-38484", "s:cdc-yellowbook-medical-tourism", "s:hse-abf-2024-inpatient" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:bangkokhospital-heart-packages", "note": "package figures and exclusion wording read off the hospital's own page on 17 September 2026; the paragraph drawing the three specialties together is marked as this project's reasoning" }, "text.how": { "tier": "tradition", "note": "standard operative description; the anticoagulation point follows from the prosthesis type and is hedged in the prose" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:cdc-yellowbook-medical-tourism" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Prosthetic heart valve.jpg", "File:Bileaflet mechanical heart valve.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "A diseased valve — most often the aortic or the mitral — is cut out and a mechanical or tissue prosthesis is sewn in its place, on cardiopulmonary bypass through an opened chest, or through a smaller incision with an…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The other open-heart operation, priced above this one on the same Bangkok list.", "rel": "kin" }, { "to": "angioplasty-stent", "type": "procedure", "name": "Coronary angioplasty and stent", "as": "The catheter procedure whose package carries the same five-word device exclusion.", "rel": "kin" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The other implant operation whose package price excludes the implant.", "rel": "contrast" }, { "to": "bangkok-hospital", "type": "facility", "name": "Bangkok Hospital", "as": "Publishes the valve packages this page reads, prosthesis excluded.", "rel": "performed-at" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where valve surgery is sold by level, by nights, and without the valve.", "rel": "destination" }, { "to": "australia", "type": "destination", "name": "Australia", "as": "Where the schedule prices the surgeon's service at a fixed fee whichever valve it is.", "rel": "destination" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The line item this operation's headline price leaves out.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who monitors the anticoagulation a mechanical valve requires, weekly, at home.", "rel": "risk" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who replaces a tissue valve in fifteen years, and where.", "rel": "risk" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The rule that keeps a chest-surgery patient on the ground.", "rel": "risk" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step at which special device turns out to mean the valve.", "rel": "step" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The pricing form this operation is sold in, and the reason its exclusions matter.", "rel": "term" } ], "source_list": [ { "id": "s:bangkokhospital-heart-packages", "kind": "web", "title": "Coronary artery angiography / percutaneous coronary intervention and Cardiovascular Surgery — package list", "publisher": "Bangkok Heart Hospital, Bangkok Hospital", "url": "https://www.bangkokhospital.com/en/bangkok-heart/package/heart-catheterization-surgery", "accessed": "2026-09-17", "note": "read with the browser on 17 September 2026, prices stated valid until 31 October 2026: CABG Level 1 1,173,000 THB and Level 2 1,437,500 THB, 8 nights each; MICS CABG 1,500,000 THB, 7 nights; valve replacement or repair Level 1 966,000 THB and Level 2 1,196,000 THB, 8 nights; totally 3D endoscopic valve replacement or repair 1,400,000 THB, 7 nights; CAG and PCI transfemoral 299,000 THB and transradial 322,000 THB, 2 nights; CAG alone 62,100 to 69,000 THB. Exclusions name pre-assessment, other specialists' consultations, 'special device used during procedure', extra ICU or ward nights and home medications." }, { "id": "s:mbs-38484", "kind": "gov", "title": "MBS item 38484 — aortic or pulmonary valve replacement with bioprosthesis or mechanical prosthesis", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=38484&qt=item", "accessed": "2026-09-17", "note": "schedule fee $2,429.60, 75% benefit $1,822.20; the mitral or tricuspid equivalent, item 38499, carries the same fee" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:hse-abf-2024-inpatient", "kind": "gov", "title": "ABF 2024 Admitted Patient Price List — Inpatient Only", "publisher": "Health Service Executive (Ireland)", "url": "https://assets.hse.ie/media/documents/ABF_2024_Admitted_Patient_Price_List_-_Inpatient_Only.pdf", "accessed": "2026-09-17", "note": "the activity-based-funding inlier inpatient price per diagnosis-related group, linked from the HSE's Northern Ireland Planned Healthcare Scheme claim page and the list behind the CBD and NIPHS repayments. Rows read on 17 September 2026: F06C CRNRY BYPSS-INV INVES MINC EUR 30,040, F06B EUR 34,430, F06A EUR 50,579; F05B CRNRY BYPSS+INV INVES MINC EUR 45,093; F04C CRD VLV INTERVTN+PMP-INV INVES MINC EUR 40,253, F04B EUR 50,628, F04A EUR 80,201; F19B TRNS-VSCLR PERC CRDC INTERVTN MINC EUR 9,887, F19A EUR 42,060; F10B INTERVENTIONAL CRNRY PR + AMI MINC EUR 8,857; M01B MAJOR MALE PELVIC INTERVTNS MINC EUR 19,899, M01A EUR 26,820; M02B TRANSURTH PROSTMY MINC EUR 8,363; N04B HYSTERECTOMY FOR N-MAL MINC EUR 13,282; G10B HERNIA INTERVENTIONS MINC EUR 9,046, G10A MAJC EUR 15,366; H08B LAP CHOLECYSTECTOMY MINC EUR 9,867, H07C OPEN CHOLECYSTECTOMY MINC EUR 16,206. An inlier price assumes a length of stay between the low and high boundaries printed beside it." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:bangkokhospital-heart-packages", "note": "package figures and exclusion wording read off the hospital's own page on 17 September 2026; the paragraph drawing the three specialties together is marked as this project's reasoning" }, "text.how": { "tier": "tradition", "note": "standard operative description; the anticoagulation point follows from the prosthesis type and is hedged in the prose" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:cdc-yellowbook-medical-tourism" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "bengaluru", "type": "hub", "name": "Bengaluru", "as": "The other half of the cardiac list this city is known for.", "rel": "procedure" }, { "from": "angioplasty-stent", "type": "procedure", "name": "Coronary angioplasty and stent", "as": "The other cardiac package on the same Thai list, sold by level and by nights.", "rel": "kin" }, { "from": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The other open-heart operation, priced below this one on the same Bangkok list.", "rel": "kin" }, { "from": "blood-supply-safety", "type": "risk", "name": "Blood supply safety", "as": "Open-chest surgery, with the same transfusion exposure.", "rel": "procedure" } ] }, { "schema": 1, "id": "hernia-repair", "type": "procedure", "names": { "name": "Hernia repair", "aliases": [ "herniorrhaphy", "hernioplasty", "inguinal hernia repair", "umbilical hernia repair" ], "said": "Price pages say hernia and then say which one and how many sides: unilateral or bilateral, open, laparoscopic or robotic. Four words, four prices, one page." }, "etymology": { "root": "hernia is Latin for a rupture, from a root meaning a bud or sprout pushing through. Herniorrhaphy adds Greek rhaphē, a seam or suture — sewing the rupture; hernioplasty, plastos, moulded, names the version done with a mesh. Inguinal is Latin inguen, the groin.", "tier": "tradition", "note": "Mesh is the point of contention in this operation's literature and is not a separate line on any package read for this record; where the package says medical supplies used during surgery under the physician's consideration, specific model, the mesh is inside that phrase." }, "region": [ "global" ], "facets": { "family": "general-surgery", "setting": "day-case", "anaesthesia": "general" }, "text": { "what": "A defect in the abdominal wall is closed and usually reinforced with a synthetic mesh, through an open incision or through keyhole ports. The commonest general-surgical operation in most countries. One night on the Bangkok packages read for this record; a day case on the Irish and Australian payer schedules, which price it both ways.", "story": "Eight prices for one operation, on one hospital's page, on one day.\n\nBumrungrad in Bangkok lists open initial inguinal hernia repair at 199,600 baht for one side and 304,700 for two; laparoscopic at 243,500 and 382,000; robotic-assisted at 350,000 and 430,000; and robotic umbilical hernia repair at 420,000. The route is a price tier, and the second side is not double.\n\nThe package that was read in full — laparoscopic, one side, SUR05, prices stated valid until 31 December 2026 — buys two hours of theatre, one night in a single room, the medical supplies and equipment used during surgery under the physician's consideration, the anaesthesia, and fees for surgeon, assistant, anaesthetist, admission, one day of ward rounds and the discharge summary. It excludes outpatient charges and anything before the operation, stays beyond one day or in intensive care, other specialists' consultations, complex or emergency cases, blood transfusion, tests before and after, and take-home medication.\n\nThe payer versions do the arithmetic differently. Ireland prices hernia interventions at minor complexity as DRG G10B: EUR 9,046 as an inpatient stay and EUR 5,151 as a day case, the group covering repair of incisional, femoral, inguinal, umbilical or epigastric hernia — five operations in one price. Australia pays the surgeon $556.05 under item 30648, femoral or inguinal hernia repair by open or minimally invasive approach in a patient ten years or over, with a 75% benefit of $417.05, and says nothing about which approach.\n\n*Inference —* the Thai page prices the technique and the Irish tariff prices the diagnosis, which is why a robot costs 75% more in Bangkok and nothing at all in Dublin. Both are internally consistent. Neither is a price for the same thing.", "how": "Open repair is a groin incision, the sac reduced, a mesh laid over the defect, the wound closed — often under general anaesthesia on these pages, though the operation is also done under local. Laparoscopic and robotic repairs place the mesh from inside through three ports, and cost more on every page read here.\n\nRecovery is measured in days for desk work and weeks for lifting, which is why this is the operation most often sold as a day case where a health service is buying and as a one-night package where a hospital is selling. Ireland's tariff prices both forms of the same group and the day case is 57% of the inpatient price.\n\nThe queue is the other half. Ireland's National Treatment Purchase Fund counted 115,450 people waiting for an inpatient or day-case appointment at the end of May 2026; NHS England's median wait across all pathways at the end of July 2026 was 12.0 weeks, with 111,379 people past 52 weeks.", "today": "As of 17 September 2026 a one-sided inguinal repair is published at 199,600 baht open, 243,500 laparoscopic and 350,000 robotic in Bangkok, with one night included. Ireland's own price for the hernia group is EUR 9,046 as an inpatient and EUR 5,151 as a day case, and the Australian schedule fee for the surgeon is $556.05.", "notes": "This page describes an operation and the prices published for it. It is not medical advice." }, "metrics": { "stay_days": 1, "days_before_flying": 10, "recovery_weeks": 4, "wait_days_home": 84, "note": "One night is the stay named in the Bumrungrad laparoscopic hernia package read for this record; Ireland's tariff prices the same group as a day case at EUR 5,151 and as an inpatient stay with an average length of 2.1 days. The eighty-four days is the median wait of 12.0 weeks across all pathways waiting to start treatment in England at the end of July 2026, published by NHS England — an all-specialty median for the English market, not a hernia figure. The ten-day figure is the CDC's guidance not to fly for ten days after abdominal surgery. Four weeks is the span usually quoted before heavy lifting.", "as_of": "2026-07-31", "source": "s:nhs-rtt-july-2026", "url": "https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Jul26-RTT-statistical-press-notice-PDF-578K-97ylx5.pdf" }, "prices": [ { "procedure": "hernia-repair", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 243500, "currency": "THB", "as_of": "2026-09-17", "kind": "package", "includes": [ "operating room for 2 hours including theatre, nurse assisting surgeon and operating team", "single room for 1 night including nursing service and regular menu meals", "medical supplies and equipment used during surgery under the physician's consideration, specific model", "anaesthesia and necessary medication during the procedure", "doctor fees: surgeon, assistant surgeon, anaesthesiologist", "admission physician fees, one day of daily round physician fees and the discharge summary fee" ], "excludes": [ "expenses at the outpatient unit or before the operation", "inpatient stays beyond one day, intensive care, or nights past the day discharge was approved", "consultations with other specialists", "complex cases requiring emergency surgery or equipment beyond the package", "blood transfusion, laboratory tests and other diagnostic tests before and after the operation", "items of a personal nature", "take-home medication and supplies" ], "source": "s:bumrungrad-sur05", "url": "https://www.bumrungrad.com/en/packages/laparoscopic-inguinal-hernia-repair-1-side", "note": "package SUR05, laparoscopic, one side, prices stated valid until 31 December 2026. Both sides is 382,000 THB. The mesh is not named anywhere on the page: it sits inside 'medical supplies and equipment used during surgery under the physician's consideration (specific model)'.", "tier": "cited", "usd": 7314.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "hernia-repair", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 199600, "amount_high": 430000, "currency": "THB", "as_of": "2026-09-17", "kind": "list", "includes": [ "the ladder of routes on one page: open one side 199,600 and both sides 304,700; laparoscopic 243,500 and 382,000; robotic-assisted 350,000 and 430,000; robotic umbilical repair 420,000" ], "excludes": [ "as the individual packages: outpatient charges, extra nights, other specialists, tests before and after, home medication" ], "source": "s:bumrungrad-surgical-packages", "url": "https://www.bumrungrad.com/en/packages/packages-center/surgical-clinics", "note": "read off the surgical clinic's package list on 17 September 2026. The robot adds 75% to the open price for the same hernia, and the second side adds between 53% and 57% rather than 100%.", "tier": "cited", "usd": 5995.0, "usd_high": 12915.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "hernia-repair", "country": "IE", "amount": 5151, "amount_high": 9046, "currency": "EUR", "as_of": "2026-09-17", "kind": "reimbursement", "includes": [ "DRG G10B HERNIA INTERVENTIONS, MINC: repair of incisional, femoral, inguinal, umbilical or epigastric hernia", "the whole episode — EUR 5,151 as a day case, EUR 9,046 as an inlier inpatient stay" ], "excludes": [ "stays beyond the high boundary, paid per diem on top", "travel and accommodation" ], "source": "s:hse-cbd-niphs-drg-guide", "url": "https://assets.hse.ie/media/documents/CBD-NIPHS-Most-Common-Procedures-DRG-Guide.pdf", "note": "what Ireland repays a patient treated abroad under the Cross Border Directive or the Northern Ireland Planned Healthcare Scheme, and its own price for the admission. The major-complexity version, G10A, is EUR 15,366. One price for five different hernias and for every surgical route.", "tier": "cited", "usd": 5943.0, "usd_high": 10437.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "hernia-repair", "country": "AU", "amount": 556.05, "currency": "AUD", "as_of": "2026-09-17", "kind": "tariff", "includes": [ "item 30648: femoral or inguinal hernia or infantile hydrocele, repair of, by open or minimally invasive approach, on a patient 10 years of age or over" ], "excludes": [ "the hospital, the theatre, the ward, the anaesthetist and the mesh" ], "source": "s:mbs-30648", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=30648&qt=item", "note": "the Medicare Benefits Schedule fee, 75% benefit $417.05, read on 17 September 2026. One fee whether the surgeon operates open or by keyhole — the opposite of the Thai page, where the route is the price.", "tier": "cited", "usd": 396.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "gallbladder-removal", "as": "The other keyhole operation on the same Bangkok package list and the same Irish tariff.", "rel": "kin" }, { "to": "prostatectomy", "as": "The other pelvic operation sold by the night and the route.", "rel": "kin" }, { "to": "bumrungrad", "as": "Publishes the eight hernia prices this page reads, mesh unnamed inside the supplies line.", "rel": "performed-at" }, { "to": "thailand", "as": "Where the surgical route is a price tier and the second side is not double.", "rel": "destination" }, { "to": "australia", "as": "Where one schedule fee covers every route to the same repair.", "rel": "destination" }, { "to": "united-kingdom", "as": "The source market whose waiting list makes a foreign price worth reading.", "rel": "destination" }, { "to": "eu-directive-2011-24", "as": "The route under which an Irish patient is repaid at the Irish price for a hernia done abroad.", "rel": "rule" }, { "to": "reading-the-exclusions", "as": "The step at which one night turns out to mean one night exactly.", "rel": "step" }, { "to": "revision-at-home", "as": "Who repairs a recurrence, and who deals with chronic groin pain after a mesh.", "rel": "risk" }, { "to": "flying-after-surgery", "as": "The clot risk that sets how long after abdominal surgery a patient can board.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Who looks at the wound at two weeks once the patient has flown.", "rel": "risk" }, { "to": "oecd-waiting-times", "as": "The series that counts the queue for exactly this kind of operation.", "rel": "measured-by" } ], "confusable_with": [ { "id": "gallbladder-removal", "tell": "Both are sold as short keyhole packages; one closes a wall and one removes an organ, and the gallbladder package is the dearer of the two at the same hospital." } ], "links": [ { "label": "Bumrungrad — laparoscopic inguinal hernia repair, one side", "url": "https://www.bumrungrad.com/en/packages/laparoscopic-inguinal-hernia-repair-1-side" }, { "label": "HSE — CBD / NIPHS most common procedures DRG guide", "url": "https://assets.hse.ie/media/documents/CBD-NIPHS-Most-Common-Procedures-DRG-Guide.pdf" } ], "sources": [ "s:bumrungrad-sur05", "s:bumrungrad-surgical-packages", "s:hse-cbd-niphs-drg-guide", "s:hse-abf-2024-inpatient", "s:mbs-30648", "s:nhs-rtt-july-2026", "s:ntpf-may-2026", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:bumrungrad-sur05", "note": "all eight Thai prices and the package terms read off the hospital's own pages on 17 September 2026; tariff figures read off the Irish guide and the Australian item page; the closing stretch is this project's reasoning and is marked" }, "text.how": { "tier": "tradition", "note": "standard operative description; the waiting figures are cited and labelled as all-specialty" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:nhs-rtt-july-2026" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Inguinal hernia repair.jpg", "File:Hernia mesh.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "A defect in the abdominal wall is closed and usually reinforced with a synthetic mesh, through an open incision or through keyhole ports. The commonest general-surgical operation in most countries.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "gallbladder-removal", "type": "procedure", "name": "Gallbladder removal", "as": "The other keyhole operation on the same Bangkok package list and the same Irish tariff.", "rel": "kin" }, { "to": "prostatectomy", "type": "procedure", "name": "Prostatectomy", "as": "The other pelvic operation sold by the night and the route.", "rel": "kin" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Publishes the eight hernia prices this page reads, mesh unnamed inside the supplies line.", "rel": "performed-at" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the surgical route is a price tier and the second side is not double.", "rel": "destination" }, { "to": "australia", "type": "destination", "name": "Australia", "as": "Where one schedule fee covers every route to the same repair.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The source market whose waiting list makes a foreign price worth reading.", "rel": "destination" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route under which an Irish patient is repaid at the Irish price for a hernia done abroad.", "rel": "rule" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step at which one night turns out to mean one night exactly.", "rel": "step" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who repairs a recurrence, and who deals with chronic groin pain after a mesh.", "rel": "risk" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The clot risk that sets how long after abdominal surgery a patient can board.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who looks at the wound at two weeks once the patient has flown.", "rel": "risk" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The series that counts the queue for exactly this kind of operation.", "rel": "measured-by" } ], "source_list": [ { "id": "s:bumrungrad-sur05", "kind": "web", "title": "Laparoscopic Inguinal Hernia Repair (Unilat) 1 Side — package SUR05", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/laparoscopic-inguinal-hernia-repair-1-side", "accessed": "2026-09-17", "note": "243,500 THB, valid until 31 December 2026; two hours of theatre and one night; exclusions name stays beyond one day, ICU, consultations, blood transfusion, pre- and post-operative tests and take-home medication" }, { "id": "s:bumrungrad-surgical-packages", "kind": "web", "title": "Surgical Clinic — package list", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/packages-center/surgical-clinics", "accessed": "2026-09-17", "note": "read with the browser on 17 September 2026: laparoscopic cholecystectomy 240,930 THB against 267,700; robotic-assisted cholecystectomy 349,500; open inguinal hernia repair one side 199,600 and both sides 304,700; laparoscopic inguinal hernia repair one side 243,500 and both sides 382,000; robotic inguinal hernia repair one side 350,000 and both 430,000; robotic umbilical hernia repair 420,000" }, { "id": "s:hse-cbd-niphs-drg-guide", "kind": "gov", "title": "CBD / NIPHS Most Common Procedures DRG Guide", "publisher": "Health Service Executive (Ireland)", "url": "https://assets.hse.ie/media/documents/CBD-NIPHS-Most-Common-Procedures-DRG-Guide.pdf", "accessed": "2026-09-16", "note": "the tariff behind both the Cross Border Directive scheme and the Northern Ireland Planned Healthcare Scheme. Cataract procedures map to DRG C16Z LENS INTERVENTIONS at a day-case price of EUR 1,171, covering phacoemulsification or other extraction of the crystalline lens and capsulotomy; colonoscopy G48B EUR 1,001; gastroscopy G47C EUR 726. Same figure as the HSE's 2024 activity-based-funding day-case price list." }, { "id": "s:hse-abf-2024-inpatient", "kind": "gov", "title": "ABF 2024 Admitted Patient Price List — Inpatient Only", "publisher": "Health Service Executive (Ireland)", "url": "https://assets.hse.ie/media/documents/ABF_2024_Admitted_Patient_Price_List_-_Inpatient_Only.pdf", "accessed": "2026-09-17", "note": "the activity-based-funding inlier inpatient price per diagnosis-related group, linked from the HSE's Northern Ireland Planned Healthcare Scheme claim page and the list behind the CBD and NIPHS repayments. Rows read on 17 September 2026: F06C CRNRY BYPSS-INV INVES MINC EUR 30,040, F06B EUR 34,430, F06A EUR 50,579; F05B CRNRY BYPSS+INV INVES MINC EUR 45,093; F04C CRD VLV INTERVTN+PMP-INV INVES MINC EUR 40,253, F04B EUR 50,628, F04A EUR 80,201; F19B TRNS-VSCLR PERC CRDC INTERVTN MINC EUR 9,887, F19A EUR 42,060; F10B INTERVENTIONAL CRNRY PR + AMI MINC EUR 8,857; M01B MAJOR MALE PELVIC INTERVTNS MINC EUR 19,899, M01A EUR 26,820; M02B TRANSURTH PROSTMY MINC EUR 8,363; N04B HYSTERECTOMY FOR N-MAL MINC EUR 13,282; G10B HERNIA INTERVENTIONS MINC EUR 9,046, G10A MAJC EUR 15,366; H08B LAP CHOLECYSTECTOMY MINC EUR 9,867, H07C OPEN CHOLECYSTECTOMY MINC EUR 16,206. An inlier price assumes a length of stay between the low and high boundaries printed beside it." }, { "id": "s:mbs-30648", "kind": "gov", "title": "MBS item 30648 — femoral or inguinal hernia or infantile hydrocele, repair of, patient 10 years or over", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=30648&qt=item", "accessed": "2026-09-17", "note": "schedule fee $556.05, 75% benefit $417.05; found through the MBS keyword search for inguinal hernia" }, { "id": "s:nhs-rtt-july-2026", "kind": "gov", "title": "Statistical Press Notice — NHS referral to treatment (RTT) waiting times data, July 2026", "publisher": "NHS England", "url": "https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Jul26-RTT-statistical-press-notice-PDF-578K-97ylx5.pdf", "accessed": "2026-09-16", "note": "published Thursday 10 September 2026. 7.3 million RTT pathways waiting to start treatment at the end of July 2026, an estimated 6.2 million unique patients; 111,379 waiting over 52 weeks, 9,095 over 65 weeks, 235 over 104 weeks; 65.4% waiting up to 18 weeks against a 92% standard; median wait 12.0 weeks. Figures include estimates for three trusts and one independent provider that did not submit." }, { "id": "s:ntpf-may-2026", "kind": "gov", "title": "NTPF Publishes May 2026 National Public Hospital Waiting List Data", "publisher": "National Treatment Purchase Fund (Ireland)", "url": "https://www.ntpf.ie/news_and_events/ntpf-publishes-may-2026-national-public-hospital-waiting-list-data/", "accessed": "2026-09-16", "note": "at the end of May 2026: 669,506 waiting for a first outpatient consultation, 115,450 for an inpatient or day-case appointment, 40,986 for a GI endoscopy, 34,049 suspended, 111,643 on the planned-procedure list" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:bumrungrad-sur05", "note": "all eight Thai prices and the package terms read off the hospital's own pages on 17 September 2026; tariff figures read off the Irish guide and the Australian item page; the closing stretch is this project's reasoning and is marked" }, "text.how": { "tier": "tradition", "note": "standard operative description; the waiting figures are cited and labelled as all-specialty" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:nhs-rtt-july-2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "gallbladder-removal", "type": "procedure", "name": "Gallbladder removal", "as": "The other keyhole operation on the same Bangkok list and the same Irish tariff, priced a little lower.", "rel": "kin" }, { "from": "prostatectomy", "type": "procedure", "name": "Prostatectomy", "as": "The other pelvic operation a foreign hospital sells by the night.", "rel": "kin" } ] }, { "schema": 1, "id": "hip-replacement", "type": "procedure", "names": { "name": "Total hip replacement", "aliases": [ "total hip arthroplasty", "THA", "THR", "hip arthroplasty" ], "said": "Surgeons say THA or THR. Package pages say total hip replacement. Where a page says direct anterior approach it is naming the way in, not a different joint." }, "etymology": { "root": "arthroplasty: Greek arthron, a joint, plus plastos, moulded. Hip is Old English hype, the same word for the bone and the flesh over it; the Latin acetabulum, the socket the surgeon reams, means a little vinegar cup.", "tier": "tradition", "note": "Unilateral is one hip, bilateral is both in one anaesthetic, and a price page that omits the word is usually quoting one." }, "region": [ "global" ], "facets": { "family": "orthopaedic", "setting": "inpatient", "anaesthesia": "regional" }, "text": { "what": "The worn ball and socket of the hip are cut out and replaced: a stem driven into the femur carrying a metal or ceramic head, and a cup fixed into the pelvis with a bearing inside it. It is done for arthritis, for fracture, and for a collapsed femoral head. The operation is short, the ward stay on published packages runs three to five nights, and the implant is billed separately from the surgery on most package price lists.", "story": "Hip replacement travels for the same reasons knee replacement does: it is elective, standardised, expensive at home, and queued. Where the two differ is on the price page. In Bangkok on 16 September 2026 the hip package at Bumrungrad is 425,200 baht against 356,500 for a knee, and it names four nights against the knee's three — the hip costs more and keeps the patient longer at the same hospital, under the same exclusions.\n\n*Trade practice —* the hip is also the joint most often sold with the approach named in the package title. Bangkok International Hospital prices a direct anterior approach hip at 420,000 baht for one side and 713,000 for two, implant excluded. The approach is a surgical argument, not a pricing category, and the literature on whether it changes the outcome at a year is not settled.\n\nThe same operation appears on three other kinds of page, and each counts something different. Practice Plus Group in England sells a hip replacement to a self-paying patient at £13,199, one number covering theatre, anaesthetic, the overnight stay, physiotherapy and post-operative appointments. Nordorthopaedics in Kaunas advertises hip replacement \"from 4.560 € / 3.800 £\" with no inclusion list on the page. Australia's Medicare Benefits Schedule sets item 49318, total arthroplasty of hip, at a schedule fee of $1,577.30 as at 1 July 2026 — which is the surgeon's fee alone, not the hospital, not the prosthesis, not the anaesthetist's own item.\n\n*Inference —* four numbers, four objects. Only the first two are the sort of thing a patient pays in one transaction, and only the first of those admits in writing that the implant is extra.", "how": "Spinal or epidural anaesthesia with sedation is usual. The surgeon reaches the joint from the back, the side or the front, dislocates it, cuts the femoral neck, reams the socket, seats the cup, broaches the femur, trials the components, reduces the new joint and closes. Standing happens the same day or the next. The NHS tells patients in England that a fit patient usually goes home one to three days after the operation, that stitches or clips come out at about ten days, and that the follow-up appointment falls six to twelve weeks out. Published packages abroad name three to five nights, which is longer, and a patient who flies has bought a hotel as well as a ward.", "today": "As of 16 September 2026, the hip prices on this site run from a Lithuanian clinic's advertised floor of 4,560 euro to £13,199 at an English self-pay hospital, with two Bangkok hospitals between them at 420,000 and 425,200 baht — both with the implant on the exclusion list. The Australian schedule fee of $1,577.30 sits in a different column because it buys a different thing: one doctor's service, with the bed and the prosthesis billed elsewhere.", "notes": "This page describes an operation and the prices published for it. It is not advice about having one, or about where." }, "metrics": { "stay_days": 4, "days_before_flying": 10, "recovery_weeks": 12, "note": "Four nights is the ward stay named in the Bumrungrad JOINT08 package; the NHS tells patients in England that a fit patient usually goes home one to three days after the operation, so the package night count is a commercial figure as much as a clinical one. The follow-up appointment at six to twelve weeks is the NHS figure. The ten days before flying is the CDC's guidance for chest or abdominal surgery, which orthopaedic teams commonly apply to major lower-limb surgery for the clot risk; no page read for this record names a figure for the hip itself.", "as_of": "2026-09-16", "source": "s:nhs-hip-recovery", "url": "https://www.nhs.uk/tests-and-treatments/hip-replacement/recovering-from-a-hip-replacement/" }, "prices": [ { "procedure": "hip-replacement", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 425200, "currency": "THB", "as_of": "2026-09-16", "kind": "package", "includes": [ "operating theatre 2.5 hours, including nursing and surgical team fees within those hours", "accommodation for 4 nights in the surgical ward", "medical equipment and medical supplies", "medications related to the procedure", "surgeon", "1 assistant surgeon if necessary", "anaesthesiologist", "physical therapy 7 sessions and occupational therapy 1 session" ], "excludes": [ "charges for implant", "consultation fee for an initial visit and follow-up visits", "inpatient stays beyond 4 nights, ICU, or stays past the approved discharge day", "specialist consultations", "outpatient fees before admission", "complex or emergency cases", "blood transfusion, laboratory tests and other diagnostic tests before and after operation", "take-home medications and medical supplies", "items of a personal nature" ], "source": "s:bumrungrad-joint08", "url": "https://www.bumrungrad.com/en/packages/total-hip-replacement-surgery", "note": "package JOINT08, price stated valid until 31 December 2026. The hip package runs 68,700 baht above the same hospital's knee package and adds a night. Exclusion nine on the hospital's own list reads: not include charges for implant.", "tier": "cited", "usd": 12771.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "hip-replacement", "country": "TH", "city": "Bangkok", "facility": "bangkok-hospital", "amount": 420000, "currency": "THB", "as_of": "2026-09-16", "kind": "package", "includes": [ "operating room charges", "recovery room charges", "medical supplies", "fees of the surgical and anaesthesia teams", "standard room, nursing and meals for 4 nights", "medications related to the surgery to take home" ], "excludes": [ "implants", "medical clearance evaluation", "specialist consultant fees", "treatment of underlying conditions", "laboratory tests", "complications", "ICU or extended stay charges" ], "source": "s:bangkok-hospital-hip-knee", "url": "https://www.bangkokhospital.com/en/bangkok-bone-brain/package/hip-knee-surgery-packages", "note": "direct anterior approach total hip arthroplasty, one side, four nights, implant excluded; the two-sided package on the same page is 713,000 THB for five nights. Prices stated valid until 31 December 2026.", "tier": "cited", "usd": 12615.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "hip-replacement", "country": "GB", "city": "England", "amount": 13199, "currency": "GBP", "as_of": "2026-09-16", "kind": "list", "includes": [ "pre-operative nurse review", "prescriptions, dressings and equipment", "anaesthetic", "any overnight stay required", "physiotherapy", "pathology and histology needed whilst admitted", "any post-operative appointments required", "a named consultant from start to finish" ], "excludes": [ "the initial consultation, listed separately at £145, which the page says includes x-rays and blood tests" ], "source": "s:practiceplus-hip", "url": "https://practiceplusgroup.com/treatments/hip-surgery/", "note": "the group's published self-pay price for hip replacement; hip revision on the same list is £22,249 and hip resurfacing £13,999 at one hospital only. The implant is not named on either side of the list, which is a different silence from naming it as an exclusion.", "tier": "cited", "usd": 17788.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "hip-replacement", "country": "LT", "city": "Kaunas", "amount": 4560, "currency": "EUR", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [], "excludes": [], "source": "s:nordorthopaedics-prices", "url": "https://www.nordorthopaedics.com/hip-knee-wrist-hand-ankle-foot-shoulder-surgery-prices/", "note": "advertised as \"from 4.560 € / 3.800 £\"; the price page carries no inclusion or exclusion list at all. The same page heads the list with an offer to help patients claim a refund from their home health board under the EU cross-border care route.", "tier": "cited", "usd": 5261.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "hip-replacement", "country": "AU", "amount": 1577.3, "currency": "AUD", "as_of": "2026-07-01", "kind": "tariff", "includes": [ "the medical service described in item 49318: total arthroplasty of hip, including minor bone grafting if performed" ], "excludes": [ "hospital accommodation and theatre", "the prosthesis", "the anaesthetist's own items", "any amount the surgeon charges above the schedule fee" ], "source": "s:mbs-49318", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=49318&qt=item", "note": "Medicare Benefits Schedule item 49318, fee last updated 1 July 2026. The 75% benefit — what Medicare pays towards a private in-hospital service — is $1,183.00, and the remainder falls to an insurer or the patient. *Trade practice —* the bed, the theatre and the prosthesis are paid on other schedules entirely, which is why a schedule fee and a package price can never be compared straight across.", "tier": "cited", "usd": 1124.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "knee-replacement", "as": "The same trade, the other joint — and the cheaper package at the same Bangkok hospital, by 68,700 baht.", "rel": "contrast" }, { "to": "bumrungrad", "as": "Publishes the four-night hip package this page reads, implant excluded.", "rel": "performed-at" }, { "to": "bangkok-hospital", "as": "Prices a direct anterior approach hip on its own page, implant excluded.", "rel": "performed-at" }, { "to": "thailand", "as": "Where both package prices on this page are sold.", "rel": "destination" }, { "to": "united-kingdom", "as": "Where the self-pay price on this page is sold, and the queue most of its buyers are leaving.", "rel": "destination" }, { "to": "lithuania", "as": "Where the advertised floor price on this page comes from, refund paperwork offered with it.", "rel": "destination" }, { "to": "implant-excluded", "as": "The line the Bangkok packages put in writing and the English price list does not mention.", "rel": "risk" }, { "to": "package-price", "as": "The pricing form this operation is sold in, and the reason its exclusions decide the bill.", "rel": "term" }, { "to": "tariff", "as": "What the Australian schedule fee is, and why it is not a price a patient pays.", "rel": "term" }, { "to": "flying-after-surgery", "as": "The clot risk that sets how long after this operation a patient can board.", "rel": "risk" }, { "to": "revision-at-home", "as": "Who operates when the cup loosens, and who pays for it.", "rel": "risk" }, { "to": "oecd-waiting-times", "as": "The series that counts the queue this operation is best known for.", "rel": "measured-by" }, { "to": "eu-directive-2011-24", "as": "The refund route the Lithuanian price page leads with.", "rel": "governed-by" } ], "confusable_with": [ { "id": "knee-replacement", "tell": "A broker's \"joint replacement\" quote names neither joint until asked; the hip package is dearer and the knee recovers more slowly." }, { "id": "disc-replacement", "tell": "Both are called replacements and both exclude the implant, but one is a limb joint and the other a spinal segment priced by the level." } ], "links": [ { "label": "Bumrungrad package JOINT08", "url": "https://www.bumrungrad.com/en/packages/total-hip-replacement-surgery" }, { "label": "MBS item 49318", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=49318&qt=item" } ], "sources": [ "s:bumrungrad-joint08", "s:bangkok-hospital-hip-knee", "s:practiceplus-hip", "s:nordorthopaedics-prices", "s:mbs-49318", "s:nhs-hip-recovery", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "every figure is read off a named page; the marked stretches are trade account and this project's reasoning" }, "text.how": { "tier": "tradition", "note": "standard operative description; the day counts are cited to the NHS recovery page" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:nhs-hip-recovery", "note": "the flying figure is the CDC's guidance for other surgery, applied by analogy and marked as such" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Hip replacement Image 3684-PH.jpg", "File:Total hip replacement radiograph.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "The worn ball and socket of the hip are cut out and replaced: a stem driven into the femur carrying a metal or ceramic head, and a cup fixed into the pelvis with a bearing inside it.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The same trade, the other joint — and the cheaper package at the same Bangkok hospital, by 68,700 baht.", "rel": "contrast" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Publishes the four-night hip package this page reads, implant excluded.", "rel": "performed-at" }, { "to": "bangkok-hospital", "type": "facility", "name": "Bangkok Hospital", "as": "Prices a direct anterior approach hip on its own page, implant excluded.", "rel": "performed-at" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where both package prices on this page are sold.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Where the self-pay price on this page is sold, and the queue most of its buyers are leaving.", "rel": "destination" }, { "to": "lithuania", "type": "destination", "name": "Lithuania", "as": "Where the advertised floor price on this page comes from, refund paperwork offered with it.", "rel": "destination" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The line the Bangkok packages put in writing and the English price list does not mention.", "rel": "risk" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The pricing form this operation is sold in, and the reason its exclusions decide the bill.", "rel": "term" }, { "to": "tariff", "type": "term", "name": "Tariff", "as": "What the Australian schedule fee is, and why it is not a price a patient pays.", "rel": "term" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The clot risk that sets how long after this operation a patient can board.", "rel": "risk" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who operates when the cup loosens, and who pays for it.", "rel": "risk" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The series that counts the queue this operation is best known for.", "rel": "measured-by" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The refund route the Lithuanian price page leads with.", "rel": "governed-by" } ], "source_list": [ { "id": "s:bumrungrad-joint08", "kind": "web", "title": "Total Hip Replacement Surgery (Exclude implant) — package JOINT08", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/total-hip-replacement-surgery", "accessed": "2026-09-16", "note": "425,200 THB, four nights, implant excluded; price stated valid until 31 December 2026" }, { "id": "s:bangkok-hospital-hip-knee", "kind": "web", "title": "Hip & Knee Surgery Packages", "publisher": "Bangkok International Hospital (Bangkok Bone and Brain)", "url": "https://www.bangkokhospital.com/en/bangkok-bone-brain/package/hip-knee-surgery-packages", "accessed": "2026-09-16", "note": "package prices with nights and an implant-excluded line; valid until 31 December 2026" }, { "id": "s:practiceplus-hip", "kind": "web", "title": "Hip surgery: costs and care plans — self-pay price list", "publisher": "Practice Plus Group", "url": "https://practiceplusgroup.com/treatments/hip-surgery/", "accessed": "2026-09-16" }, { "id": "s:nordorthopaedics-prices", "kind": "web", "title": "Orthopaedic Surgery Prices", "publisher": "Nordorthopaedics Clinic, Kaunas", "url": "https://www.nordorthopaedics.com/hip-knee-wrist-hand-ankle-foot-shoulder-surgery-prices/", "accessed": "2026-09-16", "note": "every figure is written as a 'from' price in euro and sterling; the page carries no inclusion list" }, { "id": "s:mbs-49318", "kind": "gov", "title": "MBS item 49318 — total arthroplasty of hip", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=49318&qt=item", "accessed": "2026-09-16", "note": "schedule fee $1,577.30, fee last updated 01-Jul-2026" }, { "id": "s:nhs-hip-recovery", "kind": "gov", "title": "Recovering from a hip replacement", "publisher": "NHS (England)", "url": "https://www.nhs.uk/tests-and-treatments/hip-replacement/recovering-from-a-hip-replacement/", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "every figure is read off a named page; the marked stretches are trade account and this project's reasoning" }, "text.how": { "tier": "tradition", "note": "standard operative description; the day counts are cited to the NHS recovery page" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:nhs-hip-recovery", "note": "the flying figure is the CDC's guidance for other surgery, applied by analogy and marked as such" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "canada", "type": "destination", "name": "Canada", "as": "68% inside six months in 2024, and the better half of the same queue.", "rel": "procedure" }, { "from": "bangkok", "type": "hub", "name": "Bangkok", "as": "The other joint on the same package pages.", "rel": "procedure" }, { "from": "vilnius", "type": "hub", "name": "Vilnius", "as": "The operation the Baltic pitch leads with, sold against a waiting list.", "rel": "procedure" }, { "from": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The same trade, the other joint — and the one whose package price is usually higher.", "rel": "contrast" }, { "from": "shoulder-replacement", "type": "procedure", "name": "Total shoulder replacement", "as": "The joint that sells as a package everywhere this one does not.", "rel": "contrast" }, { "from": "dvt-pe", "type": "risk", "name": "Deep vein thrombosis and pulmonary embolism", "as": "The other joint, with the same prophylaxis question and the same flight home.", "rel": "procedure" }, { "from": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The same trade, the same exclusion, usually a higher package.", "rel": "procedure" }, { "from": "tariff", "type": "term", "name": "Tariff", "as": "The operation whose schedule fee this record reads.", "rel": "procedure" }, { "from": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The same arithmetic on the other joint, where the facilitator's advertised range nearly meets the English list price.", "rel": "procedure" }, { "from": "waiting-lists", "type": "story", "name": "The queue is the product", "as": "Its twin on every waiting list that publishes one.", "rel": "procedure" } ] }, { "schema": 1, "id": "hysterectomy", "type": "procedure", "names": { "name": "Hysterectomy", "aliases": [ "total laparoscopic hysterectomy", "abdominal hysterectomy", "vaginal hysterectomy", "TLH" ], "said": "Surgeons name the route — abdominal, vaginal, laparoscopic, robotic — and the route sets both the price and the nights. Package pages name it too; payer schedules mostly do not." }, "etymology": { "root": "hysterectomy: Greek hystera, the womb, plus ektomē, a cutting out. The same root gave hysteria, a diagnosis built on the idea that the organ wandered — a history the word carries and the operation does not.", "tier": "tradition", "note": "Total means the cervix goes too; subtotal leaves it. Salpingo-oophorectomy, the removal of tubes and ovaries, is a separate phrase and sometimes a separate price." }, "region": [ "global" ], "facets": { "family": "gynaecological", "setting": "inpatient", "anaesthesia": "general" }, "text": { "what": "The uterus is removed — through the abdomen, through the vagina, or through keyhole incisions with a camera, which is the route the packages read for this record price. Two nights on the Bangkok package, general anaesthetic, weeks before heavy lifting. It is done for fibroids, bleeding, prolapse, endometriosis and cancer, and only the non-cancer version travels.", "story": "This operation travels on the queue rather than on the price, and the queue is published while the price usually is not.\n\nNHS England reported 7.3 million pathways waiting to start treatment at the end of July 2026 — an estimated 6.2 million unique patients — with 65.4% waiting up to eighteen weeks against a 92% standard and a median wait of 12.0 weeks. Ireland's National Treatment Purchase Fund counted 115,450 people waiting for an inpatient or day-case appointment at the end of May 2026, against 669,506 waiting for a first outpatient consultation. Neither figure is specific to this operation; both are what a woman with heavy bleeding and a six-month wait is reading when she looks at a foreign price page.\n\nWhat she finds there is a package. Bumrungrad in Bangkok lists total laparoscopic hysterectomy at 265,000 baht against a struck-through 285,000, under a Gynecological Awareness Month offer stated valid from 12 August to 31 October 2026. Three hours of theatre, a recovery room, two nights in a single room, the biopsy charge, and the surgeon, assistant and anaesthetist.\n\nThe exclusion list names one thing worth reading twice: \"Special Medical supplies & Special Equipment used such as Ligasure Generator, Thunderbeat\". Those are the energy devices a laparoscopic hysterectomy is routinely done with — the instruments that seal and divide vessels. Also outside: pre-operative tests, chest x-ray and ECG, outpatient charges, any extra theatre time, the difference if the room is upgraded, and take-home medication.\n\n*Inference —* an operation priced at two nights with the sealing device excluded is priced the way the knee is priced with the implant excluded, and a reader comparing it with a state tariff is comparing a part with a whole. Ireland's own admitted-patient price for a hysterectomy for non-malignancy at minor complexity is EUR 13,282, which covers the admission entire — energy devices, tests and all.", "how": "General anaesthesia; for the laparoscopic route, three or four small incisions, the abdomen inflated with carbon dioxide, the uterus detached with an energy device and removed through the vagina, the vault closed. One to three nights, and six weeks before lifting anything heavy.\n\nWhere a state pays, the schedule prices the surgeon: Australia's Medicare Benefits Schedule sets item 35653, abdominal hysterectomy with or without removal of the tubes and ovaries, at a schedule fee of $807.60, with a 75% benefit of $605.70. Where a state prices the admission, as Ireland does for repayment purposes, the figure is sixteen times larger and counts different things.", "today": "As of 17 September 2026 the published Thai package price for a total laparoscopic hysterectomy is 265,000 baht for two nights, energy devices excluded; Ireland's admitted-patient price for the same class of operation is EUR 13,282 at minor complexity and EUR 19,412 at major; and the Australian schedule fee for the surgeon's service is $807.60.", "notes": "This page describes an operation and the prices published for it. It is not medical advice." }, "metrics": { "stay_days": 2, "days_before_flying": 10, "recovery_weeks": 6, "wait_days_home": 84, "note": "Two nights is the stay named in the Bumrungrad package read for this record; the Irish tariff's average length of stay for the same diagnosis-related group is 3.5 days. The eighty-four days is the median wait of 12.0 weeks across all pathways waiting to start treatment in England at the end of July 2026, published by NHS England on 10 September 2026 — an all-specialty median for the English market, not a gynaecology figure, and it is the queue this operation's foreign prices are read against. The ten-day figure is the CDC's guidance not to fly for ten days after abdominal surgery. Six weeks is the span usually quoted before heavy lifting.", "as_of": "2026-07-31", "source": "s:nhs-rtt-july-2026", "url": "https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Jul26-RTT-statistical-press-notice-PDF-578K-97ylx5.pdf" }, "prices": [ { "procedure": "hysterectomy", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 265000, "currency": "THB", "as_of": "2026-09-17", "kind": "package", "includes": [ "operating room for 3 hours, nurse assisting surgeon and operating team", "recovery room", "medications, medical supplies and equipment used during surgery under the physician's consideration", "anaesthesia and necessary medication during admission", "biopsy charges", "single room for 2 nights including nursing service and regular menu meals", "doctor fee including surgeon, assistant surgeon and anaesthesiologist" ], "excludes": [ "special medical supplies and special equipment used, such as the Ligasure generator or Thunderbeat", "expenses at the outpatient unit or before the operation", "laboratory tests, chest x-ray and ECG before and after surgery", "theatre and anaesthetist time beyond the hours specified", "care for a patient with an underlying disease", "the difference in room charge above the package", "take-home medication and supplies" ], "source": "s:bumrungrad-gyne03", "url": "https://www.bumrungrad.com/en/packages/total-laparoscopic-hysterectomy", "note": "package GYNE03, listed at 265,000 THB against a struck-through 285,000 under a Gynecological Awareness Month 2026 offer, prices stated valid from 12 August to 31 October 2026. The energy devices named in the exclusion list are the instruments this operation is ordinarily performed with.", "tier": "cited", "usd": 7959.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "hysterectomy", "country": "IE", "amount": 13282, "currency": "EUR", "as_of": "2026-09-17", "kind": "reimbursement", "includes": [ "DRG N04B HYSTERECTOMY FOR N-MAL, MINC: abdominal and laparoscopic abdominal hysterectomies, total, subtotal or radical, and vaginal hysterectomy, total, subtotal or radical", "the whole inlier inpatient episode" ], "excludes": [ "hysterectomy for malignancy, which falls in another group", "stays beyond the high boundary, paid per diem on top", "travel and accommodation" ], "source": "s:hse-cbd-niphs-drg-guide", "url": "https://assets.hse.ie/media/documents/CBD-NIPHS-Most-Common-Procedures-DRG-Guide.pdf", "note": "what Ireland repays a patient who has this operation abroad under the Cross Border Directive or the Northern Ireland Planned Healthcare Scheme, and equally the Irish public system's own price for the admission. The major-complexity version, N04A, is EUR 19,412 on the same schedule.", "tier": "cited", "usd": 15325.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "hysterectomy", "country": "AU", "amount": 807.6, "currency": "AUD", "as_of": "2026-09-17", "kind": "tariff", "includes": [ "item 35653: hysterectomy, abdominal, with or without removal of fallopian tubes and ovaries" ], "excludes": [ "the hospital, the theatre, the ward and the anaesthetist, billed under their own items" ], "source": "s:mbs-35653", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=35653&qt=item", "note": "the Medicare Benefits Schedule fee, 75% benefit $605.70, the fee shown as applying from 1 July 2026. A surgeon's fee, not an admission — one sixteenth of the Irish figure beside it because it counts one sixteenth of the things.", "tier": "cited", "usd": 576.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "prostatectomy", "as": "The operation on the other side of the same waiting list, priced the same three ways.", "rel": "kin" }, { "to": "gallbladder-removal", "as": "The other keyhole operation that travels on a queue rather than on a price.", "rel": "kin" }, { "to": "bumrungrad", "as": "Publishes the laparoscopic hysterectomy package this page reads, energy devices excluded.", "rel": "performed-at" }, { "to": "thailand", "as": "Where the operation is sold as two nights with the sealing device outside the price.", "rel": "destination" }, { "to": "united-kingdom", "as": "The source market whose waiting list is the reason to read a foreign price at all.", "rel": "destination" }, { "to": "australia", "as": "Where the state prices the surgeon's service and the hospital bills separately.", "rel": "destination" }, { "to": "eu-directive-2011-24", "as": "The route under which an Irish patient is repaid at the Irish price for this operation done abroad.", "rel": "rule" }, { "to": "implant-excluded", "as": "The same shape of exclusion, here a sealing device rather than a joint.", "rel": "risk" }, { "to": "reading-the-exclusions", "as": "The step at which special equipment turns out to mean the instrument the operation uses.", "rel": "step" }, { "to": "flying-after-surgery", "as": "The clot risk that sets how long after abdominal surgery a patient can board.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Who checks the wound and the vault at six weeks, and where.", "rel": "risk" }, { "to": "oecd-waiting-times", "as": "The series that counts the queue this operation leaves home to escape.", "rel": "measured-by" } ], "confusable_with": [ { "id": "gallbladder-removal", "tell": "Both are keyhole abdominal operations sold as short packages; one removes the uterus and one the gallbladder, and only the second is usually a day case." } ], "links": [ { "label": "Bumrungrad — total laparoscopic hysterectomy package", "url": "https://www.bumrungrad.com/en/packages/total-laparoscopic-hysterectomy" }, { "label": "NHS England RTT waiting times, July 2026", "url": "https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Jul26-RTT-statistical-press-notice-PDF-578K-97ylx5.pdf" } ], "sources": [ "s:bumrungrad-gyne03", "s:hse-cbd-niphs-drg-guide", "s:hse-abf-2024-inpatient", "s:mbs-35653", "s:nhs-rtt-july-2026", "s:ntpf-may-2026", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:bumrungrad-gyne03", "note": "waiting figures cited to the two national publications and labelled as what they count; package terms read off the hospital's own page on 17 September 2026; the closing comparison is this project's reasoning and is marked" }, "text.how": { "tier": "tradition", "note": "standard operative description; the schedule fee is cited to the item page" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:nhs-rtt-july-2026" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Hysterectomy.png", "File:Laparoscopic surgery.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "The uterus is removed — through the abdomen, through the vagina, or through keyhole incisions with a camera, which is the route the packages read for this record price.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "prostatectomy", "type": "procedure", "name": "Prostatectomy", "as": "The operation on the other side of the same waiting list, priced the same three ways.", "rel": "kin" }, { "to": "gallbladder-removal", "type": "procedure", "name": "Gallbladder removal", "as": "The other keyhole operation that travels on a queue rather than on a price.", "rel": "kin" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Publishes the laparoscopic hysterectomy package this page reads, energy devices excluded.", "rel": "performed-at" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the operation is sold as two nights with the sealing device outside the price.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The source market whose waiting list is the reason to read a foreign price at all.", "rel": "destination" }, { "to": "australia", "type": "destination", "name": "Australia", "as": "Where the state prices the surgeon's service and the hospital bills separately.", "rel": "destination" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route under which an Irish patient is repaid at the Irish price for this operation done abroad.", "rel": "rule" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The same shape of exclusion, here a sealing device rather than a joint.", "rel": "risk" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step at which special equipment turns out to mean the instrument the operation uses.", "rel": "step" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The clot risk that sets how long after abdominal surgery a patient can board.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who checks the wound and the vault at six weeks, and where.", "rel": "risk" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The series that counts the queue this operation leaves home to escape.", "rel": "measured-by" } ], "source_list": [ { "id": "s:bumrungrad-gyne03", "kind": "web", "title": "Total Laparoscopic Hysterectomy — package GYNE03", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/total-laparoscopic-hysterectomy", "accessed": "2026-09-17", "note": "265,000 THB against 285,000 under a Gynecological Awareness Month 2026 offer, stated valid from 12 August to 31 October 2026; three hours of theatre, two nights in a single room; exclusions name 'Special Medical supplies & Special Equipment used such as Ligasure Generator, Thunderbeat'" }, { "id": "s:hse-cbd-niphs-drg-guide", "kind": "gov", "title": "CBD / NIPHS Most Common Procedures DRG Guide", "publisher": "Health Service Executive (Ireland)", "url": "https://assets.hse.ie/media/documents/CBD-NIPHS-Most-Common-Procedures-DRG-Guide.pdf", "accessed": "2026-09-16", "note": "the tariff behind both the Cross Border Directive scheme and the Northern Ireland Planned Healthcare Scheme. Cataract procedures map to DRG C16Z LENS INTERVENTIONS at a day-case price of EUR 1,171, covering phacoemulsification or other extraction of the crystalline lens and capsulotomy; colonoscopy G48B EUR 1,001; gastroscopy G47C EUR 726. Same figure as the HSE's 2024 activity-based-funding day-case price list." }, { "id": "s:hse-abf-2024-inpatient", "kind": "gov", "title": "ABF 2024 Admitted Patient Price List — Inpatient Only", "publisher": "Health Service Executive (Ireland)", "url": "https://assets.hse.ie/media/documents/ABF_2024_Admitted_Patient_Price_List_-_Inpatient_Only.pdf", "accessed": "2026-09-17", "note": "the activity-based-funding inlier inpatient price per diagnosis-related group, linked from the HSE's Northern Ireland Planned Healthcare Scheme claim page and the list behind the CBD and NIPHS repayments. Rows read on 17 September 2026: F06C CRNRY BYPSS-INV INVES MINC EUR 30,040, F06B EUR 34,430, F06A EUR 50,579; F05B CRNRY BYPSS+INV INVES MINC EUR 45,093; F04C CRD VLV INTERVTN+PMP-INV INVES MINC EUR 40,253, F04B EUR 50,628, F04A EUR 80,201; F19B TRNS-VSCLR PERC CRDC INTERVTN MINC EUR 9,887, F19A EUR 42,060; F10B INTERVENTIONAL CRNRY PR + AMI MINC EUR 8,857; M01B MAJOR MALE PELVIC INTERVTNS MINC EUR 19,899, M01A EUR 26,820; M02B TRANSURTH PROSTMY MINC EUR 8,363; N04B HYSTERECTOMY FOR N-MAL MINC EUR 13,282; G10B HERNIA INTERVENTIONS MINC EUR 9,046, G10A MAJC EUR 15,366; H08B LAP CHOLECYSTECTOMY MINC EUR 9,867, H07C OPEN CHOLECYSTECTOMY MINC EUR 16,206. An inlier price assumes a length of stay between the low and high boundaries printed beside it." }, { "id": "s:mbs-35653", "kind": "gov", "title": "MBS item 35653 — hysterectomy, abdominal, with or without removal of fallopian tubes and ovaries", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=35653&qt=item", "accessed": "2026-09-17", "note": "schedule fee $807.60, 75% benefit $605.70, fee shown as applying from 01-Jul-2026" }, { "id": "s:nhs-rtt-july-2026", "kind": "gov", "title": "Statistical Press Notice — NHS referral to treatment (RTT) waiting times data, July 2026", "publisher": "NHS England", "url": "https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Jul26-RTT-statistical-press-notice-PDF-578K-97ylx5.pdf", "accessed": "2026-09-16", "note": "published Thursday 10 September 2026. 7.3 million RTT pathways waiting to start treatment at the end of July 2026, an estimated 6.2 million unique patients; 111,379 waiting over 52 weeks, 9,095 over 65 weeks, 235 over 104 weeks; 65.4% waiting up to 18 weeks against a 92% standard; median wait 12.0 weeks. Figures include estimates for three trusts and one independent provider that did not submit." }, { "id": "s:ntpf-may-2026", "kind": "gov", "title": "NTPF Publishes May 2026 National Public Hospital Waiting List Data", "publisher": "National Treatment Purchase Fund (Ireland)", "url": "https://www.ntpf.ie/news_and_events/ntpf-publishes-may-2026-national-public-hospital-waiting-list-data/", "accessed": "2026-09-16", "note": "at the end of May 2026: 669,506 waiting for a first outpatient consultation, 115,450 for an inpatient or day-case appointment, 40,986 for a GI endoscopy, 34,049 suspended, 111,643 on the planned-procedure list" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:bumrungrad-gyne03", "note": "waiting figures cited to the two national publications and labelled as what they count; package terms read off the hospital's own page on 17 September 2026; the closing comparison is this project's reasoning and is marked" }, "text.how": { "tier": "tradition", "note": "standard operative description; the schedule fee is cited to the item page" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:nhs-rtt-july-2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "gallbladder-removal", "type": "procedure", "name": "Gallbladder removal", "as": "The other abdominal operation that travels on a queue rather than a price.", "rel": "kin" }, { "from": "phalloplasty", "type": "procedure", "name": "Phalloplasty", "as": "Priced as an earlier stage on the same list, and a stated precondition on a Bangkok hospital's candidacy page.", "rel": "kin" }, { "from": "prostatectomy", "type": "procedure", "name": "Prostatectomy", "as": "The operation on the other side of the same waiting list, priced the same three ways.", "rel": "kin" } ] }, { "schema": 1, "id": "icl", "type": "procedure", "names": { "name": "Implantable collamer lens", "aliases": [ "ICL", "implantable contact lens", "phakic intraocular lens", "EVO ICL", "toric ICL" ], "said": "Sold as an implantable contact lens, which is the selling phrase; it is a phakic intraocular lens, meaning a second lens added while the eye keeps its own." }, "etymology": { "root": "Collamer is a trade name — collagen plus polymer — for the material the lens is made of, and the C in ICL stands for it. Phakic is Greek phakos, a lentil and so a lens: an eye that still has its own. Intraocular is Latin intra, within, plus oculus, eye.", "tier": "cited", "source": "s:bumrungrad-icl-single-eye", "note": "The hospital's own description: a thin, clear, soft lens functioning like a contact lens, inserted behind the iris and in front of the eye's natural lens, made of a collagen and co-polymer material." }, "region": [ "global" ], "facets": { "family": "ophthalmic", "setting": "day-case", "anaesthesia": "local" }, "text": { "what": "A soft lens is folded through a small corneal wound and placed behind the iris, in front of the eye's own lens, which stays. No tissue is removed and the operation can in principle be reversed. It is the answer for the eyes laser surgery is refused for — thin corneas, prescriptions too strong to carve — and it costs several times as much per eye.", "story": "The pairing is the point. Both operations are sold from the same providers to the same patients, and the price gap is consistent across two countries.\n\nBumrungrad in Bangkok lists ICL for a single eye at 129,000 baht and the toric version, which also corrects astigmatism, at 161,000 — package IPDEYE42, prices stated valid until 31 December 2026. Two doors down its own list, laser vision correction by ReLEx SMILE for both eyes is 102,000 baht. One eye by lens implant costs a quarter as much again as two eyes by laser.\n\nOptegra in the United Kingdom prices EVO ICL at £3,595 per eye against LASIK at £2,095 and LASEK at £1,495 on its own laser page — the implant at one and a half to two and a half times the laser.\n\nThe hospital page is unusually clear about who it is for. Bumrungrad's list of candidates names people with thin corneas and people whose myopia, presbyopia or astigmatism \"cannot be corrected by laser treatment\", along with a requirement for sufficiently deep eye chambers and no history of uveitis, glaucoma or diabetic retinopathy.\n\nThe package terms are as clear about the money: the price covers surgeon, hospital and nursing fees for the surgery only and \"Medical device, such as, ICL (only the types specified in the package)\"; it excludes physician's fees, consultations and pre-surgical screening, medication and any other tests; and it covers out-patient same-day surgery only, with overnight stays charged extra.\n\n*Inference —* the lens is inside this package and the appointment that decides whether the eye can take one is outside it. That is the same shape as the cataract package from the same hospital, and it means the sum a traveller can plan with is the package plus an examination they cannot have until they arrive.", "how": "A suitability examination measuring the depth of the anterior chamber and the health of the cornea, sometimes a preliminary laser iridotomy to let fluid pass, then drops, a three-millimetre wound, the folded lens injected and positioned behind the iris. Minutes per eye, no stitches, no removal of tissue. Pressure in the eye is checked within hours because the new lens can obstruct flow.\n\nThe lens stays for decades and can be exchanged or taken out; where the natural lens later clouds, the ICL is removed at the cataract operation. That is the sentence on which the whole comparison with laser surgery turns, and no price page read for this record prices the removal.", "today": "As of 17 September 2026 the published prices read for this record are 129,000 baht for one eye in Bangkok, 161,000 for the toric version, and £3,595 per eye in the United Kingdom. No third country's published ICL price could be read off a provider's own page for this record.", "notes": "This page describes an elective eye operation and the prices published for it. It is not medical advice and it does not say who is a candidate." }, "metrics": { "stay_days": 0, "days_before_flying": null, "recovery_weeks": 1, "wait_days_home": null, "note": "Out-patient same-day surgery on the package read for this record, which states that an overnight stay incurs additional charges. An elective purchase rather than a queue in both markets read here, so wait_days_home stays empty. One week is the span usually quoted for return to ordinary activity; no published guidance read here sets a wait before flying.", "as_of": "2026-09-17", "source": "s:bumrungrad-icl-single-eye", "url": "https://www.bumrungrad.com/en/packages/icl-single-eye" }, "prices": [ { "procedure": "icl", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 129000, "currency": "THB", "as_of": "2026-09-17", "kind": "package", "includes": [ "surgeon fees, hospital fees and nursing fees for the surgery only", "medical device, such as the ICL — only the types specified in the package", "out-patient same-day surgery" ], "excludes": [ "physician's fees and any fees for consultations or pre-surgical screening", "medication, medical supplies and any other examinations or tests performed", "overnight stays, which incur additional charges", "the second eye" ], "source": "s:bumrungrad-icl-single-eye", "url": "https://www.bumrungrad.com/en/packages/icl-single-eye", "note": "package IPDEYE42, one eye, prices stated valid until 31 December 2026 and 'subject to change with no notice'. The toric version, for eyes with astigmatism, is 161,000 THB on the same list.", "tier": "cited", "usd": 3875.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "icl", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 161000, "currency": "THB", "as_of": "2026-09-17", "kind": "package", "includes": [ "toric ICL, single eye, on the same package terms" ], "excludes": [ "as the standard ICL package: consultations, screening, medication, other tests, overnight stay, the second eye" ], "source": "s:bumrungrad-eye-packages", "url": "https://www.bumrungrad.com/en/packages/packages-center/eye-center", "note": "the astigmatism-correcting lens is 32,000 baht more than the plain one at the same hospital on the same day — a device tier, read off the eye centre's package list on 17 September 2026.", "tier": "cited", "usd": 4836.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "icl", "country": "GB", "amount": 3595, "currency": "GBP", "as_of": "2026-09-17", "kind": "list", "includes": [ "EVO ICL, one eye", "virtual consultation", "full eye health check", "treatment plan", "the treatment", "aftercare" ], "excludes": [ "the second eye" ], "source": "s:optegra-icl-costs", "url": "https://www.optegra.com/laser-eye-surgery/icl-evo/costs/", "note": "stated per eye as a fixed price. The same provider's laser page prices LASIK at £2,095 and LASEK at £1,495 per eye, which puts the implant at one and a half to two and a half times the laser. The page carries no date of its own and was read on 17 September 2026.", "tier": "cited", "usd": 4845.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "lasik", "as": "The laser operation this one exists for the eyes that fail — and the price it is measured against on every page that sells both.", "rel": "contrast" }, { "to": "cataract-surgery", "as": "The operation that removes the natural lens; this one leaves it, and is taken out when that day comes.", "rel": "contrast" }, { "to": "bumrungrad", "as": "Publishes the ICL package this page reads, lens included and screening excluded.", "rel": "performed-at" }, { "to": "thailand", "as": "Where one eye by implant costs more than two eyes by laser at the same hospital.", "rel": "destination" }, { "to": "united-kingdom", "as": "Where the implant is priced per eye against the same provider's laser ladder.", "rel": "destination" }, { "to": "bangkok", "as": "The city whose hospital eye centres sell both halves of this choice from one list.", "rel": "place" }, { "to": "implant-excluded", "as": "The trap this package avoids by naming the lens, and narrows by naming only some types.", "rel": "risk" }, { "to": "reading-the-exclusions", "as": "The step at which same-day surgery turns out to price an overnight stay separately.", "rel": "step" }, { "to": "follow-up-gap", "as": "Who checks the eye pressure in the weeks after, and who takes the lens out in thirty years.", "rel": "risk" }, { "to": "insurance-exclusions", "as": "Why this is an out-of-pocket purchase in both markets read here.", "rel": "rule" } ], "confusable_with": [ { "id": "lasik", "tell": "Laser surgery removes corneal tissue and cannot be undone; an ICL adds a lens that can be exchanged or removed. The second costs several times the first." }, { "id": "cataract-surgery", "tell": "A cataract implant replaces the eye's own lens; an ICL sits in front of a lens that is still there and still working." } ], "links": [ { "label": "Bumrungrad — ICL single eye package", "url": "https://www.bumrungrad.com/en/packages/icl-single-eye" }, { "label": "Optegra — ICL surgery costs", "url": "https://www.optegra.com/laser-eye-surgery/icl-evo/costs/" } ], "sources": [ "s:bumrungrad-icl-single-eye", "s:bumrungrad-eye-packages", "s:optegra-icl-costs", "s:optegra-laser-costs" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:bumrungrad-icl-single-eye", "note": "prices, candidate list and package terms read off the named pages on 17 September 2026; the closing stretch is this project's reasoning and is marked" }, "text.how": { "tier": "tradition", "note": "standard operative description; the removal-at-cataract point is general practice and is stated without a figure" }, "etymology": { "tier": "cited", "source": "s:bumrungrad-icl-single-eye" }, "metrics": { "tier": "cited", "source": "s:bumrungrad-icl-single-eye" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Phakic intraocular lens.jpg", "File:Implantable collamer lens.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "A soft lens is folded through a small corneal wound and placed behind the iris, in front of the eye's own lens, which stays. No tissue is removed and the operation can in principle be reversed.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "lasik", "type": "procedure", "name": "LASIK", "as": "The laser operation this one exists for the eyes that fail — and the price it is measured against on every page that sells both.", "rel": "contrast" }, { "to": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "The operation that removes the natural lens; this one leaves it, and is taken out when that day comes.", "rel": "contrast" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Publishes the ICL package this page reads, lens included and screening excluded.", "rel": "performed-at" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where one eye by implant costs more than two eyes by laser at the same hospital.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Where the implant is priced per eye against the same provider's laser ladder.", "rel": "destination" }, { "to": "bangkok", "type": "hub", "name": "Bangkok", "as": "The city whose hospital eye centres sell both halves of this choice from one list.", "rel": "place" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The trap this package avoids by naming the lens, and narrows by naming only some types.", "rel": "risk" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step at which same-day surgery turns out to price an overnight stay separately.", "rel": "step" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who checks the eye pressure in the weeks after, and who takes the lens out in thirty years.", "rel": "risk" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "Why this is an out-of-pocket purchase in both markets read here.", "rel": "rule" } ], "source_list": [ { "id": "s:bumrungrad-icl-single-eye", "kind": "web", "title": "ICL Single Eye — package IPDEYE42", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/icl-single-eye", "accessed": "2026-09-17", "note": "129,000 THB per eye, valid until 31 December 2026; out-patient only, overnight stays charged extra; includes the ICL device of the types specified" }, { "id": "s:bumrungrad-eye-packages", "kind": "web", "title": "Eye Center — package list", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/packages-center/eye-center", "accessed": "2026-09-17", "note": "read with the browser on 17 September 2026: ReLEx SMILE both eyes 102,000 THB; ICL single eye 129,000 THB; Toric ICL single eye 161,000 THB; phacoemulsification single eye with monofocal lens, Set 1, 85,400 THB; eye screening 4,100 THB" }, { "id": "s:optegra-icl-costs", "kind": "web", "title": "ICL Surgery Costs", "publisher": "Optegra Eye Health Care, United Kingdom", "url": "https://www.optegra.com/laser-eye-surgery/icl-evo/costs/", "accessed": "2026-09-17", "note": "£3,595 per eye, described as a fixed price covering the virtual consultation, eye health check, treatment plan, the treatment and aftercare. The page carries no date of its own." }, { "id": "s:optegra-laser-costs", "kind": "web", "title": "Laser Eye Surgery Costs", "publisher": "Optegra Eye Health Care, United Kingdom", "url": "https://www.optegra.com/laser-eye-surgery/costs/", "accessed": "2026-09-17", "note": "prices stated per eye: LASEK £1,495, LASIK £2,095, ReLEx SMILE £2,695, Presbyond £2,995, each including consultations, treatment, aftercare, medication and any enhancement treatment if clinically required. The page carries no date of its own." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:bumrungrad-icl-single-eye", "note": "prices, candidate list and package terms read off the named pages on 17 September 2026; the closing stretch is this project's reasoning and is marked" }, "text.how": { "tier": "tradition", "note": "standard operative description; the removal-at-cataract point is general practice and is stated without a figure" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "cited", "source": "s:bumrungrad-icl-single-eye" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:bumrungrad-icl-single-eye" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "The implanted lens that sits in front of the natural one rather than replacing it.", "rel": "contrast" }, { "from": "lasik", "type": "procedure", "name": "LASIK", "as": "The operation for the eyes this one cannot treat, at roughly twice the price per eye from the same providers.", "rel": "contrast" } ] }, { "schema": 1, "id": "icsi", "type": "procedure", "names": { "name": "Intracytoplasmic sperm injection", "aliases": [ "ICSI", "sperm injection", "IVF-ICSI" ], "said": "Embryologists say ICSI, pronounced ick-see. Price lists say ICSI all when they mean every egg and ICSI of a single egg when they mean one. Patients are often told they are having IVF and have in fact bought this." }, "etymology": { "root": "intracytoplasmic: Latin intra, within, plus Greek kytos, a vessel, and plasma, something moulded — inside the substance of the cell. The name describes the target, a single egg's interior, and the whole technique is one needle crossing one membrane.", "tier": "tradition", "note": "conventional IVF leaves thousands of sperm in a dish with an egg and lets one find its way in. ICSI picks one sperm and puts it there. The words are used as though they were the same treatment because the bill usually is." }, "region": [ "global" ], "facets": { "family": "fertility", "setting": "outpatient-course", "anaesthesia": "none" }, "text": { "what": "An embryologist holds one egg with a suction pipette, picks up one sperm in a glass needle a few micrometres across, pushes the needle through the egg's outer coat and membrane and releases the sperm inside. It was devised for male-factor infertility, where too few sperm swim or none can penetrate an egg, and it is now applied far beyond that. The step happens to a gamete on a microscope stage; the patient is not in the room, and is under anaesthesia only for the egg collection that precedes it.", "story": "ICSI has overtaken the treatment it was invented to rescue. ESHRE's fact sheet puts it at around 73% of all fertilisation treatments worldwide against 27% for conventional insemination, and notes in the same breath that outcome rates with each technique are comparable. The CDC's national rows say the same thing about the United States: 77.7% of transfers in 2022 involved at least one embryo fertilised by ICSI, rising to 82.0% among patients under 35 — the age band least likely to have a male-factor diagnosis.\n\n*Trade practice —* the reason is partly commercial and partly defensive. ICSI removes the failed-fertilisation phone call, which is the worst call a clinic makes, and on a price list it is either bundled at no visible charge or added as a line the patient will not refuse. Reprofit's 2026 list shows the second shape plainly: 620 EUR to inject every egg in a standard cycle, 190 EUR for a single egg in a minimal-stimulation or native cycle.\n\n*Inference —* where ICSI is bundled, comparing a cycle price across two countries compares two different laboratory operations sold under one word.", "how": "Done on the day of egg collection, hours after the eggs are stripped of their surrounding cells and judged mature. Sperm may come from an ejaculate, or from a testicular extraction where there is none in the ejaculate: Reprofit prices TESE under general anaesthetic at 1,545 EUR, with screening and sperm freezing outside it. Sperm-selection add-ons are priced separately again — PICSI at 355 EUR, magnetic separation at 475 EUR, microfluidic sorting at 350 EUR on the same list.\n\nThe legal facts that move this step across a border are the ones attached to the sperm rather than the needle. Where donor sperm is banned outright, as under Türkiye's 2010 regulation on assisted reproduction practices and centres, an ICSI cycle using a donor cannot be bought at home at any price; where donor anonymity has been abolished, as in the UK for donations after 1 April 2005, the cycle can be bought but the donor cannot be anonymous. Both push the same cycle to a different country. The rule records carry the jurisdictions and their instruments.", "today": "As of September 2026 ICSI appears on the published price lists read for this record in three forms: invisible inside a cycle price in Barcelona and Thessaloniki, itemised at 620 EUR in Brno, and standard-with-no-surcharge in the US clinic's base package. A cycle price that does not name ICSI either way is not saying whether it is included.", "notes": "This page describes a laboratory technique and what registers and price lists record about it. It is not medical advice." }, "metrics": { "success_rate_pct": 33.0, "note": "33.0% is the European mean PREGNANCY rate per embryo transfer after ICSI in 2020, from the ESHRE fact sheet drawing on the EIM consortium registries — a pregnancy rate, not a birth rate, and per transfer, not per cycle started. The same source gives 33.2% after conventional IVF, 35.9% after frozen embryo transfer and 51.3% after egg donation, and puts the world average delivery rate at 15.4% per aspiration with a 32.3% cumulative delivery rate from one started aspiration. The gap between 33% per transfer and 15.4% per aspiration is the same arithmetic that makes clinic advertising possible: every cycle that never reached a transfer has left the denominator.", "as_of": "2020", "source": "s:eshre-art-factsheet", "url": "https://www.eshre.eu/-/media/sitecore-files/Press-room/ESHRE_ARTFactSheet_v10_2025.pdf" }, "prices": [ { "procedure": "icsi", "country": "CZ", "city": "Brno", "amount": 620, "currency": "EUR", "as_of": "2026-01-01", "kind": "list", "includes": [ "injection of a single sperm into an egg, all eggs", "priced for IVF treatment" ], "excludes": [ "the cycle itself" ], "source": "s:reprofit-pricelist-2026", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "note": "line \"ICSI all\" on the self-payer list valid from 1 January 2026. The same list already folds ICSI into the 3,245 EUR standard cycle, so this line is charged against the minimal-stimulation and native cycles that exclude it.", "tier": "cited", "usd": 715.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "icsi", "country": "CZ", "city": "Brno", "amount": 190, "currency": "EUR", "as_of": "2026-01-01", "kind": "list", "includes": [ "injection of a single sperm into an egg, one single egg", "priced for IVF min and IVF native" ], "excludes": [ "the cycle itself" ], "source": "s:reprofit-pricelist-2026", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "note": "line \"ICSI of a single egg\". A native cycle at 1,100 EUR plus one injection at 190 EUR is a different bill from the 3,245 EUR cycle that includes it.", "tier": "cited", "usd": 219.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "icsi", "country": "ES", "city": "Barcelona", "amount": 5290, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "ICSI", "EmbryoScope+", "blastocyst culture", "first transfer" ], "excludes": [], "source": "s:fertilab-pricing", "url": "https://fertilab.com/en/pricing/", "note": "the clinic's single line reads \"In Vitro Fertilisation IVF (ICSI)\" — one price, both words, no separable ICSI charge. Read on 16 September 2026; special prices stated to hold for reservations until 30 September 2026.", "tier": "cited", "usd": 6104.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "icsi", "country": "GR", "city": "Thessaloniki", "amount": 3860, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "ICSI", "initial consultation", "follow-ups", "ultrasounds", "sedation", "blastocyst culture", "assisted hatching", "sperm freezing", "first embryo transfer" ], "excludes": [ "preliminary investigations", "extra tests", "medications", "embryo storage" ], "source": "s:newlife-ivf-costs", "url": "https://www.newlife-ivf.co.uk/ivf-costs", "note": "the Thessaloniki clinic sells one line, IVF/ICSI, at one price; ICSI carries no separate charge and no separate consent on the price page. Read on 16 September 2026.", "tier": "cited", "usd": 4454.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "ivf", "as": "The cycle this step sits inside, and the word most price pages use for both.", "rel": "whole" }, { "to": "sperm-donation", "as": "Where the sperm comes from when it does not come from a partner, and the law that decides whether it may.", "rel": "kin" }, { "to": "pgt", "as": "The next laboratory charge on the same embryos, priced per embryo.", "rel": "kin" }, { "to": "egg-donation", "as": "The other half of the cycle that can be bought from a stranger.", "rel": "kin" }, { "to": "eshre", "as": "Publishes the European registry figures that put ICSI at three-quarters of all treatment.", "rel": "measures" }, { "to": "cdc-art-results", "as": "The US series behind the 77.7% of 2022 transfers using ICSI.", "rel": "measured-by" }, { "to": "donor-anonymity-law", "as": "Decides whether the sperm in the needle can belong to an unnamed donor.", "rel": "governed-by" }, { "to": "package-price", "as": "The form that hides this step inside a cycle price, or itemises it.", "rel": "term" }, { "to": "reading-the-exclusions", "as": "The step of the journey where a bundled ICSI and an itemised one turn out to differ.", "rel": "step" } ], "confusable_with": [ { "id": "ivf", "tell": "Conventional IVF leaves sperm and egg together in a dish; ICSI injects one sperm. Most price lists sell the second and print the first." }, { "id": "pgt", "tell": "Both are laboratory steps charged on top of a cycle, but ICSI is done to the egg on collection day and PGT to the embryo five days later." } ], "links": [ { "label": "ESHRE ART fact sheet", "url": "https://www.eshre.eu/-/media/sitecore-files/Press-room/ESHRE_ARTFactSheet_v10_2025.pdf" }, { "label": "Reprofit price list, valid from 1 January 2026", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf" } ], "sources": [ "s:eshre-art-factsheet", "s:cdc-art-2022-summary", "s:reprofit-pricelist-2026", "s:fertilab-pricing", "s:newlife-ivf-costs", "s:gurtin-2011-turkey", "s:hfea-donating-sperm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:eshre-art-factsheet", "note": "the share figures are cited; the paragraph on why clinics prefer ICSI is marked Trade practice and the comparability point is marked Inference" }, "text.how": { "tier": "cited", "source": "s:reprofit-pricelist-2026" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:eshre-art-factsheet" }, "prices": { "tier": "cited", "source": "s:reprofit-pricelist-2026" } } }, "x_commons_files": [ "File:ICSI oocyte.jpg", "File:Intracytoplasmic sperm injection.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "An embryologist holds one egg with a suction pipette, picks up one sperm in a glass needle a few micrometres across, pushes the needle through the egg's outer coat and membrane and releases the sperm inside.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The cycle this step sits inside, and the word most price pages use for both.", "rel": "whole" }, { "to": "sperm-donation", "type": "procedure", "name": "Sperm donation", "as": "Where the sperm comes from when it does not come from a partner, and the law that decides whether it may.", "rel": "kin" }, { "to": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "The next laboratory charge on the same embryos, priced per embryo.", "rel": "kin" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The other half of the cycle that can be bought from a stranger.", "rel": "kin" }, { "to": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "Publishes the European registry figures that put ICSI at three-quarters of all treatment.", "rel": "measures" }, { "to": "cdc-art-results", "type": "dataset", "name": "CDC assisted reproductive technology results", "as": "The US series behind the 77.7% of 2022 transfers using ICSI.", "rel": "measured-by" }, { "to": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "Decides whether the sperm in the needle can belong to an unnamed donor.", "rel": "governed-by" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The form that hides this step inside a cycle price, or itemises it.", "rel": "term" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step of the journey where a bundled ICSI and an itemised one turn out to differ.", "rel": "step" } ], "source_list": [ { "id": "s:eshre-art-factsheet", "kind": "org", "title": "ART fact sheet (v10, 2025)", "publisher": "European Society of Human Reproduction and Embryology", "url": "https://www.eshre.eu/-/media/sitecore-files/Press-room/ESHRE_ARTFactSheet_v10_2025.pdf", "accessed": "2026-09-16", "note": "European and world figures for 2020, drawn from the EIM consortium and ICMART" }, { "id": "s:cdc-art-2022-summary", "kind": "dataset", "title": "2022 Final Assisted Reproductive Technology (ART) Summary", "publisher": "US Centers for Disease Control and Prevention", "url": "https://data.cdc.gov/Assisted-Reproductive-Technology-ART-/2022-Final-Assisted-Reproductive-Technology-ART-Su/9tjt-seye", "accessed": "2026-09-16", "note": "clinic-level and national rows; the national rows carry locationabbr NA. Queried through the Socrata endpoint https://data.cdc.gov/resource/9tjt-seye.json" }, { "id": "s:reprofit-pricelist-2026", "kind": "web", "title": "Pricelist — Assisted Reproduction, valid from 01.01.2026 (document 0331.26ENG)", "publisher": "Reprofit International s.r.o., Brno", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "accessed": "2026-09-16", "note": "the clinic's own self-payer price list, five pages, each line naming its inclusions and its exclusions" }, { "id": "s:fertilab-pricing", "kind": "web", "title": "Price list — fertility treatments", "publisher": "Fertilab Barcelona", "url": "https://fertilab.com/en/pricing/", "accessed": "2026-09-16" }, { "id": "s:newlife-ivf-costs", "kind": "web", "title": "IVF costs, egg donation costs", "publisher": "Newlife IVF, Thessaloniki", "url": "https://www.newlife-ivf.co.uk/ivf-costs", "accessed": "2026-09-16" }, { "id": "s:gurtin-2011-turkey", "kind": "paper", "title": "Banning reproductive travel: Turkey's ART legislation and third-party assisted reproduction", "publisher": "Reproductive BioMedicine Online (Gurtin ZB)", "url": "https://www.rbmojournal.com/article/S1472-6483(11)00470-6/fulltext", "accessed": "2026-09-16", "note": "citation and the 2010 regulation's extraterritorial clause verified from the journal's own article listing; the full text returned HTTP 403 and was not read. Treated as needing verification wherever it is relied on." }, { "id": "s:hfea-donating-sperm", "kind": "org", "title": "Donating your sperm", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/donation/donors/donating-your-sperm/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:eshre-art-factsheet", "note": "the share figures are cited; the paragraph on why clinics prefer ICSI is marked Trade practice and the comparability point is marked Inference" }, "text.how": { "tier": "cited", "source": "s:reprofit-pricelist-2026" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:reprofit-pricelist-2026" }, "metrics": { "tier": "cited", "source": "s:eshre-art-factsheet" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "egg-freezing", "type": "procedure", "name": "Egg freezing", "as": "How a thawed egg is fertilised, because its outer coat hardens in freezing.", "rel": "kin" }, { "from": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The fertilisation method used in most of these cycles, and bundled into the price on nearly every list.", "rel": "part" }, { "from": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "The earlier laboratory charge on the same embryos, three days before this one.", "rel": "kin" }, { "from": "sperm-donation", "type": "procedure", "name": "Sperm donation", "as": "What donor sperm is usually used for in a laboratory rather than an insemination.", "rel": "kin" }, { "from": "icmart", "type": "org", "name": "International Committee for Monitoring Assisted Reproductive Technologies", "as": "Counted inside the same cycles, on definitions the glossary had to fix before anyone could add them up.", "rel": "procedure" }, { "from": "cdc-art-results", "type": "dataset", "name": "CDC assisted reproductive technology results", "as": "Counted inside the same cycles, as a laboratory method rather than a separate treatment.", "rel": "procedure" } ] }, { "schema": 1, "id": "ivf", "type": "procedure", "names": { "name": "In vitro fertilisation", "aliases": [ "IVF", "in vitro fertilization", "assisted reproductive technology", "ART" ], "said": "Clinics sell a cycle. Registers count an intended retrieval, a transfer and a live-birth delivery, and those three denominators give three different numbers for the same treatment. Price pages say from." }, "etymology": { "root": "in vitro: Latin, in glass — vitrum, glass. The name records the apparatus, not the diagnosis: it says only where the egg met the sperm. Its opposite, in vivo, in the living, covers the rest of human history.", "tier": "tradition", "note": "cycle is the unit of sale and the unit of counting, and it does not mean one attempt at a baby. A cycle starts with drugs, may end without an egg, and may bank embryos for transfers years later. Two price pages using the word can be selling different objects." }, "region": [ "global" ], "facets": { "family": "fertility", "setting": "outpatient-course", "anaesthesia": "sedation" }, "text": { "what": "Drugs stimulate the ovaries to ripen several eggs at once; the eggs are collected through the vaginal wall under sedation or general anaesthetic in about half an hour; the eggs are mixed with sperm in a laboratory; and two to five days later an embryo is placed in the womb. The HFEA puts a cycle at four to six weeks, or about three weeks where the first hormone-suppression stage is skipped. The stimulation drugs are billed separately by most clinics that publish a price, and they can run to a third of the bill.", "story": "IVF crosses borders for a reason knee surgery does not. A knee is cheaper somewhere else; an egg is legal somewhere else. The ESHRE taskforce that surveyed 46 clinics in six destination countries — Belgium, Czechia, Denmark, Switzerland, Slovenia and Spain — collected 1,230 patient forms in a single month and estimated 11,000 to 14,000 patients and 24,000 to 30,000 cycles a year crossing borders within Europe alone, and the reasons patients gave were led by legal barriers: a treatment banned at home, or a bar on age, sexual orientation or civil status.\n\nThe academy has fought over what to call this. Inhorn and Patrizio argued in 2009 that reproductive \"tourism\" implies leisure travel and proposed reproductive \"exile\" for patients who are forced to travel. Cohen's term for the wider class, in the Cornell Law Review in 2012, is circumvention tourism: travel to do lawfully abroad what is criminal at home.\n\nTürkiye took the argument to its end point. Its 2010 regulation on assisted reproduction treatment practices and centres did not only ban donor eggs, donor sperm and surrogacy inside the country; it reached the citizen who went abroad for them, and the people who referred or arranged. *Inference —* a prohibition that follows the passport changes the destination rather than the demand, and the clinics that serve Turkish patients sit a short flight away in northern Cyprus.\n\n*Trade practice —* the price pages are unusually good in this field precisely because the patients are shopping across jurisdictions. A clinic that expects a patient from three countries away publishes a number. What it does not publish is the drug bill.", "how": "Three legal facts move the price and the destination more than any clinical one. First, whether donor gametes may be used at all: Türkiye's 2010 regulation bans them, which is why Turkish patients appear in Cypriot and other foreign clinics rather than Turkish ones. Second, whether the donor stays anonymous: the UK ended anonymity for donations made after 1 April 2005, and a donor-conceived person may have the donor's name, date of birth and last known address at 18, while several European destinations run anonymous programmes — which is the single commonest reason a patient names for crossing a border for eggs. Third, who may be treated at all: age caps, marital status and sexual orientation appear in national statutes rather than in clinic protocols, and a clinic in the next country may have none of them. The rule records carry the country-by-country map with its instruments and dates.\n\nOn the bill: a published cycle price is normally the theatre, the laboratory and one transfer. Stimulation drugs are normally not in it — the Reprofit price list valid from 1 January 2026 names no medication in any inclusion line, and Newlife IVF in Thessaloniki puts medications in the exclusion list in terms. Preliminary tests, freezing, storage and any second transfer are separately priced almost everywhere. A cycle that ends before egg collection is charged at a reduced rate rather than refunded: Reprofit lists 130 EUR for a treatment cancelled before egg collection and 565 EUR for a cycle that produced no usable eggs.", "today": "As of September 2026 the published per-cycle prices read off clinic pages for this record run from 1,100 EUR for a native-cycle IVF with no stimulation in Brno to 5,290 EUR in Barcelona and 4,999 US dollars as a base price in New York state, with the drug bill outside all of them. The UK regulator publishes no price at all and says clinics set their own, noting that the same treatment can be two or three times more expensive depending on the clinic.", "notes": "This page describes a treatment and reports what registers and price lists say about it. It is not medical advice and it is not legal advice." }, "metrics": { "success_rate_pct": 25, "note": "25% is the HFEA's preliminary average IVF birth rate PER EMBRYO TRANSFERRED in 2023 — fresh transfers, patients using their own eggs. It is not per cycle started and not per patient. The same register gives 35% per embryo transferred for patients aged 18-34 and 5% at 43-44, and 33% per embryo transferred for frozen transfers. The US register counts from a different starting line: CDC's national rows for 2022 give 49.7% of intended retrievals ending in a live-birth delivery for patients under 35 and 7.7% for patients over 40, against 49.1% and 25.4% of TRANSFERS. Over 40 the per-transfer figure is more than three times the per-retrieval figure, because every cycle that never reached a transfer has dropped out of the denominator. CDC's per-retrieval rate is cumulative: it counts live births from that retrieval and its associated transfers within 12 months of cycle start. HFEA marks its 2023 birth rates preliminary and not validated.", "as_of": "2023", "source": "s:hfea-2023-trends", "url": "https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2023-trends-and-figures/" }, "prices": [ { "procedure": "ivf", "country": "CZ", "city": "Brno", "amount": 3245, "currency": "EUR", "as_of": "2026-01-01", "kind": "package", "includes": [ "consultation", "treatment plan", "protocol preparation", "stimulation process monitoring", "egg retrieval", "sperm analysis and preparation", "ICSI", "extended cultivation", "embryotransfer (fresh embryo)" ], "excludes": [ "2x STDs testing", "MFSS / MACS", "PICSI", "EmbryoGlue", "TimeLaps cultivation", "cryopreservation", "general anesthesia" ], "source": "s:reprofit-pricelist-2026", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "note": "line \"IVF cycle with own eggs (IVF)\" on the clinic's self-payer price list, valid from 1 January 2026. Stimulation medication appears nowhere in the inclusion column of any line on the five-page list. General anaesthesia for the egg collection is a separate 205 EUR.", "tier": "cited", "usd": 3744.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "ivf", "country": "CZ", "city": "Brno", "amount": 4985, "currency": "EUR", "as_of": "2026-01-01", "kind": "package", "includes": [ "consultation", "treatment plan", "protocol preparation", "stimulation process monitoring", "egg retrieval under general anesthesia", "sperm analysis and preparation", "embryo transfer (fresh or frozen embryo) up to six months after fertilization", "2x STDs testing", "ICSI", "extended cultivation", "cryopreservation of all embryos and 1 year of storage" ], "excludes": [ "MFSS / MACS", "PICSI", "EmbryoGlue", "TimeLaps cultivation" ], "source": "s:reprofit-pricelist-2026", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "note": "line \"IVF cycle with own eggs - Optimal\". The 1,740 EUR between this and the plain cycle buys the anaesthetic, the screening tests, the freezing and a year of storage — the four items the cheaper line leaves out.", "tier": "cited", "usd": 5752.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "ivf", "country": "CZ", "city": "Brno", "amount": 1100, "currency": "EUR", "as_of": "2026-01-01", "kind": "package", "includes": [ "consultation", "cycle monitoring", "egg retrieval", "sperm analysis and preparation", "embryo transfer (fresh embryo)" ], "excludes": [ "2x STDs testing", "ICSI", "extended cultivation", "MFSS / MACS", "PICSI", "EmbryoGlue", "TimeLaps cultivation", "cryopreservation", "general anesthesia" ], "source": "s:reprofit-pricelist-2026", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "note": "line \"IVF native cycle\" — no stimulation, so one egg at most, and ICSI, extended cultivation and freezing all sit outside. The cheapest number on the list is the one buying least.", "tier": "cited", "usd": 1269.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "ivf", "country": "ES", "city": "Barcelona", "amount": 5290, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "EmbryoScope+", "blastocyst culture", "first transfer", "ICSI" ], "excludes": [], "source": "s:fertilab-pricing", "url": "https://fertilab.com/en/pricing/", "note": "line \"In Vitro Fertilisation IVF (ICSI)\", read on 16 September 2026; the page states special prices for reservations until 30 September 2026. The page lists what each treatment includes and says nothing either way about stimulation medication — an empty exclusion column is not the same as an inclusive price.", "tier": "cited", "usd": 6104.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "ivf", "country": "GR", "city": "Thessaloniki", "amount": 3860, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "initial consultation", "follow-ups", "ultrasounds", "sedation", "ICSI", "blastocyst culture", "assisted hatching", "sperm freezing", "first embryo transfer" ], "excludes": [ "preliminary investigations", "extra tests", "medications", "embryo storage", "travel and accommodation" ], "source": "s:newlife-ivf-costs", "url": "https://www.newlife-ivf.co.uk/ivf-costs", "note": "IVF/ICSI cycle with own eggs at the clinic in Thessaloniki, read on 16 September 2026; the page carries no date of its own. Medications are named in the exclusion list. The same page sells three retrievals for 8,750 EUR.", "tier": "cited", "usd": 4454.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "ivf", "country": "US", "city": "Syracuse", "amount": 4999, "currency": "USD", "as_of": "2026-07-07", "kind": "list", "includes": [ "ICSI as standard", "assisted hatching as standard", "cryopreservation as standard" ], "excludes": [ "monitoring", "medications" ], "source": "s:cny-ivf-cost", "url": "https://www.cnyfertility.com/ivf-cost/", "note": "the clinic's own base IVF price on a page dated 7 July 2026. The same page puts its complete cycle at 7,994 to 12,888 USD once monitoring and add-ons are counted, and medications at about 2,700 USD typically, 1,500 to over 7,000 USD across protocols.", "tier": "cited", "usd": 4999.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "ivf", "country": "US", "city": "Syracuse", "amount": 7994, "amount_high": 12888, "currency": "USD", "as_of": "2026-07-07", "kind": "quoted-range", "includes": [ "a complete cycle including monitoring and standard add-ons" ], "excludes": [ "medications" ], "source": "s:cny-ivf-cost", "url": "https://www.cnyfertility.com/ivf-cost/", "note": "the clinic's own range for what it calls a complete cycle, against unattributed national figures of 19,500 to 29,700 USD given on the same page. The national range has no source named on the page and is not carried as a price row here.", "tier": "cited", "usd": 7994.0, "usd_high": 12888.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "icsi", "as": "The fertilisation method used in most of these cycles, and bundled into the price on nearly every list.", "rel": "part" }, { "to": "egg-donation", "as": "The same cycle with someone else's eggs — and the version most often crossing a border.", "rel": "contrast" }, { "to": "pgt", "as": "The test added to embryos from this cycle, priced per embryo and rated red by the UK regulator.", "rel": "part" }, { "to": "egg-freezing", "as": "The first half of this cycle, stopped after collection and resumed years later.", "rel": "kin" }, { "to": "circumvention-travel", "as": "What the law-driven half of this traffic is called in the literature.", "rel": "term" }, { "to": "reproductive-exile", "as": "The word offered for patients who travel because home will not treat them.", "rel": "term" }, { "to": "donor-anonymity-law", "as": "The rule that decides whether the donor can stay unnamed, and so where the cycle is bought.", "rel": "governed-by" }, { "to": "surrogacy-law", "as": "The neighbouring prohibition that reaches across the same borders.", "rel": "governed-by" }, { "to": "hfea", "as": "Publishes the UK birth rates this record quotes, and rates the add-ons sold alongside the cycle.", "rel": "measures" }, { "to": "eshre", "as": "Runs the European register behind the continental figures, and the taskforce that counted cross-border patients.", "rel": "measures" }, { "to": "cycle", "as": "The unit this treatment is sold and counted in, and the reason two prices are not comparable.", "rel": "term" }, { "to": "czechia", "as": "Where the cheapest published cycle on this page is sold.", "rel": "destination" }, { "to": "package-price", "as": "The pricing form a cycle is sold in, and the reason the drug bill sits outside it.", "rel": "term" } ], "confusable_with": [ { "id": "icsi", "tell": "A price page saying IVF often means ICSI; Reprofit and Fertilab both fold ICSI into the cycle price, so the two words name one bill." }, { "id": "egg-freezing", "tell": "Egg freezing is the stimulation and collection without the fertilisation; the thaw cycle is priced again years later." } ], "links": [ { "label": "Reprofit price list, valid from 1 January 2026", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf" }, { "label": "HFEA — Fertility treatment 2023: trends and figures", "url": "https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2023-trends-and-figures/" }, { "label": "CDC — 2022 Final ART Summary", "url": "https://data.cdc.gov/Assisted-Reproductive-Technology-ART-/2022-Final-Assisted-Reproductive-Technology-ART-Su/9tjt-seye" } ], "sources": [ "s:hfea-2023-trends", "s:hfea-ivf", "s:hfea-costs-funding", "s:cdc-art-2022-summary", "s:cdc-art-2019-national-summary", "s:eshre-art-factsheet", "s:shenfield-2010", "s:inhorn-patrizio-2009", "s:cohen-circumvention-2012", "s:gurtin-2011-turkey", "s:reprofit-pricelist-2026", "s:fertilab-pricing", "s:newlife-ivf-costs", "s:cny-ivf-cost", "s:hfea-donating-sperm", "s:nhs-ivf" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:shenfield-2010", "note": "the cross-border estimate, the two terminology papers and the Turkish regulation are each cited; the closing paragraph on why price pages exist is marked Trade practice and the paragraph on where Turkish patients go is marked Inference" }, "text.how": { "tier": "cited", "source": "s:reprofit-pricelist-2026", "note": "the exclusions are read off the named price lists; the legal map is summarised and belongs to the rule records" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:hfea-2023-trends" }, "prices": { "tier": "cited", "source": "s:reprofit-pricelist-2026" } } }, "x_commons_files": [ "File:Blausen 0060 AssistedReproductiveTechnology.png", "File:ICSI oocyte.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "Drugs stimulate the ovaries to ripen several eggs at once; the eggs are collected through the vaginal wall under sedation or general anaesthetic in about half an hour; the eggs are mixed with sperm in a laboratory; and…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "icsi", "type": "procedure", "name": "Intracytoplasmic sperm injection", "as": "The fertilisation method used in most of these cycles, and bundled into the price on nearly every list.", "rel": "part" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The same cycle with someone else's eggs — and the version most often crossing a border.", "rel": "contrast" }, { "to": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "The test added to embryos from this cycle, priced per embryo and rated red by the UK regulator.", "rel": "part" }, { "to": "egg-freezing", "type": "procedure", "name": "Egg freezing", "as": "The first half of this cycle, stopped after collection and resumed years later.", "rel": "kin" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "What the law-driven half of this traffic is called in the literature.", "rel": "term" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The word offered for patients who travel because home will not treat them.", "rel": "term" }, { "to": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The rule that decides whether the donor can stay unnamed, and so where the cycle is bought.", "rel": "governed-by" }, { "to": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "The neighbouring prohibition that reaches across the same borders.", "rel": "governed-by" }, { "to": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "Publishes the UK birth rates this record quotes, and rates the add-ons sold alongside the cycle.", "rel": "measures" }, { "to": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "Runs the European register behind the continental figures, and the taskforce that counted cross-border patients.", "rel": "measures" }, { "to": "cycle", "type": "term", "name": "Cycle", "as": "The unit this treatment is sold and counted in, and the reason two prices are not comparable.", "rel": "term" }, { "to": "czechia", "type": "destination", "name": "Czechia", "as": "Where the cheapest published cycle on this page is sold.", "rel": "destination" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The pricing form a cycle is sold in, and the reason the drug bill sits outside it.", "rel": "term" } ], "source_list": [ { "id": "s:hfea-2023-trends", "kind": "org", "title": "Fertility treatment 2023: trends and figures", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2023-trends-and-figures/", "accessed": "2026-09-16", "note": "the UK regulator's annual register report; birth rates marked preliminary and not yet validated" }, { "id": "s:hfea-ivf", "kind": "org", "title": "In vitro fertilisation (IVF)", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/treatments/explore-all-treatments/in-vitro-fertilisation-ivf/", "accessed": "2026-09-16" }, { "id": "s:hfea-costs-funding", "kind": "org", "title": "Costs and funding", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/treatments/explore-all-treatments/costs-and-funding/", "accessed": "2026-09-16", "note": "the regulator declines to publish a price and says clinics set their own" }, { "id": "s:cdc-art-2022-summary", "kind": "dataset", "title": "2022 Final Assisted Reproductive Technology (ART) Summary", "publisher": "US Centers for Disease Control and Prevention", "url": "https://data.cdc.gov/Assisted-Reproductive-Technology-ART-/2022-Final-Assisted-Reproductive-Technology-ART-Su/9tjt-seye", "accessed": "2026-09-16", "note": "clinic-level and national rows; the national rows carry locationabbr NA. Queried through the Socrata endpoint https://data.cdc.gov/resource/9tjt-seye.json" }, { "id": "s:cdc-art-2019-national-summary", "kind": "org", "title": "2019 Assisted Reproductive Technology Fertility Clinic and National Summary Report", "publisher": "US Centers for Disease Control and Prevention", "url": "https://archive.cdc.gov/www_cdc_gov/art/reports/2019/pdf/2019-Report-ART-Fertility-Clinic-National-Summary-h.pdf", "accessed": "2026-09-16", "note": "read for CDC's own definitions of intended retrieval, actual retrieval, transfer and live-birth delivery" }, { "id": "s:eshre-art-factsheet", "kind": "org", "title": "ART fact sheet (v10, 2025)", "publisher": "European Society of Human Reproduction and Embryology", "url": "https://www.eshre.eu/-/media/sitecore-files/Press-room/ESHRE_ARTFactSheet_v10_2025.pdf", "accessed": "2026-09-16", "note": "European and world figures for 2020, drawn from the EIM consortium and ICMART" }, { "id": "s:shenfield-2010", "kind": "paper", "title": "Cross border reproductive care in six European countries", "publisher": "Human Reproduction 25(6):1361-1368, ESHRE Taskforce on Cross Border Reproductive Care", "url": "https://academic.oup.com/humrep/article/25/6/1361/2915759", "accessed": "2026-09-16" }, { "id": "s:inhorn-patrizio-2009", "kind": "paper", "title": "Rethinking reproductive \"tourism\" as reproductive \"exile\"", "publisher": "Fertility and Sterility 92(3):904-906 (Inhorn MC, Patrizio P)", "url": "https://www.fertstert.org/article/S0015-0282(09)00046-6/fulltext", "accessed": "2026-09-16", "note": "citation and the authors' framing verified from the publisher's own article listing; the full text returned HTTP 403 and was not read" }, { "id": "s:cohen-circumvention-2012", "kind": "paper", "title": "Circumvention Tourism", "publisher": "Cornell Law Review 97(6):1309 (Cohen IG)", "url": "https://scholarship.law.cornell.edu/clr/vol97/iss6/1", "accessed": "2026-09-16" }, { "id": "s:gurtin-2011-turkey", "kind": "paper", "title": "Banning reproductive travel: Turkey's ART legislation and third-party assisted reproduction", "publisher": "Reproductive BioMedicine Online (Gurtin ZB)", "url": "https://www.rbmojournal.com/article/S1472-6483(11)00470-6/fulltext", "accessed": "2026-09-16", "note": "citation and the 2010 regulation's extraterritorial clause verified from the journal's own article listing; the full text returned HTTP 403 and was not read. Treated as needing verification wherever it is relied on." }, { "id": "s:reprofit-pricelist-2026", "kind": "web", "title": "Pricelist — Assisted Reproduction, valid from 01.01.2026 (document 0331.26ENG)", "publisher": "Reprofit International s.r.o., Brno", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "accessed": "2026-09-16", "note": "the clinic's own self-payer price list, five pages, each line naming its inclusions and its exclusions" }, { "id": "s:fertilab-pricing", "kind": "web", "title": "Price list — fertility treatments", "publisher": "Fertilab Barcelona", "url": "https://fertilab.com/en/pricing/", "accessed": "2026-09-16" }, { "id": "s:newlife-ivf-costs", "kind": "web", "title": "IVF costs, egg donation costs", "publisher": "Newlife IVF, Thessaloniki", "url": "https://www.newlife-ivf.co.uk/ivf-costs", "accessed": "2026-09-16" }, { "id": "s:cny-ivf-cost", "kind": "web", "title": "IVF Cost 2026: breakdown of prices, add-ons", "publisher": "CNY Fertility", "url": "https://www.cnyfertility.com/ivf-cost/", "accessed": "2026-09-16", "note": "page dated 7 July 2026; carries the clinic's own list prices and unattributed national ranges" }, { "id": "s:hfea-donating-sperm", "kind": "org", "title": "Donating your sperm", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/donation/donors/donating-your-sperm/", "accessed": "2026-09-16" }, { "id": "s:nhs-ivf", "kind": "org", "title": "IVF", "publisher": "National Health Service (United Kingdom)", "url": "https://www.nhs.uk/conditions/ivf/", "accessed": "2026-09-16", "note": "page last reviewed 15 April 2025" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:shenfield-2010", "note": "the cross-border estimate, the two terminology papers and the Turkish regulation are each cited; the closing paragraph on why price pages exist is marked Trade practice and the paragraph on where Turkish patients go is marked Inference" }, "text.how": { "tier": "cited", "source": "s:reprofit-pricelist-2026", "note": "the exclusions are read off the named price lists; the legal map is summarised and belongs to the rule records" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:reprofit-pricelist-2026" }, "metrics": { "tier": "cited", "source": "s:hfea-2023-trends" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "belgium", "type": "destination", "name": "Belgium", "as": "The treatment that brings patients here from countries that restrict it.", "rel": "procedure" }, { "from": "cyprus", "type": "destination", "name": "Cyprus", "as": "The treatment its licensed units are built around.", "rel": "procedure" }, { "from": "czechia", "type": "destination", "name": "Czechia", "as": "Sold here as a programme in euro, priced from a published list.", "rel": "procedure" }, { "from": "greece", "type": "destination", "name": "Greece", "as": "The treatment its export clinics are built on.", "rel": "procedure" }, { "from": "iran", "type": "destination", "name": "Iran", "as": "Fertility treatment sought here by patients from across the region.", "rel": "procedure" }, { "from": "israel", "type": "destination", "name": "Israel", "as": "One of the treatments the inbound flow is built on.", "rel": "procedure" }, { "from": "malaysia", "type": "destination", "name": "Malaysia", "as": "The treatment Malaysia sells hardest, and the one its neighbours travel for.", "rel": "procedure" }, { "from": "north-cyprus", "type": "destination", "name": "Northern Cyprus", "as": "The treatment nearly every clinic here sells.", "rel": "procedure" }, { "from": "portugal", "type": "destination", "name": "Portugal", "as": "The treatment the 2018 ruling reshaped here.", "rel": "procedure" }, { "from": "south-africa", "type": "destination", "name": "South Africa", "as": "Named as a draw for patients from across the continent.", "rel": "procedure" }, { "from": "spain", "type": "destination", "name": "Spain", "as": "The treatment its national registry counts, clinic by clinic.", "rel": "procedure" }, { "from": "taiwan", "type": "destination", "name": "Taiwan", "as": "Fertility work sold to patients from across the Chinese-speaking region.", "rel": "procedure" }, { "from": "tunisia", "type": "destination", "name": "Tunisia", "as": "Named by the health ministry among the treatments more than half its foreign patients come for.", "rel": "procedure" }, { "from": "barcelona", "type": "hub", "name": "Barcelona", "as": "The cycle every programme quoted here is built around.", "rel": "procedure" }, { "from": "dubai", "type": "hub", "name": "Dubai", "as": "Sold here to a regional market that often cannot buy it at home.", "rel": "procedure" }, { "from": "izmir", "type": "hub", "name": "İzmir", "as": "Sold here by clinics that also serve the domestic Aegean market.", "rel": "procedure" }, { "from": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "The fertility work that distinguishes this cluster from Penang's.", "rel": "procedure" }, { "from": "mumbai", "type": "hub", "name": "Mumbai", "as": "A large private fertility trade sits alongside the hospitals here.", "rel": "procedure" }, { "from": "nicosia", "type": "hub", "name": "Nicosia", "as": "The treatment both sides of this city sell.", "rel": "procedure" }, { "from": "prague", "type": "hub", "name": "Prague", "as": "The cycle the donation sits inside.", "rel": "procedure" }, { "from": "tbilisi", "type": "hub", "name": "Tbilisi", "as": "The cycle every programme here is built around.", "rel": "procedure" }, { "from": "tel-aviv", "type": "hub", "name": "Tel Aviv", "as": "The treatment most often named as the reason for the journey.", "rel": "procedure" }, { "from": "abortion-care", "type": "procedure", "name": "Abortion", "as": "The other reproductive procedure whose travel is set by what each country's law allows rather than by price.", "rel": "contrast" }, { "from": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The cycle this is a version of, run on somebody else's eggs.", "rel": "whole" }, { "from": "egg-freezing", "type": "procedure", "name": "Egg freezing", "as": "The cycle this is the first half of, and the treatment the frozen eggs come back to.", "rel": "part" }, { "from": "icsi", "type": "procedure", "name": "Intracytoplasmic sperm injection", "as": "The cycle this step sits inside, and the word most price pages use for both.", "rel": "whole" }, { "from": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "The cycle this test is added to, and the bill it is charged on top of.", "rel": "part" }, { "from": "sperm-donation", "type": "procedure", "name": "Sperm donation", "as": "The cycle donor sperm is used in when insemination is not the treatment.", "rel": "kin" }, { "from": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "The treatment that makes the embryo, priced and bought separately from the programme.", "rel": "part" }, { "from": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "Its fertility centres report treating over 15,000 families a year.", "rel": "performs" }, { "from": "memorial-sisli", "type": "facility", "name": "Memorial Şişli Hospital", "as": "Its fertility, andrology and genetics centre is the unit foreign patients reach it through most.", "rel": "performs" }, { "from": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The treatment the donation feeds.", "rel": "procedure" }, { "from": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "The treatment that makes gestational surrogacy possible, and which many of the same acts regulate.", "rel": "procedure" }, { "from": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "The treatment its consortium counts across Europe.", "rel": "procedure" }, { "from": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "The treatment it licenses, counts and publishes a birth rate for.", "rel": "procedure" }, { "from": "icmart", "type": "org", "name": "International Committee for Monitoring Assisted Reproductive Technologies", "as": "The treatment counted, cycle by cycle, in every national return it receives.", "rel": "procedure" }, { "from": "temos", "type": "org", "name": "Temos International Healthcare Accreditation", "as": "One of the treatments its reproductive care programme covers.", "rel": "procedure" }, { "from": "cycle", "type": "term", "name": "Cycle", "as": "The treatment this word is the unit of.", "rel": "procedure" }, { "from": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The treatment most of these journeys are made for.", "rel": "procedure" }, { "from": "cdc-art-results", "type": "dataset", "name": "CDC assisted reproductive technology results", "as": "The treatment counted, cycle by cycle.", "rel": "procedure" }, { "from": "hfea-results", "type": "dataset", "name": "HFEA fertility treatment results", "as": "The treatment counted, cycle by cycle, since 1991.", "rel": "procedure" }, { "from": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "Where the drugs are the missing line, at 1,500 to over 7,000 dollars on one clinic's own page.", "rel": "procedure" } ] }, { "schema": 1, "id": "kidney-transplant", "type": "procedure", "names": { "name": "Kidney transplant", "aliases": [ "renal transplant", "renal transplantation", "kidney graft" ], "said": "Nephrologists say living or deceased donor first and everything else second, because that distinction sets the waiting time, the outcome and, across a border, the law. Brokers say kidney transplant package and name neither." }, "etymology": { "root": "graft: from Old French greffe, ultimately Greek graphion, a stylus — the shoot cut for grafting was named for the shape of a writing stylus. Allograft: Greek allos, other, plus the same word; the organ is another person's tissue and the body knows it. Renal: Latin ren, kidney.", "tier": "tradition", "note": "financial neutrality is the term of art for the line between lawful reimbursement and purchase: the Declaration of Istanbul defines it as donors and their families neither losing nor gaining financially by donating." }, "region": [ "global" ], "facets": { "family": "transplant", "setting": "inpatient", "anaesthesia": "general" }, "text": { "what": "A kidney from a living or a deceased donor is placed in the recipient's lower abdomen and plumbed into the iliac vessels and the bladder; the recipient's own kidneys are usually left in place. It replaces dialysis rather than curing the disease that destroyed the kidneys, and it commits the recipient to immunosuppressant drugs and monitoring for as long as the graft works. A living donor has a healthy organ removed and gains nothing clinically by it.", "story": "Two people are operated on, and only one of them is ill. That is what makes this the hardest subject in cross-border care, and it is why the law, rather than the price, is the first thing on this page.\n\nThe standing international statement is the Declaration of Istanbul on Organ Trafficking and Transplant Tourism, agreed by 151 participants in Istanbul in April 2008, published in The Lancet on 5 July 2008 and revised in Madrid in July 2018. Its definitions do the work. \"Travel for transplantation is the movement of persons across jurisdictional borders for transplantation purposes.\" It \"becomes transplant tourism, and thus unethical, if it involves trafficking in persons for the purpose of organ removal or trafficking in human organs, or if the resources (organs, professionals and transplant centres) devoted to providing transplants to non-resident patients undermine the country's ability to provide transplant services for its own population.\" Organ trafficking, in the same text, covers \"removing organs from living or deceased donors without valid consent or authorisation or in exchange for financial gain or comparable advantage to the donor and/or a third person\", and also the soliciting or recruiting of donors or recipients \"where carried out for financial gain or comparable advantage\". Crossing a border for a transplant is not, by that text, wrong in itself. Buying the organ is.\n\nThe World Health Organization says the same thing as a rule rather than a definition. Guiding Principle 5, endorsed by the Sixty-third World Health Assembly in May 2010: \"Cells, tissues and organs should only be donated freely, without any monetary payment or other reward of monetary value. Purchasing, or offering to purchase, cells, tissues or organs for transplantation, or their sale by living persons or by the next of kin for deceased persons, should be banned.\" The same principle permits \"reimbursing reasonable and verifiable expenses incurred by the donor, including loss of income\", which is the line every national statute has to draw somewhere.\n\nNational law then diverges, and it diverges on two separate questions. Whether a non-resident may be transplanted at all, and whether a living donor unrelated to the recipient may donate. Some countries permit both under conditions — an authorisation committee, a documented relationship, a ministry approval. Some permit transplantation of residents only. Commercial purchase is prohibited nearly everywhere: in the United States the National Organ Transplant Act makes it \"unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce\", while excluding from valuable consideration the reasonable costs of removal, transport and storage and the donor's \"travel, housing, and lost wages\". The country-by-country reading, one named instrument and one date at a time, sits on this directory's transplant prohibition page.\n\nOn scale, the figure most often repeated comes from the Declaration's own preamble, and it is old: \"In 2007 it was estimated that up to 10% of transplants worldwide involved such practices\", citing a provisional picture assembled by Shimazono in the Bulletin of the World Health Organization. It was a reconstruction from fragmentary reporting, its author said so, and nothing better has replaced it here.", "how": "General anaesthesia, three to five hours, and a ward stay that is short by the standards of major surgery: Milliman's 2025 estimate of the average US hospital stay is 7.5 days, against 20.2 for a liver. Immunosuppression starts at once and does not stop. Rejection is commonest early; infection is the price of the drugs that prevent it. What the published literature records about grafts obtained abroad through commercial routes is worse on every axis. A Riyadh centre compared 60 patients who had been transplanted abroad with 254 transplanted locally between January 2015 and December 2018: delayed graft function 18.3% against 6.3%, acute rejection 40% against 7.9%, and graft failure at three years 11.7% against 0.8%, with \"higher posttransplant infection in general\" and more urological complications. The US Centers for Disease Control's account of what travels with the patient is that donors \"might not be screened as thoroughly\", that organs \"might be obtained using unethical means\", and that recipients \"may not receive adequate follow-up, including documentation from their surgeons\". A transplant with no operative note is a lifelong medical problem for whoever inherits the patient.", "today": "The only price read for this record on 16 September 2026 is an American actuarial estimate. Milliman puts average 2025 US billed charges for a kidney transplant at 446,800 dollars across the window from 30 days before admission to 180 days after discharge, of which procurement — recovering, preserving and transporting the organ — is 135,400 and the transplant admission itself 142,500. The report states that billed charges \"are unlikely to equal the actual amount paid\". No hospital price for a self-paying foreign recipient was read here, and a price quoted for an operation whose second participant is a living donor is not a comparable object in any case.", "notes": "This page describes an operation and reports what published instruments and studies say about it. It is not medical advice and it is not legal advice, and it does not say what any reader should do." }, "metrics": { "stay_days": 7.5, "days_before_flying": null, "recovery_weeks": null, "note": "Milliman's estimated 2025 US average hospital length of stay, from claims data rather than a protocol. No published wait before flying was read for this record; the constraint after a kidney transplant is the immunosuppression and the monitoring, not the flight.", "as_of": "2025", "source": "s:milliman-transplant-2025", "url": "https://www.milliman.com/en/insight/2025-us-organ-and-tissue-transplants-costs-utilization" }, "prices": [ { "procedure": "kidney-transplant", "country": "US", "amount": 446800, "currency": "USD", "as_of": "2025", "kind": "estimate", "includes": [ "30 days pretransplant, $30,900", "procurement, $135,400", "hospital transplant admission, $142,500", "physician services during the admission, $22,100", "180 days posttransplant discharge, $88,200", "outpatient immunosuppressants and other prescriptions, $27,700" ], "excludes": [ "anything outside the window of 30 days before admission to 180 days after discharge", "immunosuppressants past that window, which the recipient takes for the life of the graft", "the difference between a billed charge and a negotiated rate" ], "source": "s:milliman-transplant-2025", "url": "https://www.milliman.com/en/insight/2025-us-organ-and-tissue-transplants-costs-utilization", "note": "an actuarial estimate of US average billed charges, not a quoted price. Procurement is the second largest line and is the one that has no equivalent on any other price page in this directory.", "tier": "cited", "usd": 446800.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "liver-transplant", "as": "The same law, the same donor question, a longer operation and four times the bill.", "rel": "kin" }, { "to": "transplant-prohibition", "as": "Where the country-by-country law sits: one named instrument, one date, one jurisdiction at a time.", "rel": "governed-by" }, { "to": "transplant-harm", "as": "What the published follow-up records about grafts bought abroad, for the recipient and for the donor.", "rel": "risk" }, { "to": "declaration-of-istanbul-group", "as": "Keeps the standing international text this page quotes, and revised it in 2018.", "rel": "org" }, { "to": "istanbul-declaration-2008", "as": "The Istanbul summit of April 2008, where the definitions on this page were agreed.", "rel": "event" }, { "to": "who", "as": "Guiding Principle 5, endorsed by the World Health Assembly in 2010, is the rule the statutes are written against.", "rel": "org" }, { "to": "bone-marrow-transplant", "as": "The other transplant here where a healthy second person takes the risk.", "rel": "kin" }, { "to": "bloodborne-virus", "as": "What an unscreened donor can transmit with the graft.", "rel": "risk" }, { "to": "malpractice-recourse", "as": "Who answers for an operation performed where the recipient cannot sue and the donor cannot be found.", "rel": "risk" }, { "to": "follow-up-gap", "as": "A graft that arrives home without an operative note, and a clinic that must take it on anyway.", "rel": "risk" } ], "confusable_with": [ { "id": "dialysis-holiday", "tell": "Dialysis abroad is a booked treatment slot on a trip. A transplant abroad is an operation on two people, one of whom is not the traveller." } ], "links": [ { "label": "The Declaration of Istanbul, 2018 edition", "url": "https://www.declarationofistanbul.org/the-declaration" }, { "label": "WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation (WHA63.22, 2010)", "url": "https://iris.who.int/server/api/core/bitstreams/53e1102b-4874-49bf-97bc-c529b1c246f0/content" }, { "label": "42 U.S. Code § 274e", "url": "https://www.law.cornell.edu/uscode/text/42/274e" } ], "sources": [ "s:doi-2018-text", "s:declaration-of-istanbul", "s:who-guiding-principles", "s:usc-42-274e", "s:milliman-transplant-2025", "s:altheaby-transplant-tourism-2022", "s:cdc-yellowbook-2026-medical-tourism" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:doi-2018-text", "note": "every quotation is from the named instrument; the 10% figure is carried as the Declaration carries it, with its 2007 date and its provisional method stated" }, "text.how": { "tier": "cited", "source": "s:altheaby-transplant-tourism-2022" }, "prices": { "tier": "cited", "source": "s:milliman-transplant-2025" }, "etymology": { "tier": "tradition" } } }, "x_commons_files": [ "File:Kidney transplant.svg", "File:Renal transplant surgery.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "A kidney from a living or a deceased donor is placed in the recipient's lower abdomen and plumbed into the iliac vessels and the bladder; the recipient's own kidneys are usually left in place.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "The same law, the same donor question, a longer operation and four times the bill.", "rel": "kin" }, { "to": "transplant-prohibition", "type": "rule", "name": "Buying an organ, and being transplanted abroad", "as": "Where the country-by-country law sits: one named instrument, one date, one jurisdiction at a time.", "rel": "governed-by" }, { "to": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "What the published follow-up records about grafts bought abroad, for the recipient and for the donor.", "rel": "risk" }, { "to": "declaration-of-istanbul-group", "type": "org", "name": "Declaration of Istanbul Custodian Group", "as": "Keeps the standing international text this page quotes, and revised it in 2018.", "rel": "org" }, { "to": "istanbul-declaration-2008", "type": "event", "name": "The Declaration of Istanbul, 2008", "as": "The Istanbul summit of April 2008, where the definitions on this page were agreed.", "rel": "event" }, { "to": "who", "type": "org", "name": "World Health Organization", "as": "Guiding Principle 5, endorsed by the World Health Assembly in 2010, is the rule the statutes are written against.", "rel": "org" }, { "to": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "The other transplant here where a healthy second person takes the risk.", "rel": "kin" }, { "to": "bloodborne-virus", "type": "risk", "name": "Bloodborne virus from treatment abroad", "as": "What an unscreened donor can transmit with the graft.", "rel": "risk" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "Who answers for an operation performed where the recipient cannot sue and the donor cannot be found.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "A graft that arrives home without an operative note, and a clinic that must take it on anyway.", "rel": "risk" } ], "source_list": [ { "id": "s:doi-2018-text", "kind": "org", "title": "The Declaration of Istanbul on Organ Trafficking and Transplant Tourism, 2018 edition — preamble, definitions and the eleven principles", "publisher": "Declaration of Istanbul Custodian Group; adopted in Madrid in July 2018, updating the 2008 text first published in The Lancet on 5 July 2008", "url": "https://www.declarationofistanbul.org/the-declaration", "accessed": "2026-09-16", "note": "the full text on the Custodian Group's own site; its preamble carries the 2007 estimate from Shimazono, Bulletin of the World Health Organization 85(12):955-962, and its references list the Council of Europe Convention against Trafficking in Human Organs, ETS No. 216, Santiago de Compostela, 25 March 2015" }, { "id": "s:declaration-of-istanbul", "kind": "org", "title": "The Declaration of Istanbul on Organ Trafficking and Transplant Tourism (2018 edition)", "publisher": "Declaration of Istanbul Custodian Group", "url": "https://www.declarationofistanbul.org/", "accessed": "2026-09-16" }, { "id": "s:who-guiding-principles", "kind": "org", "title": "WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation, as endorsed by the Sixty-third World Health Assembly, May 2010, in Resolution WHA63.22", "publisher": "World Health Organization", "url": "https://iris.who.int/server/api/core/bitstreams/53e1102b-4874-49bf-97bc-c529b1c246f0/content", "accessed": "2026-09-16" }, { "id": "s:usc-42-274e", "kind": "statute", "title": "42 U.S. Code § 274e — Prohibition of organ purchases", "publisher": "National Organ Transplant Act 1984, as codified; text via Legal Information Institute, Cornell Law School", "url": "https://www.law.cornell.edu/uscode/text/42/274e", "accessed": "2026-09-16" }, { "id": "s:milliman-transplant-2025", "kind": "report", "title": "2025 U.S. organ and tissue transplants: Estimated costs and utilization, emerging issues, and solutions", "publisher": "Nick Ortner and Hanna Holzer, Milliman, February 2025", "url": "https://www.milliman.com/en/insight/2025-us-organ-and-tissue-transplants-costs-utilization", "accessed": "2026-09-16", "note": "estimated US average billed charges per transplant for the window 30 days before admission to 180 days after discharge, broken into six components; the report states that billed charges are unlikely to equal the amount actually paid" }, { "id": "s:altheaby-transplant-tourism-2022", "kind": "paper", "title": "Graft and Patient Outcomes of Kidney Transplant Tourism: A Single-Center Experience", "publisher": "Avicenna Journal of Medicine 2022;12(3):120-126 (Altheaby A, Owaidah K, Alotaibi A, et al.), King Abdulaziz Medical City, Riyadh", "url": "https://pubmed.ncbi.nlm.nih.gov/36092382/", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:doi-2018-text", "note": "every quotation is from the named instrument; the 10% figure is carried as the Declaration carries it, with its 2007 date and its provisional method stated" }, "text.how": { "tier": "cited", "source": "s:altheaby-transplant-tourism-2022" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:milliman-transplant-2025" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "india", "type": "destination", "name": "India", "as": "Sought here, and the reason the transplant rules are read closely.", "rel": "procedure" }, { "from": "nepal", "type": "destination", "name": "Nepal", "as": "Among the operations Nepali patients most often leave for.", "rel": "procedure" }, { "from": "bogota", "type": "hub", "name": "Bogotá", "as": "Transplant medicine is part of what the city's hospitals sell across borders, and it is the part with the sharpest rules.", "rel": "performs" }, { "from": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "The other transplant in this directory where a second person carries the risk.", "rel": "kin" }, { "from": "dialysis-holiday", "type": "procedure", "name": "Dialysis away from home", "as": "What this treatment is the alternative to, and the operation that ends it.", "rel": "contrast" }, { "from": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "The same law and the same donor question, a shorter operation and less than half the bill.", "rel": "kin" }, { "from": "fundacion-santa-fe", "type": "facility", "name": "Fundación Santa Fe de Bogotá", "as": "Among the programmes carrying a separate JCI clinical care centre certification.", "rel": "performs" }, { "from": "medicana", "type": "facility", "name": "Medicana Health Group", "as": "Named among the group's specialties, without a hospital or a volume against it.", "rel": "performs" }, { "from": "memorial-sisli", "type": "facility", "name": "Memorial Şişli Hospital", "as": "Licensed for it in March 2004, the first private Turkish hospital to be.", "rel": "performs" }, { "from": "bloodborne-virus", "type": "risk", "name": "Bloodborne virus from treatment abroad", "as": "Where donor-derived infection enters the same list.", "rel": "procedure" }, { "from": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "The organ the outcome figures on this page are for.", "rel": "procedure" }, { "from": "transplant-prohibition", "type": "rule", "name": "Buying an organ, and being transplanted abroad", "as": "The operation most of this law was written about.", "rel": "procedure" }, { "from": "declaration-of-istanbul-group", "type": "org", "name": "Declaration of Istanbul Custodian Group", "as": "The operation the Declaration was written about.", "rel": "procedure" }, { "from": "istanbul-declaration-2008", "type": "event", "name": "The Declaration of Istanbul, 2008", "as": "The operation the declaration was written about.", "rel": "procedure" } ] }, { "schema": 1, "id": "knee-arthroscopy", "type": "procedure", "names": { "name": "Knee arthroscopy", "aliases": [ "keyhole knee surgery", "arthroscopic partial meniscectomy", "meniscus surgery", "knee scope" ], "said": "Patients say keyhole. Surgeons name what was done through the keyhole — meniscectomy, meniscal repair, chondroplasty, loose body removal — because the camera is the access, not the operation." }, "etymology": { "root": "arthroscopy: Greek arthron, a joint, plus skopein, to look. Meniscus is Greek meniskos, a little moon, for the crescent of cartilage. Meniscectomy adds ektome, a cutting out.", "tier": "tradition", "note": "A diagnostic arthroscopy looks; a therapeutic one cuts. Australia's schedule separates the two, and pays for the look only where the diagnosis was undetermined beforehand." }, "region": [ "global" ], "facets": { "family": "orthopaedic", "setting": "day-case", "anaesthesia": "general" }, "text": { "what": "A camera and instruments go into the knee through two or three small portals. Torn meniscus is trimmed or stitched, loose bodies are removed, roughened cartilage is smoothed, the joint is washed out. It is usually a day case or one night, and it is the cheapest of the knee operations on this site's price table by a factor of three.", "story": "Arthroscopy is the procedure whose indications moved under it. *Trade practice —* trial evidence on arthroscopy for the worn knee has been argued over for two decades, and the argument reached patients not as a headline but as a payer's fine print: the schedule kept paying, and narrowed whom it paid for.\n\nAustralia's schedule shows what that looks like in an item number. Item 49572 pays $795.05 as at 1 July 2026 for partial meniscectomy for an atraumatic tear — and excludes, in its own wording, a service performed for the purpose of treating osteoarthritis. Item 49570 pays for a diagnostic arthroscopy only where the pre-procedure diagnosis is undetermined. The payer did not ban the operation; it defined the patient.\n\nThe package market has no such clause. Bumrungrad prices arthroscopic knee meniscus surgery — repair or resection, with debridement, chondroplasty, synovectomy and microfracture named in the same package — at 243,300 baht with one night, marked down from 270,300. Practice Plus Group lists knee arthroscopy at £5,899 in England, the same figure as its meniscus surgery line. Nordorthopaedics advertises knee arthroscopy \"from 1.500 € / 1.250 £\", the cheapest orthopaedic price this batch read.\n\n*Inference —* a patient reading only package pages would not learn that the indication is contested. The dispute lives in the payer's fine print, and the fine print does not travel.", "how": "General or spinal anaesthesia, twenty to forty-five minutes of surgery, two or three portals, and home the same day or the next. Walking is immediate and unaided within days for a simple trim; a meniscal repair, as against a resection, is followed by weeks of restricted weight-bearing and a brace, and the two are priced identically on most of the pages read for this record.", "today": "As of 16 September 2026 knee arthroscopy prices on this site run from an advertised Lithuanian floor of 1,500 euro through £5,899 in England to 243,300 baht in Bangkok with one night included, against an Australian schedule fee of $795.05 that carries a written indication test the package prices do not.", "notes": "This page describes an operation, the argument about when it is warranted, and the prices published for it. It is not clinical advice." }, "metrics": { "stay_days": 1, "days_before_flying": null, "recovery_weeks": null, "note": "One night is the stay named on Bumrungrad's arthroscopic knee meniscus package. No page read for this record publishes a recovery span or a flying interval for keyhole knee surgery, and the CDC's ten-day figure quoted elsewhere in this batch is guidance for chest and abdominal surgery, so it is not carried onto a day case here.", "as_of": "2026-09-16", "source": "s:bumrungrad-joint-packages", "url": "https://www.bumrungrad.com/en/packages/packages-center/joint-replacement-surgery" }, "prices": [ { "procedure": "knee-arthroscopy", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 243300, "currency": "THB", "as_of": "2026-09-16", "kind": "package", "includes": [ "arthroscopic surgery to repair or resect the meniscus", "debridement, abrasive chondroplasty, synovectomy", "cartilage procedures such as microfracture", "1 night of hospital stay" ], "excludes": [], "source": "s:bumrungrad-joint-packages", "url": "https://www.bumrungrad.com/en/packages/packages-center/joint-replacement-surgery", "note": "listed at 243,300 THB against 270,300 THB under a campaign the page labels \"Special Campaign Discount Common Procedures\". Repair and resection — two operations with different recoveries — are priced as one package. The per-package exclusion list sits on the package's own detail page, not read for this record.", "tier": "cited", "usd": 7308.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "knee-arthroscopy", "country": "GB", "city": "England", "amount": 5899, "currency": "GBP", "as_of": "2026-09-16", "kind": "list", "includes": [ "pre-operative nurse review", "prescriptions, dressings and equipment", "anaesthetic", "any overnight stay required", "physiotherapy", "pathology and histology needed whilst admitted", "any post-operative appointments required", "a named knee consultant from start to finish" ], "excludes": [ "the initial consultation, listed separately at £145" ], "source": "s:practiceplus-knee", "url": "https://practiceplusgroup.com/treatments/knee-surgery/", "note": "knee arthroscopy and knee repair — meniscus surgery are both listed at £5,899 on the same page, which prices the camera rather than what is done through it.", "tier": "cited", "usd": 7950.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "knee-arthroscopy", "country": "LT", "city": "Kaunas", "amount": 1500, "currency": "EUR", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [], "excludes": [], "source": "s:nordorthopaedics-prices", "url": "https://www.nordorthopaedics.com/hip-knee-wrist-hand-ankle-foot-shoulder-surgery-prices/", "note": "advertised as \"from 1.500 € / 1.250 £\", the lowest orthopaedic figure read for this batch; the page states no inclusion list.", "tier": "cited", "usd": 1731.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "knee-arthroscopy", "country": "AU", "amount": 795.05, "currency": "AUD", "as_of": "2026-07-01", "kind": "tariff", "includes": [ "the medical service described in item 49572: partial meniscectomy of knee, by arthroscopic means, for atraumatic meniscus tear" ], "excludes": [ "a service for the purpose of treating osteoarthritis, which the item excludes in its own wording", "hospital accommodation and theatre", "the anaesthetist's own items", "any amount charged above the schedule fee" ], "source": "s:mbs-49572", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=49572&qt=item", "note": "Medicare Benefits Schedule item 49572, fee last updated 1 July 2026; 75% benefit $596.30. The item is the clearest example in this batch of a payer writing a contested indication into the price itself.", "tier": "cited", "usd": 567.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "acl-reconstruction", "as": "The bigger operation through the same portals, and three times the price.", "rel": "contrast" }, { "to": "knee-replacement", "as": "What the arthritic knee ends up having when the keyhole work does not hold.", "rel": "contrast" }, { "to": "bumrungrad", "as": "Packages repair and resection of the meniscus at one price with one night.", "rel": "performed-at" }, { "to": "thailand", "as": "Where the Bangkok arthroscopy package on this page is sold.", "rel": "destination" }, { "to": "united-kingdom", "as": "Where the £5,899 self-pay price on this page is sold.", "rel": "destination" }, { "to": "lithuania", "as": "Where the cheapest advertised orthopaedic price in this batch comes from.", "rel": "destination" }, { "to": "australia", "as": "Whose schedule writes the disputed indication into the item's own wording.", "rel": "destination" }, { "to": "day-case", "as": "What this operation usually is, and what a one-night package quietly is not.", "rel": "term" }, { "to": "prior-authorisation", "as": "The gate a payer uses where the indication is contested.", "rel": "term" }, { "to": "is-it-cheaper", "as": "The question a day case answers worst, once the flight is counted.", "rel": "story" } ], "confusable_with": [ { "id": "acl-reconstruction", "tell": "Both are keyhole; a scope trims or repairs cartilage, a reconstruction replaces a ligament with a graft, and the Bangkok packages differ by 35,700 baht." } ], "links": [ { "label": "MBS item 49572", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=49572&qt=item" } ], "sources": [ "s:bumrungrad-joint-packages", "s:practiceplus-knee", "s:nordorthopaedics-prices", "s:mbs-49572" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "the item wording and every price are read off named pages; the state of the trial literature is marked as trade account because no study is cited here, and the closing stretch is this project's reasoning" }, "text.how": { "tier": "tradition", "note": "standard operative description" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:bumrungrad-joint-packages" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Knee arthroscopy.jpg", "File:Arthroscopy of the knee joint.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "A camera and instruments go into the knee through two or three small portals. Torn meniscus is trimmed or stitched, loose bodies are removed, roughened cartilage is smoothed, the joint is washed out.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "acl-reconstruction", "type": "procedure", "name": "Anterior cruciate ligament reconstruction", "as": "The bigger operation through the same portals, and three times the price.", "rel": "contrast" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "What the arthritic knee ends up having when the keyhole work does not hold.", "rel": "contrast" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Packages repair and resection of the meniscus at one price with one night.", "rel": "performed-at" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the Bangkok arthroscopy package on this page is sold.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Where the £5,899 self-pay price on this page is sold.", "rel": "destination" }, { "to": "lithuania", "type": "destination", "name": "Lithuania", "as": "Where the cheapest advertised orthopaedic price in this batch comes from.", "rel": "destination" }, { "to": "australia", "type": "destination", "name": "Australia", "as": "Whose schedule writes the disputed indication into the item's own wording.", "rel": "destination" }, { "to": "day-case", "type": "term", "name": "Day case", "as": "What this operation usually is, and what a one-night package quietly is not.", "rel": "term" }, { "to": "prior-authorisation", "type": "term", "name": "Prior authorisation", "as": "The gate a payer uses where the indication is contested.", "rel": "term" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The question a day case answers worst, once the flight is counted.", "rel": "story" } ], "source_list": [ { "id": "s:bumrungrad-joint-packages", "kind": "web", "title": "Sports Medicine & Joint Center — package list", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/packages-center/joint-replacement-surgery", "accessed": "2026-09-16", "note": "arthroscopy, ligament, knee and hip package prices in one table; read in a browser because the page is rendered by script" }, { "id": "s:practiceplus-knee", "kind": "web", "title": "Private knee surgery and treatment — self-pay price list", "publisher": "Practice Plus Group", "url": "https://practiceplusgroup.com/treatments/knee-surgery/", "accessed": "2026-09-16" }, { "id": "s:nordorthopaedics-prices", "kind": "web", "title": "Orthopaedic Surgery Prices", "publisher": "Nordorthopaedics Clinic, Kaunas", "url": "https://www.nordorthopaedics.com/hip-knee-wrist-hand-ankle-foot-shoulder-surgery-prices/", "accessed": "2026-09-16", "note": "every figure is written as a 'from' price in euro and sterling; the page carries no inclusion list" }, { "id": "s:mbs-49572", "kind": "gov", "title": "MBS item 49572 — partial meniscectomy of knee by arthroscopic means", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=49572&qt=item", "accessed": "2026-09-16", "note": "schedule fee $795.05, fee last updated 01-Jul-2026" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "the item wording and every price are read off named pages; the state of the trial literature is marked as trade account because no study is cited here, and the closing stretch is this project's reasoning" }, "text.how": { "tier": "tradition", "note": "standard operative description" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:bumrungrad-joint-packages" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "acl-reconstruction", "type": "procedure", "name": "Anterior cruciate ligament reconstruction", "as": "The smaller operation done through the same portals, and often in the same anaesthetic.", "rel": "contrast" }, { "from": "bangkok-hospital", "type": "facility", "name": "Bangkok Hospital", "as": "Sold here at a fixed price with one ward night counted in and the implant left out.", "rel": "performs" }, { "from": "day-case", "type": "term", "name": "Day case", "as": "An operation that is usually this at home and is sold abroad with a night in it.", "rel": "procedure" }, { "from": "prior-authorisation", "type": "term", "name": "Prior authorisation", "as": "The operation where a payer wrote a contested indication into the schedule itself.", "rel": "procedure" } ] }, { "schema": 1, "id": "knee-replacement", "type": "procedure", "names": { "name": "Total knee replacement", "aliases": [ "total knee arthroplasty", "TKA", "knee arthroplasty", "knee replacement" ], "said": "Surgeons say TKA. Package pages say total knee replacement. Brokers say knee, and mean either one knee or two without saying which." }, "etymology": { "root": "arthroplasty: Greek arthron, a joint, plus plastos, moulded — a joint remoulded. The word predates the implant by a century and once meant cutting a new joint surface out of the patient's own bone.", "tier": "tradition", "note": "bilateral means both knees in one anaesthetic; unilateral means one. A package priced for one is roughly half a package priced for two, and the two words are easy to miss on a price page." }, "region": [ "global" ], "facets": { "family": "orthopaedic", "setting": "inpatient", "anaesthesia": "regional" }, "text": { "what": "The worn surfaces of the knee are cut away and replaced with metal and plastic: a femoral component on the thigh bone, a tibial tray on the shin, a polyethylene bearing between them, and often a patellar button behind the kneecap. It is done for arthritis that has stopped responding to anything else. Recovery runs in weeks, not days, and the implant itself is a separate purchase from the operation on most package price lists.", "story": "Knee replacement is one of the two or three operations that built cross-border care, for a reason that has nothing to do with surgery: it is elective, it is standardised, it is expensive at home, and the queue for it is long in every country that funds healthcare publicly. A patient who cannot walk to the shops and has been told to wait fourteen months has a motive that a patient facing an emergency does not.\n\n*Trade practice —* the operation also suits the package model better than almost anything else. The steps are the same everywhere, the implant comes from one of four or five multinational manufacturers, and the length of stay is predictable enough that a hospital can quote a fixed price and mostly hold to it. That is why the price pages exist for knees and hips and not for, say, a pancreatic resection.\n\n*Inference —* the same standardisation is what makes the published prices comparable at all, and it is also what makes them misleading. A package that names three nights and excludes the implant is quoting a different object from one that names five nights and includes it.", "how": "Regional anaesthesia is usual — a spinal or an epidural with sedation — because it lowers the rate of clots and lets the patient begin moving sooner. The surgeon opens the front of the knee, cuts the ends of the femur and tibia to jigs, trials the components, cements or press-fits them, closes, and the physiotherapist has the patient standing the same day or the next. Published packages usually name three to five nights on the ward. The implant is billed separately by most hospitals that publish a package price, and it is frequently the largest single line.", "today": "Where a price is published at all, a unilateral knee runs from roughly ten thousand US dollars in Southeast Asia to several times that in the United States, and every figure on this site's price table names its own date, currency and what it includes. The comparison that matters is not the headline number: it is the headline number plus the implant, plus the nights past the package, plus the flight, plus the follow-up at home that nobody quoted.", "notes": "This page describes an operation. It is not advice about whether to have one, or where." }, "metrics": { "stay_days": 3, "days_before_flying": 10, "recovery_weeks": 12, "note": "Three nights is the ward stay named in the Bumrungrad package read for this record, not a clinical standard; stays elsewhere run longer. The ten-day figure is the CDC's guidance not to fly for ten days after chest or abdominal surgery, which orthopaedic teams commonly apply to major lower-limb surgery for the clot risk; the twelve weeks is the usual span quoted for getting back to ordinary walking, and it varies widely.", "as_of": "2026-09-16", "source": "s:cdc-yellowbook-medical-tourism", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" }, "prices": [ { "procedure": "knee-replacement", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 356500, "currency": "THB", "as_of": "2026-09-16", "kind": "package", "includes": [ "operating theatre, 3 hours", "nursing and surgical team fees within those 3 hours", "3 nights in the surgical ward", "medical equipment and supplies", "medications related to the procedure", "surgeon", "assistant surgeon if needed", "anaesthesiologist" ], "excludes": [ "the implant", "first consultation and follow-up visits", "specialist consultations", "nights beyond 3, and any ICU", "blood transfusion", "laboratory and imaging before or after surgery", "take-home medication", "outpatient charges before admission", "complex or emergency cases", "patients the hospital rates high risk: organ failure, severe systemic disease at ASA classification III and above, a myocardial infarction within four weeks, HIV infection, or a previous knee operation unless the attending physician decides otherwise" ], "source": "s:bumrungrad-joint04", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery", "note": "package JOINT04, price stated valid until 31 December 2026. The exclusion list is longer than the inclusion list, and the implant — often the single largest line on a knee bill — sits on it. The page also carries an eligibility block above the inclusion list: the package is for the patient without complication, and it names who does not qualify. A package price is therefore a price for the straightforward case, which is the thing it is easy to read past.", "tier": "cited", "usd": 10707.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "knee-replacement", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 525600, "currency": "THB", "as_of": "2026-09-16", "kind": "package", "includes": [ "both knees in one admission" ], "excludes": [ "the implant" ], "source": "s:bumrungrad-packages", "url": "https://www.bumrungrad.com/en/packages", "note": "bilateral, listed at 525,600 THB against a struck-through 584,000 THB. Two knees for less than twice one knee is the usual shape of a bilateral price.", "tier": "cited", "usd": 15786.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "knee-replacement", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 945000, "currency": "THB", "as_of": "2026-09-16", "kind": "package", "includes": [ "both knees", "robotic assistance (MAKO)" ], "excludes": [ "the implant" ], "source": "s:bumrungrad-packages", "url": "https://www.bumrungrad.com/en/packages", "note": "robot-assisted bilateral, listed at 945,000 THB against a struck-through 1,050,000 THB. The robot is a price tier, and whether it changes outcomes is argued in the literature rather than settled.", "tier": "cited", "usd": 28383.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "knee-replacement", "country": "GB", "amount": 13799, "currency": "GBP", "as_of": "2026-04", "kind": "list", "includes": [ "pre-operative nurse review", "prescriptions, dressings and equipment", "the anaesthetic", "any overnight stay required", "physiotherapy", "pathology and histology needed whilst admitted", "any post-operative appointments required", "a named consultant from start to finish" ], "excludes": [ "the initial consultation, listed separately at £145" ], "source": "s:practiceplus-knee", "url": "https://practiceplusgroup.com/treatments/knee-surgery/", "note": "Self-pay list price, the page stating \"Prices correct as at April 2026\". Seven of the nine things the Bangkok package excludes sit inside this one. The implant is named on neither side — not as an inclusion here and not as a price anywhere this project could read — which is a different silence from the Bangkok exclusion rather than a smaller one.", "tier": "cited", "usd": 18596.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "hip-replacement", "as": "The same trade, the other joint — and the one whose package price is usually higher.", "rel": "contrast" }, { "to": "bumrungrad", "as": "Publishes the knee package this page reads, implant excluded.", "rel": "performed-at" }, { "to": "thailand", "as": "Where the knee package on this page is sold.", "rel": "destination" }, { "to": "package-price", "as": "The pricing form this operation is usually sold in, and the reason its exclusions matter.", "rel": "term" }, { "to": "implant-excluded", "as": "The line item this operation's headline price usually leaves out.", "rel": "risk" }, { "to": "flying-after-surgery", "as": "The clot risk that sets how long after this operation a patient can board.", "rel": "risk" }, { "to": "waiting-lists", "as": "The queue at home that sends most knee patients abroad in the first place.", "rel": "kin" }, { "to": "follow-up-gap", "as": "Who takes the stitches out, and who sees the knee at six weeks.", "rel": "risk" }, { "to": "world-bank-health-spending", "as": "The series behind the map of what each country spends on health per person.", "rel": "measured-by" } ], "confusable_with": [ { "id": "hip-replacement", "tell": "Knee and hip packages are priced separately and recover differently; a broker's \"joint replacement\" quote names neither until you ask." } ], "links": [ { "label": "Bumrungrad package JOINT04", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery" } ], "sources": [ "s:bumrungrad-joint04", "s:bumrungrad-packages", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "tradition", "note": "the trade's account of why this operation travels; the inline marks say which stretches are which" }, "text.how": { "tier": "tradition", "note": "standard operative description; the three-night figure is cited to the package page" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:bumrungrad-joint04" } } }, "x_commons_files": [ "File:Knee replacement implant.jpg", "File:Total Knee Replacement X-ray.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "The worn surfaces of the knee are cut away and replaced with metal and plastic: a femoral component on the thigh bone, a tibial tray on the shin, a polyethylene bearing between them, and often a patellar button behind…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "The same trade, the other joint — and the one whose package price is usually higher.", "rel": "contrast" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Publishes the knee package this page reads, implant excluded.", "rel": "performed-at" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the knee package on this page is sold.", "rel": "destination" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The pricing form this operation is usually sold in, and the reason its exclusions matter.", "rel": "term" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The line item this operation's headline price usually leaves out.", "rel": "risk" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The clot risk that sets how long after this operation a patient can board.", "rel": "risk" }, { "to": "waiting-lists", "type": "story", "name": "The queue is the product", "as": "The queue at home that sends most knee patients abroad in the first place.", "rel": "kin" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who takes the stitches out, and who sees the knee at six weeks.", "rel": "risk" }, { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "The series behind the map of what each country spends on health per person.", "rel": "measured-by" } ], "source_list": [ { "id": "s:bumrungrad-joint04", "kind": "web", "title": "Total Knee Replacement Surgery (Exclude implant) — package JOINT04", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery", "accessed": "2026-09-16", "note": "read off the hospital's own package page; price stated valid until 31 December 2026" }, { "id": "s:bumrungrad-packages", "kind": "web", "title": "Packages & Programs — joint replacement and spine", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "tradition", "note": "the trade's account of why this operation travels; the inline marks say which stretches are which" }, "text.how": { "tier": "tradition", "note": "standard operative description; the three-night figure is cited to the package page" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:bumrungrad-joint04" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "canada", "type": "destination", "name": "Canada", "as": "61% of them done inside six months in 2024 — the operation that defines this market.", "rel": "procedure" }, { "from": "thailand", "type": "destination", "name": "Thailand", "as": "One of the operations sold here at a published fixed price.", "rel": "procedure" }, { "from": "bangkok", "type": "hub", "name": "Bangkok", "as": "Sold here at a published fixed price, implant billed separately.", "rel": "procedure" }, { "from": "bengaluru", "type": "hub", "name": "Bengaluru", "as": "Sold on an estimate in the central hospitals rather than as a package.", "rel": "procedure" }, { "from": "colombo", "type": "hub", "name": "Colombo", "as": "Quoted here itemised rather than as a package.", "rel": "procedure" }, { "from": "johannesburg", "type": "hub", "name": "Johannesburg", "as": "The elective end of the same city, sold on an exchange rate.", "rel": "procedure" }, { "from": "acl-reconstruction", "type": "procedure", "name": "Anterior cruciate ligament reconstruction", "as": "The other knee on the price table, thirty years further on.", "rel": "contrast" }, { "from": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "The other operation whose price page turns on which implant is in the package.", "rel": "contrast" }, { "from": "heart-valve-replacement", "type": "procedure", "name": "Heart valve replacement", "as": "The other implant operation whose package price excludes the implant.", "rel": "contrast" }, { "from": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "The same trade, the other joint — and the cheaper package at the same Bangkok hospital, by 68,700 baht.", "rel": "contrast" }, { "from": "knee-arthroscopy", "type": "procedure", "name": "Knee arthroscopy", "as": "What the arthritic knee ends up having when the keyhole work does not hold.", "rel": "contrast" }, { "from": "shoulder-replacement", "type": "procedure", "name": "Total shoulder replacement", "as": "The operation whose package pages set the shape this one is missing from.", "rel": "contrast" }, { "from": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "One of the operations it sells at a published fixed price, implant excluded.", "rel": "performs" }, { "from": "hospital-cima-san-jose", "type": "facility", "name": "Hospital CIMA San José", "as": "Among the operations the Escazú cluster sells, with the recovery stay in a hotel rather than a ward.", "rel": "performs" }, { "from": "max-saket", "type": "facility", "name": "Max Super Speciality Hospital, Saket", "as": "One of the operations the Delhi corridor sells to foreign patients, quoted rather than listed.", "rel": "performs" }, { "from": "anaesthetic-risk-unscreened", "type": "risk", "name": "Fitness for anaesthesia, assessed on arrival", "as": "The operation whose package bar this record was read off.", "rel": "procedure" }, { "from": "blood-supply-safety", "type": "risk", "name": "Blood supply safety", "as": "The package whose exclusion list names blood transfusion as a charge.", "rel": "procedure" }, { "from": "dvt-pe", "type": "risk", "name": "Deep vein thrombosis and pulmonary embolism", "as": "Major lower-limb surgery, where regional anaesthesia is preferred partly to lower this risk.", "rel": "procedure" }, { "from": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "Major lower-limb surgery, where orthopaedic teams commonly apply the same ten-day interval for the clot risk.", "rel": "procedure" }, { "from": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Six-week and twelve-week reviews, and the physiotherapy between them, sit outside every package this site has read.", "rel": "procedure" }, { "from": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The operation this exclusion was read off, and the one where the device is often the largest line.", "rel": "procedure" }, { "from": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The operation where an infection means the implant comes out.", "rel": "procedure" }, { "from": "covid-shutdown-2020", "type": "event", "name": "The 2020 shutdown", "as": "The kind of planned operation the cancellation modelling was about.", "rel": "procedure" }, { "from": "bundled-payment", "type": "term", "name": "Bundled payment", "as": "The operation these programmes were built around, at home and abroad alike.", "rel": "procedure" }, { "from": "length-of-stay", "type": "term", "name": "Length of stay", "as": "The operation whose three-night package this record reads.", "rel": "procedure" }, { "from": "package-price", "type": "term", "name": "Package price", "as": "The operation whose package this record reads, implant excluded.", "rel": "procedure" }, { "from": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "One of the seven procedures, and the one this site prices most closely.", "rel": "procedure" }, { "from": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The operation worked end to end on this page.", "rel": "procedure" }, { "from": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "The operation whose package names the exclusion in its own title.", "rel": "procedure" }, { "from": "waiting-lists", "type": "story", "name": "The queue is the product", "as": "The operation the queue sends abroad more than any other.", "rel": "procedure" } ] }, { "schema": 1, "id": "lasik", "type": "procedure", "names": { "name": "LASIK", "aliases": [ "laser in situ keratomileusis", "laser eye surgery", "femto-LASIK", "laser vision correction" ], "said": "Clinics say laser eye surgery and price four different operations under it — LASEK, LASIK, SMILE, Presbyond — which is why a quoted price means nothing until the acronym beside it is read." }, "etymology": { "root": "LASIK is an acronym: laser in situ keratomileusis. Keratomileusis is Greek keras, keratos, horn — the cornea — plus smileusis, a carving: carving the cornea in place. Laser is itself an acronym, light amplification by stimulated emission of radiation. LASEK substitutes epithelial for in situ; SMILE names small-incision lenticule extraction, a different operation sold from the same page.", "tier": "tradition", "note": "A flap is cut in the cornea, lifted, the bed underneath reshaped by an excimer laser, the flap replaced. LASEK and PRK do without the flap and hurt more for longer; SMILE removes a disc of tissue through a small incision and cuts no flap at all." }, "region": [ "global" ], "facets": { "family": "ophthalmic", "setting": "day-case", "anaesthesia": "local" }, "text": { "what": "A thin flap is cut in the surface of the cornea, the tissue beneath is reshaped with an excimer laser to change where the eye focuses, and the flap is laid back without stitches. Both eyes in one sitting, minutes each, drops rather than injections. It treats the cornea, which means it cannot help an eye whose prescription is too strong or whose cornea is too thin — and that is the eye the implanted lens exists for.", "story": "Almost nobody pays for this out of a public budget, which is why its price pages are the plainest in this batch: a per-eye figure and a list of what the figure buys.\n\nOptegra in the United Kingdom publishes a four-rung ladder, all per eye: LASEK £1,495, LASIK £2,095, ReLEx SMILE £2,695, Presbyond £2,995, each stated to include consultations, treatment, aftercare, medication and any enhancement treatment if clinically required. Two eyes doubles all four.\n\nLasikPlus in the United States states prices starting between $2,495 and $2,895 per eye before any discounts or promotions, covering the all-laser procedure, pre-operative exams and follow-up care, and cites a Market Scope survey range of $1,500 to $5,000 per eye across the country.\n\nBumrungrad in Bangkok does not sell LASIK on the page read for this record. It sells the newer lenticule operation: vision correction with ReLEx SMILE for both eyes, 102,000 baht, package IPDEYE34 — and its terms state the package does not include the doctor's fee for the initial consultation or the examinations that decide whether the patient is suitable at all.\n\n*Inference —* that is the comparison worth making. Both eyes by SMILE in Bangkok is a little over half the price of one eye by SMILE in England, and the Thai package leaves out exactly the appointment that decides eligibility, which is the appointment a traveller cannot have before booking.\n\nThe state's position is written into the Australian schedule. Item 42702 pays for lens extraction with an intraocular lens and excludes, in its own descriptor, \"surgery performed to correct a refractive error\". Refractive surgery is a purchase, not an entitlement, in every market read for this record.", "how": "A suitability examination first — corneal thickness, prescription stability, dry eye, pupil size — and it is the examination that turns patients away. Then the flap, the laser, the flap back, an hour of rest, drops for weeks, a check the next day. Vision is usually usable within a day or two.\n\nWhat the price pages differ on is the aftercare and the enhancement. Optegra's figure states that it covers aftercare, medication and a further treatment if clinically required; the Bangkok package covers the procedure and excludes the consultation and the screening; the American page describes an enhancement policy in the words \"often included\" within a set period. For a patient who flies home, an enhancement included at the clinic that did the surgery is an enhancement in another country.", "today": "As of 17 September 2026 the published per-eye prices read for this record are £1,495 to £2,995 in the United Kingdom by technique, $2,495 to $2,895 in the United States before discounts, and CAD 490 to CAD 3,090 at one Canadian chain, from its starting tier to its top one. In Bangkok the equivalent page sells the lenticule operation for both eyes at 102,000 baht, with the screening and the initial consultation outside the package.", "notes": "This page describes an elective eye operation and the prices published for it. It is not medical advice and it does not say who is a candidate." }, "metrics": { "stay_days": 0, "days_before_flying": null, "recovery_weeks": 1, "wait_days_home": null, "note": "A day case, and in most markets an out-of-pocket purchase rather than a queue, so wait_days_home stays empty. One week is the span usually quoted for return to ordinary activity after a flap procedure; the surface techniques take longer. No published guidance read for this record sets a wait before flying, though clinics commonly advise against swimming and dusty air for some weeks.", "as_of": "2026-09-17", "source": "s:optegra-laser-costs", "url": "https://www.optegra.com/laser-eye-surgery/costs/" }, "prices": [ { "procedure": "lasik", "country": "GB", "amount": 2095, "currency": "GBP", "as_of": "2026-09-17", "kind": "list", "includes": [ "LASIK, one eye", "consultations", "treatment", "aftercare", "medication", "any enhancement treatment if clinically required" ], "excludes": [ "the second eye" ], "source": "s:optegra-laser-costs", "url": "https://www.optegra.com/laser-eye-surgery/costs/", "note": "the provider's own table, stated per eye: LASEK £1,495, LASIK £2,095, ReLEx SMILE £2,695, Presbyond £2,995, with finance quoted from £36 a month on a 20% deposit over 60 months. The page carries no date of its own and was read on 17 September 2026.", "tier": "cited", "usd": 2823.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "lasik", "country": "US", "amount": 2495, "amount_high": 2895, "currency": "USD", "as_of": "2026-09-17", "kind": "quoted-range", "includes": [ "all-laser LASIK, one eye", "pre-operative exams", "follow-up care" ], "excludes": [ "the second eye", "any enhancement outside the stated period" ], "source": "s:lasikplus-lasik-cost", "url": "https://www.lasikplus.com/cost-of-lasik/", "note": "stated as starting between $2,495 and $2,895 per eye 'before any discounts or promotions'. The same page cites a Market Scope survey range of $1,500 to $5,000 per eye nationally — a figure from a commercial survey, carried here as the page's own citation rather than as a price.", "tier": "cited", "usd": 2495.0, "usd_high": 2895.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "lasik", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 102000, "currency": "THB", "as_of": "2026-09-17", "kind": "package", "includes": [ "ReLEx SMILE laser vision correction for both eyes", "the doctor's fee for the procedure" ], "excludes": [ "the doctor's fee for the initial consultation", "the examinations that determine whether the procedure is suitable" ], "source": "s:bumrungrad-relex-smile", "url": "https://www.bumrungrad.com/en/packages/relex-smile", "note": "package IPDEYE34. This is SMILE, not LASIK — the hospital's eye centre sells the lenticule operation rather than the flap one on the page read for this record — and it is carried on this page because it is the same purchase for the same patient, at a price for two eyes that is below the British per-eye figure for the same technique.", "tier": "cited", "usd": 3064.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "lasik", "country": "CA", "amount": 490, "amount_high": 3090, "currency": "CAD", "as_of": "2026-09-17", "kind": "quoted-range", "includes": [ "LASIK, one eye, at the technology tier the price buys" ], "excludes": [ "the second eye", "the optional Vision Enhancement Plan the page names for future enhancements" ], "source": "s:lasikmd-pricing", "url": "https://www.lasikmd.com/cost-and-affordability/pricing", "note": "the page states 'LASIK starting at $490 per eye' and 'Custom LASIK up to $3,090/eye'. A sixfold spread inside one provider and one country, which is the clearest illustration on this page that a per-eye laser price is a tier rather than a figure. The footer states prices vary by market, technology, prescription strength and plan selected, and change without notice.", "tier": "cited", "usd": 352.0, "usd_high": 2221.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "icl", "as": "The operation for the eyes this one cannot treat, at roughly twice the price per eye from the same providers.", "rel": "contrast" }, { "to": "cataract-surgery", "as": "The lens operation the Australian schedule funds, in the same descriptor that refuses this one.", "rel": "contrast" }, { "to": "bumrungrad", "as": "Sells the lenticule version of this operation for both eyes, screening excluded.", "rel": "performed-at" }, { "to": "united-kingdom", "as": "Where the four techniques are priced as a ladder, per eye, aftercare included.", "rel": "destination" }, { "to": "united-states", "as": "Where the price is quoted per eye before discounts and the survey range is four times wide.", "rel": "destination" }, { "to": "thailand", "as": "Where both eyes cost less than one eye elsewhere, and the suitability examination is a separate purchase.", "rel": "destination" }, { "to": "bangkok", "as": "The city whose hospital eye centres sell refractive surgery as a package.", "rel": "place" }, { "to": "insurance-exclusions", "as": "Why this operation is bought rather than claimed, in every market read here.", "rel": "rule" }, { "to": "getting-a-quote", "as": "The step at which a per-eye price turns into a per-patient one.", "rel": "step" }, { "to": "follow-up-gap", "as": "Who sees the eye the next day, and who does the enhancement a year later.", "rel": "risk" }, { "to": "revision-at-home", "as": "What an included enhancement is worth once the patient is on another continent.", "rel": "risk" } ], "confusable_with": [ { "id": "icl", "tell": "LASIK reshapes the cornea and removes tissue; an ICL adds a lens inside the eye and removes nothing. Clinics sell both from one page and the second costs several times the first." }, { "id": "cataract-surgery", "tell": "Cataract surgery replaces a clouded natural lens; refractive surgery reshapes a clear cornea in an eye that sees, to get rid of glasses." } ], "links": [ { "label": "Optegra — laser eye surgery costs", "url": "https://www.optegra.com/laser-eye-surgery/costs/" }, { "label": "Bumrungrad — ReLEx SMILE package", "url": "https://www.bumrungrad.com/en/packages/relex-smile" } ], "sources": [ "s:optegra-laser-costs", "s:lasikplus-lasik-cost", "s:bumrungrad-relex-smile", "s:bumrungrad-eye-packages", "s:mbs-42702", "s:lasikmd-pricing" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:optegra-laser-costs", "note": "each price read off the provider's own page on 17 September 2026; the comparison between the Thai and British SMILE prices is this project's arithmetic and is marked" }, "text.how": { "tier": "tradition", "note": "standard description of the operation and the screening; the aftercare differences are cited to the three pages" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:optegra-laser-costs" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Lasik surgery.jpg", "File:LASIK flap.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "A thin flap is cut in the surface of the cornea, the tissue beneath is reshaped with an excimer laser to change where the eye focuses, and the flap is laid back without stitches.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "icl", "type": "procedure", "name": "Implantable collamer lens", "as": "The operation for the eyes this one cannot treat, at roughly twice the price per eye from the same providers.", "rel": "contrast" }, { "to": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "The lens operation the Australian schedule funds, in the same descriptor that refuses this one.", "rel": "contrast" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Sells the lenticule version of this operation for both eyes, screening excluded.", "rel": "performed-at" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Where the four techniques are priced as a ladder, per eye, aftercare included.", "rel": "destination" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "Where the price is quoted per eye before discounts and the survey range is four times wide.", "rel": "destination" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where both eyes cost less than one eye elsewhere, and the suitability examination is a separate purchase.", "rel": "destination" }, { "to": "bangkok", "type": "hub", "name": "Bangkok", "as": "The city whose hospital eye centres sell refractive surgery as a package.", "rel": "place" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "Why this operation is bought rather than claimed, in every market read here.", "rel": "rule" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step at which a per-eye price turns into a per-patient one.", "rel": "step" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who sees the eye the next day, and who does the enhancement a year later.", "rel": "risk" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "What an included enhancement is worth once the patient is on another continent.", "rel": "risk" } ], "source_list": [ { "id": "s:optegra-laser-costs", "kind": "web", "title": "Laser Eye Surgery Costs", "publisher": "Optegra Eye Health Care, United Kingdom", "url": "https://www.optegra.com/laser-eye-surgery/costs/", "accessed": "2026-09-17", "note": "prices stated per eye: LASEK £1,495, LASIK £2,095, ReLEx SMILE £2,695, Presbyond £2,995, each including consultations, treatment, aftercare, medication and any enhancement treatment if clinically required. The page carries no date of its own." }, { "id": "s:lasikplus-lasik-cost", "kind": "web", "title": "How Much Does LASIK Cost?", "publisher": "LasikPlus, United States", "url": "https://www.lasikplus.com/cost-of-lasik/", "accessed": "2026-09-17", "note": "states prices starting between $2,495 and $2,895 per eye 'before any discounts or promotions', covering the all-laser procedure, pre-operative exams and follow-up care, and cites a Market Scope survey range of $1,500 to $5,000 per eye across the United States" }, { "id": "s:bumrungrad-relex-smile", "kind": "web", "title": "Vision correction with ReLEx SMILE for both eyes package — IPDEYE34", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/relex-smile", "accessed": "2026-09-17", "note": "102,000 THB for both eyes; the page states the package does not include the doctor's fee for the initial consultation or the examinations that decide suitability" }, { "id": "s:bumrungrad-eye-packages", "kind": "web", "title": "Eye Center — package list", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/packages-center/eye-center", "accessed": "2026-09-17", "note": "read with the browser on 17 September 2026: ReLEx SMILE both eyes 102,000 THB; ICL single eye 129,000 THB; Toric ICL single eye 161,000 THB; phacoemulsification single eye with monofocal lens, Set 1, 85,400 THB; eye screening 4,100 THB" }, { "id": "s:mbs-42702", "kind": "gov", "title": "MBS item 42702 — lens extraction and insertion of intraocular lens", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=42702&qt=item", "accessed": "2026-09-17", "note": "schedule fee $910.35, 75% benefit $682.80, fee shown as applying from 01-Jul-2026. The descriptor excludes 'surgery performed to correct a refractive error, other than anisometropia that exceeds 3 dioptres and develops after the removal of cataract in the first eye'." }, { "id": "s:lasikmd-pricing", "kind": "web", "title": "Pricing", "publisher": "LASIK MD, Canada", "url": "https://www.lasikmd.com/cost-and-affordability/pricing", "accessed": "2026-09-17", "note": "read 17 September 2026: 'LASIK starting at $490 per eye' and 'Custom LASIK up to $3,090/eye', per eye, with no date on the page. The footer states prices are subject to change without prior notice and vary by market, technology, prescription strength and plan selected. The page publishes no ICL or SMILE price." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:optegra-laser-costs", "note": "each price read off the provider's own page on 17 September 2026; the comparison between the Thai and British SMILE prices is this project's arithmetic and is marked" }, "text.how": { "tier": "tradition", "note": "standard description of the operation and the screening; the aftercare differences are cited to the three pages" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:optegra-laser-costs" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "philippines", "type": "destination", "name": "Philippines", "as": "Eye surgery bought on short visits, often by returning Filipinos.", "rel": "procedure" }, { "from": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "The refractive operation the same Australian item explicitly refuses to pay for.", "rel": "contrast" }, { "from": "icl", "type": "procedure", "name": "Implantable collamer lens", "as": "The laser operation this one exists for the eyes that fail — and the price it is measured against on every page that sells both.", "rel": "contrast" } ] }, { "schema": 1, "id": "liposuction", "type": "procedure", "names": { "name": "Liposuction", "aliases": [ "lipoplasty", "suction-assisted lipectomy", "lipo", "body contouring" ], "said": "Clinics price it by area, and the definition of an area is the clinic's. Tumescent means the fat was flooded first with dilute local anaesthetic and adrenaline; power-assisted, ultrasound-assisted and laser-assisted name the machine." }, "etymology": { "root": "liposuction: Greek lipos, fat, plus Latin sugere, to suck. Lipectomy, the older word on hospital price lists, is fat plus ektome, a cutting out - a different operation, in which skin and fat are excised rather than aspirated.", "tier": "tradition", "note": "an area, a site and a zone are the same unit under three names, and no two clinics draw them the same way. A price 'per site' is uninterpretable until the page says what a site is." }, "region": [ "global" ], "facets": { "family": "cosmetic", "setting": "day-case", "anaesthesia": "varies" }, "text": { "what": "Fat is broken up and aspirated through small cannulas passed under the skin, usually after the area has been flooded with dilute local anaesthetic and adrenaline. It removes fat, not weight and not skin: where skin has lost its recoil, the result is loose skin over a smaller volume. Large-volume removal is a physiologically bigger operation than the price pages suggest, and anaesthetic and fluid management is where the published complications cluster.", "story": "Liposuction is the most-performed surgical cosmetic procedure in the American society's annual count, and the one whose price is hardest to compare across borders, because the unit is invented by the seller. Yanhee in Bangkok prices a tumescent site at 55,000 baht and names ten named regions at 66,000 to 74,000 with a night on the ward. Premier Clinic in Prague prices one MicroAire area from 19,500 koruna, two from 56,000, three from 72,500, four from 85,000 - a curve that says the second area is the expensive one. Artplastica in Poland lists fat aspiration from 12,000 zloty with no area count at all. The American society publishes 4,711 US dollars as a surgeon's fee with no theatre in it.\n\n*Inference --* four prices, four units. Comparing them requires a reader to know how many areas each covers, and only one of the four pages says.\n\nLiposuction also travels as an ingredient. Fat grafting to the buttock, to the breast and to the face all begin with a liposuction, and the harvest is priced inside those operations rather than beside them - which is why a buttock price and a liposuction price cannot be added together.", "how": "Local anaesthesia with sedation for a small area, general for several; published Thai packages name one night, European day surgery is routine. Compression garments are worn for weeks. Swelling and firmness settle over months, and the contour at four weeks is not the contour at six months. Volume removed is the figure that changes the risk profile, and the safe ceiling in a single sitting is argued in the literature rather than fixed by one number.", "today": "The four published prices on this record, read in September 2026, span 12,000 zloty to 74,000 baht per named region, plus a US surgeon's fee of 4,711 dollars. Each one prices a different quantity of the same operation.", "notes": "This page describes an operation. It gives no advice about having one." }, "metrics": { "stay_days": 1, "note": "One night is the stay printed beside every liposuction line on the Yanhee table read for this record; day-case liposuction under local anaesthesia is routine elsewhere and carries no ward stay at all. No complication rate is carried here: the published series measure by volume aspirated and by anaesthetic setting, which are not comparable to a single figure for the operation.", "as_of": "2026-09-16", "source": "s:yanhee-plastic-prices", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/" }, "prices": [ { "procedure": "liposuction", "country": "TH", "city": "Bangkok", "amount": 55000, "amount_high": 74000, "currency": "THB", "as_of": "2026-09-16", "kind": "list", "includes": [ "one site, tumescent technique, at the bottom of the range", "one night on the ward" ], "excludes": [ "not stated on the page" ], "source": "s:yanhee-plastic-prices", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "note": "55,000 THB per site tumescent; named regions - both arms, upper abdomen, lower abdomen, hip and waist per side, back - at 66,000 THB; outer and inner thighs and calves at 74,000 THB", "tier": "cited", "usd": 1652.0, "usd_high": 2223.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "liposuction", "country": "CZ", "city": "Prague", "amount": 19500, "amount_high": 85000, "currency": "CZK", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [ "MicroAire liposuction, one area at the bottom of the range, four areas at the top" ], "excludes": [ "not stated on the page" ], "source": "s:premier-clinic-prague-prices", "url": "https://www.premier-clinic.cz/en/price-list-plastic-surgery/", "note": "one area from 19,500 CZK, two from 56,000, three from 72,500, four from 85,000. The jump from one area to two is larger than any step after it.", "tier": "cited", "usd": 926.0, "usd_high": 4036.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "liposuction", "country": "PL", "city": "Szczecin", "amount": 12000, "currency": "PLN", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [ "fat aspiration" ], "excludes": [ "hospitalisation, listed separately at 800 PLN a day", "the number of areas is not stated" ], "source": "s:artplastica-cennik", "url": "https://www.artplastica.pl/cennik-zabiegi-operacje-plastyczne/", "note": "listed as 'from', with the clinic's statement that prices are indicative", "tier": "cited", "usd": 3189.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "liposuction", "country": "US", "amount": 4711, "currency": "USD", "as_of": "2026-09-16", "kind": "survey", "includes": [ "surgeon fee only" ], "excludes": [ "anesthesia", "operating room facilities", "other related expenses" ], "source": "s:asps-cost-liposuction", "url": "https://www.plasticsurgery.org/cosmetic-procedures/liposuction/cost", "note": "no year named on the page; the row carries the date it was read", "tier": "cited", "usd": 4711.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "bbl", "as": "The operation that begins with this one, and then injects what it harvested.", "rel": "part" }, { "to": "abdominoplasty", "as": "The operation that removes the skin this one leaves behind, and the one it is often sold beside.", "rel": "contrast" }, { "to": "breast-augmentation", "as": "Where the harvested fat goes when no implant is used.", "rel": "contrast" }, { "to": "thailand", "as": "Where the price is published per named region of the body.", "rel": "destination" }, { "to": "czechia", "as": "Where the price is published per area, with the area count on the page.", "rel": "destination" }, { "to": "united-states", "as": "The market whose published figure is a surgeon's fee rather than a price.", "rel": "destination" }, { "to": "anaesthetic-risk-unscreened", "as": "Large-volume aspiration is an anaesthetic problem as much as a surgical one.", "rel": "risk" }, { "to": "package-price", "as": "The form in which areas, garments and ward nights are bundled or not.", "rel": "term" }, { "to": "the-price-that-isnt", "as": "Four prices for one operation, each counting a different quantity.", "rel": "story" } ], "confusable_with": [ { "id": "abdominoplasty", "tell": "Liposuction takes fat through a cannula and leaves the skin; abdominoplasty cuts skin and fat away and moves the navel. Packages sometimes sell both under one word." } ], "links": [ { "label": "Premier Clinic Prague price list", "url": "https://www.premier-clinic.cz/en/price-list-plastic-surgery/" } ], "sources": [ "s:yanhee-plastic-prices", "s:premier-clinic-prague-prices", "s:artplastica-cennik", "s:asps-cost-liposuction" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "prices read off the four named pages; the comparison paragraph is marked as inference inline" }, "text.how": { "tier": "tradition" }, "etymology": { "tier": "tradition" } } }, "x_commons_files": [ "File:Liposuction.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "Fat is broken up and aspirated through small cannulas passed under the skin, usually after the area has been flooded with dilute local anaesthetic and adrenaline.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "The operation that begins with this one, and then injects what it harvested.", "rel": "part" }, { "to": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "The operation that removes the skin this one leaves behind, and the one it is often sold beside.", "rel": "contrast" }, { "to": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "Where the harvested fat goes when no implant is used.", "rel": "contrast" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the price is published per named region of the body.", "rel": "destination" }, { "to": "czechia", "type": "destination", "name": "Czechia", "as": "Where the price is published per area, with the area count on the page.", "rel": "destination" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The market whose published figure is a surgeon's fee rather than a price.", "rel": "destination" }, { "to": "anaesthetic-risk-unscreened", "type": "risk", "name": "Fitness for anaesthesia, assessed on arrival", "as": "Large-volume aspiration is an anaesthetic problem as much as a surgical one.", "rel": "risk" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The form in which areas, garments and ward nights are bundled or not.", "rel": "term" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "Four prices for one operation, each counting a different quantity.", "rel": "story" } ], "source_list": [ { "id": "s:yanhee-plastic-prices", "kind": "web", "title": "Plastic Surgery Prices", "publisher": "Yanhee Hospital, Bangkok", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "accessed": "2026-09-16", "note": "hospital's own price table: procedure, nights, price in Thai baht. The page carries no validity date and no inclusion list." }, { "id": "s:premier-clinic-prague-prices", "kind": "web", "title": "Price List - Plastic Surgery", "publisher": "Premier Clinic, Prague", "url": "https://www.premier-clinic.cz/en/price-list-plastic-surgery/", "accessed": "2026-09-16", "note": "clinic's own English price list, every line prefixed 'from', in Czech koruna" }, { "id": "s:artplastica-cennik", "kind": "web", "title": "Cennik zabiegow i operacji plastycznych", "publisher": "Beauty Group - Artplastica, Szczecin", "url": "https://www.artplastica.pl/cennik-zabiegi-operacje-plastyczne/", "accessed": "2026-09-16", "note": "clinic's own price list in zloty; the page states the prices are indicative and may change at consultation, and lists hospitalisation at 800 PLN a day separately" }, { "id": "s:asps-cost-liposuction", "kind": "org", "title": "Liposuction Cost", "publisher": "American Society of Plastic Surgeons", "url": "https://www.plasticsurgery.org/cosmetic-procedures/liposuction/cost", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "prices read off the four named pages; the comparison paragraph is marked as inference inline" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "brazil", "type": "destination", "name": "Brazil", "as": "One of the operations behind the country's surgical count.", "rel": "procedure" }, { "from": "colombia", "type": "destination", "name": "Colombia", "as": "The volume operation behind the country's surgical count.", "rel": "procedure" }, { "from": "dominican-republic", "type": "destination", "name": "Dominican Republic", "as": "The commonest procedure in the 2013-14 cluster, at 74% of cases.", "rel": "procedure" }, { "from": "medellin", "type": "hub", "name": "Medellín", "as": "The base of the body-contouring trade here, sold with the garments and the massage.", "rel": "performs" }, { "from": "santo-domingo", "type": "hub", "name": "Santo Domingo", "as": "The base of the body-contouring trade, and the wound the mycobacteria entered.", "rel": "performs" }, { "from": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "The operation that takes the fat and leaves the skin; this one takes the skin.", "rel": "contrast" }, { "from": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "The first half of this operation, and the reason its price cannot be added to a liposuction price.", "rel": "part" }, { "from": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "Where the fat comes from when the augmentation is done without an implant.", "rel": "part" }, { "from": "bbl-mortality", "type": "risk", "name": "Death from gluteal fat grafting", "as": "Where the fat comes from, and its own share of the risk.", "rel": "procedure" }, { "from": "fungal-meningitis", "type": "risk", "name": "Fungal meningitis after epidural anaesthesia", "as": "Among the cosmetic procedures the exposed patients had travelled for.", "rel": "procedure" }, { "from": "nontuberculous-mycobacteria", "type": "risk", "name": "Nontuberculous mycobacteria", "as": "Among the procedures in both Dominican clusters.", "rel": "procedure" }, { "from": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "Second on its worldwide surgical ranking for 2024, at 2,087,189 procedures.", "rel": "procedure" }, { "from": "dominican-republic-ntm-outbreak", "type": "event", "name": "The Dominican mycobacterial outbreaks, 2013–14 and 2017", "as": "The commonest operation in the 2013–14 cluster, at 74% of cases.", "rel": "procedure" } ] }, { "schema": 1, "id": "liver-transplant", "type": "procedure", "names": { "name": "Liver transplant", "aliases": [ "orthotopic liver transplantation", "OLT", "living-donor liver transplant", "LDLT", "hepatic transplantation" ], "said": "Surgeons say deceased-donor or living-donor before anything else, because that word sets the waiting time, the second operating table and, across a border, the law. Price pages say liver transplant package and often say neither." }, "etymology": { "root": "hepatic: Greek hēpar, hēpatos, liver — the root under hepatitis and under the hepatic artery the graft is plumbed onto. Orthotopic: Greek orthos, upright or correct, plus topos, place; the new liver goes where the old one was, which is why the old one has to come out first. A kidney does not work that way.", "tier": "tradition", "note": "LDLT, living-donor liver transplantation, takes part of a healthy person's liver — usually the right lobe for an adult recipient, the left lateral segment for a child — and both sides regrow. A price quoted for a deceased-donor graft and a price quoted for a living donor are not the same object: the second one buys two operations on two people, one of whom is well." }, "region": [ "global" ], "facets": { "family": "transplant", "setting": "inpatient", "anaesthesia": "general" }, "text": { "what": "A diseased liver is removed and replaced, either with a whole organ from a deceased donor or with a lobe cut from a living one. The graft is joined to the recipient's hepatic artery, portal vein, inferior vena cava and bile duct, and the bile duct is where most of the later trouble comes from. The recipient takes immunosuppressant drugs for as long as the graft works. A living donor has healthy liver tissue removed, gains nothing clinically, and keeps the scar.", "story": "The law comes before the price on this page, for the same reason it does on the kidney page: two people go to theatre and only one of them is ill.\n\nThe standing international text is the Declaration of Istanbul on Organ Trafficking and Transplant Tourism, agreed in Istanbul in April 2008 and revised in Madrid in July 2018. It defines the neutral act plainly — \"Travel for transplantation is the movement of persons across jurisdictional borders for transplantation purposes\" — and then separates it from the two things it is routinely confused with, the trafficking of organs and the trafficking of people for organ removal. Its fourth principle sets the line the statutes are drawn against: \"Organ donation should be a financially neutral act.\" The World Health Organization put the same rule in its Guiding Principles, endorsed by the World Health Assembly in May 2010, which allow reimbursement of a donor's verifiable expenses and forbid donation \"without any monetary payment or other reward of monetary value\".\n\nNational law then splits on two questions that are easy to run together. Whether a non-resident may be transplanted in the country at all. And whether a living donor who is not related to the recipient may donate, and on whose authority — a committee, a court, a ministry. Some countries permit both under conditions, some permit residents only, and purchase is prohibited nearly everywhere: in the United States the National Organ Transplant Act makes it unlawful to transfer a human organ \"for valuable consideration\" where the transfer affects interstate commerce, while putting the donor's travel, housing and lost wages outside that phrase. One instrument, one date, one jurisdiction at a time, the reading sits on this directory's transplant prohibition page rather than here.\n\nWhat the published follow-up records is specific to this organ and it is not encouraging. A 2021 review in the World Journal of Hepatology found \"improper pre-and post-transplant infectious screening, inadequate opportunistic infection prophylaxis, and loss to follow-up\" among patients who had travelled. It carries a Saudi series comparing grafts obtained in China with domestic ones — sepsis 9.5% against 0.83%, acquired hepatitis B 5.4% against 0%, biliary complications 32.4% against 11.7% — and a Taiwanese survival comparison, domestic against abroad, of 89.2%, 79.5% and 75.2% at one, five and ten years against 79.8%, 62.3% and 49.9%.\n\n*Inference —* those figures count patients who came home and presented somewhere that published. A recipient who died abroad is in nobody's series.", "how": "General anaesthesia and a long operation; the recipient is opened, the old liver dissected off the vena cava, the graft implanted and four sets of plumbing joined. Intensive care follows, then a ward stay measured in weeks rather than nights: PSRI Hospital in Delhi, which publishes a price, tells patients to expect 10-15 days in hospital and a few months at home. Immunosuppression starts immediately and does not stop. Where the donor is living, a second team operates on a healthy person the same day, and that person's own recovery, complications and lost earnings sit outside every package price read for this record.", "today": "Two published prices were read for this record on 17 September 2026 and they are not comparable. Milliman's actuarial table puts estimated average US billed charges for a liver transplant at 1,017,800 dollars against 446,800 for a kidney, with 10,916 liver transplants estimated for 2025. PSRI Hospital in Delhi publishes 18-20 lakh rupees for a living-donor transplant and 30-35 lakh for deceased-donor and complex cases, prose inclusions and no validity date. No third country's provider page carrying a liver transplant price was found for this batch, and no page found anywhere states a price for a non-resident specifically. A directory can report that absence; it cannot fill it.", "notes": "This page describes an operation and reports what named instruments and published studies say about it. It is not medical advice and it is not legal advice, and it does not tell anyone what to do." }, "metrics": { "stay_days": null, "days_before_flying": null, "recovery_weeks": null, "success_rate_pct": null, "note": "No single published stay figure is carried. PSRI Hospital publishes a range of 10-15 days in hospital, which is a hospital's own guidance to its patients rather than a clinical standard, and the Taiwanese and Saudi outcome figures in the story are series, not rates that would survive being averaged. The constraint after this operation is the immunosuppression and the monitoring, and no source read here states a wait before flying.", "as_of": "2026-09-17", "source": "s:psri-liver-cost-2026", "url": "https://psrihospital.com/liver-transplant-cost-in-india-from-diagnosis-to-recovery/" }, "prices": [ { "procedure": "liver-transplant", "country": "US", "amount": 1017800, "currency": "USD", "as_of": "2025", "kind": "estimate", "includes": [ "estimated average billed charges for one liver transplant episode" ], "excludes": [ "the difference between a billed charge and a negotiated or paid rate", "immunosuppressants for the life of the graft" ], "source": "s:milliman-transplant-table-2025", "url": "https://assets.milliman.com/downloads/2025-organ-transplant/index-font-2.html", "note": "an actuarial estimate, not a quoted price and not a bill anyone paid. The same table puts a kidney at 446,800 and a double lung at 2,346,500, and estimates 10,916 liver transplants in the United States in 2025. Its own footer reads: NOTE: ALL DATA IS ESTIMATED.", "tier": "cited", "usd": 1017800.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "liver-transplant", "country": "IN", "city": "New Delhi", "amount": 1800000, "amount_high": 2000000, "currency": "INR", "as_of": "2026", "kind": "estimate", "includes": [ "pre-operative evaluation and testing", "donor matching", "surgery, anaesthesia and surgeon fees", "hospital accommodation and intensive care", "medications", "post-transplant follow-up and monitoring" ], "excludes": [ "nothing is named as excluded on the page, which is itself the gap", "travel, accommodation for the family, and the donor's lost earnings" ], "source": "s:psri-liver-cost-2026", "url": "https://psrihospital.com/liver-transplant-cost-in-india-from-diagnosis-to-recovery/", "note": "living-donor transplant, standard cases, on the hospital's own page. The inclusion list is a prose sentence rather than a package schedule, and the page carries no validity date. The same hospital advertises medical visa letters and embassy documentation for international patients.", "tier": "cited", "usd": 18752.0, "usd_high": 20836.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "liver-transplant", "country": "IN", "city": "New Delhi", "amount": 3000000, "amount_high": 3500000, "currency": "INR", "as_of": "2026", "kind": "estimate", "includes": [ "deceased-donor transplants and complex cases, the page naming transplant for hepatocellular carcinoma among them" ], "excludes": [ "the same unnamed remainder as the row above" ], "source": "s:psri-liver-cost-2026", "url": "https://psrihospital.com/liver-transplant-cost-in-india-from-diagnosis-to-recovery/", "note": "the upper band on the same page. The distance between 18 lakh and 35 lakh is the difference between a straightforward living-donor case and a cancer case, not between two hospitals.", "tier": "cited", "usd": 31253.0, "usd_high": 36462.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "kidney-transplant", "as": "The same law and the same donor question, a shorter operation and less than half the bill.", "rel": "kin" }, { "to": "transplant-prohibition", "as": "Where the country-by-country reading sits: whether a non-resident may be transplanted, and whether an unrelated living donor may give.", "rel": "governed-by" }, { "to": "transplant-harm", "as": "What the published follow-up records about grafts obtained abroad, for the recipient and for the donor.", "rel": "risk" }, { "to": "declaration-of-istanbul-group", "as": "Keeps the international text this page quotes, and revised it in Madrid in 2018.", "rel": "org" }, { "to": "istanbul-declaration-2008", "as": "The April 2008 summit where the definitions on this page were agreed.", "rel": "event" }, { "to": "who", "as": "Guiding Principle 5, endorsed by the World Health Assembly in 2010, is the rule the national statutes are written against.", "rel": "org" }, { "to": "bone-marrow-transplant", "as": "The other graft here that needs a second healthy person to agree to something.", "rel": "kin" }, { "to": "india", "as": "Where the only hospital-published liver transplant price read for this record is sold.", "rel": "destination" }, { "to": "bloodborne-virus", "as": "Acquired hepatitis B ran at 5.4% against 0% in the series this page carries.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Loss to follow-up is named in the published review as one of the three mechanisms of harm.", "rel": "risk" }, { "to": "malpractice-recourse", "as": "Who answers for an operation performed where the recipient cannot sue and the donor cannot be traced.", "rel": "risk" }, { "to": "medical-visa", "as": "The document the hospital that published this price offers to write a letter for.", "rel": "rule" } ], "confusable_with": [ { "id": "kidney-transplant", "tell": "A kidney goes in the lower abdomen and the old ones stay; a liver replaces its predecessor in the same bed. The law is the same, the bill is not, and only one of the two has dialysis as an alternative while the patient waits." } ], "links": [ { "label": "Neupane et al., World Journal of Hepatology 2021;13(7):717-722", "url": "https://www.wjgnet.com/1948-5182/full/v13/i7/717.htm" }, { "label": "Milliman's 2025 transplant cost table", "url": "https://assets.milliman.com/downloads/2025-organ-transplant/index-font-2.html" }, { "label": "The Declaration of Istanbul, 2018 edition", "url": "https://www.declarationofistanbul.org/the-declaration" } ], "sources": [ "s:neupane-liver-transplant-2021", "s:milliman-transplant-table-2025", "s:milliman-transplant-press-2025", "s:psri-liver-cost-2026", "s:declaration-of-istanbul", "s:doi-2018-text", "s:who-guiding-principles", "s:usc-42-274e" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:neupane-liver-transplant-2021", "note": "the instrument quotations are from the Declaration and the WHO Guiding Principles; the outcome figures are the review's, carried with the comparison it makes; the closing paragraph is marked Inference" }, "text.how": { "tier": "cited", "source": "s:psri-liver-cost-2026", "note": "the operative description is standard; the stay figure is the hospital's own" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:milliman-transplant-table-2025" }, "metrics": { "tier": "cited", "source": "s:psri-liver-cost-2026" } } }, "x_commons_files": [ "File:Liver transplant.jpg", "File:Liver anatomy.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "A diseased liver is removed and replaced, either with a whole organ from a deceased donor or with a lobe cut from a living one.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "The same law and the same donor question, a shorter operation and less than half the bill.", "rel": "kin" }, { "to": "transplant-prohibition", "type": "rule", "name": "Buying an organ, and being transplanted abroad", "as": "Where the country-by-country reading sits: whether a non-resident may be transplanted, and whether an unrelated living donor may give.", "rel": "governed-by" }, { "to": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "What the published follow-up records about grafts obtained abroad, for the recipient and for the donor.", "rel": "risk" }, { "to": "declaration-of-istanbul-group", "type": "org", "name": "Declaration of Istanbul Custodian Group", "as": "Keeps the international text this page quotes, and revised it in Madrid in 2018.", "rel": "org" }, { "to": "istanbul-declaration-2008", "type": "event", "name": "The Declaration of Istanbul, 2008", "as": "The April 2008 summit where the definitions on this page were agreed.", "rel": "event" }, { "to": "who", "type": "org", "name": "World Health Organization", "as": "Guiding Principle 5, endorsed by the World Health Assembly in 2010, is the rule the national statutes are written against.", "rel": "org" }, { "to": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "The other graft here that needs a second healthy person to agree to something.", "rel": "kin" }, { "to": "india", "type": "destination", "name": "India", "as": "Where the only hospital-published liver transplant price read for this record is sold.", "rel": "destination" }, { "to": "bloodborne-virus", "type": "risk", "name": "Bloodborne virus from treatment abroad", "as": "Acquired hepatitis B ran at 5.4% against 0% in the series this page carries.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Loss to follow-up is named in the published review as one of the three mechanisms of harm.", "rel": "risk" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "Who answers for an operation performed where the recipient cannot sue and the donor cannot be traced.", "rel": "risk" }, { "to": "medical-visa", "type": "term", "name": "Medical visa", "as": "The document the hospital that published this price offers to write a letter for.", "rel": "rule" } ], "source_list": [ { "id": "s:neupane-liver-transplant-2021", "kind": "paper", "title": "Current state of medical tourism involving liver transplantation — the risk of infections and potential complications", "publisher": "World Journal of Hepatology 2021;13(7):717-722 (Neupane R, Taweesedt PT, Anjum H, Surani S)", "url": "https://pubmed.ncbi.nlm.nih.gov/34367493/", "accessed": "2026-09-16" }, { "id": "s:milliman-transplant-table-2025", "kind": "report", "title": "Estimated 2025 U.S. organ transplant costs — the interactive cost table accompanying the 2025 report", "publisher": "Nick Ortner and Hanna Holzer, Milliman; table hosted at assets.milliman.com and embedded in the report page", "url": "https://assets.milliman.com/downloads/2025-organ-transplant/index-font-2.html", "accessed": "2026-09-17", "note": "read with the browser tools because the figures are rendered by script. Gives, per organ, the total number of transplants estimated for 2025 and the estimated average billed charges: liver 10,916 and $1,017,800; kidney 28,092 and $446,800; double lung 2,938 and $2,346,500. The table's own footer reads: NOTE: ALL DATA IS ESTIMATED. SOURCE: ESTIMATES BASED ON OPTN, HRSA, AND MILLIMAN PROPRIETARY DATA" }, { "id": "s:milliman-transplant-press-2025", "kind": "report", "title": "Milliman releases 2025 report on U.S. organ and tissue transplant costs, utilization, and emerging issues — press release, Seattle, 13 February 2025", "publisher": "Milliman, Inc.", "url": "https://media.milliman.com/v1/media/edge/images/millimaninc5660-milliman6442-prod27d5-0001/media/Milliman/PDFs/Press-releases/2025/2-13-25_Organ-Transplant-press-release.pdf", "accessed": "2026-09-17" }, { "id": "s:psri-liver-cost-2026", "kind": "web", "title": "Liver Transplant Cost in India 2026: Surgery Price, Recovery & Outcomes", "publisher": "PSRI Hospital (Pushpawati Singhania Research Institute), Sheikh Sarai, New Delhi", "url": "https://psrihospital.com/liver-transplant-cost-in-india-from-diagnosis-to-recovery/", "accessed": "2026-09-17", "note": "the hospital's own page. Quotes a living-donor range of 18-20 lakh rupees and 30-35 lakh for deceased-donor and complex cases, a hospital stay of 10-15 days, and an international-patient service that includes medical visa letters and embassy documentation. The page carries no inclusion list beyond a prose sentence and no validity date." }, { "id": "s:declaration-of-istanbul", "kind": "org", "title": "The Declaration of Istanbul on Organ Trafficking and Transplant Tourism (2018 edition)", "publisher": "Declaration of Istanbul Custodian Group", "url": "https://www.declarationofistanbul.org/", "accessed": "2026-09-16" }, { "id": "s:doi-2018-text", "kind": "org", "title": "The Declaration of Istanbul on Organ Trafficking and Transplant Tourism, 2018 edition — preamble, definitions and the eleven principles", "publisher": "Declaration of Istanbul Custodian Group; adopted in Madrid in July 2018, updating the 2008 text first published in The Lancet on 5 July 2008", "url": "https://www.declarationofistanbul.org/the-declaration", "accessed": "2026-09-16", "note": "the full text on the Custodian Group's own site; its preamble carries the 2007 estimate from Shimazono, Bulletin of the World Health Organization 85(12):955-962, and its references list the Council of Europe Convention against Trafficking in Human Organs, ETS No. 216, Santiago de Compostela, 25 March 2015" }, { "id": "s:who-guiding-principles", "kind": "org", "title": "WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation, as endorsed by the Sixty-third World Health Assembly, May 2010, in Resolution WHA63.22", "publisher": "World Health Organization", "url": "https://iris.who.int/server/api/core/bitstreams/53e1102b-4874-49bf-97bc-c529b1c246f0/content", "accessed": "2026-09-16" }, { "id": "s:usc-42-274e", "kind": "statute", "title": "42 U.S. Code § 274e — Prohibition of organ purchases", "publisher": "National Organ Transplant Act 1984, as codified; text via Legal Information Institute, Cornell Law School", "url": "https://www.law.cornell.edu/uscode/text/42/274e", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:neupane-liver-transplant-2021", "note": "the instrument quotations are from the Declaration and the WHO Guiding Principles; the outcome figures are the review's, carried with the comparison it makes; the closing paragraph is marked Inference" }, "text.how": { "tier": "cited", "source": "s:psri-liver-cost-2026", "note": "the operative description is standard; the stay figure is the hospital's own" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:milliman-transplant-table-2025" }, "metrics": { "tier": "cited", "source": "s:psri-liver-cost-2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "taiwan", "type": "destination", "name": "Taiwan", "as": "The living-donor programme Taiwan is named for in the region.", "rel": "procedure" }, { "from": "cairo", "type": "hub", "name": "Cairo", "as": "The capability a national epidemic left behind, and the one this city is regionally unusual for.", "rel": "procedure" }, { "from": "chennai", "type": "hub", "name": "Chennai", "as": "Chennai programmes take referrals for this from across South Asia and the Gulf, by the trade's account.", "rel": "procedure" }, { "from": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "The work that keeps families here for weeks and fills the guesthouse streets.", "rel": "procedure" }, { "from": "taipei", "type": "hub", "name": "Taipei", "as": "Built on decades of endemic hepatitis B and the hepatology that followed it.", "rel": "procedure" }, { "from": "dialysis-holiday", "type": "procedure", "name": "Dialysis away from home", "as": "The other organ in this directory where a traveller is already a patient before the journey starts.", "rel": "kin" }, { "from": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "The same law, the same donor question, a longer operation and four times the bill.", "rel": "kin" }, { "from": "albert-einstein-sao-paulo", "type": "facility", "name": "Hospital Israelita Albert Einstein", "as": "Among the complex programmes its international referrals come for.", "rel": "performs" }, { "from": "asan-medical-center", "type": "facility", "name": "Asan Medical Center", "as": "The programme its foreign referrals come for, and the one the national registry ranks it first on.", "rel": "performs" }, { "from": "medanta", "type": "facility", "name": "Medanta — The Medicity, Gurugram", "as": "One of the campus's named referral programmes.", "rel": "performs" }, { "from": "blood-supply-safety", "type": "risk", "name": "Blood supply safety", "as": "The largest transfusion requirement of any elective operation here.", "rel": "procedure" }, { "from": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "The organ with the same pattern and a higher mortality penalty.", "rel": "procedure" }, { "from": "transplant-prohibition", "type": "rule", "name": "Buying an organ, and being transplanted abroad", "as": "The other, and the one with the published infection literature.", "rel": "procedure" }, { "from": "istanbul-declaration-2008", "type": "event", "name": "The Declaration of Istanbul, 2008", "as": "The other organ trade the declaration covers.", "rel": "procedure" } ] }, { "schema": 1, "id": "panchakarma", "type": "procedure", "names": { "name": "Panchakarma", "aliases": [ "pancakarma", "Ayurvedic purification therapy", "body purification programme", "Ayurveda cure" ], "said": "Kerala resorts sell it inside a named package - rejuvenation, body purification, slimming - and price it per night with the room. German clinics sell a Kur and price the treatments separately from the room." }, "etymology": { "root": "panchakarma: Sanskrit panca, five, plus karman, action - the five actions. The classical five are vamana (therapeutic emesis), virecana (purgation), basti (medicated enema), nasya (nasal administration) and raktamoksa (bloodletting); most of what is sold to visitors under the name is the oil work and steam that classically precede them.", "tier": "tradition", "note": "snehana is oleation, the oiling that precedes purification; svedana is sudation, the sweating; shirodhara is the pouring of warm oil on the forehead; pizhichil is the oil bath. These words appear on the tariff rather than in translation, and they name the treatments a day is built from." }, "region": [ "south-asia", "europe-west" ], "facets": { "family": "rehabilitation", "setting": "outpatient-course", "anaesthesia": "none" }, "text": { "what": "A residential course of Ayurvedic treatment, prescribed by a physician after consultation and run daily for two to four weeks: oil applications and massage, herbal steam, forehead oil pouring, medicated enemas and internal preparations, with a prescribed vegetarian diet, yoga and rest. It is bought by the night or by the package, and the treatment plan is set by the resident doctor rather than by the price paid.", "story": "Panchakarma is the oldest long-stay product in this trade and the one that sits most awkwardly inside it: a therapeutic system with its own diagnostics, its own state regulation in India, and a resort economy built on top of it.\n\nThe tariffs show the structure. Somatheeram in Kerala prices a fourteen-night Body Purification Package per person by room category and by season: from 2,422 euro single in a standard cottage in June to September, to 3,668 euro for the same room in the December to March peak, with the top suite at 8,736. The booklet states its validity as 1 October 2025 to 30 September 2026, that all applicable taxes are included, that the package covers doctor's consultations, treatments, medication, Ayurvedic full board, yoga, meditation and accommodation, with airport transfers for stays of seven days or more, and that the package includes treatments to the value of 140 euro a day per person. It also states that the resort is a healing retreat serving only treatment patients: a room-only booking is confirmed with a package or not at all.\n\nBarberyn in Sri Lanka splits the same product in two. Rooms run 200 to 450 euro a night single for the season dated 15 April to 30 November 2026, full board with transfers and excursions; Ayurveda treatment is mandatory for every guest and is charged separately at 100 euro a day, or 700 a week.\n\nAyurveda Parkschloesschen in Germany prices a thirteen-night classic Panchakarma cure at 4,090 euro for the treatment package, plus room and full board from 4,160 - roughly five times the Kerala figure for a night shorter, which is the whole of the cost argument in one line.\n\n*Inference --* the reason a reader cannot compare these three to a hospital price is that the object is different. There is no operation, no implant, no discharge summary. What is bought is a physician's plan, a therapist's hands and a fortnight of days, and the only figure that transfers across borders is the day rate.", "how": "A consultation on arrival sets the plan; the resort's own booklet states that the content of a package may differ with the patient's condition and that the final decision belongs to the consulting doctor. Days run to a timetable of oil treatments, steam, diet and rest, with yoga and lectures. Classical purification is heavier than the resort version and is not offered to everyone. The recommended minimum stay printed on the Kerala booklet for its purification package is fourteen to twenty-one days, and the daily treatment runs ninety to a hundred and twenty minutes.", "today": "Three published tariffs sit on this record - India, Sri Lanka and Germany - each read off the provider's own price list in September 2026, and each with a stated validity period. Two of the three price the treatment separately from the bed.", "notes": "This page describes a treatment system as it is sold to visitors, and the prices it is sold at. It makes no claim about what the treatment does, and gives no medical advice." }, "metrics": { "stay_days": 14, "note": "Fourteen nights is the package length both South Asian tariffs on this record are built around, and the Kerala booklet states a recommended minimum duration of 14 to 21 days for its purification package with 90 to 120 minutes of daily treatment. The German cure read for this record runs thirteen nights. No outcome figure is carried: none of the three providers publishes one.", "as_of": "2026-09-16", "source": "s:somatheeram-tariff-2025-26", "url": "https://somatheeram-c3c5.kxcdn.com/pricelists/somatheeram-tariff-en-eur-2025-2026.pdf" }, "prices": [ { "procedure": "panchakarma", "country": "IN", "city": "Kovalam", "amount": 2422, "amount_high": 3668, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "fourteen nights, single occupancy, standard cottage", "doctor's consultations", "treatments in the plan, to a stated value of 140 EUR a day per person", "medication", "Ayurvedic full board", "yoga and meditation", "airport transfers for stays of seven days or more", "a Backwaters excursion for stays of fourteen days or more", "all applicable taxes" ], "excludes": [ "flights", "room-only stays, which the resort states it confirms only in connection with a package" ], "source": "s:somatheeram-tariff-2025-26", "url": "https://somatheeram-c3c5.kxcdn.com/pricelists/somatheeram-tariff-en-eur-2025-2026.pdf", "note": "Body Purification Package, the tariff's panchakarma line. 2,422 EUR is low season (June to September), 3,668 EUR peak (December to March), both single in the cheapest room category; the top suite runs 5,614 to 8,736 EUR for the same fourteen nights. Tariff validity 01.10.2025 to 30.09.2026.", "tier": "cited", "usd": 2794.0, "usd_high": 4232.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "panchakarma", "country": "LK", "amount": 100, "currency": "EUR", "as_of": "2026-09-16", "kind": "list", "includes": [ "one day of prescribed Ayurveda treatment, mandatory for every guest" ], "excludes": [ "the room, charged separately at 200 to 450 EUR a night single by category, full board with transfers and excursions", "air conditioning, a supplement of 15 EUR a day where available" ], "source": "s:barberyn-summer-rates", "url": "https://www.barberynresorts.com/faq/waves_summer-rates/", "note": "treatment at 100 EUR a day or 700 a week, quoted for the season 15 April to 30 November 2026. This resort splits bed from treatment, which makes its day rate the most directly comparable figure on the record.", "tier": "cited", "usd": 115.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "panchakarma", "country": "DE", "amount": 4090, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "thirteen nights of the classic Panchakarma cure treatment package", "medical consultations: initial pulse reading, therapy plan, follow-ups and final consultation", "eight synchronised treatments and nine further treatments including oil pouring, herbal steam and medicated enemas", "daily yoga, meditation and lectures", "use of the spa facilities" ], "excludes": [ "room and full board, quoted separately from 4,160 EUR" ], "source": "s:parkschloesschen-panchakarma", "url": "https://www.ayurveda-parkschloesschen.de/uebersicht/panchakarma_kur_klassisch/", "note": "treatment and bed priced apart, as in Sri Lanka; together the thirteen nights run from 8,250 EUR", "tier": "cited", "usd": 4719.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "india", "as": "Where the state licenses Ayurvedic hospitals and the resort tariff is written in euro for visitors.", "rel": "destination" }, { "to": "sri-lanka", "as": "Where the bed and the treatment are two prices, and the treatment is compulsory.", "rel": "destination" }, { "to": "germany", "as": "Where the same fortnight costs about five times the Kerala price.", "rel": "destination" }, { "to": "wellness-travel", "as": "The category this is sold in, and the category it does not entirely fit.", "rel": "term" }, { "to": "health-tourism", "as": "The wider word under which spa and cure stays are counted.", "rel": "term" }, { "to": "addiction-rehab", "as": "The other long-stay residential course, priced the same way and bought by a different traveller.", "rel": "contrast" }, { "to": "executive-health-screening", "as": "The short diagnostic product sold alongside it in the same brochures.", "rel": "contrast" }, { "to": "counterfeit-medicines", "as": "Herbal preparations dispensed abroad and carried home raise a separate question about what is in them.", "rel": "risk" }, { "to": "length-of-stay", "as": "Here the stay is the product, not a consequence of the procedure.", "rel": "term" } ], "confusable_with": [ { "id": "addiction-rehab", "tell": "Both sell weeks of residential care in warm countries. Panchakarma is an Ayurvedic treatment course; a rehabilitation programme treats dependence with therapy and nursing." } ], "links": [ { "label": "Somatheeram tariff booklet 2025/26", "url": "https://somatheeram-c3c5.kxcdn.com/pricelists/somatheeram-tariff-en-eur-2025-2026.pdf" }, { "label": "Barberyn rates", "url": "https://www.barberynresorts.com/faq/waves_summer-rates/" } ], "sources": [ "s:somatheeram-tariff-2025-26", "s:barberyn-summer-rates", "s:parkschloesschen-panchakarma" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:somatheeram-tariff-2025-26", "note": "tariff terms quoted from the three price lists; the closing paragraph is marked as inference inline" }, "text.how": { "tier": "cited", "source": "s:somatheeram-tariff-2025-26", "note": "the consultation and duration statements are the resort's own; the description of classical purification is marked tradition in the etymology" }, "etymology": { "tier": "tradition" } } }, "x_commons_files": [ "File:Shirodhara.jpg", "File:Ayurveda massage.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "A residential course of Ayurvedic treatment, prescribed by a physician after consultation and run daily for two to four weeks: oil applications and massage, herbal steam, forehead oil pouring, medicated enemas and…", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "india", "type": "destination", "name": "India", "as": "Where the state licenses Ayurvedic hospitals and the resort tariff is written in euro for visitors.", "rel": "destination" }, { "to": "sri-lanka", "type": "destination", "name": "Sri Lanka", "as": "Where the bed and the treatment are two prices, and the treatment is compulsory.", "rel": "destination" }, { "to": "germany", "type": "destination", "name": "Germany", "as": "Where the same fortnight costs about five times the Kerala price.", "rel": "destination" }, { "to": "wellness-travel", "type": "term", "name": "Wellness travel", "as": "The category this is sold in, and the category it does not entirely fit.", "rel": "term" }, { "to": "health-tourism", "type": "term", "name": "Health tourism", "as": "The wider word under which spa and cure stays are counted.", "rel": "term" }, { "to": "addiction-rehab", "type": "procedure", "name": "Residential addiction treatment", "as": "The other long-stay residential course, priced the same way and bought by a different traveller.", "rel": "contrast" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The short diagnostic product sold alongside it in the same brochures.", "rel": "contrast" }, { "to": "counterfeit-medicines", "type": "risk", "name": "Substandard and falsified medicines", "as": "Herbal preparations dispensed abroad and carried home raise a separate question about what is in them.", "rel": "risk" }, { "to": "length-of-stay", "type": "term", "name": "Length of stay", "as": "Here the stay is the product, not a consequence of the procedure.", "rel": "term" } ], "source_list": [ { "id": "s:somatheeram-tariff-2025-26", "kind": "web", "title": "Tariff Booklet 2025/26", "publisher": "Somatheeram Ayurvedic Hospital and Yoga Centre, Kerala", "url": "https://somatheeram-c3c5.kxcdn.com/pricelists/somatheeram-tariff-en-eur-2025-2026.pdf", "accessed": "2026-09-16", "note": "euro tariff, validity 01.10.2025 to 30.09.2026, all applicable taxes stated as included" }, { "id": "s:barberyn-summer-rates", "kind": "web", "title": "Summer Rates", "publisher": "Barberyn Ayurveda Resorts, Sri Lanka", "url": "https://www.barberynresorts.com/faq/waves_summer-rates/", "accessed": "2026-09-16", "note": "rates stated for 15 April 2026 to 30 November 2026" }, { "id": "s:parkschloesschen-panchakarma", "kind": "web", "title": "Panchakarma Kur Klassisch", "publisher": "Ayurveda Parkschloesschen, Bad Wildstein, Germany", "url": "https://www.ayurveda-parkschloesschen.de/uebersicht/panchakarma_kur_klassisch/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:somatheeram-tariff-2025-26", "note": "tariff terms quoted from the three price lists; the closing paragraph is marked as inference inline" }, "text.how": { "tier": "cited", "source": "s:somatheeram-tariff-2025-26", "note": "the consultation and duration statements are the resort's own; the description of classical purification is marked tradition in the etymology" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "india", "type": "destination", "name": "India", "as": "The AYUSH course that earned its own visa class.", "rel": "procedure" }, { "from": "colombo", "type": "hub", "name": "Colombo", "as": "The Ayurvedic course sold elsewhere on the island, not in these hospitals.", "rel": "contrast" }, { "from": "addiction-rehab", "type": "procedure", "name": "Residential addiction treatment", "as": "The other long-stay course sold by the night, in the same countries, to a different buyer.", "rel": "contrast" }, { "from": "health-tourism", "type": "term", "name": "Health tourism", "as": "A course of treatment that sits inside this word and outside the medical one.", "rel": "procedure" }, { "from": "wellness-travel", "type": "term", "name": "Wellness travel", "as": "A course this site treats as a procedure and the sector counts as a retreat.", "rel": "procedure" } ] }, { "schema": 1, "id": "pgt", "type": "procedure", "names": { "name": "Preimplantation genetic testing", "aliases": [ "PGT", "PGT-A", "PGT-M", "PGT-SR", "PGS", "PGD", "embryo screening" ], "said": "Laboratories still write PGS and PGD, the older names; regulators write PGT-A for chromosome counting, PGT-M for a named inherited condition and PGT-SR for a structural rearrangement. A clinic that says genetic testing without a suffix has not said which." }, "etymology": { "root": "aneuploidy: Greek an-, not, plus eu-, well, plus ploos, fold — not well folded, a cell whose chromosome count is off the expected set. Preimplantation marks the window: after fertilisation, before the embryo is put back, the only days in a human life when the whole genome can be read and the result acted on by choosing a different embryo.", "tier": "tradition", "note": "PGT-A screens embryos with no known inherited condition; PGT-M tests for a specific condition already in the family. The first is contested; the second is not, and they are sold from the same price list under one heading." }, "region": [ "global" ], "facets": { "family": "fertility", "setting": "staged", "anaesthesia": "none" }, "text": { "what": "A few cells are taken from the outer layer of a five-day-old embryo, the embryo is frozen, and the cells are sequenced. PGT-A counts chromosomes and reports each embryo as euploid, aneuploid or mosaic; PGT-M looks for one inherited condition already known in the family; PGT-SR looks for a structural rearrangement a parent carries. The transfer happens weeks later, after the results. Nothing is done to the patient: the biopsy is done to the embryo, and the anaesthesia belonged to the egg collection days earlier.", "story": "PGT-A is the clearest case on this site of a test being sold hard while its own regulator rates it down. The HFEA gives PGT-A at blastocyst stage a red rating, defined as: on balance, the findings from moderate or high quality evidence show that this add-on may reduce treatment effectiveness. The same page states there is no evidence from randomised controlled trials that PGT-A at this stage is effective at improving the chance of having a baby for most patients having IVF, and treats the miscarriage-reduction finding in older patients and those with repeated loss as a secondary outcome. The rating was last reviewed on 16 October 2023.\n\nMeanwhile the CDC's national rows put 58.2% of all US transfers in 2022 as involving at least one embryo that had been through preimplantation genetic testing — 53.6% among patients under 35, 65.6% among those aged 38 to 40.\n\n*Inference —* a red-rated add-on on a majority of transfers in the largest single market is not a clinical consensus; it is a commercial one. *Trade practice —* the pricing explains part of it. PGT is charged per embryo, so the patient with the most embryos pays the most, and the decision is taken at the moment of greatest hope and least comparison shopping — after a retrieval has already succeeded.\n\nThe travel argument attached to this test is different from the rest of the batch. It is not mainly about price. Where the law restricts what embryos may be tested for — sex without a medical reason, late-onset conditions, tissue matching for a sibling — the test moves to a jurisdiction that permits it, and that is circumvention rather than saving.", "how": "Priced per embryo everywhere, on top of a cycle. Reprofit's list valid from 1 January 2026 charges 600 EUR for the biopsy and examination of one embryo for PGT-A or PGT-SR; PGT-M is 1,995 EUR to prepare the karyomapping panel and then 775 EUR per embryo, with Sanger sequencing a further 740 EUR where the panel cannot be used. Testing embryos already frozen costs 1,040 EUR for the first including biopsy and a year of storage, and 735 EUR for each one after. A consultation to interpret the results is 40 EUR. The same clinic also sells the whole thing bundled, as a cycle with PGT-A on all embryos at 7,775 EUR. A US clinic quotes its PGT from 3,899 dollars depending on how many embryos are tested.\n\nTwo rules move this test across a border. What may be tested for: the permitted indications are set nationally, and sex selection for social reasons, testing for adult-onset conditions and tissue typing sit on different sides of the line in different countries. And what may be done with the results: whether mosaic embryos may be transferred, and whether embryos found unaffected must be used before a fresh cycle is funded, are regulatory questions rather than laboratory ones. The rule records carry the instruments and the dates.", "today": "As of September 2026 the published prices read off pages for this record run from 600 EUR per embryo in Brno to 3,899 US dollars as a starting figure in New York state, with the cycle that produced the embryos outside all of them. The UK regulator's red rating on PGT-A stands as last reviewed on 16 October 2023, and the most recent US national figure has the test on the majority of transfers.", "notes": "This page describes a test and reports what its regulator and the US register say about it. It is not medical advice, and it does not say whether any particular embryo should be tested." }, "metrics": { "success_rate_pct": null, "note": "No success rate is carried because the regulator that reviews this add-on declines to assert one. The HFEA rates PGT-A red — on balance, moderate or high quality evidence shows the add-on may reduce treatment effectiveness — and states there is no randomised-trial evidence that it improves the chance of a birth for most IVF patients; last reviewed 16 October 2023. What can be counted is uptake, not benefit: the CDC's 2022 US national rows put 58.2% of transfers as including at least one embryo tested, by age band 53.6% under 35, 63.8% at 35 to 37, 65.6% at 38 to 40 and 52.9% over 40. That is a share of transfers, not a rate of anything succeeding.", "as_of": "2023-10-16", "source": "s:hfea-pgt-a", "url": "https://www.hfea.gov.uk/treatments/treatment-add-ons/pre-implantation-genetic-testing-for-aneuploidy-pgt-a/" }, "prices": [ { "procedure": "pgt", "country": "CZ", "city": "Brno", "amount": 600, "currency": "EUR", "as_of": "2026-01-01", "kind": "list", "includes": [ "biopsy and examination of 1 embryo, PGT-A or PGT-SR" ], "excludes": [ "the IVF cycle", "freezing and storage", "consultation of the results, listed at 40 EUR" ], "source": "s:reprofit-pricelist-2026", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "note": "per embryo. Six embryos is 3,600 EUR, which is more than the clinic's whole standard IVF cycle at 3,245 EUR. Valid from 1 January 2026.", "tier": "cited", "usd": 692.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "pgt", "country": "CZ", "city": "Brno", "amount": 1995, "currency": "EUR", "as_of": "2026-01-01", "kind": "list", "includes": [ "preparation for karyomapping, PGT-M" ], "excludes": [ "the biopsy and examination of each embryo, listed at 775 EUR each", "Sanger sequencing where karyomapping cannot be used, listed at 740 EUR" ], "source": "s:reprofit-pricelist-2026", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "note": "testing for a named inherited condition is a fixed set-up charge plus a per-embryo charge, so the family with a known condition pays a different shape of bill from the patient buying chromosome screening.", "tier": "cited", "usd": 2302.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "pgt", "country": "CZ", "city": "Brno", "amount": 7775, "currency": "EUR", "as_of": "2026-01-01", "kind": "package", "includes": [ "consultation, treatment plan, protocol preparation, stimulation monitoring", "egg retrieval under general anesthesia", "sperm preparation and MFSS / MACS", "2x STDs testing", "ICSI", "extended cultivation", "PGT-A of all embryos", "consultation of PGT-A results with a geneticist", "cryopreservation of all embryos and 1 year of storage", "embryo transfer (frozen embryo) up to six months after fertilization" ], "excludes": [ "PICSI", "EmbryoGlue", "TimeLaps cultivation" ], "source": "s:reprofit-pricelist-2026", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "note": "line \"IVF cycle with own eggs - Genetic Insight\": a cycle with unlimited PGT-A folded in, at 4,530 EUR above the clinic's plain cycle. A bundle removes the per-embryo arithmetic and with it the comparison.", "tier": "cited", "usd": 8971.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "pgt", "country": "US", "city": "Syracuse", "amount": 3899, "currency": "USD", "as_of": "2026-07-07", "kind": "list", "includes": [ "preimplantation genetic testing, listed as starting at this price" ], "excludes": [ "the IVF cycle", "medications" ], "source": "s:cny-ivf-cost", "url": "https://www.cnyfertility.com/ivf-cost/", "note": "the clinic states the typical total starts here and depends on the number of embryos tested; page dated 7 July 2026.", "tier": "cited", "usd": 3899.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "ivf", "as": "The cycle this test is added to, and the bill it is charged on top of.", "rel": "part" }, { "to": "icsi", "as": "The earlier laboratory charge on the same embryos, three days before this one.", "rel": "kin" }, { "to": "egg-donation", "as": "Frequently tested as well, and the packages that guarantee blastocysts price the two together.", "rel": "kin" }, { "to": "surrogacy", "as": "Commonly run before a carrier transfer, and excluded from the programme price along with the IVF.", "rel": "kin" }, { "to": "hfea", "as": "Rates this add-on red and publishes the reasoning this record quotes.", "rel": "measures" }, { "to": "cdc-art-results", "as": "The US series behind the 58.2% of 2022 transfers carrying a tested embryo.", "rel": "measured-by" }, { "to": "circumvention-travel", "as": "Why this test moves country when the permitted indications differ, rather than when the price does.", "rel": "term" }, { "to": "the-price-that-isnt", "as": "A per-embryo charge that can exceed the cycle it is added to.", "rel": "story" }, { "to": "reading-the-exclusions", "as": "Where a bundled PGT and a per-embryo PGT turn out to be different purchases.", "rel": "step" } ], "confusable_with": [ { "id": "icsi", "tell": "ICSI is done to the egg on collection day; PGT is done to the embryo on day five. Both are per-cycle laboratory charges and neither is the cycle." } ], "links": [ { "label": "HFEA — PGT-A add-on rating", "url": "https://www.hfea.gov.uk/treatments/treatment-add-ons/pre-implantation-genetic-testing-for-aneuploidy-pgt-a/" }, { "label": "Reprofit price list, valid from 1 January 2026", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf" } ], "sources": [ "s:hfea-pgt-a", "s:cdc-art-2022-summary", "s:reprofit-pricelist-2026", "s:cny-ivf-cost", "s:cohen-circumvention-2012" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:hfea-pgt-a", "note": "the rating and the uptake share are cited; the reading of the gap between them is marked Inference and the pricing argument is marked Trade practice" }, "text.how": { "tier": "cited", "source": "s:reprofit-pricelist-2026" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:hfea-pgt-a" }, "prices": { "tier": "cited", "source": "s:reprofit-pricelist-2026" } } }, "x_commons_files": [ "File:Blastocyst biopsy.jpg", "File:Human blastocyst.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "A few cells are taken from the outer layer of a five-day-old embryo, the embryo is frozen, and the cells are sequenced.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The cycle this test is added to, and the bill it is charged on top of.", "rel": "part" }, { "to": "icsi", "type": "procedure", "name": "Intracytoplasmic sperm injection", "as": "The earlier laboratory charge on the same embryos, three days before this one.", "rel": "kin" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "Frequently tested as well, and the packages that guarantee blastocysts price the two together.", "rel": "kin" }, { "to": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "Commonly run before a carrier transfer, and excluded from the programme price along with the IVF.", "rel": "kin" }, { "to": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "Rates this add-on red and publishes the reasoning this record quotes.", "rel": "measures" }, { "to": "cdc-art-results", "type": "dataset", "name": "CDC assisted reproductive technology results", "as": "The US series behind the 58.2% of 2022 transfers carrying a tested embryo.", "rel": "measured-by" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "Why this test moves country when the permitted indications differ, rather than when the price does.", "rel": "term" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "A per-embryo charge that can exceed the cycle it is added to.", "rel": "story" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "Where a bundled PGT and a per-embryo PGT turn out to be different purchases.", "rel": "step" } ], "source_list": [ { "id": "s:hfea-pgt-a", "kind": "org", "title": "Pre-implantation genetic testing for aneuploidy (PGT-A) — treatment add-ons rating", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/treatments/treatment-add-ons/pre-implantation-genetic-testing-for-aneuploidy-pgt-a/", "accessed": "2026-09-16" }, { "id": "s:cdc-art-2022-summary", "kind": "dataset", "title": "2022 Final Assisted Reproductive Technology (ART) Summary", "publisher": "US Centers for Disease Control and Prevention", "url": "https://data.cdc.gov/Assisted-Reproductive-Technology-ART-/2022-Final-Assisted-Reproductive-Technology-ART-Su/9tjt-seye", "accessed": "2026-09-16", "note": "clinic-level and national rows; the national rows carry locationabbr NA. Queried through the Socrata endpoint https://data.cdc.gov/resource/9tjt-seye.json" }, { "id": "s:reprofit-pricelist-2026", "kind": "web", "title": "Pricelist — Assisted Reproduction, valid from 01.01.2026 (document 0331.26ENG)", "publisher": "Reprofit International s.r.o., Brno", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "accessed": "2026-09-16", "note": "the clinic's own self-payer price list, five pages, each line naming its inclusions and its exclusions" }, { "id": "s:cny-ivf-cost", "kind": "web", "title": "IVF Cost 2026: breakdown of prices, add-ons", "publisher": "CNY Fertility", "url": "https://www.cnyfertility.com/ivf-cost/", "accessed": "2026-09-16", "note": "page dated 7 July 2026; carries the clinic's own list prices and unattributed national ranges" }, { "id": "s:cohen-circumvention-2012", "kind": "paper", "title": "Circumvention Tourism", "publisher": "Cornell Law Review 97(6):1309 (Cohen IG)", "url": "https://scholarship.law.cornell.edu/clr/vol97/iss6/1", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:hfea-pgt-a", "note": "the rating and the uptake share are cited; the reading of the gap between them is marked Inference and the pricing argument is marked Trade practice" }, "text.how": { "tier": "cited", "source": "s:reprofit-pricelist-2026" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:reprofit-pricelist-2026" }, "metrics": { "tier": "cited", "source": "s:hfea-pgt-a" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "prague", "type": "hub", "name": "Prague", "as": "The priced extra on most programmes quoted here.", "rel": "procedure" }, { "from": "tel-aviv", "type": "hub", "name": "Tel Aviv", "as": "Sold alongside the cycle, and a reason some patients choose this system over their own.", "rel": "procedure" }, { "from": "egg-freezing", "type": "procedure", "name": "Egg freezing", "as": "The next optional charge on embryos made from these eggs.", "rel": "kin" }, { "from": "icsi", "type": "procedure", "name": "Intracytoplasmic sperm injection", "as": "The next laboratory charge on the same embryos, priced per embryo.", "rel": "kin" }, { "from": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The test added to embryos from this cycle, priced per embryo and rated red by the UK regulator.", "rel": "part" }, { "from": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "Commonly added to embryos before a carrier transfer, and charged per embryo.", "rel": "kin" }, { "from": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "The add-on it rates red for improving the chance of a birth and green for reducing miscarriage.", "rel": "procedure" }, { "from": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "A test that moves country when the permitted indications differ rather than when the price does.", "rel": "procedure" }, { "from": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "Priced per embryo, so six embryos cost more than the cycle that made them.", "rel": "procedure" } ] }, { "schema": 1, "id": "phalloplasty", "type": "procedure", "names": { "name": "Phalloplasty", "aliases": [ "gender-affirming phalloplasty", "RFF phalloplasty", "ALT phalloplasty", "bottom surgery", "genital reconstruction" ], "said": "Surgeons name the flap — radial forearm, anterolateral thigh, latissimus dorsi, SCIP — because the flap sets the donor scar, the number of operations and the price. Price lists name the stage. Nobody prices the whole thing in one line, and a page that does is pricing one stage of it." }, "etymology": { "root": "phallos, Greek, the penis, and in older usage the carved or carried image of one; plus -plasty, from plastos, moulded. Metoidioplasty, the other operation in this family, is built on Greek meta-, change of position, and aidoion, the genitals — a word Greek used as a euphemism, from aidos, shame.", "tier": "tradition", "note": "Phalloplasty builds a penis from tissue taken somewhere else. Metoidioplasty releases and lengthens the clitoris, which testosterone has already enlarged, and does not use a flap. They are different operations with different prices, different stages and different donor scars, and both get called bottom surgery." }, "region": [ "global", "southeast-asia", "north-america", "europe-west" ], "facets": { "family": "gender-affirming", "setting": "staged", "anaesthesia": "general" }, "text": { "what": "A penis is built from a flap of the patient's own skin, fat and nerve — most often the forearm, otherwise the thigh, groin or back — transferred to the pubis and connected to blood vessels and nerves there. Where urethral lengthening is done, a tube is made inside the flap so that urine passes through the new organ; that is the part that leaks, narrows and needs repair most often. Rigidity, where it is wanted, comes later from an implanted prosthesis, and testicular prostheses later still. The work is staged across separate admissions and usually separate years.", "story": "The clearest published statement about what this operation costs is a Bangkok hospital's list, and it is published one stage at a time. Yanhee Hospital prices a total phalloplasty at 426,000 baht with fourteen nights attached; before it, urethral prefabrication on the forearm at 97,700 with one night, and vaginal closure at 199,000 with five; after it, a coronoplasty at 96,000, a penile prosthesis at 99,000 and a scrotal prosthesis at 96,000, the last two stated to exclude the implants themselves. *Inference —* the six rows add to 1,013,700 baht before any implant, which is the number a reader comparing this with a single headline price is actually looking for, and no page publishes it.\n\nThe same table carries a line that is rarer than the prices. Vaginal closure is quoted at 199,000 baht where the hysterectomy was done at Yanhee and 228,800 where it was done, in the table's own words, at \"Other Places\". A staged operation split across two countries costs more at the second one, and here somebody has put a figure on it.\n\nIn the United States the Gender Confirmation Center estimates phalloplasty at 35,000 to 50,000 dollars and then says something a price page rarely says: the operation is \"not available to cash-pay patients\" and needs insurance pre-approval, while metoidioplasty, vaginectomy and groin flap phalloplasty are available without it. That is a surgical practice declining to sell the largest operation on its own list for cash. In London, the private list that publishes guide prices for chest surgery and for vaginoplasty has no phalloplasty or metoidioplasty row on it at all.\n\n*Inference —* those two absences point the same way. This is the operation in the gender-affirming set with the most stages, the most revisions and the longest tail of complications, and the pages that would otherwise quote a price are the pages that stop.", "how": "General anaesthesia, long operations, and an admission per stage. The flap is raised with its artery, vein and sensory nerve, moved, and plumbed in under a microscope; the donor site is grafted and leaves a permanent scar the size of the flap. Where the urethra is lengthened, it is usually prefabricated in a separate earlier operation. Hospital stays on the one published table run from one night for the prefabrication to fourteen for the phalloplasty itself. Candidacy conditions are published by the clinics rather than imposed by them alone: one Bangkok hospital lists a minimum age of 20, at least a year of testosterone, a year living in the acquired gender, psychiatric clearance, and mastectomy and hysterectomy completed at least six months earlier.", "today": "Two countries' provider pages carrying a phalloplasty price were read on 17 September 2026 — a Thai staged list and a US practice's estimate that comes with a refusal to take cash for it. Between those two numbers sit a different currency, a different number of stages, a different definition of what is included, and the implants, which the Thai list excludes by name.", "notes": "This page describes an operation. It is not advice about whether to have one, or where." }, "metrics": { "stay_days": 14, "days_before_flying": null, "recovery_weeks": null, "note": "Fourteen nights is the ward stay attached to the Stage 3 total phalloplasty row on the Yanhee price table; the other stages on the same table carry one, two, three and five nights. No source read for this record publishes a wait before flying or a recovery span, and a staged operation has no single recovery to measure.", "as_of": "2026-09-17", "source": "s:yanhee-plastic-prices", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/" }, "prices": [ { "procedure": "phalloplasty", "country": "TH", "city": "Bangkok", "amount": 426000, "currency": "THB", "as_of": "2026-09-17", "kind": "list", "includes": [ "14 nights in hospital, as stated in the nights column" ], "excludes": [ "urethral prefabrication of the forearm, listed separately at 97,700 with 1 night", "vaginal closure, listed at 199,000 with 5 nights where the earlier hysterectomy was done at the same hospital", "coronoplasty at 96,000", "penile prosthesis at 99,000 and scrotal prosthesis at 96,000, both stated to exclude the implant", "everything outside the ward: hotel, flights, the weeks between stages" ], "source": "s:yanhee-plastic-prices", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "note": "listed as STAGE 3: Total Phalloplasty. The table carries no validity date and no inclusion list. Its exclusion of the prosthesis implants is the same move a joint package makes when it excludes the joint.", "tier": "cited", "usd": 12795.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "phalloplasty", "country": "TH", "city": "Bangkok", "amount": 228800, "currency": "THB", "as_of": "2026-09-17", "kind": "list", "includes": [ "vaginal closure after a hysterectomy performed elsewhere", "5 nights" ], "excludes": [ "the phalloplasty itself and every other stage" ], "source": "s:yanhee-plastic-prices", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "note": "the same row costs 199,000 baht where the earlier stage was done at this hospital and 228,800 where it was done, in the table's own words, at Other Places. A published surcharge for arriving mid-course from another surgeon is unusual enough to carry on its own.", "tier": "cited", "usd": 6872.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "phalloplasty", "country": "US", "city": "San Francisco", "amount": 35000, "amount_high": 50000, "currency": "USD", "as_of": "2024-10-15", "kind": "estimate", "includes": [ "hospital stays", "post-operative supplies while in the hospital", "occupational therapy" ], "excludes": [ "medications", "travel", "cash-paying patients altogether: the page states phalloplasty is not available to them and requires insurance pre-approval" ], "source": "s:gcc-bottom-surgery-cost", "url": "https://www.genderconfirmation.com/bottom-surgery-cost/", "note": "the practice's own estimate, on a page marked medically reviewed 15 October 2024. Metoidioplasty is estimated at 23,000 to 24,500 dollars on the same page and is available without insurance, as are vaginectomy, scrotectomy and groin flap phalloplasty.", "tier": "cited", "usd": 35000.0, "usd_high": 50000.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "gender-affirming-care-access", "as": "Whether the health system at home does this at all, and who it will do it for.", "rel": "governed-by" }, { "to": "vaginoplasty", "as": "The other genital operation: one admission against this one's four.", "rel": "contrast" }, { "to": "top-surgery", "as": "Stage one on the same Thai list, at a quarter of the price and two nights.", "rel": "kin" }, { "to": "hysterectomy", "as": "Priced as an earlier stage on the same list, and a stated precondition on a Bangkok hospital's candidacy page.", "rel": "kin" }, { "to": "thailand", "as": "Where the one staged price list read for this record is published.", "rel": "destination" }, { "to": "bangkok", "as": "The city holding that hospital and the surgeons whose flap techniques are on their pages without prices.", "rel": "hub" }, { "to": "united-states", "as": "Where a practice publishes an estimate for this operation and declines to sell it for cash.", "rel": "destination" }, { "to": "revision-at-home", "as": "Urethral fistula and stricture are the complications that arrive after the flight, and they need a surgeon.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Four stages across years, and the record of the first three sitting in another country.", "rel": "risk" }, { "to": "implant-excluded", "as": "The prosthesis is excluded from the prosthesis row, in the same way an artificial joint is excluded from a joint package.", "rel": "risk" }, { "to": "getting-a-quote", "as": "The step where a staged operation has to be added up, because no page adds it up.", "rel": "step" }, { "to": "reading-the-exclusions", "as": "Where the words Other Places, and what they cost, would be found.", "rel": "step" } ], "confusable_with": [ { "id": "vaginoplasty", "tell": "Both are called bottom surgery and both are called genital reconstruction. One is a single admission with a dilation regime after it; the other is a sequence of admissions with an implant at the end." } ], "links": [ { "label": "Yanhee Hospital plastic surgery price table", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/" }, { "label": "Kamol Cosmetic Hospital — flap options and candidacy", "url": "https://kamolhospital.com/services/phalloplasty/" }, { "label": "Gender Confirmation Center — bottom surgery costs", "url": "https://www.genderconfirmation.com/bottom-surgery-cost/" } ], "sources": [ "s:yanhee-plastic-prices", "s:gcc-bottom-surgery-cost", "s:kamol-phalloplasty", "s:ltc-price-list" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:yanhee-plastic-prices", "note": "every row is read off the named page; the addition of the six stages and the paragraph about why the other lists stop are marked Inference" }, "text.how": { "tier": "cited", "source": "s:kamol-phalloplasty", "note": "flap description is standard; the candidacy list and the stay figures are read off the named pages" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:yanhee-plastic-prices" }, "metrics": { "tier": "cited", "source": "s:yanhee-plastic-prices" } } }, "x_commons_files": [ "File:Radial forearm free flap donor site.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "A penis is built from a flap of the patient's own skin, fat and nerve — most often the forearm, otherwise the thigh, groin or back — transferred to the pubis and connected to blood vessels and nerves there.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "gender-affirming-care-access", "type": "rule", "name": "Access to gender-affirming care", "as": "Whether the health system at home does this at all, and who it will do it for.", "rel": "governed-by" }, { "to": "vaginoplasty", "type": "procedure", "name": "Vaginoplasty", "as": "The other genital operation: one admission against this one's four.", "rel": "contrast" }, { "to": "top-surgery", "type": "procedure", "name": "Top surgery", "as": "Stage one on the same Thai list, at a quarter of the price and two nights.", "rel": "kin" }, { "to": "hysterectomy", "type": "procedure", "name": "Hysterectomy", "as": "Priced as an earlier stage on the same list, and a stated precondition on a Bangkok hospital's candidacy page.", "rel": "kin" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the one staged price list read for this record is published.", "rel": "destination" }, { "to": "bangkok", "type": "hub", "name": "Bangkok", "as": "The city holding that hospital and the surgeons whose flap techniques are on their pages without prices.", "rel": "hub" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "Where a practice publishes an estimate for this operation and declines to sell it for cash.", "rel": "destination" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Urethral fistula and stricture are the complications that arrive after the flight, and they need a surgeon.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Four stages across years, and the record of the first three sitting in another country.", "rel": "risk" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The prosthesis is excluded from the prosthesis row, in the same way an artificial joint is excluded from a joint package.", "rel": "risk" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step where a staged operation has to be added up, because no page adds it up.", "rel": "step" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "Where the words Other Places, and what they cost, would be found.", "rel": "step" } ], "source_list": [ { "id": "s:yanhee-plastic-prices", "kind": "web", "title": "Plastic Surgery Prices", "publisher": "Yanhee Hospital, Bangkok", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "accessed": "2026-09-16", "note": "hospital's own price table: procedure, nights, price in Thai baht. The page carries no validity date and no inclusion list." }, { "id": "s:gcc-bottom-surgery-cost", "kind": "web", "title": "A Comprehensive Guide to Bottom Surgery Costs", "publisher": "Gender Confirmation Center, San Francisco; page marked medically reviewed 15 October 2024", "url": "https://www.genderconfirmation.com/bottom-surgery-cost/", "accessed": "2026-09-16", "note": "a surgical practice's own published estimates, with its inclusion and exclusion list and its policy that phalloplasty is not offered to cash-paying patients" }, { "id": "s:kamol-phalloplasty", "kind": "web", "title": "Phalloplasty — flap options and candidacy requirements", "publisher": "Kamol Cosmetic Hospital, Bangkok", "url": "https://kamolhospital.com/services/phalloplasty/", "accessed": "2026-09-17", "note": "four flap techniques with the length each is said to produce, and a candidacy list: minimum age 20, at least one year of testosterone, one year living in the acquired gender, psychiatric clearance, and mastectomy and hysterectomy completed at least six months before. No price is published on the page." }, { "id": "s:ltc-price-list", "kind": "web", "title": "Price List — surgery, facial feminisation, MTF GCS/SRS, body masculinisation", "publisher": "The London Transgender Clinic, London", "url": "https://www.thelondontransgenderclinic.uk/price-list/", "accessed": "2026-09-17", "note": "read with the browser tools. Every surgical line is prefixed 'Starts from'. The page states that an exact price cannot be given before consultation, that a formal quotation covers treatment, aftercare and the hospital stay where required, and that guide prices are subject to change. It carries no date. There is no phalloplasty or metoidioplasty row on it." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:yanhee-plastic-prices", "note": "every row is read off the named page; the addition of the six stages and the paragraph about why the other lists stop are marked Inference" }, "text.how": { "tier": "cited", "source": "s:kamol-phalloplasty", "note": "flap description is standard; the candidacy list and the stay figures are read off the named pages" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:yanhee-plastic-prices" }, "metrics": { "tier": "cited", "source": "s:yanhee-plastic-prices" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "top-surgery", "type": "procedure", "name": "Top surgery", "as": "Stage one before it on the Thai list, and a precondition on a Bangkok hospital's candidacy page.", "rel": "kin" }, { "from": "vaginoplasty", "type": "procedure", "name": "Vaginoplasty", "as": "The other genital operation, staged where this one is single, and priced by the stage.", "rel": "contrast" }, { "from": "gender-affirming-care-access", "type": "rule", "name": "Access to gender-affirming care", "as": "The other genital operation this access rule gates, priced stage by stage where anyone prices it at all.", "rel": "procedure" } ] }, { "schema": 1, "id": "prostatectomy", "type": "procedure", "names": { "name": "Prostatectomy", "aliases": [ "radical prostatectomy", "robotic-assisted radical prostatectomy", "RARP", "TURP" ], "said": "Two operations wear one word. Radical prostatectomy takes the whole gland out for cancer; transurethral resection shaves the middle of it away for an enlarged prostate. Price pages list both, four or five times apart." }, "etymology": { "root": "prostate: Greek prostatēs, one who stands before — the gland stands before the bladder. Ektomē is a cutting out; transurethral is Latin trans, across, plus urethra, from Greek ourein, to urinate. Radical here is Latin radix, a root: the whole gland and its roots, not a description of the surgeon.", "tier": "tradition", "note": "Robotic-assisted means a console-driven instrument set, not an autonomous machine. On the package page read for this record it is a price tier of its own." }, "region": [ "global" ], "facets": { "family": "urological", "setting": "inpatient", "anaesthesia": "general" }, "text": { "what": "For cancer, the whole prostate and the seminal vesicles are removed and the bladder rejoined to the urethra — increasingly through a robotic console, with four nights on the Bangkok package read for this record. For benign enlargement, the obstructing tissue is shaved away from inside through the urethra, with three nights on the same hospital's list. Continence and erectile function are the outcomes that decide whether the operation was a good one, and no price page read here mentions either.", "story": "The gap between the two operations is the first thing the price list shows. Bumrungrad publishes robotic-assisted radical prostatectomy at 1,014,000 baht, package ROBOTIC05, and transurethral resection of the prostate at 216,000 baht under either general anaesthesia or a spinal block. Nearly five to one, for two operations on one organ.\n\nThe radical package buys five hours of theatre, four nights in a single room, biopsy of three specimens, and the surgeon, assistant, anaesthetist and pathologist. It excludes outpatient charges and anything before the operation, consultations with other specialists, blood transfusion, laboratory and imaging before and after, stays beyond four days or in intensive care, take-home medication — and, unusually, the daily ward round: \"Charges for admission physician fees, daily round physician fees and discharge summary fee\" sit on the exclusion list. The cheaper cholecystectomy package at the same hospital includes one day of ward rounds; the million-baht one does not.\n\nThe payer versions are a different shape again. Ireland's admitted-patient price for DRG M01B, major male pelvic interventions at minor complexity — the group a radical prostatectomy falls in — is EUR 19,899, and EUR 26,820 at major complexity; a transurethral prostatectomy, M02B, is EUR 8,363. Australia's schedule pays the surgeon $1,907.25 for item 37210, radical prostatectomy with nerve sparing where clinically indicated, and leaves the hospital to bill the rest.\n\n*Inference —* a foreign patient reading the Thai figure against the Irish one is reading a five-hour theatre slot with four nights against a whole Irish admission at a fifth of the price. Neither number says anything about how many of these operations the surgeon did last year, which is the figure the literature associates with continence and which nobody publishes on a price page.", "how": "Radical: general anaesthesia, six small ports, the gland freed from the bladder neck and the urethra, nerves spared where the cancer allows, the specimen removed through an enlarged port, the bladder sewn to the urethra, a catheter left in for a week or two. That catheter is the detail that decides travel — it comes out after the flight home, or it does not come out at all until a second appointment abroad.\n\nTURP: spinal or general anaesthesia, a resectoscope through the urethra, the obstructing tissue shaved and washed out, a catheter and irrigation for a day or two, three nights on the package read here.\n\nBoth are elective in the sense that they wait. NHS England reported a median wait of 12.0 weeks across all pathways at the end of July 2026 and 111,379 people waiting more than 52 weeks; Ireland counted 115,450 waiting for an inpatient or day-case appointment at the end of May 2026. Those are the queues this operation's foreign prices are read against.", "today": "As of 17 September 2026 the published Thai package price for robotic radical prostatectomy is 1,014,000 baht with four nights, against 216,000 baht for a transurethral resection with three. Ireland's admitted-patient price for the major pelvic group is EUR 19,899 at minor complexity, and the Australian schedule fee for the surgeon's service is $1,907.25.", "notes": "This page describes an operation and the prices published for it. It is not medical advice." }, "metrics": { "stay_days": 4, "days_before_flying": 10, "recovery_weeks": 6, "wait_days_home": 84, "note": "Four nights is the stay named in the Bumrungrad robotic radical prostatectomy package read for this record; the transurethral operation on the same hospital's list names three, and the Irish tariff's average length of stay for the major pelvic group is 2.8 days. The eighty-four days is the median wait of 12.0 weeks across all pathways waiting to start treatment in England at the end of July 2026, published by NHS England — an all-specialty median for the English market, not a urology figure. The ten-day figure is the CDC's guidance not to fly for ten days after abdominal surgery. Six weeks is the span usually quoted before heavy lifting; continence and potency take longer and are not published by any source read here.", "as_of": "2026-07-31", "source": "s:nhs-rtt-july-2026", "url": "https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Jul26-RTT-statistical-press-notice-PDF-578K-97ylx5.pdf" }, "prices": [ { "procedure": "prostatectomy", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 1014000, "currency": "THB", "as_of": "2026-09-17", "kind": "package", "includes": [ "operating room for 5 hours including theatre, nurse assisting surgeon and operating team", "single room for 4 nights including nursing service and regular menu meals", "medical supplies and equipment used during surgery under the physician's consideration, specific model", "anaesthesia and necessary medication during the procedure", "biopsy charges for 3 specimens", "doctor fees: surgeon, assistant surgeon, anaesthesiologist and pathologist" ], "excludes": [ "expenses at the outpatient unit or before the operation", "stays beyond four days, intensive care, or nights past the day discharge was approved", "consultations with other specialists", "complex cases requiring emergency surgery or equipment beyond the package", "admission physician fees, daily round physician fees and the discharge summary fee", "blood transfusion, laboratory tests and imaging before and after the operation", "take-home medication and supplies" ], "source": "s:bumrungrad-robotic05", "url": "https://www.bumrungrad.com/en/packages/robotic-assisted-radical-prostatectomy-ga-tiva", "note": "package ROBOTIC05, prices stated valid until 31 December 2026 and the service available for 365 days from purchase. The ward round is on the exclusion list of the hospital's million-baht package and on the inclusion list of its quarter-million-baht one.", "tier": "cited", "usd": 30456.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "prostatectomy", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 216000, "currency": "THB", "as_of": "2026-09-17", "kind": "package", "includes": [ "transurethral resection of the prostate for benign enlargement, under general anaesthesia or spinal block", "three nights in hospital, as stated on the package list" ], "excludes": [ "not itemised on the list page read for this record" ], "source": "s:bumrungrad-urology-packages", "url": "https://www.bumrungrad.com/en/packages/packages-center/urology-center", "note": "the same price under either anaesthetic. It is the other operation the word prostatectomy covers, and at a fifth of the robotic radical price it is the figure a reader is most likely to mistake for it. The same list carries Urolift at 330,000 THB and water vapour therapy at 261,300 THB for the same benign condition.", "tier": "cited", "usd": 6488.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "prostatectomy", "country": "IE", "amount": 19899, "currency": "EUR", "as_of": "2026-09-17", "kind": "tariff", "includes": [ "DRG M01B MAJOR MALE PELVIC INTERVTNS, MINC — the inlier inpatient episode, at minor complexity" ], "excludes": [ "stays beyond the high boundary, paid per diem on top", "travel and accommodation" ], "source": "s:hse-abf-2024-inpatient", "url": "https://assets.hse.ie/media/documents/ABF_2024_Admitted_Patient_Price_List_-_Inpatient_Only.pdf", "note": "the Irish public system's own price for the admission, and the ceiling on what it repays a patient treated abroad. Major complexity, M01A, is EUR 26,820; a transurethral prostatectomy, M02B, is EUR 8,363 — the same five-to-one ratio between the two operations as on the Thai package list, arrived at by a different method.", "tier": "cited", "usd": 22959.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "prostatectomy", "country": "AU", "amount": 1907.25, "currency": "AUD", "as_of": "2026-09-17", "kind": "tariff", "includes": [ "item 37210: radical prostatectomy involving total excision of the prostate, sparing of nerves around the prostate where clinically indicated, with or without bladder neck reconstruction" ], "excludes": [ "the hospital, the theatre, the ward, the anaesthetist and the robot", "services to which certain other items apply, named in the descriptor" ], "source": "s:mbs-37210", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=37210&qt=item", "note": "the Medicare Benefits Schedule fee, 75% benefit $1,430.45, the fee shown as applying from 1 July 2026. The descriptor is the only document on this page that mentions nerve sparing, which is the part of the operation patients ask about.", "tier": "cited", "usd": 1359.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "hysterectomy", "as": "The operation on the other side of the same waiting list, priced the same three ways.", "rel": "kin" }, { "to": "hernia-repair", "as": "The other pelvic operation a foreign hospital sells by the night.", "rel": "kin" }, { "to": "bumrungrad", "as": "Publishes both prostate packages this page reads, the ward round excluded from the larger one.", "rel": "performed-at" }, { "to": "thailand", "as": "Where the robot is a price tier and the ward round is an exclusion.", "rel": "destination" }, { "to": "australia", "as": "Where the schedule names nerve sparing and pays the surgeon alone.", "rel": "destination" }, { "to": "united-kingdom", "as": "The source market whose queue makes a foreign price legible.", "rel": "destination" }, { "to": "eu-directive-2011-24", "as": "The route under which an Irish patient is repaid at the Irish admitted-patient price.", "rel": "rule" }, { "to": "reading-the-exclusions", "as": "The step at which the daily ward round turns out to be billed separately.", "rel": "step" }, { "to": "follow-up-gap", "as": "Who removes the catheter, and who measures the PSA at three months.", "rel": "risk" }, { "to": "the-discharge-summary", "as": "The document this package charges for separately and a home urologist cannot work without.", "rel": "step" }, { "to": "flying-after-surgery", "as": "The clot risk that sets how long after pelvic surgery a patient can board.", "rel": "risk" }, { "to": "oecd-waiting-times", "as": "The series that counts the queue this operation waits in at home.", "rel": "measured-by" } ], "confusable_with": [ { "id": "hernia-repair", "tell": "Both are keyhole operations in the same region sold by the night; one removes a gland for cancer and the other closes a defect in the abdominal wall." } ], "links": [ { "label": "Bumrungrad — robotic-assisted radical prostatectomy package", "url": "https://www.bumrungrad.com/en/packages/robotic-assisted-radical-prostatectomy-ga-tiva" }, { "label": "MBS item 37210", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=37210&qt=item" } ], "sources": [ "s:bumrungrad-robotic05", "s:bumrungrad-urology-packages", "s:hse-abf-2024-inpatient", "s:mbs-37210", "s:nhs-rtt-july-2026", "s:ntpf-may-2026", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:bumrungrad-robotic05", "note": "package terms and both Thai prices read off the hospital's own pages on 17 September 2026; tariff figures read off the Irish price list and the Australian item page; the closing stretch is this project's reasoning and is marked" }, "text.how": { "tier": "tradition", "note": "standard operative description; the waiting figures are cited and labelled as all-specialty" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:nhs-rtt-july-2026" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Prostatectomy.jpg", "File:Da Vinci Surgical System.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "For cancer, the whole prostate and the seminal vesicles are removed and the bladder rejoined to the urethra — increasingly through a robotic console, with four nights on the Bangkok package read for this record.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "hysterectomy", "type": "procedure", "name": "Hysterectomy", "as": "The operation on the other side of the same waiting list, priced the same three ways.", "rel": "kin" }, { "to": "hernia-repair", "type": "procedure", "name": "Hernia repair", "as": "The other pelvic operation a foreign hospital sells by the night.", "rel": "kin" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Publishes both prostate packages this page reads, the ward round excluded from the larger one.", "rel": "performed-at" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the robot is a price tier and the ward round is an exclusion.", "rel": "destination" }, { "to": "australia", "type": "destination", "name": "Australia", "as": "Where the schedule names nerve sparing and pays the surgeon alone.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The source market whose queue makes a foreign price legible.", "rel": "destination" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route under which an Irish patient is repaid at the Irish admitted-patient price.", "rel": "rule" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step at which the daily ward round turns out to be billed separately.", "rel": "step" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who removes the catheter, and who measures the PSA at three months.", "rel": "risk" }, { "to": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "The document this package charges for separately and a home urologist cannot work without.", "rel": "step" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The clot risk that sets how long after pelvic surgery a patient can board.", "rel": "risk" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The series that counts the queue this operation waits in at home.", "rel": "measured-by" } ], "source_list": [ { "id": "s:bumrungrad-robotic05", "kind": "web", "title": "Robotic-assisted radical prostatectomy (GA-TIVA) — package ROBOTIC05", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/robotic-assisted-radical-prostatectomy-ga-tiva", "accessed": "2026-09-17", "note": "1,014,000 THB, valid until 31 December 2026; five hours of theatre, four nights in a single room, biopsy of three specimens; exclusions name daily round physician fees, stays beyond four days, ICU, laboratory and imaging before and after" }, { "id": "s:bumrungrad-urology-packages", "kind": "web", "title": "Urology Center — package list", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/packages-center/urology-center", "accessed": "2026-09-17", "note": "read with the browser on 17 September 2026: robotic-assisted radical prostatectomy 1,014,000 THB; transurethral resection of the prostate (TURP) 216,000 THB under either general anaesthesia or spinal block, three nights; Urolift 330,000; ReZum water vapour therapy 261,300; basic prostate check 7,500" }, { "id": "s:hse-abf-2024-inpatient", "kind": "gov", "title": "ABF 2024 Admitted Patient Price List — Inpatient Only", "publisher": "Health Service Executive (Ireland)", "url": "https://assets.hse.ie/media/documents/ABF_2024_Admitted_Patient_Price_List_-_Inpatient_Only.pdf", "accessed": "2026-09-17", "note": "the activity-based-funding inlier inpatient price per diagnosis-related group, linked from the HSE's Northern Ireland Planned Healthcare Scheme claim page and the list behind the CBD and NIPHS repayments. Rows read on 17 September 2026: F06C CRNRY BYPSS-INV INVES MINC EUR 30,040, F06B EUR 34,430, F06A EUR 50,579; F05B CRNRY BYPSS+INV INVES MINC EUR 45,093; F04C CRD VLV INTERVTN+PMP-INV INVES MINC EUR 40,253, F04B EUR 50,628, F04A EUR 80,201; F19B TRNS-VSCLR PERC CRDC INTERVTN MINC EUR 9,887, F19A EUR 42,060; F10B INTERVENTIONAL CRNRY PR + AMI MINC EUR 8,857; M01B MAJOR MALE PELVIC INTERVTNS MINC EUR 19,899, M01A EUR 26,820; M02B TRANSURTH PROSTMY MINC EUR 8,363; N04B HYSTERECTOMY FOR N-MAL MINC EUR 13,282; G10B HERNIA INTERVENTIONS MINC EUR 9,046, G10A MAJC EUR 15,366; H08B LAP CHOLECYSTECTOMY MINC EUR 9,867, H07C OPEN CHOLECYSTECTOMY MINC EUR 16,206. An inlier price assumes a length of stay between the low and high boundaries printed beside it." }, { "id": "s:mbs-37210", "kind": "gov", "title": "MBS item 37210 — radical prostatectomy", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=37210&qt=item", "accessed": "2026-09-17", "note": "schedule fee $1,907.25, 75% benefit $1,430.45, fee shown as applying from 01-Jul-2026; descriptor names total excision of the prostate with nerve sparing where clinically indicated" }, { "id": "s:nhs-rtt-july-2026", "kind": "gov", "title": "Statistical Press Notice — NHS referral to treatment (RTT) waiting times data, July 2026", "publisher": "NHS England", "url": "https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Jul26-RTT-statistical-press-notice-PDF-578K-97ylx5.pdf", "accessed": "2026-09-16", "note": "published Thursday 10 September 2026. 7.3 million RTT pathways waiting to start treatment at the end of July 2026, an estimated 6.2 million unique patients; 111,379 waiting over 52 weeks, 9,095 over 65 weeks, 235 over 104 weeks; 65.4% waiting up to 18 weeks against a 92% standard; median wait 12.0 weeks. Figures include estimates for three trusts and one independent provider that did not submit." }, { "id": "s:ntpf-may-2026", "kind": "gov", "title": "NTPF Publishes May 2026 National Public Hospital Waiting List Data", "publisher": "National Treatment Purchase Fund (Ireland)", "url": "https://www.ntpf.ie/news_and_events/ntpf-publishes-may-2026-national-public-hospital-waiting-list-data/", "accessed": "2026-09-16", "note": "at the end of May 2026: 669,506 waiting for a first outpatient consultation, 115,450 for an inpatient or day-case appointment, 40,986 for a GI endoscopy, 34,049 suspended, 111,643 on the planned-procedure list" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:bumrungrad-robotic05", "note": "package terms and both Thai prices read off the hospital's own pages on 17 September 2026; tariff figures read off the Irish price list and the Australian item page; the closing stretch is this project's reasoning and is marked" }, "text.how": { "tier": "tradition", "note": "standard operative description; the waiting figures are cited and labelled as all-specialty" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:nhs-rtt-july-2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "hernia-repair", "type": "procedure", "name": "Hernia repair", "as": "The other pelvic operation sold by the night and the route.", "rel": "kin" }, { "from": "hysterectomy", "type": "procedure", "name": "Hysterectomy", "as": "The operation on the other side of the same waiting list, priced the same three ways.", "rel": "kin" }, { "from": "severance", "type": "facility", "name": "Severance Hospital", "as": "Among the robotic work its unit volumes are reported for, the first programme in the world past twenty thousand operations.", "rel": "performs" } ] }, { "schema": 1, "id": "proton-therapy", "type": "procedure", "names": { "name": "Proton beam therapy", "aliases": [ "proton therapy", "PBT", "proton beam radiotherapy", "particle therapy" ], "said": "Oncologists say protons, or PBT. PTCOG, the field's own body, counts particle therapy, which lumps protons together with carbon ions; a country that has one carbon-ion room and no proton room still appears on that map." }, "etymology": { "root": "proton: Greek prōton, the neuter of prōtos, first — the first and lightest of the nuclear particles. Therapy: Greek therapeia, attendance on the sick.", "tier": "tradition", "note": "particle therapy is the wider term and includes carbon-ion treatment, which is a different beam in a different and much rarer machine. Counts published under one name rarely mean the other." }, "region": [ "global" ], "facets": { "family": "oncology", "setting": "outpatient-course", "anaesthesia": "none" }, "text": { "what": "Radiotherapy delivered with protons instead of X-rays. A proton slows as it travels through tissue and releases most of its energy at the point where it stops, so a beam aimed to stop inside a tumour deposits its dose there and little beyond it. Cancer Research UK puts it plainly: protons \"treat cancer by producing a sudden burst of energy when they stop\", destroying the tumour and causing \"little damage to the nearby healthy cells\". The treatment is given daily over weeks, with no hospital admission, and the machine that produces the beam costs more than most hospitals.", "story": "This operation travels because of where the machine is, not what it costs. PTCOG, the Particle Therapy Co-Operative Group, keeps the field's register; its public world map gave 128 particle therapy facilities in clinical operation worldwide when it was read for this record on 16 September 2026, and its list of individual facilities is behind a login. A 2026 review in Frontiers in Oncology, citing PTCOG, reports that \"by the end of 2024, there were over 120 operational proton therapy centers worldwide, primarily distributed across North America, Europe, and East Asia, with the total number of treated patients exceeding 450,000\". Its country table, whose own heading calls the figures approximate, gives 45 or more in the United States, 25 or more in Japan, 15 or more across the smaller European countries, 10 or more in China, eight in Germany, four each in the United Kingdom and France — and one each in Canada, Australia, India and the Middle East.\n\n*Inference —* that distribution is the whole of the subject here. A patient in a country with one centre, or none, is not choosing between a price at home and a price abroad. There is nothing at home to price.\n\nThe clearest case is a state doing the travelling. England's National Health Service began the Proton Overseas Programme in 2008 and sent patients to ProCure in Oklahoma City and to the University of Florida Proton Therapy Institute while it built its own centres. Its patient guide says the medical costs are paid centrally, that \"the NHS will fund economy travel costs for the patient and a carer\", and that \"the NHS will not fund the cost of meals or refreshments\". Between 2008 and September 2020 the programme treated 830 patients for central nervous system, base of skull, spinal and paraspinal tumours, and 495 for tumours elsewhere. In the second group the median age was 11 and 70.3% were under 16. The UK centres at the Christie in Manchester and University College London Hospital have since opened; NHS National Services Scotland still states, on a page published 10 December 2025, that \"travel abroad may still be a requirement for some patients, depending upon individual clinical assessments\".\n\n*Trade practice —* the field calls the point where the beam stops the Bragg peak, after the physicist who described the effect. The Cancer Research UK page describes the physics without using the phrase.", "how": "A course runs \"between 3 to 7 weeks\", every day from Monday to Friday, with each session taking 30 to 60 minutes in the treatment room. Nobody is admitted: patients live near the centre and attend. The NHS guide for adults travelling abroad says \"on average many patients are abroad for nine weeks\", and that \"most patients are able to fly home immediately after completing their treatment\", which is the opposite of the pattern on every surgical page in this directory. *Trade practice —* small children who cannot hold still are given a general anaesthetic for each daily session, which turns a fifteen-minute treatment into a morning. Indications published by Cancer Research UK are, for adults, \"cancers that develop at the base of the skull or near the spine\", and for children, teenagers and young adults, a longer list.", "today": "No price appears on the proton centre pages read for this record on 16 September 2026: the Proton Therapy Center in Prague, which sells internationally, publishes no price list in either language, and states only that treatment is covered by health insurance. Brokers circulate euro figures for the same centre; this directory does not carry a number it has not read on the provider's own page. PTCOG's own table of facilities under construction, updated June 2026, lists them across sixteen countries, the United States and China with the most — which is to say the map that sends people abroad is being redrawn, slowly, and mostly in the countries that already have centres.", "notes": "This page describes a treatment. It is not advice about whether to have one, or where." }, "metrics": { "stay_days": 0, "days_before_flying": 0, "recovery_weeks": null, "note": "Nobody is admitted for proton therapy: the ward stay is nil and the stay abroad is measured in weeks, nine on the NHS guide's average. The zero for flying is that guide's statement that most patients fly home immediately after finishing; it is a statement about this treatment only, and does not carry over to the surgery pages in this directory.", "as_of": "2026-09-16", "source": "s:nhs-pbt-adult-guide", "url": "https://www.england.nhs.uk/wp-content/uploads/2013/08/pbt_adult.pdf" }, "kin": [ { "to": "gamma-knife", "as": "The other machine people cross borders to reach, and the one that does its work in a single day.", "rel": "contrast" }, { "to": "car-t", "as": "The same shape of scarcity in a vial rather than a building: a treatment you travel to because only certain centres may give it.", "rel": "kin" }, { "to": "united-kingdom", "as": "Ran a state programme that flew its own patients abroad for eleven years before its centres opened.", "rel": "destination" }, { "to": "united-states", "as": "Holds more proton centres than any other country, and took the UK programme's patients.", "rel": "destination" }, { "to": "japan", "as": "The densest network of particle therapy centres per head, proton and carbon-ion both.", "rel": "destination" }, { "to": "uk-nhs-treatment-abroad", "as": "The route under which the NHS paid for treatment its own hospitals could not yet give.", "rel": "governed-by" }, { "to": "the-companion", "as": "The carer the NHS funded a seat for, on a nine-week absence.", "rel": "step" }, { "to": "insurance-exclusions", "as": "The line where a payer decides this beam is worth the difference, or is not.", "rel": "rule" }, { "to": "repatriation-cost", "as": "What a course of daily treatment abroad costs beyond the treatment.", "rel": "risk" } ], "confusable_with": [ { "id": "gamma-knife", "tell": "Both are called precise radiation. Proton therapy is a course of daily fractions over weeks in a building the size of a football pitch; gamma knife is one session in an afternoon." } ], "links": [ { "label": "PTCOG facilities world map", "url": "https://ptcog.online/facilities-world-map/" }, { "label": "NHS England — guide for adults receiving proton beam therapy abroad", "url": "https://www.england.nhs.uk/wp-content/uploads/2013/08/pbt_adult.pdf" } ], "sources": [ "s:ptcog-world-map", "s:ptcog-under-construction", "s:frontiers-proton-2026", "s:cruk-proton", "s:nhs-pbt-adult-guide", "s:nss-scotland-pbt", "s:pop-cns-outcomes", "s:pop-noncns-outcomes" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:frontiers-proton-2026", "note": "the centre counts are cited; the paragraph about what a one-centre country means for a patient is marked Inference inline, and the Bragg peak sentence is marked Trade practice" }, "text.how": { "tier": "cited", "source": "s:cruk-proton", "note": "course length and session length cited; the daily paediatric anaesthetic is marked Trade practice" }, "etymology": { "tier": "tradition" } } }, "x_commons_files": [ "File:Proton therapy gantry.jpg", "File:Bragg Peak.svg" ], "confidence": "high", "needs_verification": true, "updated": "2026-09-16", "blurb": "Radiotherapy delivered with protons instead of X-rays. A proton slows as it travels through tissue and releases most of its energy at the point where it stops, so a beam aimed to stop inside a tumour deposits its dose…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "gamma-knife", "type": "procedure", "name": "Gamma knife radiosurgery", "as": "The other machine people cross borders to reach, and the one that does its work in a single day.", "rel": "contrast" }, { "to": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "The same shape of scarcity in a vial rather than a building: a treatment you travel to because only certain centres may give it.", "rel": "kin" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Ran a state programme that flew its own patients abroad for eleven years before its centres opened.", "rel": "destination" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "Holds more proton centres than any other country, and took the UK programme's patients.", "rel": "destination" }, { "to": "japan", "type": "destination", "name": "Japan", "as": "The densest network of particle therapy centres per head, proton and carbon-ion both.", "rel": "destination" }, { "to": "uk-nhs-treatment-abroad", "type": "rule", "name": "NHS funding for treatment abroad", "as": "The route under which the NHS paid for treatment its own hospitals could not yet give.", "rel": "governed-by" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "The carer the NHS funded a seat for, on a nine-week absence.", "rel": "step" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "The line where a payer decides this beam is worth the difference, or is not.", "rel": "rule" }, { "to": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "What a course of daily treatment abroad costs beyond the treatment.", "rel": "risk" } ], "source_list": [ { "id": "s:ptcog-world-map", "kind": "org", "title": "Particle therapy facilities world map", "publisher": "Particle Therapy Co-Operative Group (PTCOG)", "url": "https://ptcog.online/facilities-world-map/", "accessed": "2026-09-16", "note": "carries the headline count of facilities in clinical operation worldwide; the facility list itself is behind a login. The visible page read 128 on the access date while the page's own schema.org metadata, dated 26 May 2025, still carried 133. PTCOG counts particle therapy, which is proton plus carbon-ion." }, { "id": "s:ptcog-under-construction", "kind": "org", "title": "Particle therapy facilities under construction (update June 2026)", "publisher": "Particle Therapy Co-Operative Group (PTCOG)", "url": "https://ptcog.online/facilities-under-construction/", "accessed": "2026-09-16", "note": "a public table of facilities under construction, listed by country" }, { "id": "s:frontiers-proton-2026", "kind": "paper", "title": "Advances in proton therapy technology and global clinical applications", "publisher": "Frontiers in Oncology, 11 February 2026, doi:10.3389/fonc.2026.1718677", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12932165/", "accessed": "2026-09-16", "note": "carries a country-by-country table of operational and planned centres as of the end of 2024, drawn from PTCOG; the table's own header calls the figures approximate" }, { "id": "s:cruk-proton", "kind": "org", "title": "Proton beam therapy", "publisher": "Cancer Research UK", "url": "https://www.cancerresearchuk.org/about-cancer/treatment/radiotherapy/external/types/proton-beam-therapy", "accessed": "2026-09-16", "note": "course length, daily schedule and indications; the page's reference list names NHS England, accessed November 2023" }, { "id": "s:nhs-pbt-adult-guide", "kind": "gov", "title": "A guide for adult patients receiving Proton Beam Therapy abroad", "publisher": "NHS England", "url": "https://www.england.nhs.uk/wp-content/uploads/2013/08/pbt_adult.pdf", "accessed": "2026-09-16", "note": "the NHS Proton Overseas Programme's own patient guide, published 2013; its statement that the treatment was not then available in the UK has since been overtaken by the Christie and UCLH centres" }, { "id": "s:nss-scotland-pbt", "kind": "gov", "title": "Paediatric Radiotherapy / proton beam", "publisher": "NHS National Services Scotland", "url": "https://www.nss.nhs.scot/specialist-healthcare/specialist-services/proton-beam-therapy/", "accessed": "2026-09-16", "note": "published 10 December 2025; states that travel abroad may still be required for some patients" }, { "id": "s:pop-cns-outcomes", "kind": "paper", "title": "Outcomes of Patients Treated in the UK Proton Overseas Programme: Central Nervous System Group", "publisher": "Clinical Oncology 35 (2023), doi:10.1016/j.clon.2023.01.024, PMID 36804292", "url": "https://doi.org/10.1016/j.clon.2023.01.024", "accessed": "2026-09-16", "note": "830 patients treated abroad between 2008 and September 2020 in the CNS, base of skull, spinal and paraspinal group" }, { "id": "s:pop-noncns-outcomes", "kind": "paper", "title": "Outcomes of Patients Treated in the UK Proton Overseas Programme: Non-central Nervous System Group", "publisher": "Clinical Oncology 35 (2023), doi:10.1016/j.clon.2023.02.009, PMID 36813694", "url": "https://doi.org/10.1016/j.clon.2023.02.009", "accessed": "2026-09-16", "note": "495 patients, median age 11, 70.3% under 16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:frontiers-proton-2026", "note": "the centre counts are cited; the paragraph about what a one-centre country means for a patient is marked Inference inline, and the Bragg peak sentence is marked Trade practice" }, "text.how": { "tier": "cited", "source": "s:cruk-proton", "note": "course length and session length cited; the daily paediatric anaesthetic is marked Trade practice" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "china", "type": "destination", "name": "China", "as": "The expensive radiotherapy the zone was built to make reachable without a visa.", "rel": "procedure" }, { "from": "germany", "type": "destination", "name": "Germany", "as": "The treatment foreign patients most often fly here to buy.", "rel": "procedure" }, { "from": "japan", "type": "destination", "name": "Japan", "as": "The treatment Japan is most often named for by patients arriving from elsewhere in Asia.", "rel": "procedure" }, { "from": "singapore", "type": "destination", "name": "Singapore", "as": "One of the expensive treatments patients fly here for rather than for a lower price.", "rel": "procedure" }, { "from": "united-states", "type": "destination", "name": "United States", "as": "One of the treatments patients fly into this country for.", "rel": "procedure" }, { "from": "chennai", "type": "hub", "name": "Chennai", "as": "Apollo runs a proton centre in this city; this directory has not yet read its page for the claim.", "rel": "procedure" }, { "from": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "The same scarcity told in concrete rather than in licences.", "rel": "kin" }, { "from": "gamma-knife", "type": "procedure", "name": "Gamma knife radiosurgery", "as": "The other machine people cross a border to reach, and the one that takes weeks rather than an afternoon.", "rel": "contrast" }, { "from": "apollo-chennai", "type": "facility", "name": "Apollo Hospitals, Greams Road, Chennai", "as": "The group runs a proton centre at Tharamani in the same city, which draws a different patient again.", "rel": "procedure" }, { "from": "heidelberg-university-hospital", "type": "facility", "name": "Heidelberg University Hospital", "as": "Its heavy ion facility is what its name travels on, and the 600-tonne gantry is the reason.", "rel": "performs" }, { "from": "samsung-medical-center", "type": "facility", "name": "Samsung Medical Center", "as": "Among the oncology programmes its foreign referrals come for.", "rel": "performs" }, { "from": "uk-nhs-treatment-abroad", "type": "rule", "name": "NHS funding for treatment abroad", "as": "The treatment the NHS bought abroad and commissioned by name before it could deliver it at home.", "rel": "procedure" } ] }, { "schema": 1, "id": "rhinoplasty", "type": "procedure", "names": { "name": "Rhinoplasty", "aliases": [ "nose job", "nasal reshaping", "septorhinoplasty", "open rhinoplasty", "closed rhinoplasty" ], "said": "Surgeons say open or closed, and mean whether a small cut crosses the strip of skin between the nostrils. Price pages say nose job. Septorhinoplasty means the breathing partition inside the nose was straightened in the same operation, which is a different bill and sometimes a different payer." }, "etymology": { "root": "rhinoplasty: Greek rhis, rhinos, a nose, plus plastos, moulded. The word carries no promise about which nose the moulding aims at; that argument is conducted in consultations and in national aesthetics, not in the Greek.", "tier": "tradition", "note": "augmentation rhinoplasty builds a bridge up, usually with an implant or the patient's own rib or ear cartilage; reduction rhinoplasty takes bone and cartilage away. Bangkok price tables sell the first by implant brand, European ones sell the second by operating time." }, "region": [ "global" ], "facets": { "family": "cosmetic", "setting": "day-case", "anaesthesia": "general" }, "text": { "what": "Bone and cartilage of the nose are cut, filed, repositioned or added to, through the nostrils or through a small bridging incision at the base of the nose. An implant or a graft of the patient's own cartilage builds a bridge; a rasp and osteotomes take one down. Swelling hides the result for months, and the operation has one of the higher revision rates in cosmetic surgery.", "story": "Rhinoplasty travels for two different reasons that end up on the same price page. One is money: the operation is elective everywhere, excluded by insurers everywhere, and priced four or five times higher in the United States than in Bangkok or Prague. The other is taste. Surgeons in Seoul, Istanbul and Bangkok built reputations for particular noses, and patients cross borders for a house style as much as for a discount.\n\nThe price tables show the split plainly. Yanhee Hospital in Bangkok lists augmentation rhinoplasty by implant origin - standard, USA, Korea - at 30,000, 40,000 and 50,000 baht, and a rib-graft reconstruction at 220,000 with a night on the ward. Premier Clinic in Prague lists one line, open rhinoplasty from 51,300 koruna. The American Society of Plastic Surgeons publishes an average surgeon fee of 7,637 US dollars and states in the same breath that it excludes anaesthesia and the operating room.\n\n*Trade practice --* revision is the number that decides whether a cheap nose was cheap. A second operation is harder than the first, most surgeons will not revise another surgeon's work for a year, and a revision booked at home after a rhinoplasty bought abroad is priced as a new private operation.", "how": "General anaesthesia is usual, and most published packages send the patient out the same day or after one night. Splints and internal dressings come off at five to seven days, which sets the earliest sensible flight home. Bruising around the eyes fades over two to three weeks; the fine shape of the tip settles over a year or more, which is why before-and-after photographs taken at six weeks show a nose that is still swollen. Where the operation also straightens the septum, some health systems pay for that half and not the other, and the surgeon's letter has to separate them.", "today": "Four published prices sit on this record, from Thailand, Czechia, Poland and the United States, each read off the seller's own page in September 2026. They are not comparable until the reader adds what each leaves out: the American figure is a surgeon's fee alone, the Polish one is indicative and excludes an 800 zloty ward day, the Thai one is sorted by implant brand, and the Czech one begins with the word from.", "notes": "This page describes an operation. It does not advise anyone to have one, or to have one anywhere." }, "metrics": { "stay_days": 0, "note": "Day-case is the usual published setting: Yanhee's table shows no night for implant augmentation and two nights for nose reshaping and ultrasonic rhinoplasty, so the figure here is the lower of the hospital's own published stays and not a clinical standard. No revision rate is carried on this record because no source read for it published one that counts a defined population.", "as_of": "2026-09-16", "source": "s:yanhee-plastic-prices", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/" }, "prices": [ { "procedure": "rhinoplasty", "country": "TH", "city": "Bangkok", "amount": 30000, "currency": "THB", "as_of": "2026-09-16", "kind": "list", "includes": [ "augmentation rhinoplasty with a standard nose implant" ], "excludes": [ "stated nights on the ward: the table shows none for this line" ], "source": "s:yanhee-plastic-prices", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "note": "the same table prices a USA implant at 40,000 THB, a Korean implant at 50,000 THB, an open-technique rhinoplasty at 105,000 THB and a rib-graft reconstruction at 220,000 THB with one night. The page carries no validity date and no inclusion list.", "tier": "cited", "usd": 901.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "rhinoplasty", "country": "CZ", "city": "Prague", "amount": 51300, "currency": "CZK", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [ "full nose surgery, open rhinoplasty" ], "excludes": [ "not stated on the page" ], "source": "s:premier-clinic-prague-prices", "url": "https://www.premier-clinic.cz/en/price-list-plastic-surgery/", "note": "listed as 'from'; full nose surgery including alar reduction is listed from 61,500 CZK", "tier": "cited", "usd": 2436.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "rhinoplasty", "country": "PL", "city": "Szczecin", "amount": 23000, "currency": "PLN", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [ "full osteocartilaginous nose correction" ], "excludes": [ "hospitalisation, listed separately at 800 PLN a day" ], "source": "s:artplastica-cennik", "url": "https://www.artplastica.pl/cennik-zabiegi-operacje-plastyczne/", "note": "the clinic states the listed prices are indicative and may change at the individual medical consultation", "tier": "cited", "usd": 6112.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "rhinoplasty", "country": "US", "amount": 7637, "currency": "USD", "as_of": "2026-09-16", "kind": "survey", "includes": [ "surgeon fee only" ], "excludes": [ "anesthesia", "operating room facilities", "other related expenses" ], "source": "s:asps-cost-rhinoplasty", "url": "https://www.plasticsurgery.org/cosmetic-procedures/rhinoplasty/cost", "note": "the society's published average, described only as 'the latest statistics' with no year named on the page, which is why this row carries the date it was read", "tier": "cited", "usd": 7637.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "facelift", "as": "The other face operation sold by the same clinics, at roughly twice the price.", "rel": "contrast" }, { "to": "south-korea", "as": "A destination whose surgeons are sought for a house style rather than a discount.", "rel": "destination" }, { "to": "turkiye", "as": "Where nose surgery sits in the same package economy that built the hair clinics.", "rel": "destination" }, { "to": "thailand", "as": "Where the price is published by implant brand.", "rel": "destination" }, { "to": "czechia", "as": "The European price list this record reads, in koruna.", "rel": "destination" }, { "to": "revision", "as": "The second operation this one needs more often than any other face procedure, and which the first price never covers.", "rel": "term" }, { "to": "revision-at-home", "as": "Who fixes it, and at what price, once the patient has flown back.", "rel": "risk" }, { "to": "flying-after-surgery", "as": "The splint comes off before the flight, and the clot risk of the flight itself is argued separately.", "rel": "risk" }, { "to": "package-price", "as": "The pricing form that hides whether the implant, the ward night and the anaesthetist are in the number.", "rel": "term" }, { "to": "the-price-that-isnt", "as": "Why four published prices for one operation are not four comparable numbers.", "rel": "story" } ], "confusable_with": [ { "id": "facelift", "tell": "Both are sold as face surgery; a rhinoplasty changes bone and cartilage under the skin, a facelift moves the skin and the layer beneath it." } ], "links": [ { "label": "Yanhee Hospital plastic surgery price table", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/" }, { "label": "ASPS average surgeon fee", "url": "https://www.plasticsurgery.org/cosmetic-procedures/rhinoplasty/cost" } ], "sources": [ "s:yanhee-plastic-prices", "s:premier-clinic-prague-prices", "s:artplastica-cennik", "s:asps-cost-rhinoplasty" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "the price paragraphs are read off the four pages in sources; the revision paragraph is marked as trade practice inline" }, "text.how": { "tier": "tradition", "note": "standard operative and recovery description; the day-case setting is cited to the Yanhee table" }, "etymology": { "tier": "tradition" } } }, "x_commons_files": [ "File:Rhinoplasty.jpg", "File:Nose surgery diagram.png" ], "confidence": "high", "updated": "2026-09-16", "blurb": "Bone and cartilage of the nose are cut, filed, repositioned or added to, through the nostrils or through a small bridging incision at the base of the nose.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "facelift", "type": "procedure", "name": "Facelift", "as": "The other face operation sold by the same clinics, at roughly twice the price.", "rel": "contrast" }, { "to": "south-korea", "type": "destination", "name": "South Korea", "as": "A destination whose surgeons are sought for a house style rather than a discount.", "rel": "destination" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "Where nose surgery sits in the same package economy that built the hair clinics.", "rel": "destination" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the price is published by implant brand.", "rel": "destination" }, { "to": "czechia", "type": "destination", "name": "Czechia", "as": "The European price list this record reads, in koruna.", "rel": "destination" }, { "to": "revision", "type": "term", "name": "Revision", "as": "The second operation this one needs more often than any other face procedure, and which the first price never covers.", "rel": "term" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who fixes it, and at what price, once the patient has flown back.", "rel": "risk" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The splint comes off before the flight, and the clot risk of the flight itself is argued separately.", "rel": "risk" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The pricing form that hides whether the implant, the ward night and the anaesthetist are in the number.", "rel": "term" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "Why four published prices for one operation are not four comparable numbers.", "rel": "story" } ], "source_list": [ { "id": "s:yanhee-plastic-prices", "kind": "web", "title": "Plastic Surgery Prices", "publisher": "Yanhee Hospital, Bangkok", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "accessed": "2026-09-16", "note": "hospital's own price table: procedure, nights, price in Thai baht. The page carries no validity date and no inclusion list." }, { "id": "s:premier-clinic-prague-prices", "kind": "web", "title": "Price List - Plastic Surgery", "publisher": "Premier Clinic, Prague", "url": "https://www.premier-clinic.cz/en/price-list-plastic-surgery/", "accessed": "2026-09-16", "note": "clinic's own English price list, every line prefixed 'from', in Czech koruna" }, { "id": "s:artplastica-cennik", "kind": "web", "title": "Cennik zabiegow i operacji plastycznych", "publisher": "Beauty Group - Artplastica, Szczecin", "url": "https://www.artplastica.pl/cennik-zabiegi-operacje-plastyczne/", "accessed": "2026-09-16", "note": "clinic's own price list in zloty; the page states the prices are indicative and may change at consultation, and lists hospitalisation at 800 PLN a day separately" }, { "id": "s:asps-cost-rhinoplasty", "kind": "org", "title": "Rhinoplasty Cost", "publisher": "American Society of Plastic Surgeons", "url": "https://www.plasticsurgery.org/cosmetic-procedures/rhinoplasty/cost", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "the price paragraphs are read off the four pages in sources; the revision paragraph is marked as trade practice inline" }, "text.how": { "tier": "tradition", "note": "standard operative and recovery description; the day-case setting is cited to the Yanhee table" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "argentina", "type": "destination", "name": "Argentina", "as": "One of the operations Buenos Aires is known for.", "rel": "procedure" }, { "from": "iran", "type": "destination", "name": "Iran", "as": "The operation this country performs at the volume it is known for.", "rel": "procedure" }, { "from": "south-korea", "type": "destination", "name": "South Korea", "as": "The operation the country's reputation abroad is built on.", "rel": "procedure" }, { "from": "tunisia", "type": "destination", "name": "Tunisia", "as": "One of the operations the European end of this trade is built on.", "rel": "procedure" }, { "from": "johannesburg", "type": "hub", "name": "Johannesburg", "as": "The cosmetic line that has long been sold here with a holiday attached.", "rel": "procedure" }, { "from": "phuket", "type": "hub", "name": "Phuket", "as": "One of the short operations the island's private hospitals quote to people who fly in.", "rel": "procedure" }, { "from": "seoul", "type": "hub", "name": "Seoul", "as": "The operation the Apgujeong blocks are built on.", "rel": "procedure" }, { "from": "tunis", "type": "hub", "name": "Tunis", "as": "The advertised core of the francophone cosmetic trade here.", "rel": "procedure" }, { "from": "facelift", "type": "procedure", "name": "Facelift", "as": "The other face operation on the same price lists, at roughly half the price.", "rel": "contrast" }, { "from": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "A nasal procedure, and the one the plastic surgeons' 7-to-10-day figure was written for.", "rel": "procedure" }, { "from": "revision", "type": "term", "name": "Revision", "as": "The face operation revised more often than any other, and the first price never covers it.", "rel": "procedure" } ] }, { "schema": 1, "id": "root-canal", "type": "procedure", "names": { "name": "Root canal treatment", "aliases": [ "endodontic treatment", "root filling", "RCT" ], "said": "Dentists say endodontics. Price lists say root canal and then say which tooth, because a molar has three or four canals and a front tooth has one." }, "etymology": { "root": "endodontic: Greek endon, within, plus odous, odontos, a tooth — the work inside the tooth. Canal is Latin canalis, a channel: the space the nerve and blood vessels ran in before they died.", "tier": "tradition", "note": "The tooth's name on the price list is the price: anterior, premolar, molar, in ascending order of canals and of money." }, "region": [ "global" ], "facets": { "family": "dental", "setting": "day-case", "anaesthesia": "local" }, "text": { "what": "The dead or infected pulp is removed, the canals inside the root are cleaned, shaped and filled, and the tooth is sealed. The NHS describes it as treatment for infection at the centre of a tooth. One or two appointments under local anaesthetic, and the tooth usually needs a crown afterwards, which is a second bill.", "story": "This is the cheapest procedure in the dental batch and the one whose price lists diverge the most, because three of the four sort by tooth and one sorts by the clock.\n\nBangkok International Dental Center prices by which tooth it is: anterior 11,000 baht, premolar 14,000, molar 17,000. Sani Dental Group in Los Algodones flattens it — root canal, any tooth, $340, with retreatment at $370 — and prints a US comparison of $1,100 beside it that carries no source. Index Medica in Kraków prices only the front tooth on the page read for this record, at £120, against what the clinic calls an average UK price of £700.\n\nMedicare Dental Clinic in Budapest prices it by time: €123 for thirty minutes, €175 for forty-five, €243 for an hour, and then a second scale for a specialist — €476 to finish a front tooth in one session, €715 for a molar. *Inference —* a page that sells minutes and a page that sells teeth cannot be compared line to line, and the specialist rows are the only figures on any of the four that price the difficulty of the case rather than its position in the mouth.\n\nAgainst all of them sits the English NHS band 2 charge, £76.60, which covers root canal treatment along with fillings, extractions and gum treatment in the same course. The patient's share, not the cost.", "how": "Isolate the tooth, open it, find the canals, clean and shape them, fill them, seal the top. Where it fails or an old filling has to come out, the same clinics list retreatment at a higher price — $370 against $340 in Los Algodones.\n\nWhat these pages do not price is the crown the treated tooth usually needs, which is on the same lists at 13,000 to 25,000 baht, €336 to €394, $120 to $600 and £355 to £429. A quoted root canal is half a plan.", "today": "As of 17 September 2026 root canal treatment is published at 11,000 to 17,000 baht in Bangkok by tooth, €123 to €715 in Budapest by time and by seniority, $340 flat in Los Algodones and £120 for a front tooth in Kraków, against an English NHS band 2 patient charge of £76.60 for the whole course.", "notes": "This page describes a dental procedure and the prices published for it. It is not dental advice." }, "metrics": { "stay_days": 0, "days_before_flying": null, "recovery_weeks": null, "note": "A clinic appointment. None of the four price pages read for this record states how many visits the price assumes, which for a patient on a return ticket is the operative number; the Budapest list is the only one that names a single-session option and charges a specialist's fee for it.", "as_of": "2026-09-17", "source": "s:nhs-root-canal", "url": "https://www.nhs.uk/conditions/root-canal-treatment/" }, "prices": [ { "procedure": "root-canal", "country": "TH", "city": "Bangkok", "amount": 11000, "amount_high": 17000, "currency": "THB", "as_of": "2026-09-17", "kind": "list", "includes": [ "root canal treatment by tooth: anterior 11,000, premolar 14,000, molar 17,000" ], "excludes": [ "the crown the tooth usually needs afterwards", "x-rays, medications, sterilisation, nursing fees and clinic service fees, charged separately", "sterilisation at 150 to 250 baht per visit" ], "source": "s:bidc-fees", "url": "https://bangkokdentalcenter.com/fees/", "note": "the page states package rates are applicable till 30 September 2026 and that prices are not inclusive of x-rays, medications, sterilization, nursing fees and clinic service fees.", "tier": "cited", "usd": 330.0, "usd_high": 511.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "root-canal", "country": "HU", "city": "Budapest", "amount": 123, "amount_high": 715, "currency": "EUR", "as_of": "2026-09-17", "kind": "list", "includes": [ "chair time: €123 for 30 minutes, €175 for 45, €243 for 60", "or a specialist finishing in one session: €476 front tooth, €715 molar" ], "excludes": [ "the crown", "the post and core where the tooth needs one" ], "source": "s:mdental-budapest-prices", "url": "https://www.mdentalclinic.eu/prices", "note": "the only page of the four read for this record that prices endodontics by time rather than by tooth, and the only one with a separate specialist scale. A molar finished in one sitting by a specialist is nearly six times the half-hour rate.", "tier": "cited", "usd": 142.0, "usd_high": 825.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "root-canal", "country": "MX", "city": "Los Algodones", "amount": 340, "currency": "USD", "as_of": "2026-09-17", "kind": "list", "includes": [ "root canal, any tooth" ], "excludes": [ "the crown", "retreatment, listed separately at $370" ], "source": "s:sani-dental-prices", "url": "https://sanidentalgroup.com/price-list", "note": "listed at $340 with MXN $6,800 beside it and a US comparison column of $1,100 that carries no source. One price for a front tooth and a molar alike, which no other list read for this record does. The page states all prices are a base or starting price.", "tier": "cited", "usd": 340.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "root-canal", "country": "PL", "city": "Kraków", "amount": 120, "currency": "GBP", "as_of": "2026-09-17", "kind": "list", "includes": [ "root canal treatment for a front tooth", "examination, x-rays and local anaesthetic, which the page lists as free" ], "excludes": [ "premolars and molars, not priced on the page read for this record", "the crown" ], "source": "s:indexmedica-prices", "url": "https://www.indexmedica.com/prices/", "note": "£120 against a column the clinic labels average UK price at £700; the euro table gives €129 against an Irish comparison of €550. The comparison columns are the clinic's own.", "tier": "cited", "usd": 162.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "root-canal", "country": "GB", "amount": 76.6, "currency": "GBP", "as_of": "2026-09-17", "kind": "tariff", "includes": [ "band 2: root canal treatment to treat an infection or inflammation, plus fillings, extractions and extensive gum treatment in the same course" ], "excludes": [ "a crown, which moves the course into band 3 at £332.10", "private treatment" ], "source": "s:nhs-dental-charges", "url": "https://www.nhs.uk/nhs-services/dentists/dental-costs/understanding-nhs-dental-charges/", "note": "the patient's charge in England for a course of treatment, not the cost of the work; one charge however many teeth the course covers. The page states it was last reviewed on 13 March 2025 and does not give the date the amounts took effect.", "tier": "cited", "usd": 103.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "dental-crown", "as": "What the treated tooth usually needs next, on the same list and at several times the price.", "rel": "kin" }, { "to": "dental-implant", "as": "The alternative when the tooth cannot be saved, at ten to twenty times the cost.", "rel": "contrast" }, { "to": "full-mouth-restoration", "as": "The larger job that counts root canals among its lines.", "rel": "whole" }, { "to": "thailand", "as": "Where the price is set by which tooth it is.", "rel": "destination" }, { "to": "hungary", "as": "Where endodontics is sold by the half hour.", "rel": "destination" }, { "to": "mexico", "as": "Where one price covers any tooth in the mouth.", "rel": "destination" }, { "to": "poland", "as": "Where the front tooth is priced and the molar is not.", "rel": "destination" }, { "to": "united-kingdom", "as": "The source market whose band 2 charge of £76.60 sits under all of these.", "rel": "destination" }, { "to": "getting-a-quote", "as": "The step at which by-the-tooth and by-the-hour turn out not to compare.", "rel": "step" }, { "to": "revision-at-home", "as": "Who retreats a root filling that fails after the flight home.", "rel": "risk" } ], "confusable_with": [ { "id": "dental-crown", "tell": "The root canal empties and fills the inside of the tooth; the crown covers the outside. Most teeth that get the first need the second, and they are priced apart." } ], "links": [ { "label": "NHS — root canal treatment", "url": "https://www.nhs.uk/conditions/root-canal-treatment/" }, { "label": "Index Medica price list", "url": "https://www.indexmedica.com/prices/" } ], "sources": [ "s:nhs-root-canal", "s:nhs-dental-charges", "s:bidc-fees", "s:mdental-budapest-prices", "s:sani-dental-prices", "s:indexmedica-prices" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.what": { "tier": "cited", "source": "s:nhs-root-canal" }, "text.story": { "tier": "cited", "source": "s:mdental-budapest-prices", "note": "figures read off each clinic's own page on the accessed date; the comparison stretch is marked as this project's reasoning" }, "text.how": { "tier": "tradition", "note": "standard endodontic sequence; the prices named are cited to the four lists" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:nhs-root-canal" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Root canal treatment.jpg", "File:Endodontic therapy diagram.png" ], "confidence": "high", "updated": "2026-09-17", "blurb": "The dead or infected pulp is removed, the canals inside the root are cleaned, shaped and filled, and the tooth is sealed. The NHS describes it as treatment for infection at the centre of a tooth.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "What the treated tooth usually needs next, on the same list and at several times the price.", "rel": "kin" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The alternative when the tooth cannot be saved, at ten to twenty times the cost.", "rel": "contrast" }, { "to": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "The larger job that counts root canals among its lines.", "rel": "whole" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the price is set by which tooth it is.", "rel": "destination" }, { "to": "hungary", "type": "destination", "name": "Hungary", "as": "Where endodontics is sold by the half hour.", "rel": "destination" }, { "to": "mexico", "type": "destination", "name": "Mexico", "as": "Where one price covers any tooth in the mouth.", "rel": "destination" }, { "to": "poland", "type": "destination", "name": "Poland", "as": "Where the front tooth is priced and the molar is not.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The source market whose band 2 charge of £76.60 sits under all of these.", "rel": "destination" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step at which by-the-tooth and by-the-hour turn out not to compare.", "rel": "step" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who retreats a root filling that fails after the flight home.", "rel": "risk" } ], "source_list": [ { "id": "s:nhs-root-canal", "kind": "gov", "title": "Root canal treatment", "publisher": "NHS (England)", "url": "https://www.nhs.uk/conditions/root-canal-treatment/", "accessed": "2026-09-16" }, { "id": "s:nhs-dental-charges", "kind": "gov", "title": "Understanding NHS dental charges — bands 1, 2 and 3", "publisher": "NHS (England)", "url": "https://www.nhs.uk/nhs-services/dentists/dental-costs/understanding-nhs-dental-charges/", "accessed": "2026-09-16", "note": "band amounts read on the accessed date; the page does not state the date the amounts took effect" }, { "id": "s:bidc-fees", "kind": "web", "title": "Dental Fees — standardised treatment fees", "publisher": "Bangkok International Dental Center", "url": "https://bangkokdentalcenter.com/fees/", "accessed": "2026-09-16", "note": "implant fixture and implant crown priced in separate columns; page states package rates applicable till 30 September 2026" }, { "id": "s:mdental-budapest-prices", "kind": "web", "title": "Treatment Prices", "publisher": "Medicare Dental Clinic, Budapest", "url": "https://www.mdentalclinic.eu/prices", "accessed": "2026-09-16", "note": "treatment price and lab fee shown as separate lines; packages name accommodation and transfers" }, { "id": "s:sani-dental-prices", "kind": "web", "title": "Dental Price List in Mexico", "publisher": "Sani Dental Group, Los Algodones", "url": "https://sanidentalgroup.com/price-list", "accessed": "2026-09-16", "note": "prices in US dollars with a Mexican peso figure beside each; the page states every price is a base or starting price" }, { "id": "s:indexmedica-prices", "kind": "web", "title": "Prices — dental treatment in Kraków", "publisher": "Index Medica, Kraków", "url": "https://www.indexmedica.com/prices/", "accessed": "2026-09-16", "note": "two tables, one in sterling against a column the clinic labels average UK price, one in euro against average Irish price. Read 16 September 2026: complete implant including screw, healing ring, individual abutment and full-ceramic zirconia crown GBP 1,450 or EUR 1,552; implant screw alone GBP 575; full-ceramic zirconia crown GBP 429 or EUR 469; root canal on a front tooth GBP 120. Examination, x-rays and local anaesthetic are listed free. A deposit of 80% of each stage is due on signing the treatment plan; American Express and Diners Club are not accepted." } ], "tiers": { "text.what": { "tier": "cited", "source": "s:nhs-root-canal" }, "text.story": { "tier": "cited", "source": "s:mdental-budapest-prices", "note": "figures read off each clinic's own page on the accessed date; the comparison stretch is marked as this project's reasoning" }, "text.how": { "tier": "tradition", "note": "standard endodontic sequence; the prices named are cited to the four lists" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:nhs-root-canal" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "sopron", "type": "hub", "name": "Sopron", "as": "Day-case work that fits between a morning drive and an evening one.", "rel": "procedure" }, { "from": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "What usually comes first, on the same bill and the same trip.", "rel": "kin" } ] }, { "schema": 1, "id": "shoulder-replacement", "type": "procedure", "names": { "name": "Total shoulder replacement", "aliases": [ "total shoulder arthroplasty", "TSA", "reverse total shoulder replacement", "rTSA", "shoulder arthroplasty" ], "said": "Surgeons say anatomic or reverse, and the difference is which side of the joint gets the ball. Price pages usually say shoulder replacement and say neither." }, "etymology": { "root": "arthroplasty: Greek arthron, a joint, plus plastos, moulded. Glenoid, the socket, is Greek glene, the pupil of the eye or a socket, plus eidos, form — an eye-shaped hollow.", "tier": "tradition", "note": "Reverse means the ball is fixed to the socket side and the cup to the arm, which lets the deltoid drive a shoulder whose rotator cuff has gone. Australia's schedule covers anatomic and reverse under one item number." }, "region": [ "global" ], "facets": { "family": "orthopaedic", "setting": "inpatient", "anaesthesia": "general" }, "text": { "what": "The arthritic or destroyed shoulder joint is replaced with a stemmed or stemless humeral component and a glenoid component. In an anatomic replacement the ball stays on the arm bone; in a reverse, the ball is fixed to the shoulder blade and the socket to the arm, so the deltoid can lift where the rotator cuff cannot. It is done for arthritis, for cuff-deficient arthritis and for some fractures.", "story": "Shoulder replacement is the joint operation that travels least well and prices worst. It is done in smaller numbers than hip or knee, the reverse version depends on tendon anatomy a package page cannot assess in advance, and the first six weeks afterwards are a sling and a physiotherapy schedule rather than a walk to the shops.\n\nThe price pages show the gap. Bangkok's two largest international hospitals publish arthroscopic shoulder work and no shoulder replacement at all: at Bumrungrad on 16 September 2026 a basic arthroscopic shoulder package is 337,300 baht, a labral repair 345,100 and a rotator cuff repair 371,200, each with two nights — and nothing for a replacement. A patient who wants the joint replaced in Bangkok is asking for a quote, not buying a package.\n\nWhere a replacement is priced, the numbers come in the two shapes this subject keeps producing. Practice Plus Group in England lists shoulder replacement at £12,749, one figure covering the stay and the tests. Nordorthopaedics in Kaunas advertises it \"from 4.500 € / 3.750 £\" with no inclusion list. Australia's Medicare Benefits Schedule sets item 48918, anatomic or reverse total shoulder replacement, at $1,803.15 as at 1 July 2026 — the highest of the joint schedule fees this batch read, and still only the surgeon's fee.\n\n*Inference —* the schedule fee ranking is worth reading beside the package ranking. Australia's payer prices the shoulder above the hip and the knee; the Bangkok package market prices the shoulder at nothing, because it does not sell one.", "how": "General anaesthesia, usually with an interscalene nerve block. The surgeon opens the front of the shoulder between deltoid and pectoralis, cuts the humeral head, prepares the glenoid, seats the components, tests the tension and closes. The arm goes into a sling. Australia's item 48918 includes, in its own wording, associated rotator cuff repair, biceps tenodesis and tuberosity osteotomy if performed — three separate operations folded into one fee, which is what a bundled item number does.", "today": "As of 16 September 2026 the published shoulder prices on this site are an English self-pay figure of £12,749, a Lithuanian advertised floor of 4,500 euro, and an Australian schedule fee of $1,803.15. No hospital read for this batch publishes a shoulder replacement package price in Asia, and the largest Bangkok price pages carry arthroscopy instead.", "notes": "This page describes an operation and the prices published for it, and says nothing about whether any reader should have one." }, "metrics": { "stay_days": null, "days_before_flying": null, "recovery_weeks": null, "note": "No page read for this record publishes a ward stay, a recovery span or a flying interval for shoulder replacement. The nearest figure found is the two nights Bumrungrad names for its arthroscopic shoulder packages, which are different operations, so it is not carried here. The gaps are real gaps, not omissions.", "as_of": "2026-09-16", "source": "s:practiceplus-shoulder", "url": "https://practiceplusgroup.com/treatments/shoulder-and-elbow-surgery/" }, "prices": [ { "procedure": "shoulder-replacement", "country": "GB", "city": "England", "amount": 12749, "currency": "GBP", "as_of": "2026-09-16", "kind": "list", "includes": [ "the quoted price for surgery includes any necessary tests or hospital stays" ], "excludes": [ "the initial consultation, listed separately at £145" ], "source": "s:practiceplus-shoulder", "url": "https://practiceplusgroup.com/treatments/shoulder-and-elbow-surgery/", "note": "the group's published self-pay price. On the same list a rotator cuff repair is £5,749 and a shoulder arthroscopy £5,149, so the replacement is priced at roughly twice the keyhole work.", "tier": "cited", "usd": 17181.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "shoulder-replacement", "country": "LT", "city": "Kaunas", "amount": 4500, "currency": "EUR", "as_of": "2026-09-16", "kind": "quoted-range", "includes": [], "excludes": [], "source": "s:nordorthopaedics-prices", "url": "https://www.nordorthopaedics.com/hip-knee-wrist-hand-ankle-foot-shoulder-surgery-prices/", "note": "advertised as \"from 4.500 € / 3.750 £\". The page lists shoulder arthroscopy at 1.700 € and rotator cuff repair at 2.000 €, and states no inclusion list for any of them.", "tier": "cited", "usd": 5192.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "shoulder-replacement", "country": "AU", "amount": 1803.15, "currency": "AUD", "as_of": "2026-07-01", "kind": "tariff", "includes": [ "the medical service described in item 48918: anatomic or reverse total shoulder replacement, including associated rotator cuff repair, biceps tenodesis or tuberosity osteotomy if performed" ], "excludes": [ "hospital accommodation and theatre", "the prosthesis", "the anaesthetist's own items", "any amount charged above the schedule fee" ], "source": "s:mbs-48918", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=48918&qt=item", "note": "Medicare Benefits Schedule item 48918, fee last updated 1 July 2026; the 75% benefit is $1,352.40. The item is the dearest of the joint replacement fees read for this batch, above hip at $1,577.30.", "tier": "cited", "usd": 1285.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "hip-replacement", "as": "The joint that sells as a package everywhere this one does not.", "rel": "contrast" }, { "to": "knee-replacement", "as": "The operation whose package pages set the shape this one is missing from.", "rel": "contrast" }, { "to": "bumrungrad", "as": "Publishes arthroscopic shoulder packages and no shoulder replacement price.", "rel": "performed-at" }, { "to": "united-kingdom", "as": "Where the self-pay price on this page is sold.", "rel": "destination" }, { "to": "lithuania", "as": "Where the advertised floor price on this page comes from.", "rel": "destination" }, { "to": "australia", "as": "Whose payer sets the schedule fee on this page, and prices the shoulder above the hip.", "rel": "destination" }, { "to": "implant-excluded", "as": "The cost the Australian schedule fee leaves entirely outside itself.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Who runs the sling protocol and the six weeks of physiotherapy after the flight home.", "rel": "risk" }, { "to": "tariff", "as": "What a schedule fee is, and what it does not buy.", "rel": "term" }, { "to": "getting-a-quote", "as": "The step a shoulder patient cannot skip, because the package price does not exist.", "rel": "step" } ], "confusable_with": [ { "id": "hip-replacement", "tell": "Both are joint replacements, but the shoulder is rarely packaged and its recovery is measured in sling weeks rather than walking weeks." } ], "links": [ { "label": "MBS item 48918", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=48918&qt=item" }, { "label": "Practice Plus Group shoulder prices", "url": "https://practiceplusgroup.com/treatments/shoulder-and-elbow-surgery/" } ], "sources": [ "s:practiceplus-shoulder", "s:nordorthopaedics-prices", "s:mbs-48918", "s:bumrungrad-joint-packages" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "the absence of a Bangkok package price is a reading of the hospital's own package list on the accessed date" }, "text.how": { "tier": "tradition", "note": "standard operative description; the bundled wording is quoted from the MBS item" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "note": "every number is null because no page read publishes one" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Shoulder replacement.jpg", "File:Reverse shoulder prosthesis X-ray.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "The arthritic or destroyed shoulder joint is replaced with a stemmed or stemless humeral component and a glenoid component.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "The joint that sells as a package everywhere this one does not.", "rel": "contrast" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The operation whose package pages set the shape this one is missing from.", "rel": "contrast" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Publishes arthroscopic shoulder packages and no shoulder replacement price.", "rel": "performed-at" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Where the self-pay price on this page is sold.", "rel": "destination" }, { "to": "lithuania", "type": "destination", "name": "Lithuania", "as": "Where the advertised floor price on this page comes from.", "rel": "destination" }, { "to": "australia", "type": "destination", "name": "Australia", "as": "Whose payer sets the schedule fee on this page, and prices the shoulder above the hip.", "rel": "destination" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The cost the Australian schedule fee leaves entirely outside itself.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who runs the sling protocol and the six weeks of physiotherapy after the flight home.", "rel": "risk" }, { "to": "tariff", "type": "term", "name": "Tariff", "as": "What a schedule fee is, and what it does not buy.", "rel": "term" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step a shoulder patient cannot skip, because the package price does not exist.", "rel": "step" } ], "source_list": [ { "id": "s:practiceplus-shoulder", "kind": "web", "title": "Private shoulder and elbow surgery — self-pay price list", "publisher": "Practice Plus Group", "url": "https://practiceplusgroup.com/treatments/shoulder-and-elbow-surgery/", "accessed": "2026-09-16" }, { "id": "s:nordorthopaedics-prices", "kind": "web", "title": "Orthopaedic Surgery Prices", "publisher": "Nordorthopaedics Clinic, Kaunas", "url": "https://www.nordorthopaedics.com/hip-knee-wrist-hand-ankle-foot-shoulder-surgery-prices/", "accessed": "2026-09-16", "note": "every figure is written as a 'from' price in euro and sterling; the page carries no inclusion list" }, { "id": "s:mbs-48918", "kind": "gov", "title": "MBS item 48918 — anatomic or reverse total shoulder replacement", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=48918&qt=item", "accessed": "2026-09-16", "note": "schedule fee $1,803.15, fee last updated 01-Jul-2026" }, { "id": "s:bumrungrad-joint-packages", "kind": "web", "title": "Sports Medicine & Joint Center — package list", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/packages-center/joint-replacement-surgery", "accessed": "2026-09-16", "note": "arthroscopy, ligament, knee and hip package prices in one table; read in a browser because the page is rendered by script" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "the absence of a Bangkok package price is a reading of the hospital's own package list on the accessed date" }, "text.how": { "tier": "tradition", "note": "standard operative description; the bundled wording is quoted from the MBS item" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "note": "every number is null because no page read publishes one" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [] }, { "schema": 1, "id": "sperm-donation", "type": "procedure", "names": { "name": "Sperm donation", "aliases": [ "donor sperm", "donor insemination", "DI", "AID" ], "said": "Clinics sell a straw or a vial. Registers count donor insemination, DI, separately from IVF. The donor's own paperwork says compensation per clinic visit, and in the UK that is a capped sum set by the regulator." }, "etymology": { "root": "insemination: Latin in- plus semen, seed — the seeding. Donation keeps Latin donare, to give, in every jurisdiction, including those that print a fixed payment per visit beside the word.", "tier": "tradition", "note": "donor insemination places sperm in the uterus and is a different treatment, and a different price, from donor sperm used to fertilise eggs in an IVF or ICSI cycle. A register that counts DI births is not counting the second group." }, "region": [ "global" ], "facets": { "family": "fertility", "setting": "outpatient-course", "anaesthesia": "none" }, "text": { "what": "Screened, frozen sperm from a man who is not the patient's partner, thawed and either placed in the uterus around ovulation — donor insemination, a few minutes in a clinic room with no anaesthetic — or used to fertilise eggs in an IVF or ICSI cycle. The sperm is bought as a unit: a straw, a vial, a sample. Almost everything that varies across borders concerns the donor rather than the technique: whether he may be paid, how much, how many families he may create, and whether the child may one day know his name.", "story": "Sperm is the gamete that travels on its own. It freezes and ships, so the patient does not always have to move; when the patient does move, the reason is usually a rule about who may be treated rather than the price of the vial.\n\nThe UK numbers show how small this treatment is beside the arguments about it. The HFEA's 2023 report counts around 820 babies born following donor insemination, and around one in five of all UK IVF and DI births — 4,300 births — following treatment with donor eggs, sperm or embryos.\n\nThe UK also shows what a regulated market looks like priced out. A sperm donor may claim up to 45 pounds per clinic visit, raised from 35 pounds on 1 October 2024; his sperm may create children in up to ten UK families; anonymity ended for donations made after 1 April 2005, and a person conceived from one can have the donor's name, date of birth and last known address at 18, with non-identifying information from 16.\n\n*Trade practice —* a capped payment and an identity release produce a shortage, and a shortage produces importing. *Inference —* the traffic in this treatment is therefore two-directional in a way the others are not: patients cross borders, and so do straws, and the second movement is invisible in every patient-counting exercise.", "how": "Priced as a unit of sperm plus a treatment, and the two are on different lines. Reprofit lists donated sperm from its own cryobank at 490 EUR and an intrauterine insemination including capacitation of the sperm at 310 EUR; Newlife IVF in Thessaloniki lists donor sperm from 415 EUR and an insemination at 565 EUR. Fertilab in Barcelona prices the same insemination at 940 EUR with a partner's sperm and 1,450 EUR with a donor's — the 510 EUR between them is the vial.\n\nThe legal facts that move this treatment are attached to the donor. Whether donor sperm may be used at all: Türkiye's 2010 regulation on assisted reproduction practices and centres bans donor gametes, and the same instrument reaches citizens who go abroad for them. Whether the donor is anonymous: an identity-release jurisdiction and an anonymous one are selling different products under one word, and patients choose between them deliberately. Who may be treated: rules on marital status and on single and same-sex patients sit in national statute in many jurisdictions, and they decide whether a clinic at home will take the patient at all. The rule records carry the map.", "today": "As of September 2026 the published prices read off pages for this record put a vial of donor sperm at 415 to 490 EUR in Greece and Czechia, and the treatment it is used in at 310 to 1,450 EUR depending on the country and on whether the insemination price already contains the sperm. The UK cap on what the donor himself receives stands at 45 pounds a visit.", "notes": "This page describes a treatment and the published prices and caps attached to it. It is not medical advice and it is not legal advice." }, "metrics": { "success_rate_pct": null, "note": "No live-birth rate is carried here because the registers read for this record report donor insemination by births rather than by rate. The HFEA's 2023 report counts around 820 babies born following DI treatment in the UK, and around 4,300 UK births — about one in five of all IVF and DI births — following treatment using donor eggs, sperm or embryos. A birth count is not a success rate: neither figure has a denominator of cycles started, transfers or patients attached to it in the report read.", "as_of": "2023", "source": "s:hfea-2023-trends", "url": "https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2023-trends-and-figures/" }, "prices": [ { "procedure": "sperm-donation", "country": "CZ", "city": "Brno", "amount": 490, "currency": "EUR", "as_of": "2026-01-01", "kind": "list", "includes": [ "donated sperm from the clinic's own cryobank" ], "excludes": [ "the insemination or IVF cycle it is used in", "storage, listed separately at 185 EUR for 2 samples up to 5 years" ], "source": "s:reprofit-pricelist-2026", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "note": "line \"Donated sperm\", valid from 1 January 2026. The intrauterine insemination that uses it is a separate 310 EUR on the same list.", "tier": "cited", "usd": 565.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "sperm-donation", "country": "GR", "city": "Thessaloniki", "amount": 415, "currency": "EUR", "as_of": "2026-09-16", "kind": "list", "includes": [ "donor sperm, listed as from this price" ], "excludes": [ "the insemination, listed separately at 565 EUR", "preliminary investigations", "medications" ], "source": "s:newlife-ivf-costs", "url": "https://www.newlife-ivf.co.uk/ivf-costs", "note": "read on 16 September 2026; the page carries no date of its own.", "tier": "cited", "usd": 479.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "sperm-donation", "country": "ES", "city": "Barcelona", "amount": 1450, "currency": "EUR", "as_of": "2026-09-16", "kind": "package", "includes": [ "intrauterine insemination with donor sperm" ], "excludes": [], "source": "s:fertilab-pricing", "url": "https://fertilab.com/en/pricing/", "note": "the same clinic prices insemination with a partner's sperm at 940 EUR, so the donor vial is worth 510 EUR inside this line. The page says nothing either way about stimulation medication. Read on 16 September 2026.", "tier": "cited", "usd": 1673.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "sperm-donation", "country": "GB", "amount": 45, "currency": "GBP", "as_of": "2024-10-01", "kind": "tariff", "includes": [ "the maximum a UK sperm donor may claim per clinic visit" ], "excludes": [ "higher expenses such as travel and childcare, which may be claimed on top" ], "source": "s:hfea-donating-sperm", "url": "https://www.hfea.gov.uk/donation/donors/donating-your-sperm/", "note": "a regulator's cap on what the donor receives, not a price to a patient. Raised from 35 pounds on 1 October 2024. UK donors are over 18 and under 46; a donor's sperm may create children in up to ten UK families; donations made after 1 April 2005 are identity-release at 18.", "tier": "cited", "usd": 61.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "icsi", "as": "What donor sperm is usually used for in a laboratory rather than an insemination.", "rel": "kin" }, { "to": "egg-donation", "as": "The same bargain on the other side of the dish, with a larger price and a longer queue.", "rel": "contrast" }, { "to": "donor-anonymity-law", "as": "The rule that decides whether the donor can stay unnamed, and so which country the vial is bought in.", "rel": "governed-by" }, { "to": "ivf", "as": "The cycle donor sperm is used in when insemination is not the treatment.", "rel": "kin" }, { "to": "hfea", "as": "Sets the UK visit payment, the ten-family limit and the identity-release rule this record quotes.", "rel": "governs" }, { "to": "circumvention-travel", "as": "What the traffic is called where the reason to move is a prohibition on who may be treated.", "rel": "term" }, { "to": "surrogacy", "as": "The other third-party arrangement, and the one whose law diverges hardest across borders.", "rel": "kin" }, { "to": "united-kingdom", "as": "The jurisdiction whose capped payment and identity release this record reads off the regulator's own pages.", "rel": "place" } ], "confusable_with": [ { "id": "egg-donation", "tell": "Sperm ships frozen and the patient can stay home; eggs mostly do not, and the cycle has to be bought where the donor is." }, { "id": "icsi", "tell": "Donor sperm names whose sperm it is; ICSI names how it gets into the egg. A bill can carry both lines or neither." } ], "links": [ { "label": "HFEA — donating your sperm", "url": "https://www.hfea.gov.uk/donation/donors/donating-your-sperm/" }, { "label": "Newlife IVF costs, Thessaloniki", "url": "https://www.newlife-ivf.co.uk/ivf-costs" } ], "sources": [ "s:hfea-donating-sperm", "s:hfea-2023-trends", "s:reprofit-pricelist-2026", "s:newlife-ivf-costs", "s:fertilab-pricing", "s:gurtin-2011-turkey" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:hfea-donating-sperm", "note": "the counts and the caps are cited; the shortage argument is marked Trade practice and the two-directional traffic point is marked Inference" }, "text.how": { "tier": "cited", "source": "s:reprofit-pricelist-2026", "note": "the Turkish regulation is taken from a journal listing whose full text could not be retrieved; it is also carried on the rule record" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:hfea-2023-trends" }, "prices": { "tier": "cited", "source": "s:reprofit-pricelist-2026" } } }, "x_commons_files": [ "File:Sperm sample cryovial.jpg", "File:Human sperm stained for semen quality testing.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "Screened, frozen sperm from a man who is not the patient's partner, thawed and either placed in the uterus around ovulation — donor insemination, a few minutes in a clinic room with no anaesthetic — or used to fertilise…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "icsi", "type": "procedure", "name": "Intracytoplasmic sperm injection", "as": "What donor sperm is usually used for in a laboratory rather than an insemination.", "rel": "kin" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The same bargain on the other side of the dish, with a larger price and a longer queue.", "rel": "contrast" }, { "to": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The rule that decides whether the donor can stay unnamed, and so which country the vial is bought in.", "rel": "governed-by" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The cycle donor sperm is used in when insemination is not the treatment.", "rel": "kin" }, { "to": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "Sets the UK visit payment, the ten-family limit and the identity-release rule this record quotes.", "rel": "governs" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "What the traffic is called where the reason to move is a prohibition on who may be treated.", "rel": "term" }, { "to": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "The other third-party arrangement, and the one whose law diverges hardest across borders.", "rel": "kin" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The jurisdiction whose capped payment and identity release this record reads off the regulator's own pages.", "rel": "place" } ], "source_list": [ { "id": "s:hfea-donating-sperm", "kind": "org", "title": "Donating your sperm", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/donation/donors/donating-your-sperm/", "accessed": "2026-09-16" }, { "id": "s:hfea-2023-trends", "kind": "org", "title": "Fertility treatment 2023: trends and figures", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2023-trends-and-figures/", "accessed": "2026-09-16", "note": "the UK regulator's annual register report; birth rates marked preliminary and not yet validated" }, { "id": "s:reprofit-pricelist-2026", "kind": "web", "title": "Pricelist — Assisted Reproduction, valid from 01.01.2026 (document 0331.26ENG)", "publisher": "Reprofit International s.r.o., Brno", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "accessed": "2026-09-16", "note": "the clinic's own self-payer price list, five pages, each line naming its inclusions and its exclusions" }, { "id": "s:newlife-ivf-costs", "kind": "web", "title": "IVF costs, egg donation costs", "publisher": "Newlife IVF, Thessaloniki", "url": "https://www.newlife-ivf.co.uk/ivf-costs", "accessed": "2026-09-16" }, { "id": "s:fertilab-pricing", "kind": "web", "title": "Price list — fertility treatments", "publisher": "Fertilab Barcelona", "url": "https://fertilab.com/en/pricing/", "accessed": "2026-09-16" }, { "id": "s:gurtin-2011-turkey", "kind": "paper", "title": "Banning reproductive travel: Turkey's ART legislation and third-party assisted reproduction", "publisher": "Reproductive BioMedicine Online (Gurtin ZB)", "url": "https://www.rbmojournal.com/article/S1472-6483(11)00470-6/fulltext", "accessed": "2026-09-16", "note": "citation and the 2010 regulation's extraterritorial clause verified from the journal's own article listing; the full text returned HTTP 403 and was not read. Treated as needing verification wherever it is relied on." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:hfea-donating-sperm", "note": "the counts and the caps are cited; the shortage argument is marked Trade practice and the two-directional traffic point is marked Inference" }, "text.how": { "tier": "cited", "source": "s:reprofit-pricelist-2026", "note": "the Turkish regulation is taken from a journal listing whose full text could not be retrieved; it is also carried on the rule record" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:reprofit-pricelist-2026" }, "metrics": { "tier": "cited", "source": "s:hfea-2023-trends" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The same bargain on the other side of the dish, with a different cap and a different queue.", "rel": "contrast" }, { "from": "icsi", "type": "procedure", "name": "Intracytoplasmic sperm injection", "as": "Where the sperm comes from when it does not come from a partner, and the law that decides whether it may.", "rel": "kin" }, { "from": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The other half of it.", "rel": "procedure" } ] }, { "schema": 1, "id": "spinal-fusion", "type": "procedure", "names": { "name": "Spinal fusion", "aliases": [ "arthrodesis of the spine", "ACDF", "anterior cervical discectomy and fusion", "TLIF", "transforaminal lumbar interbody fusion", "interbody fusion" ], "said": "Surgeons name the approach and the level and never say fusion on its own: ACDF for the neck from the front, TLIF or PLIF for the lower back. Price pages sell it by the level, and one level is the unit." }, "etymology": { "root": "arthrodesis: Greek arthron, a joint, plus desis, a binding — a joint bound shut. Fusion is Latin fundere, to pour or melt together, borrowed from metal. Interbody means between the vertebral bodies, where the cage and the graft go.", "tier": "tradition", "note": "A level, or motion segment, is one pair of vertebrae and the disc between them. Every published price read for this record is a one-level price, and a second level is a second price." }, "region": [ "global" ], "facets": { "family": "orthopaedic", "setting": "inpatient", "anaesthesia": "general" }, "text": { "what": "Two vertebrae are joined into one bone. The disc between them is removed, a cage or a block of graft is packed into the gap, and screws and rods or a plate hold the segment still while it knits. It is done for instability, for deformity and for nerve compression that recurs. The unit of both surgery and price is the level; the metalwork and the graft are billed separately on most package pages.", "story": "Fusion is the spine operation that most resembles a joint replacement in the price list: standardised enough to package, expensive enough to travel for, and quoted per level with the hardware carved out.\n\nBumrungrad's Spine Institute prices it twice on one page. A transforaminal lumbar interbody fusion at one level is 576,300 baht with two nights in a standard single room, and an anterior cervical discectomy and fusion at one level is 420,000 baht with one night. Both prices stand until 31 December 2026. The lumbar package's exclusion list opens with the line that decides the bill: implant and artificial bone graft.\n\nIn England, Practice Plus Group lists an anterior cervical discectomy and fusion at £14,400 on its self-pay page, the same named operation as the Bangkok cervical package, and states nothing about what the figure covers. Australia's Medicare Benefits Schedule sets item 51041, spinal fusion of the anterior column at one motion segment, at $1,295.85 as at 1 July 2026, with items 51042 to 51045 stepping up for two, three, four and five or more segments.\n\n*Inference —* the Australian ladder is the clearest published statement in this batch that spine surgery is sold by the segment. A quote that names a price without naming the number of levels has left out the multiplier.\n\n*Trade practice —* fusion also carries an argument the price pages do not: a fused segment throws load onto its neighbours, and the case for motion-preserving disc replacement instead is made on exactly that ground. Both sit on the same Bangkok page, and at the same level in the neck the disc replacement is 48,600 baht dearer than the fusion.", "how": "General anaesthesia. For a neck fusion the surgeon works from the front through a crease incision, removes the disc, seats a cage or graft, and plates the two vertebrae; the patient is often up the same day and out the next. For a lumbar interbody fusion the approach is from behind through the foramen, the disc is cleared, the cage is placed and pedicle screws and rods are locked across the segment; Bumrungrad's package books three hours and thirty minutes of theatre and two nights. Bone knits over months, not weeks, and the imaging that confirms it happens at home.", "today": "As of 16 September 2026 the fusion prices on this site are 420,000 baht for a one-level cervical fusion and 576,300 for a one-level lumbar fusion in Bangkok, both excluding the implant; £14,400 for the cervical operation in England; and an Australian schedule fee of $1,295.85 for one segment, which buys the surgeon's service and nothing else.", "notes": "This page describes an operation and the prices published for it. Nothing here is medical advice." }, "metrics": { "stay_days": 2, "days_before_flying": 10, "recovery_weeks": null, "note": "Two nights is the ward stay named in Bumrungrad's TLIF01 package; the same hospital's one-level cervical fusion package names one night. Neither page states a recovery span, and no page read for this record does, so recovery_weeks stays empty. The ten days before flying is the CDC's guidance for chest or abdominal surgery, applied here by analogy for the clot risk and not stated by any spine page read.", "as_of": "2026-09-16", "source": "s:bumrungrad-tlif01", "url": "https://www.bumrungrad.com/en/packages/transforaminal-lumbar-interbody-fusion" }, "prices": [ { "procedure": "spinal-fusion", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 576300, "currency": "THB", "as_of": "2026-09-16", "kind": "package", "includes": [ "operating room charges for 3 hours and 30 minutes including OR room, recovery room, scrub nurse and circulating nurse", "accommodation for 2 days in a standard single room", "medical equipment and medical supplies specified in the package", "anaesthesia and medications related to the procedure", "surgeon", "assistant surgeon if necessary", "anaesthesiologist" ], "excludes": [ "implant and artificial bone graft", "consultation fee for an initial visit and follow-up visits", "inpatient stay more than 2 days, ICU, or stay past the approved discharge day", "internist's and other specialists' consultations", "outpatient fees before admission", "complex cases requiring emergency surgery", "laboratory and diagnostic tests before and after operation, blood transfusion and biopsy", "take-home medications and medical supplies", "pre-operative exercise programme by a physical therapist" ], "source": "s:bumrungrad-tlif01", "url": "https://www.bumrungrad.com/en/packages/transforaminal-lumbar-interbody-fusion", "note": "package TLIF01, one level, price stated valid until 31 December 2026. The first exclusion is the cage and the graft, which on a fusion is the largest carved-out line.", "tier": "cited", "usd": 17309.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "spinal-fusion", "country": "TH", "city": "Bangkok", "facility": "bumrungrad", "amount": 420000, "currency": "THB", "as_of": "2026-09-16", "kind": "package", "includes": [ "one-level anterior cervical discectomy with fusion", "1-night hospital stay in a standard single room" ], "excludes": [], "source": "s:bumrungrad-spine-packages", "url": "https://www.bumrungrad.com/en/packages/packages-center/spine-specialists-center", "note": "listed on the Spine Institute package page as Anterior Cervical Discectomy with Fusion 1 Level (ACDF), 420,000 THB with one night. The neck fusion is 156,300 baht cheaper than the lumbar one at the same hospital and keeps the patient a night less.", "tier": "cited", "usd": 12615.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "spinal-fusion", "country": "GB", "city": "England", "amount": 14400, "currency": "GBP", "as_of": "2026-09-16", "kind": "list", "includes": [], "excludes": [], "source": "s:practiceplus-spinal", "url": "https://practiceplusgroup.com/treatments/spinal-surgery/", "note": "listed as anterior cervical discectomy fusion on the group's self-pay spinal page, beside slipped disc surgery at £8,399 and spinal decompression at £8,849. The page states no inclusion list for the spinal prices, unlike the same group's hip and knee pages.", "tier": "cited", "usd": 19406.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "spinal-fusion", "country": "AU", "amount": 1295.85, "currency": "AUD", "as_of": "2026-07-01", "kind": "tariff", "includes": [ "the medical service described in item 51041: spinal fusion, anterior column (anterior, direct lateral or posterior interbody), one motion segment" ], "excludes": [ "hospital accommodation and theatre", "the cage, screws, rods and graft", "the anaesthetist's own items", "any amount charged above the schedule fee" ], "source": "s:mbs-51041", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=51041&qt=item", "note": "Medicare Benefits Schedule item 51041, fee last updated 1 July 2026; 75% benefit $971.90. Items 51042 to 51045 price two, three, four and five or more motion segments, which is the schedule saying in item numbers that fusion is sold by the level.", "tier": "cited", "usd": 924.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "disc-replacement", "as": "The motion-preserving alternative argued against this one, and 48,600 baht dearer at the same neck level on the same Bangkok page.", "rel": "contrast" }, { "to": "bumrungrad", "as": "Publishes both the cervical and the lumbar fusion packages this page reads.", "rel": "performed-at" }, { "to": "thailand", "as": "Where both fusion packages on this page are sold.", "rel": "destination" }, { "to": "united-kingdom", "as": "Where the £14,400 cervical fusion on this page is sold, with no inclusion list beside it.", "rel": "destination" }, { "to": "australia", "as": "Whose schedule prices fusion by the motion segment, one item number per level.", "rel": "destination" }, { "to": "implant-excluded", "as": "The cage, the screws and the graft — the first line on the Bangkok exclusion list.", "rel": "risk" }, { "to": "reading-the-exclusions", "as": "The step that decides what a one-level fusion price actually covers.", "rel": "step" }, { "to": "package-price", "as": "The form this operation is sold in, priced per level.", "rel": "term" }, { "to": "flying-after-surgery", "as": "The clot risk that sets the wait before the flight home.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Who orders the imaging that shows whether the bone knitted.", "rel": "risk" } ], "confusable_with": [ { "id": "disc-replacement", "tell": "Both remove the disc; fusion locks the segment and disc replacement keeps it moving, and the Australian schedule pays the same fee for either." } ], "links": [ { "label": "Bumrungrad package TLIF01", "url": "https://www.bumrungrad.com/en/packages/transforaminal-lumbar-interbody-fusion" }, { "label": "MBS item 51041", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=51041&qt=item" } ], "sources": [ "s:bumrungrad-tlif01", "s:bumrungrad-spine-packages", "s:practiceplus-spinal", "s:mbs-51041", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "prices and levels read off the named pages; the marked stretches are this project's reasoning and the trade's argument" }, "text.how": { "tier": "tradition", "note": "standard operative description; the theatre time and nights are cited to the package page" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:bumrungrad-tlif01" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Spinal fusion X-ray.jpg", "File:Lumbar interbody fusion cage.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "Two vertebrae are joined into one bone. The disc between them is removed, a cage or a block of graft is packed into the gap, and screws and rods or a plate hold the segment still while it knits.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "disc-replacement", "type": "procedure", "name": "Artificial disc replacement", "as": "The motion-preserving alternative argued against this one, and 48,600 baht dearer at the same neck level on the same Bangkok page.", "rel": "contrast" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Publishes both the cervical and the lumbar fusion packages this page reads.", "rel": "performed-at" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where both fusion packages on this page are sold.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Where the £14,400 cervical fusion on this page is sold, with no inclusion list beside it.", "rel": "destination" }, { "to": "australia", "type": "destination", "name": "Australia", "as": "Whose schedule prices fusion by the motion segment, one item number per level.", "rel": "destination" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The cage, the screws and the graft — the first line on the Bangkok exclusion list.", "rel": "risk" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step that decides what a one-level fusion price actually covers.", "rel": "step" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The form this operation is sold in, priced per level.", "rel": "term" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The clot risk that sets the wait before the flight home.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who orders the imaging that shows whether the bone knitted.", "rel": "risk" } ], "source_list": [ { "id": "s:bumrungrad-tlif01", "kind": "web", "title": "Transforaminal Lumbar Interbody Fusion (TLIF) Surgery — package TLIF01", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/transforaminal-lumbar-interbody-fusion", "accessed": "2026-09-16", "note": "576,300 THB, two nights, implant and artificial bone graft excluded; valid until 31 December 2026" }, { "id": "s:bumrungrad-spine-packages", "kind": "web", "title": "Spine Surgery — Spine Institute package list", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/packages-center/spine-specialists-center", "accessed": "2026-09-16", "note": "endoscopic discectomy, ACDF, cervical disc replacement and TLIF prices" }, { "id": "s:practiceplus-spinal", "kind": "web", "title": "Private back surgery — self-pay price list", "publisher": "Practice Plus Group", "url": "https://practiceplusgroup.com/treatments/spinal-surgery/", "accessed": "2026-09-16", "note": "anterior cervical discectomy and fusion listed at £14,400" }, { "id": "s:mbs-51041", "kind": "gov", "title": "MBS item 51041 — spinal fusion, anterior column, one motion segment", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=51041&qt=item", "accessed": "2026-09-16", "note": "schedule fee $1,295.85, fee last updated 01-Jul-2026" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "prices and levels read off the named pages; the marked stretches are this project's reasoning and the trade's argument" }, "text.how": { "tier": "tradition", "note": "standard operative description; the theatre time and nights are cited to the package page" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:bumrungrad-tlif01" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "seoul", "type": "hub", "name": "Seoul", "as": "Korean spine surgery draws its own referrals, separate from the cosmetic trade.", "rel": "procedure" }, { "from": "disc-replacement", "type": "procedure", "name": "Artificial disc replacement", "as": "The operation this one competes with, 48,600 baht cheaper at the same Bangkok hospital and paid the same fee in Australia.", "rel": "contrast" }, { "from": "wooridul", "type": "facility", "name": "Wooridul Spine Hospital", "as": "One of the two operations this hospital exists to do, listed on the state's own page for it.", "rel": "performs" } ] }, { "schema": 1, "id": "stem-cell-unproven", "type": "procedure", "names": { "name": "Unapproved stem cell treatment", "aliases": [ "stem cell therapy", "regenerative medicine", "stromal vascular fraction", "SVF", "exosome therapy", "cell therapy" ], "said": "The clinic says regenerative medicine and names the tissue the cells came from. The regulator says unapproved and names the disease they were sold for. Neither word describes a mechanism." }, "etymology": { "root": "stem cell is a calque of the German Stammzelle — Stamm, a stem, stock or lineage — carried into English from late nineteenth-century embryology, where it meant the cell a line of descendants comes from. Stromal vascular fraction is a processing description, not a diagnosis: what is left of fat tissue after the fat cells are separated out.", "tier": "tradition", "note": "Autologous means the cells came from the patient; allogeneic means from someone else. Neither word says what the cells do. A product named for its source — umbilical cord, amniotic fluid, Wharton's jelly, adipose tissue — has been named for where it was got, which is the part of the transaction that is verifiable." }, "region": [ "global", "north-america", "mexico", "central-america" ], "facets": { "family": "unproven", "setting": "outpatient-course", "anaesthesia": "varies" }, "text": { "what": "A cell preparation is injected, infused or implanted as a treatment for a condition it has not been approved to treat. The cells come from the patient's own fat or bone marrow, or from donated birth tissue; the delivery is an outpatient appointment or a short course of them; the payment is in advance and in full. The transaction is complete whether or not anything happens afterwards.", "story": "Two regulators' documents and four studies do most of the work on this page, and none of them is about a faraway country.\n\nThe US Food and Drug Administration states the approval position in one sentence: \"Currently, the only stem cell products that are FDA-approved for use in the United States consist of blood-forming stem cells (also known as hematopoietic progenitor cells) that are derived from umbilical cord blood.\" On the same alert, on exosomes: \"There are currently no FDA-approved exosome products.\" The page then lists what such products are marketed for anyway — arthritis, back pain, multiple sclerosis, Parkinson's, ALS, Alzheimer's, autism, macular degeneration, cardiac and pulmonary disease, chronic pain.\n\nThe agency has taken this to court. On 3 June 2019 the US District Court for the Southern District of Florida granted summary judgment against US Stem Cell Clinic LLC of Weston, Florida, US Stem Cell Inc. of Sunrise, and their chief scientific officer Kristin Comella, finding that they had adulterated and misbranded their stromal vascular fraction products; Judge Ursula Ungaro entered a permanent injunction on 25 June. The FDA's statement that day put the risks as \"blindness, infection or possibly death\" and said the agency had sent 46 manufacturers and health care professionals regulatory correspondences, including warning letters, over the preceding year.\n\nThe blindness is not rhetorical. In 2017 the New England Journal of Medicine reported three patients who had adipose-derived cells injected into both eyes for macular degeneration at a US clinic. Their best documented acuity before injection ranged from 20/30 to 20/200. At one year it ranged from 20/200 to no light perception.\n\nThe geography is the part most accounts get backwards. Turner and Knoepfler, surveying internet marketing in 2016, wrote that the practice was \"a well-known phenomenon in countries with lax medical regulations\" and then found \"widespread promotion of such interventions by businesses based in the United States\". Berger and colleagues, searching globally the same year, found marketing \"skewed toward developed economies including the United States, Ireland, Australia, and Germany\", with websites making \"broad, imprecise therapeutic claims\" and frequently failing to detail the procedure.\n\nThe border case has been counted once. A 2019 web survey of Tijuana, published in 2021, found 110 websites corresponding to 76 confirmed locations marketing regenerative medicine across the line from San Diego; 99.1% showed no affiliation to an academic institution, 67.3% claimed the tissue was the patient's own, most did not state the route of administration, and of the 13 that claimed licensing, one matched available licensing information.", "how": "Priced as a package by condition rather than by dose, paid before treatment, and delivered in a few days. Two clinics publish figures. The Stem Cell Institute in Panama City lists 15,825 US dollars for a child and 26,900 for an adult, stating that airport customs clearance, ground transport and a hotel stay are inside the number; its page names the conditions it markets for and says nothing about approval. GIOSTAR Mexico publishes bands by condition group — 6,000 to 13,000 dollars for musculoskeletal, 12,000 to 18,000 for neurological, 9,000 to 14,000 for autoimmune, from 4,950 for wellness, from 50,000 for an NK cell cancer programme — states a cell count of 35 to 140 million across one to four vials, and cites certification by COFEPRIS, the Mexican health regulator, which is a manufacturing and premises certification rather than an approval of the treatment for a disease.", "today": "As of 17 September 2026 no register counts how many people cross a border for an unapproved cell product, what they pay or what becomes of them. What exists is a regulator's list of what is approved, a court record of what has been enjoined, marketplace surveys, and case reports — and the case reports exist because the harm was bad enough to reach a specialist. The two published price pages read for this record are in Panama and Mexico; no US clinic page carrying a published price was read for it.", "notes": "This page reports what named regulators and published studies say. It is not medical advice, and it makes no claim about any particular clinic beyond what that clinic publishes about itself." }, "metrics": { "stay_days": null, "days_before_flying": null, "recovery_weeks": null, "success_rate_pct": null, "complication_rate_pct": null, "note": "Every number here is null and each is a gap somebody could close. There is no published denominator: no count of patients treated, no register of outcomes, no complication rate. The FDA names blindness, infection and death as risks; the three-patient NEJM series is a demonstration, not an incidence.", "as_of": "2026-09-17", "source": "s:fda-regenerative-consumer-alert", "url": "https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/consumer-alert-regenerative-medicine-products-including-stem-cells-and-exosomes" }, "prices": [ { "procedure": "stem-cell-unproven", "country": "PA", "city": "Panama City", "amount": 15825, "amount_high": 26900, "currency": "USD", "as_of": "2026-09-17", "kind": "package", "includes": [ "the injections and the clinic's medical team", "customs clearance on arrival at the airport", "ground transportation", "a stay at a named hotel" ], "excludes": [ "flights", "anything the page does not name, including any repeat course" ], "source": "s:cellmedicine-stem-cell-cost", "url": "https://www.cellmedicine.com/how-much-does-stem-cell-therapy-cost/", "note": "15,825 dollars for a child and 26,900 for an adult, on the clinic's own page. The product is described as umbilical-cord-derived mesenchymal cells under a proprietary name. The page carries no date and makes no statement about regulatory approval.", "tier": "cited", "usd": 15825.0, "usd_high": 26900.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "stem-cell-unproven", "country": "MX", "amount": 4950, "amount_high": 18000, "currency": "USD", "as_of": "2026-08", "kind": "package", "includes": [ "medical evaluation", "laboratory tests and imaging", "cell processing with quality testing", "the treatment sessions", "monitoring and aftercare", "accommodation and transfers coordinated by the clinic's concierge" ], "excludes": [ "an NK cell cancer programme, priced separately from 50,000 dollars", "flights", "any dose beyond the one to four vials the plan sets" ], "source": "s:giostar-mexico-cost", "url": "https://giostarmexico.com/stem-cell-therapy-mexico-cost-at-giostar-mexico-global-standards-transparent-pricing-financing-options/", "note": "bands by condition group on the clinic's own page, marked verified August 2026: musculoskeletal 6,000-13,000, autoimmune 9,000-14,000, neurological 12,000-18,000, wellness from 4,950. The page cites COFEPRIS certification of the facility, which certifies premises and practice rather than approving a treatment for a disease.", "tier": "cited", "usd": 4950.0, "usd_high": 18000.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "unproven-stem-cell", "as": "What can go wrong, who has measured it, and what the case reports record.", "rel": "risk" }, { "to": "stem-cell-regulation", "as": "Which preparations are lawful to sell where, and on whose approval.", "rel": "governed-by" }, { "to": "advertising-rules", "as": "What a clinic may claim about a product no regulator has approved.", "rel": "governed-by" }, { "to": "mexico", "as": "Where one of the two published price pages sits, and where the border survey counted 76 locations in one city.", "rel": "destination" }, { "to": "tijuana", "as": "The city the one published count of these clinics was made in.", "rel": "hub" }, { "to": "panama", "as": "Where the other published price page sits.", "rel": "destination" }, { "to": "united-states", "as": "The regulator that has enjoined a clinic, and the country the marketing surveys found most of the businesses in.", "rel": "destination" }, { "to": "deciding-whether", "as": "The step where a poor prognosis meets a confident page.", "rel": "step" }, { "to": "second-opinion", "as": "The step at which an unapproved indication is most often identified as one.", "rel": "step" }, { "to": "malpractice-recourse", "as": "A claim about a product no regulator approved, brought against a provider in another country.", "rel": "risk" }, { "to": "counterfeit-medicines", "as": "The mirror case: a product that is not what it says, against a product that is exactly what it says and has not been shown to do anything.", "rel": "contrast" }, { "to": "car-t", "as": "The approved cell therapy, with a licensed indication, a named manufacturer and a price in the same order of magnitude times ten.", "rel": "contrast" } ], "confusable_with": [ { "id": "bone-marrow-transplant", "tell": "Haematopoietic transplantation is an approved use of blood-forming stem cells for named blood diseases, done in a transplant unit. A clinic offering cells for arthritis or autism is selling something else under the same two words." } ], "links": [ { "label": "FDA consumer alert on regenerative medicine products", "url": "https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/consumer-alert-regenerative-medicine-products-including-stem-cells-and-exosomes" }, { "label": "FDA statement on the 2019 stem cell clinic permanent injunction", "url": "https://www.fda.gov/news-events/press-announcements/statement-stem-cell-clinic-permanent-injunction-and-fdas-ongoing-efforts-protect-patients-risks" }, { "label": "Chavez et al., Stem Cell Research & Therapy 2021;12:189", "url": "https://pubmed.ncbi.nlm.nih.gov/33736697/" } ], "sources": [ "s:fda-regenerative-consumer-alert", "s:fda-stem-cell-injunction-2019", "s:kuriyan-stem-cell-2017", "s:turner-knoepfler-2016", "s:berger-2016-global-distribution", "s:chavez-tijuana-2021", "s:cellmedicine-stem-cell-cost", "s:giostar-mexico-cost" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:fda-regenerative-consumer-alert", "note": "every quotation is from the named regulator document or the named paper; no figure here is this project's" }, "text.how": { "tier": "cited", "source": "s:cellmedicine-stem-cell-cost", "note": "both price structures are read off the clinics' own pages; the sentence about what COFEPRIS certification is describes the certification, not the treatment" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:cellmedicine-stem-cell-cost" }, "metrics": { "tier": "cited", "source": "s:fda-regenerative-consumer-alert" } } }, "x_commons_files": [ "File:Mesenchymal stem cell.jpg", "File:Human embryonic stem cells.png" ], "confidence": "high", "updated": "2026-09-17", "blurb": "A cell preparation is injected, infused or implanted as a treatment for a condition it has not been approved to treat.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" }, { "key": "mexico", "name": "Mexico", "note": "its own entry because the border towns are a category of their own" }, { "key": "central-america", "name": "Central America", "note": "Costa Rica, Panama, Guatemala, Belize" } ], "kin_out": [ { "to": "unproven-stem-cell", "type": "risk", "name": "Unproven stem cell treatment", "as": "What can go wrong, who has measured it, and what the case reports record.", "rel": "risk" }, { "to": "stem-cell-regulation", "type": "rule", "name": "Regulating cell and tissue therapies", "as": "Which preparations are lawful to sell where, and on whose approval.", "rel": "governed-by" }, { "to": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "What a clinic may claim about a product no regulator has approved.", "rel": "governed-by" }, { "to": "mexico", "type": "destination", "name": "Mexico", "as": "Where one of the two published price pages sits, and where the border survey counted 76 locations in one city.", "rel": "destination" }, { "to": "tijuana", "type": "hub", "name": "Tijuana", "as": "The city the one published count of these clinics was made in.", "rel": "hub" }, { "to": "panama", "type": "destination", "name": "Panama", "as": "Where the other published price page sits.", "rel": "destination" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The regulator that has enjoined a clinic, and the country the marketing surveys found most of the businesses in.", "rel": "destination" }, { "to": "deciding-whether", "type": "pathway", "name": "Deciding whether to go", "as": "The step where a poor prognosis meets a confident page.", "rel": "step" }, { "to": "second-opinion", "type": "pathway", "name": "The second opinion", "as": "The step at which an unapproved indication is most often identified as one.", "rel": "step" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "A claim about a product no regulator approved, brought against a provider in another country.", "rel": "risk" }, { "to": "counterfeit-medicines", "type": "risk", "name": "Substandard and falsified medicines", "as": "The mirror case: a product that is not what it says, against a product that is exactly what it says and has not been shown to do anything.", "rel": "contrast" }, { "to": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "The approved cell therapy, with a licensed indication, a named manufacturer and a price in the same order of magnitude times ten.", "rel": "contrast" } ], "source_list": [ { "id": "s:fda-regenerative-consumer-alert", "kind": "org", "title": "Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes", "publisher": "US Food and Drug Administration", "url": "https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/consumer-alert-regenerative-medicine-products-including-stem-cells-and-exosomes", "accessed": "2026-09-16" }, { "id": "s:fda-stem-cell-injunction-2019", "kind": "org", "title": "Statement on stem cell clinic permanent injunction and FDA's ongoing efforts to protect patients from risks of unapproved products", "publisher": "US Food and Drug Administration", "url": "https://www.fda.gov/news-events/press-announcements/statement-stem-cell-clinic-permanent-injunction-and-fdas-ongoing-efforts-protect-patients-risks", "accessed": "2026-09-16", "note": "25 June 2019; summary judgment of 3 June 2019 in the Southern District of Florida" }, { "id": "s:kuriyan-stem-cell-2017", "kind": "paper", "title": "Vision Loss after Intravitreal Injection of Autologous \"Stem Cells\" for AMD", "publisher": "New England Journal of Medicine 2017;376(11):1047-1053 (Kuriyan AE, Albini TA, Townsend JH, et al.)", "url": "https://pubmed.ncbi.nlm.nih.gov/28296617/", "accessed": "2026-09-16" }, { "id": "s:turner-knoepfler-2016", "kind": "paper", "title": "Selling Stem Cells in the USA: Assessing the Direct-to-Consumer Industry", "publisher": "Cell Stem Cell 2016;19(2):154-157 (Turner L, Knoepfler P)", "url": "https://pubmed.ncbi.nlm.nih.gov/27374789/", "accessed": "2026-09-16" }, { "id": "s:berger-2016-global-distribution", "kind": "paper", "title": "Global Distribution of Businesses Marketing Stem Cell-Based Interventions", "publisher": "Cell Stem Cell 19:158-162, 2016; Berger I, Ahmad A, Bansal A, Kapoor T, Sipp D, Rasko JEJ; doi 10.1016/j.stem.2016.07.015", "url": "https://europepmc.org/article/MED/27494673", "accessed": "2026-09-16" }, { "id": "s:chavez-tijuana-2021", "kind": "paper", "title": "Online marketing practices of regenerative medicine clinics in US-Mexico border region: a web surveillance study", "publisher": "Stem Cell Research & Therapy 2021;12(1):189 (Chavez J, Shah NA, Ruoss S, Cuomo RE, Ward SR, Mackey TK); doi 10.1186/s13287-021-02254-4", "url": "https://pubmed.ncbi.nlm.nih.gov/33736697/", "accessed": "2026-09-17", "note": "searches run March to April 2019 in English and Spanish; 110 websites in Tijuana corresponding to 76 confirmed locations; 13 claimed licensing and 1 matched available licensing information" }, { "id": "s:cellmedicine-stem-cell-cost", "kind": "web", "title": "How Much Does Stem Cell Therapy Cost?", "publisher": "Stem Cell Institute, Panama City, Panama", "url": "https://www.cellmedicine.com/how-much-does-stem-cell-therapy-cost/", "accessed": "2026-09-17", "note": "the clinic's own page: 15,825 USD for a child and 26,900 USD for an adult, stated to include airport customs clearance, ground transport and a hotel stay. The page names the conditions marketed and makes no statement about regulatory approval." }, { "id": "s:giostar-mexico-cost", "kind": "web", "title": "Stem Cell Therapy Mexico Cost at GIOSTAR Mexico", "publisher": "GIOSTAR Mexico", "url": "https://giostarmexico.com/stem-cell-therapy-mexico-cost-at-giostar-mexico-global-standards-transparent-pricing-financing-options/", "accessed": "2026-09-17", "note": "the clinic's own page, marked verified August 2026: packages by condition group, a stated cell count of 35-140 million across 1-4 vials, and a claim of COFEPRIS-certified facilities. No FDA approval is claimed." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:fda-regenerative-consumer-alert", "note": "every quotation is from the named regulator document or the named paper; no figure here is this project's" }, "text.how": { "tier": "cited", "source": "s:cellmedicine-stem-cell-cost", "note": "both price structures are read off the clinics' own pages; the sentence about what COFEPRIS certification is describes the certification, not the treatment" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:cellmedicine-stem-cell-cost" }, "metrics": { "tier": "cited", "source": "s:fda-regenerative-consumer-alert" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "izmir", "type": "hub", "name": "İzmir", "as": "The same evidentiary problem as the thermal indications: a therapeutic claim older or louder than its testing.", "rel": "contrast" }, { "from": "tijuana", "type": "hub", "name": "Tijuana", "as": "Sold here to patients who cannot buy it at home, which is the whole of its business model.", "rel": "performs" }, { "from": "unproven-stem-cell", "type": "risk", "name": "Unproven stem cell treatment", "as": "The treatment itself, and what is actually sold under the name.", "rel": "procedure" }, { "from": "stem-cell-regulation", "type": "rule", "name": "Regulating cell and tissue therapies", "as": "The procedure these instruments are argued over.", "rel": "procedure" }, { "from": "leigh-turner", "type": "person", "name": "Leigh Turner", "as": "The trade he counted, and the record carrying his 2021 figures.", "rel": "procedure" } ] }, { "schema": 1, "id": "surrogacy", "type": "procedure", "names": { "name": "Surrogacy", "aliases": [ "gestational surrogacy", "gestational carrier", "traditional surrogacy", "host surrogacy" ], "said": "US registers say gestational carrier. UK law says the surrogate, and calls her the mother until a court says otherwise. Agencies say journey, and price it as one." }, "etymology": { "root": "surrogate: Latin surrogare, to put in another's place — sub, in place of, plus rogare, to ask or propose, a word from Roman public law about substituting one officeholder for another. The pregnancy, not the parenthood, is what is substituted, and the two come apart in court.", "tier": "tradition", "note": "gestational surrogacy uses an embryo made from other people's gametes, so the surrogate is not genetically related to the child; traditional surrogacy uses her own egg. Statutes treat the two differently, and a price page usually means the first." }, "region": [ "global" ], "facets": { "family": "fertility", "setting": "staged", "anaesthesia": "varies" }, "text": { "what": "A woman carries a pregnancy for someone else. In the usual form an embryo is created by IVF from the intended parents' or donors' gametes and transferred to her; she has no genetic link to the child. The medical part is a frozen embryo transfer, which is an outpatient appointment. Everything expensive and everything contested is elsewhere: the screening, the insurance, the compensation, the contract, and the legal step that moves parenthood from the woman who gave birth to the people who commissioned the pregnancy.", "story": "Surrogacy is the case where the law does not merely change the price. It changes whether the thing exists.\n\nThe UK regulator states the English position in flat terms: a surrogate in the UK cannot be paid except for reasonable expenses; the agreement is not legally binding; the surrogate is the legal mother of the child unless a parental order is obtained, whatever the gametes were and whoever the intended parents are; and a foreign birth certificate naming the intended parents does not change any of that, because UK law recognises the surrogate as the legal parent until the order is made. Anything paid above reasonable expenses has to be authorised by the family court before an order can be granted.\n\nThe United States prices what England forbids. Circle Surrogacy publishes a fixed-cost programme at 189,500 US dollars covering agency fees, surrogate base compensation, screening, insurance and legal fees, with surrogate compensation stated at 60,000 to 75,000 dollars and above — and IVF and egg-donor costs explicitly outside the total, egg donors themselves running 30,000 to 60,000 dollars.\n\n*Inference —* the two paragraphs above are the same transaction viewed from two jurisdictions, and the gap between them is what generates the travel. Cohen's term for travelling to do lawfully abroad what is criminal at home is circumvention tourism; where the traveller feels pushed rather than pulled, Inhorn and Patrizio's word is exile. Which countries permit it, for whom, and under which instrument is the rule record's work, and it moves faster than any other law on this site.", "how": "Priced as a programme, not a procedure, and the programme is mostly other people's fees. The published US total separates into agency fee, surrogate compensation, medical insurance for the surrogate and the baby, screening, and legal fees for both sides — and then sets the IVF itself and any egg donor outside the total, which is the single largest exclusion on any price in this batch. Payment is staged against events rather than months: 56,500 dollars at sign-on and 133,000 dollars at match, on the published schedule.\n\nThe legal facts that decide the destination are three. Whether surrogacy is lawful at all for a non-resident. Whether payment beyond expenses is lawful, which separates a compensated market from an altruistic one and roughly decides the supply of surrogates. And how parenthood transfers: a pre-birth order in the destination, an adoption, or a home-country parental order obtained after the family returns, which is the UK route and which no foreign document replaces. A fourth question decides whether the child can leave at all — nationality and travel documents — and it is where cross-border arrangements fail in practice rather than in principle.\n\nThe clinical bill is small beside all of this and is bought separately. Reprofit in Brno prices the consultation and preparation of a frozen transfer for a patient using a surrogate and the patient's own imported embryos at 680 EUR, with the transfer itself another 815 EUR: twice the fee for the same preparation without a surrogate, and still a rounding error against the programme price.", "today": "As of September 2026 the one published all-in programme price read off a page for this record is 189,500 US dollars, with IVF and egg donation outside it. No European clinic page read for this batch publishes a surrogacy programme price; the Czech list prices only the embryo transfer and its preparation. The gap between a 189,500-dollar published total and an unpriceable one is a legal gap, not a market one.", "notes": "This page describes an arrangement and the published prices and rules attached to it. It is not legal advice and it is not medical advice. Which countries allow this, for whom, is on the rule record with its instruments and dates." }, "metrics": { "success_rate_pct": null, "note": "No success rate is carried: the registers read for this record count gestational-carrier transfers but do not publish a live-birth rate for them separately. The CDC's 2022 US national rows put 4.7% of all transfers as using a gestational carrier, rising with patient age from 3.1% under 35 to 9.6% over 40 — a share of transfers, not a share of patients and not a rate of anything succeeding.", "as_of": "2022", "source": "s:cdc-art-2022-summary", "url": "https://data.cdc.gov/Assisted-Reproductive-Technology-ART-/2022-Final-Assisted-Reproductive-Technology-ART-Su/9tjt-seye" }, "prices": [ { "procedure": "surrogacy", "country": "US", "amount": 189500, "currency": "USD", "as_of": "2026-09-16", "kind": "package", "includes": [ "surrogate compensation and expenses", "surrogacy agency fees", "medical insurance for the surrogate and the baby", "surrogate screening costs", "legal fees for surrogacy", "parental legal rights" ], "excludes": [ "IVF costs, paid directly to the clinic", "egg donor costs, stated at 30,000 to 60,000 USD" ], "source": "s:circle-surrogacy-cost", "url": "https://www.circlesurrogacy.com/intended-parents/process/surrogacy-cost", "note": "the agency's fixed-cost programme, read on 16 September 2026; the page carries no date of its own. Surrogate compensation is stated separately at 60,000 to 75,000 USD and above, inside the total. Payment is staged: 56,500 USD at sign-on, 133,000 USD at match. The exclusion of the IVF is the largest single exclusion on any price in this batch.", "tier": "cited", "usd": 189500.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "surrogacy", "country": "CZ", "city": "Brno", "amount": 680, "currency": "EUR", "as_of": "2026-01-01", "kind": "list", "includes": [ "consultation and preparation of frozen embryo transfer treatment for a patient with a surrogate mother, using the patient's own imported embryos" ], "excludes": [ "the frozen embryo transfer itself, listed at 815 EUR", "any arrangement with, or payment to, a surrogate" ], "source": "s:reprofit-pricelist-2026", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "note": "the same preparation without a surrogate is listed at 340 EUR on the same page: the clinic charges double for the paperwork of a third party. This is a clinical fee, not a surrogacy programme price, and the list carries no other surrogacy line.", "tier": "cited", "usd": 785.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "surrogacy-law", "as": "The rule that decides whether this exists at all in a given country, for whom, and at what payment.", "rel": "governed-by" }, { "to": "ivf", "as": "The treatment that makes the embryo, priced and bought separately from the programme.", "rel": "part" }, { "to": "egg-donation", "as": "Frequently the other purchase in the same arrangement, and excluded from the programme price alongside the IVF.", "rel": "kin" }, { "to": "pgt", "as": "Commonly added to embryos before a carrier transfer, and charged per embryo.", "rel": "kin" }, { "to": "circumvention-travel", "as": "The name for crossing a border to do what home law forbids.", "rel": "term" }, { "to": "reproductive-exile", "as": "The word for the same journey told from the traveller's side.", "rel": "term" }, { "to": "hfea", "as": "Publishes the UK position this record quotes: expenses only, no binding agreement, and a parental order after the birth.", "rel": "governs" }, { "to": "united-states", "as": "Where the one published all-in programme price on this page is sold.", "rel": "destination" }, { "to": "malpractice-recourse", "as": "Whose court hears it when an arrangement across two jurisdictions fails.", "rel": "risk" }, { "to": "deposit-and-refund", "as": "The staged payments, and what is returned when a journey ends between them.", "rel": "risk" } ], "confusable_with": [ { "id": "egg-donation", "tell": "Donation moves a gamete and ends at the transfer; surrogacy moves a pregnancy and ends in a court. A country can allow the first and criminalise the second." } ], "links": [ { "label": "HFEA — surrogacy", "url": "https://www.hfea.gov.uk/treatments/explore-all-treatments/surrogacy/" }, { "label": "Circle Surrogacy — cost", "url": "https://www.circlesurrogacy.com/intended-parents/process/surrogacy-cost" } ], "sources": [ "s:hfea-surrogacy", "s:circle-surrogacy-cost", "s:reprofit-pricelist-2026", "s:cdc-art-2022-summary", "s:cohen-circumvention-2012", "s:inhorn-patrizio-2009" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:hfea-surrogacy", "note": "the UK position and the US programme price are cited; the paragraph reading them against each other is marked Inference" }, "text.how": { "tier": "cited", "source": "s:circle-surrogacy-cost", "note": "the fourth point, on nationality and travel documents, is this project's summary of where such arrangements fail and is not attached to a named instrument here" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:cdc-art-2022-summary" }, "prices": { "tier": "cited", "source": "s:circle-surrogacy-cost" } } }, "x_commons_files": [ "File:Pregnant woman silhouette.svg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "A woman carries a pregnancy for someone else. In the usual form an embryo is created by IVF from the intended parents' or donors' gametes and transferred to her; she has no genetic link to the child.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "The rule that decides whether this exists at all in a given country, for whom, and at what payment.", "rel": "governed-by" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment that makes the embryo, priced and bought separately from the programme.", "rel": "part" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "Frequently the other purchase in the same arrangement, and excluded from the programme price alongside the IVF.", "rel": "kin" }, { "to": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "Commonly added to embryos before a carrier transfer, and charged per embryo.", "rel": "kin" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The name for crossing a border to do what home law forbids.", "rel": "term" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The word for the same journey told from the traveller's side.", "rel": "term" }, { "to": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "Publishes the UK position this record quotes: expenses only, no binding agreement, and a parental order after the birth.", "rel": "governs" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "Where the one published all-in programme price on this page is sold.", "rel": "destination" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "Whose court hears it when an arrangement across two jurisdictions fails.", "rel": "risk" }, { "to": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "The staged payments, and what is returned when a journey ends between them.", "rel": "risk" } ], "source_list": [ { "id": "s:hfea-surrogacy", "kind": "org", "title": "Surrogacy", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/treatments/explore-all-treatments/surrogacy/", "accessed": "2026-09-16" }, { "id": "s:circle-surrogacy-cost", "kind": "web", "title": "Surrogacy cost", "publisher": "Circle Surrogacy", "url": "https://www.circlesurrogacy.com/intended-parents/process/surrogacy-cost", "accessed": "2026-09-16" }, { "id": "s:reprofit-pricelist-2026", "kind": "web", "title": "Pricelist — Assisted Reproduction, valid from 01.01.2026 (document 0331.26ENG)", "publisher": "Reprofit International s.r.o., Brno", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "accessed": "2026-09-16", "note": "the clinic's own self-payer price list, five pages, each line naming its inclusions and its exclusions" }, { "id": "s:cdc-art-2022-summary", "kind": "dataset", "title": "2022 Final Assisted Reproductive Technology (ART) Summary", "publisher": "US Centers for Disease Control and Prevention", "url": "https://data.cdc.gov/Assisted-Reproductive-Technology-ART-/2022-Final-Assisted-Reproductive-Technology-ART-Su/9tjt-seye", "accessed": "2026-09-16", "note": "clinic-level and national rows; the national rows carry locationabbr NA. Queried through the Socrata endpoint https://data.cdc.gov/resource/9tjt-seye.json" }, { "id": "s:cohen-circumvention-2012", "kind": "paper", "title": "Circumvention Tourism", "publisher": "Cornell Law Review 97(6):1309 (Cohen IG)", "url": "https://scholarship.law.cornell.edu/clr/vol97/iss6/1", "accessed": "2026-09-16" }, { "id": "s:inhorn-patrizio-2009", "kind": "paper", "title": "Rethinking reproductive \"tourism\" as reproductive \"exile\"", "publisher": "Fertility and Sterility 92(3):904-906 (Inhorn MC, Patrizio P)", "url": "https://www.fertstert.org/article/S0015-0282(09)00046-6/fulltext", "accessed": "2026-09-16", "note": "citation and the authors' framing verified from the publisher's own article listing; the full text returned HTTP 403 and was not read" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:hfea-surrogacy", "note": "the UK position and the US programme price are cited; the paragraph reading them against each other is marked Inference" }, "text.how": { "tier": "cited", "source": "s:circle-surrogacy-cost", "note": "the fourth point, on nationality and travel documents, is this project's summary of where such arrangements fail and is not attached to a named instrument here" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:circle-surrogacy-cost" }, "metrics": { "tier": "cited", "source": "s:cdc-art-2022-summary" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "georgia", "type": "destination", "name": "Georgia", "as": "One of the treatments that brings patients here from countries that prohibit it.", "rel": "procedure" }, { "from": "greece", "type": "destination", "name": "Greece", "as": "The arrangement a Greek court authorises before it begins.", "rel": "procedure" }, { "from": "tbilisi", "type": "hub", "name": "Tbilisi", "as": "The treatment that brings most of this city's foreign traffic, and the one its law is the reason for.", "rel": "procedure" }, { "from": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "Commonly run before a carrier transfer, and excluded from the programme price along with the IVF.", "rel": "kin" }, { "from": "sperm-donation", "type": "procedure", "name": "Sperm donation", "as": "The other third-party arrangement, and the one whose law diverges hardest across borders.", "rel": "kin" }, { "from": "memorial-sisli", "type": "facility", "name": "Memorial Şişli Hospital", "as": "Turkish law bars third-party reproduction, so a fertility centre here sells its own citizens a narrower menu than its foreign patients may expect.", "rel": "contrast" }, { "from": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "The procedure these instruments govern.", "rel": "procedure" }, { "from": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The clearest case: lawful in one country, void or criminal in the next.", "rel": "procedure" }, { "from": "circumvention", "type": "story", "name": "Circumvention", "as": "The arrangement where the law does not change the price but decides whether the thing exists.", "rel": "procedure" } ] }, { "schema": 1, "id": "top-surgery", "type": "procedure", "names": { "name": "Top surgery", "aliases": [ "chest masculinisation", "chest reconstruction", "subcutaneous mastectomy", "double incision with free nipple graft", "keyhole top surgery", "periareolar top surgery" ], "said": "The phrase is the community's, not the profession's: top and bottom, meaning chest and genitals. Surgeons write subcutaneous mastectomy or chest wall masculinisation in the notes, and then write top surgery on the price list, because that is what the page is searched for." }, "etymology": { "root": "mastectomy: Greek mastos, breast, plus ektomē, a cutting out. Periareolar and areola: Latin areola, a small open space, the diminutive of area. The trade names are geometric rather than Greek — double incision, keyhole, inverted T — and each names the scar it leaves rather than the tissue it removes.", "tier": "tradition", "note": "Free nipple graft means the nipple is removed entirely and replaced as a graft, so it loses sensation and may lose colour; keyhole and periareolar techniques keep it attached. Two price lines that differ by a few hundred are often describing that difference." }, "region": [ "global", "southeast-asia", "europe-west", "north-america" ], "facets": { "family": "gender-affirming", "setting": "inpatient", "anaesthesia": "general" }, "text": { "what": "Breast tissue is removed and the chest is reshaped to a male contour. Where the breasts are small and the skin elastic, the work is done through the areola and the nipple stays attached; where they are larger, the skin envelope is cut away in a horizontal ellipse and the nipples are taken off, resized and replaced as grafts. Liposuction is often added at the sides. Drains come out in days, stitches in about a week, and the scars are permanent and visible.", "story": "This is the cheapest and commonest operation in the gender-affirming set, and it is the one that travels most easily: one general anaesthetic, a night or two on a ward, and a flight home inside a fortnight.\n\nThree countries publish a price for it and the three documents are not the same kind of thing. Yanhee Hospital in Bangkok lists a mastectomy at 111,000 baht with two nights, an inverted-T or inframammary version at 131,000, a nipple graft at 24,000 on top, and a surcharge of 25,500 where the patient weighs more than 70 kilogrammes — a table, priced by technique and by body, with no inclusion list at all. The London Transgender Clinic gives guide prices from £8,915 for the periareolar technique, £9,365 for double excision with free nipple graft and £12,415 with liposuction, every line reading \"Starts from\". The Gender Confirmation Center in San Francisco separates the surgeon's fee, at 8,500 to 11,500 dollars, from the whole, which it estimates at 14,000 to 17,000 dollars for a cash-paying patient, and adds a pathology charge it puts at 600 dollars.\n\n*Inference —* that third page is the useful one for reading the other two, because it shows where the missing money sits. A surgeon's fee is not a price. Facility and anaesthesia are quoted case by case, the laboratory that examines the removed tissue bills separately, and a list that quotes one of those three is quoting a third of a bill.\n\nThe same Bangkok table prices a different operation a few sections away. Under male breast reduction — gynaecomastia surgery, done on men with enlarged breast tissue — a mastectomy is 71,000 baht with one night, against 111,000 with two. The operation on the table is not identical, but the distance between those two rows is worth noticing on a page about what things cost.\n\nWhat sends people abroad for it is cost, waiting, and whether the system at home offers the operation to them at all. The last of those is administrative and legal and sits on this directory's gender-affirming care access page.", "how": "General anaesthesia, two to three hours, and a stay published as two nights on the Thai table and two to five nights on another Bangkok hospital's page depending on technique. That hospital also publishes the tail: sutures out at seven days, back to work after two weeks, full healing at four to six months. Compression binders are worn for weeks. The parts that need a clinician after the flight home are drain management where drains are still in, the nipple grafts, and haematoma, which declares itself early and needs a theatre.", "today": "As of 17 September 2026 the published prices read for this record run from 111,000 baht in Bangkok to 14,000-17,000 dollars in San Francisco, and the three pages disagree about what a price is: a table with nights attached, a guide price that starts from, and an estimate with the surgeon's fee itemised out of it. Nothing read for this record publishes what the revision rate is, and one of the three publishes what a revision costs.", "notes": "This page describes an operation. It is not advice about whether to have one, or where." }, "metrics": { "stay_days": 2, "days_before_flying": null, "recovery_weeks": null, "note": "Two nights is the ward stay attached to the mastectomy rows on the Yanhee price table; Kamol Cosmetic Hospital publishes two to five nights depending on technique, sutures removed at seven days, return to work after two weeks and full healing at four to six months. No source read here states a wait before flying.", "as_of": "2026-09-17", "source": "s:yanhee-plastic-prices", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/" }, "prices": [ { "procedure": "top-surgery", "country": "TH", "city": "Bangkok", "amount": 111000, "amount_high": 131000, "currency": "THB", "as_of": "2026-09-17", "kind": "list", "includes": [ "2 nights in hospital, as stated in the nights column" ], "excludes": [ "nipple graft, listed separately at 24,000", "nipple reduction at 36,000", "an added 25,500 where body weight is over 70 kg", "everything else: the page carries no inclusion list" ], "source": "s:yanhee-plastic-prices", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "note": "listed as STAGE 1: Mastectomy at 111,000, with the inverted T scar and inframammary approach versions both at 131,000. The table carries no validity date. A separate section of the same table prices a mastectomy for gynaecomastia at 71,000 with one night.", "tier": "cited", "usd": 3334.0, "usd_high": 3935.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "top-surgery", "country": "GB", "city": "London", "amount": 8915, "amount_high": 12415, "currency": "GBP", "as_of": "2026-09-17", "kind": "quoted-range", "includes": [ "a formal quotation is stated to include the treatment, aftercare and the hospital stay where required" ], "excludes": [ "the initial face-to-face consultation at £250", "any exact price before that consultation" ], "source": "s:ltc-price-list", "url": "https://www.thelondontransgenderclinic.uk/price-list/", "note": "periareolar incision from £8,915, double excision with free nipple graft from £9,365, with liposuction from £12,415. Every line reads Starts from and the page states guide prices are subject to change.", "tier": "cited", "usd": 12014.0, "usd_high": 16731.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "top-surgery", "country": "US", "city": "San Francisco", "amount": 14000, "amount_high": 17000, "currency": "USD", "as_of": "2024-03-13", "kind": "estimate", "includes": [ "the practice's estimate of a total for a cash-paying patient", "a compression binder and wound care, stated to be provided free" ], "excludes": [ "pathology testing, stated at 600 dollars and required for everything but revisions", "facility and anaesthesiology fees, quoted case by case", "scar management: silicone products at 15 to 150 dollars, steroid injections at 150 a treatment after the first three", "accommodation and post-operative care services, stated at 250 to 2,500 dollars a day" ], "source": "s:gcc-top-surgery-price", "url": "https://www.genderconfirmation.com/top-surgery-price/", "note": "on a page marked medically reviewed 13 March 2024. The surgeon's fee alone is given as 8,500 to 11,500 dollars for chest reconstruction and 1,500 to 3,000 for a revision; the gap between that fee and the 14,000-17,000 total is the rest of the bill, itemised.", "tier": "cited", "usd": 14000.0, "usd_high": 17000.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "gender-affirming-care-access", "as": "Whether this is offered, funded or permitted at home — the reason the flight exists.", "rel": "governed-by" }, { "to": "vaginoplasty", "as": "The other end of the same price list, at four times the money and nine nights.", "rel": "kin" }, { "to": "phalloplasty", "as": "Stage one before it on the Thai list, and a precondition on a Bangkok hospital's candidacy page.", "rel": "kin" }, { "to": "breast-augmentation", "as": "The mirror operation, priced by implant on the same tables.", "rel": "contrast" }, { "to": "thailand", "as": "Where the table that prices this by technique, scar and body weight is published.", "rel": "destination" }, { "to": "united-kingdom", "as": "Where a private list publishes guide prices and a queue sends people to look at them.", "rel": "destination" }, { "to": "united-states", "as": "Where a practice publishes the surgeon's fee and the total separately, which is what makes the other lists readable.", "rel": "destination" }, { "to": "reading-the-exclusions", "as": "A surgeon's fee, a facility fee and a pathology charge are three different numbers and two of them are usually missing.", "rel": "step" }, { "to": "flying-after-surgery", "as": "What sets the earliest sensible flight after a general anaesthetic and a chest wound.", "rel": "risk" }, { "to": "revision-at-home", "as": "Haematoma and graft loss declare themselves in the first fortnight, often after the flight.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Who takes the drains out, and who looks at the scars at six weeks.", "rel": "risk" }, { "to": "insurance-exclusions", "as": "Whether a policy covers this at home is what decides whether the cash price matters at all.", "rel": "rule" } ], "confusable_with": [ { "id": "breast-augmentation", "tell": "Both are chest surgery and both sit on the same clinic price lists; one removes tissue and leaves a scar across the chest, the other adds an implant that is itself a separate purchase." } ], "links": [ { "label": "Yanhee Hospital plastic surgery price table", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/" }, { "label": "The London Transgender Clinic price list", "url": "https://www.thelondontransgenderclinic.uk/price-list/" }, { "label": "Gender Confirmation Center — top surgery price", "url": "https://www.genderconfirmation.com/top-surgery-price/" } ], "sources": [ "s:yanhee-plastic-prices", "s:ltc-price-list", "s:gcc-top-surgery-price", "s:kamol-top-surgery" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:yanhee-plastic-prices", "note": "the three price documents are read off their own pages; the paragraph reading them against each other is marked Inference" }, "text.how": { "tier": "cited", "source": "s:kamol-top-surgery" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:yanhee-plastic-prices" }, "metrics": { "tier": "cited", "source": "s:yanhee-plastic-prices" } } }, "x_commons_files": [ "File:Transgender Pride flag.svg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "Breast tissue is removed and the chest is reshaped to a male contour.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "gender-affirming-care-access", "type": "rule", "name": "Access to gender-affirming care", "as": "Whether this is offered, funded or permitted at home — the reason the flight exists.", "rel": "governed-by" }, { "to": "vaginoplasty", "type": "procedure", "name": "Vaginoplasty", "as": "The other end of the same price list, at four times the money and nine nights.", "rel": "kin" }, { "to": "phalloplasty", "type": "procedure", "name": "Phalloplasty", "as": "Stage one before it on the Thai list, and a precondition on a Bangkok hospital's candidacy page.", "rel": "kin" }, { "to": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "The mirror operation, priced by implant on the same tables.", "rel": "contrast" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the table that prices this by technique, scar and body weight is published.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Where a private list publishes guide prices and a queue sends people to look at them.", "rel": "destination" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "Where a practice publishes the surgeon's fee and the total separately, which is what makes the other lists readable.", "rel": "destination" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "A surgeon's fee, a facility fee and a pathology charge are three different numbers and two of them are usually missing.", "rel": "step" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "What sets the earliest sensible flight after a general anaesthetic and a chest wound.", "rel": "risk" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Haematoma and graft loss declare themselves in the first fortnight, often after the flight.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Who takes the drains out, and who looks at the scars at six weeks.", "rel": "risk" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "Whether a policy covers this at home is what decides whether the cash price matters at all.", "rel": "rule" } ], "source_list": [ { "id": "s:yanhee-plastic-prices", "kind": "web", "title": "Plastic Surgery Prices", "publisher": "Yanhee Hospital, Bangkok", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "accessed": "2026-09-16", "note": "hospital's own price table: procedure, nights, price in Thai baht. The page carries no validity date and no inclusion list." }, { "id": "s:ltc-price-list", "kind": "web", "title": "Price List — surgery, facial feminisation, MTF GCS/SRS, body masculinisation", "publisher": "The London Transgender Clinic, London", "url": "https://www.thelondontransgenderclinic.uk/price-list/", "accessed": "2026-09-17", "note": "read with the browser tools. Every surgical line is prefixed 'Starts from'. The page states that an exact price cannot be given before consultation, that a formal quotation covers treatment, aftercare and the hospital stay where required, and that guide prices are subject to change. It carries no date. There is no phalloplasty or metoidioplasty row on it." }, { "id": "s:gcc-top-surgery-price", "kind": "web", "title": "How Much is Top Surgery: A Detailed Guide", "publisher": "Gender Confirmation Center, San Francisco; page marked medically reviewed 13 March 2024", "url": "https://www.genderconfirmation.com/top-surgery-price/", "accessed": "2026-09-16", "note": "cash-pay estimates, separating the surgeon's fee from facility and anaesthesia fees" }, { "id": "s:kamol-top-surgery", "kind": "web", "title": "Top Surgery / Mastectomy — techniques, stay and recovery", "publisher": "Kamol Cosmetic Hospital, Bangkok", "url": "https://kamolhospital.com/services/top-surgery-mastectomy/", "accessed": "2026-09-17", "note": "states a stay of 2-5 nights depending on technique, suture removal at 7 days, return to work after 2 weeks and full healing at 4-6 months. No price is published on the page." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:yanhee-plastic-prices", "note": "the three price documents are read off their own pages; the paragraph reading them against each other is marked Inference" }, "text.how": { "tier": "cited", "source": "s:kamol-top-surgery" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:yanhee-plastic-prices" }, "metrics": { "tier": "cited", "source": "s:yanhee-plastic-prices" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "phalloplasty", "type": "procedure", "name": "Phalloplasty", "as": "Stage one on the same Thai list, at a quarter of the price and two nights.", "rel": "kin" }, { "from": "vaginoplasty", "type": "procedure", "name": "Vaginoplasty", "as": "Usually the first operation and usually the cheapest, on the same price lists.", "rel": "kin" }, { "from": "gender-affirming-care-access", "type": "rule", "name": "Access to gender-affirming care", "as": "The third, and the one most often bought abroad.", "rel": "procedure" } ] }, { "schema": 1, "id": "vaginoplasty", "type": "procedure", "names": { "name": "Vaginoplasty", "aliases": [ "gender-affirming vaginoplasty", "genital reconstruction", "sex reassignment surgery", "SRS", "GCS", "penile inversion vaginoplasty", "peritoneal vaginoplasty" ], "said": "Surgeons name the technique, because the technique sets the price: penile inversion, scrotal skin graft, sigmoid colon, peritoneal flap. Thai price lists say gender affirmation surgery by, then the technique. A London list says gender confirmation surgery. The older trade term is SRS and it is still what most price pages are indexed under." }, "etymology": { "root": "vagina: Latin vagina, a sheath or scabbard, the word a Roman would use for the thing a sword goes into; applied to the anatomy by sixteenth-century anatomists. Plus -plasty, Greek plastos, moulded. Vulvoplasty and its sibling zero-depth use the same suffix on vulva, Latin for womb or covering.", "tier": "tradition", "note": "The same word names two different operations. In cosmetic surgery vaginoplasty means tightening an existing vagina, and most pages returned by a search for the price of a vaginoplasty in Türkiye are selling that. On this page vaginoplasty means constructing one. A price page that does not say which is not comparable to either." }, "region": [ "global", "southeast-asia", "west-asia", "europe-west", "north-america" ], "facets": { "family": "gender-affirming", "setting": "inpatient", "anaesthesia": "general" }, "text": { "what": "The testes are removed, the penile and scrotal tissue is dismantled, and a vaginal canal is made in the space between the bladder and the rectum, lined with penile skin turned inside out, with a scrotal skin graft, with a segment of sigmoid colon, or with peritoneum drawn down from the abdomen. A clitoris is built from glans tissue on its own nerve, the urethra is shortened and repositioned, and labia are formed from the remaining skin. The canal is held open afterwards by dilation, which is a daily obligation for a long period and then a permanent one.", "story": "Thailand has taken this operation for fifty years and it is the only country in this directory where a hospital publishes a full table of prices for it by technique. Yanhee Hospital in Bangkok lists nine nights and 420,000 baht for the skin-graft version, 580,000 for a sigmoid colon vaginoplasty, and 780,000 for the peritoneal ones. The same table prices the revisions — a failed colovaginoplasty replaced with a skin graft at 765,000 baht, a recto-neovaginal fistula repaired at 965,000 — which is a rarer piece of publication than the primary prices, and the two columns belong together.\n\nOther long-established Thai clinics publish nothing. The Suporn Clinic in Chonburi states that it does not publish prices, and sets out a deposit and cancellation schedule instead. Chettawut Plastic Surgery Center in Bangkok publishes no package figure either; the only number on its surgery FAQ is an extra charge of 32,000 baht where the scrotal skin turns out to be insufficient and a groin graft is needed. Kamol Cosmetic Hospital names five techniques with their operating times and a stay of four to six nights, and no price at all.\n\n*Inference —* that split is the useful thing on this page. Where a clinic's patients arrive through word of mouth in a community, the price is quoted in correspondence; where they arrive through a search engine, it is on the page. Neither pattern says anything about the surgery.\n\nAt the other end, what is published in London and San Francisco is a guide rather than a price. The London Transgender Clinic's list starts gender confirmation surgery at £31,160 for the penile-scrotal flap technique and £34,310 for colovaginoplasty, every line prefixed \"Starts from\", and states plainly that no exact price can be given before a consultation. The Gender Confirmation Center in San Francisco estimates vaginoplasty at 23,000 to 24,500 dollars and says hospital stay, in-hospital supplies and occupational therapy go into the quote while medications and travel do not.\n\nThree things move this operation across borders: what it costs, how long the queue is at home, and whether the health system at home will do it at all. The third is law and administration rather than surgery, and it is on this directory's gender-affirming care access page, not here.", "how": "General anaesthesia, four to six hours by most published technique lists, and hospital stays that run longer than almost anything else in this directory: nine nights on the Thai price table, four to six on another Bangkok hospital's page. Permanent hair removal on the donor skin is done for months beforehand, not after. The canal is packed, then dilated: Chettawut's published instruction is a daily dilation routine for two years to hold the depth, dropping to two or three times a week after that, \"for life\". Discharge from hospital is not the end of the stay abroad — the first post-operative weeks belong to the surgeon who operated, and the stitches, the packing and the first complications all fall inside them.", "today": "As of 17 September 2026 the prices read off provider pages for this record span three countries and three kinds of document: a Thai hospital's fixed table with nights attached, a London clinic's guide prices with \"Starts from\" on every line, and a US practice's estimate with an inclusion sentence. None of the three publishes what a revision costs at home, and only the Thai table publishes what a revision costs where the operation was done." }, "metrics": { "stay_days": 9, "days_before_flying": null, "recovery_weeks": null, "note": "Nine nights is the ward stay attached to every primary gender affirmation surgery row on the Yanhee price table, not a clinical standard; Kamol Cosmetic Hospital's page states four to six nights for its own techniques. No source read for this record publishes a wait before flying. Dilation, not the flight, is what sets the shape of the months after.", "as_of": "2026-09-17", "source": "s:yanhee-plastic-prices", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/" }, "prices": [ { "procedure": "vaginoplasty", "country": "TH", "city": "Bangkok", "amount": 420000, "currency": "THB", "as_of": "2026-09-17", "kind": "list", "includes": [ "9 nights in hospital, as stated in the nights column" ], "excludes": [ "the page states no inclusion list at all beyond the nights", "hair removal beforehand", "accommodation outside the hospital", "flights and the weeks in Bangkok after discharge" ], "source": "s:yanhee-plastic-prices", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "note": "listed as Gender Affirmation Surgery by Labia (Skin Graft). The table carries no validity date and no inclusion list; the nights column is the only thing attached to the number.", "tier": "cited", "usd": 12615.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "vaginoplasty", "country": "TH", "city": "Bangkok", "amount": 580000, "amount_high": 820000, "currency": "THB", "as_of": "2026-09-17", "kind": "list", "includes": [ "9 nights in hospital" ], "excludes": [ "as above — nothing else is named" ], "source": "s:yanhee-plastic-prices", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "note": "the bowel and peritoneal techniques on the same table: colonvaginoplasty 580,000, penile-peritoneal and full-length peritoneal flap 780,000 each, laparoscopic colonvaginoplasty 820,000. Revisions are priced separately and can exceed the primary: replacing a failed colovaginoplasty with a skin graft is listed at 765,000 and repairing a recto-neovaginal fistula at 965,000.", "tier": "cited", "usd": 17420.0, "usd_high": 24629.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "vaginoplasty", "country": "GB", "city": "London", "amount": 31160, "amount_high": 34310, "currency": "GBP", "as_of": "2026-09-17", "kind": "quoted-range", "includes": [ "a formal quotation is stated to include the treatment, aftercare and the hospital stay where required" ], "excludes": [ "the initial face-to-face consultation, listed separately at £250", "any price certainty before that consultation" ], "source": "s:ltc-price-list", "url": "https://www.thelondontransgenderclinic.uk/price-list/", "note": "the clinic's guide prices: penile scrotal flat technique from £31,160, colovaginoplasty from £34,310. Vulvoplasty, the zero-depth operation, is listed separately from £18,935 and orchidectomy from £6,765. Every line reads Starts from, and the page states that guide prices are subject to change.", "tier": "cited", "usd": 41993.0, "usd_high": 46238.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "vaginoplasty", "country": "US", "city": "San Francisco", "amount": 23000, "amount_high": 24500, "currency": "USD", "as_of": "2024-10-15", "kind": "estimate", "includes": [ "hospital stays", "post-operative supplies while in the hospital", "occupational therapy" ], "excludes": [ "medications", "travel" ], "source": "s:gcc-bottom-surgery-cost", "url": "https://www.genderconfirmation.com/bottom-surgery-cost/", "note": "the practice's own cash-pay estimate, on a page marked medically reviewed 15 October 2024. Vulvaplasty is estimated separately at 20,500 to 22,000 dollars. The page's inclusion sentence is what the quote will contain, not what the number above covers.", "tier": "cited", "usd": 23000.0, "usd_high": 24500.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "gender-affirming-care-access", "as": "Whether the health system at home will do this, pay for it, or permit it — the third reason the operation travels.", "rel": "governed-by" }, { "to": "phalloplasty", "as": "The other genital operation, staged where this one is single, and priced by the stage.", "rel": "contrast" }, { "to": "top-surgery", "as": "Usually the first operation and usually the cheapest, on the same price lists.", "rel": "kin" }, { "to": "thailand", "as": "Where the only full published table of prices by technique is sold.", "rel": "destination" }, { "to": "bangkok", "as": "The city holding the hospital that publishes those prices, and two long-established clinics that publish none.", "rel": "hub" }, { "to": "united-kingdom", "as": "Where a private list quotes guide prices roughly three times the Bangkok table, and states it cannot quote at all before a consultation.", "rel": "destination" }, { "to": "revision-at-home", "as": "Who repairs a fistula or a lost depth, and where the price for that is published.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Dilation is a two-year daily instruction, and nobody abroad supervises it.", "rel": "risk" }, { "to": "reading-the-exclusions", "as": "The step at which a price with a nights column and no inclusion list has to be read.", "rel": "step" }, { "to": "the-companion", "as": "Nine nights in hospital and weeks in the city afterwards are an escort's calendar too.", "rel": "step" }, { "to": "malpractice-recourse", "as": "Where a claim goes when the operation was performed in another jurisdiction.", "rel": "risk" }, { "to": "circumvention-travel", "as": "The word for crossing a border to obtain what home law or a home waiting list withholds.", "rel": "term" } ], "confusable_with": [ { "id": "top-surgery", "tell": "Chest surgery and genital surgery are separate operations, separately priced and often years apart; a clinic advertising gender surgery may do one and not the other." } ], "links": [ { "label": "Yanhee Hospital plastic surgery price table", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/" }, { "label": "The London Transgender Clinic price list", "url": "https://www.thelondontransgenderclinic.uk/price-list/" }, { "label": "Kamol Cosmetic Hospital — techniques and stay", "url": "https://kamolhospital.com/services/gender-reassignment-surgery-srs/" } ], "sources": [ "s:yanhee-plastic-prices", "s:ltc-price-list", "s:gcc-bottom-surgery-cost", "s:kamol-srs", "s:chettawut-srs-faq", "s:suporn-patient-administration" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:yanhee-plastic-prices", "note": "every price and every clinic's publication policy is read off the named page; the paragraph about why some publish and some do not is marked Inference" }, "text.how": { "tier": "cited", "source": "s:kamol-srs", "note": "operating times and stay from the hospital page; the dilation schedule is quoted from the Chettawut FAQ" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:yanhee-plastic-prices" }, "metrics": { "tier": "cited", "source": "s:yanhee-plastic-prices" } } }, "x_commons_files": [ "File:Gender symbols side by side.svg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "The testes are removed, the penile and scrotal tissue is dismantled, and a vaginal canal is made in the space between the bladder and the rectum, lined with penile skin turned inside out, with a scrotal skin graft, with…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" }, { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "gender-affirming-care-access", "type": "rule", "name": "Access to gender-affirming care", "as": "Whether the health system at home will do this, pay for it, or permit it — the third reason the operation travels.", "rel": "governed-by" }, { "to": "phalloplasty", "type": "procedure", "name": "Phalloplasty", "as": "The other genital operation, staged where this one is single, and priced by the stage.", "rel": "contrast" }, { "to": "top-surgery", "type": "procedure", "name": "Top surgery", "as": "Usually the first operation and usually the cheapest, on the same price lists.", "rel": "kin" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the only full published table of prices by technique is sold.", "rel": "destination" }, { "to": "bangkok", "type": "hub", "name": "Bangkok", "as": "The city holding the hospital that publishes those prices, and two long-established clinics that publish none.", "rel": "hub" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Where a private list quotes guide prices roughly three times the Bangkok table, and states it cannot quote at all before a consultation.", "rel": "destination" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who repairs a fistula or a lost depth, and where the price for that is published.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Dilation is a two-year daily instruction, and nobody abroad supervises it.", "rel": "risk" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step at which a price with a nights column and no inclusion list has to be read.", "rel": "step" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "Nine nights in hospital and weeks in the city afterwards are an escort's calendar too.", "rel": "step" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "Where a claim goes when the operation was performed in another jurisdiction.", "rel": "risk" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The word for crossing a border to obtain what home law or a home waiting list withholds.", "rel": "term" } ], "source_list": [ { "id": "s:yanhee-plastic-prices", "kind": "web", "title": "Plastic Surgery Prices", "publisher": "Yanhee Hospital, Bangkok", "url": "https://www.yanhee.net/pricing-packages/plastic-surgery-prices/", "accessed": "2026-09-16", "note": "hospital's own price table: procedure, nights, price in Thai baht. The page carries no validity date and no inclusion list." }, { "id": "s:ltc-price-list", "kind": "web", "title": "Price List — surgery, facial feminisation, MTF GCS/SRS, body masculinisation", "publisher": "The London Transgender Clinic, London", "url": "https://www.thelondontransgenderclinic.uk/price-list/", "accessed": "2026-09-17", "note": "read with the browser tools. Every surgical line is prefixed 'Starts from'. The page states that an exact price cannot be given before consultation, that a formal quotation covers treatment, aftercare and the hospital stay where required, and that guide prices are subject to change. It carries no date. There is no phalloplasty or metoidioplasty row on it." }, { "id": "s:gcc-bottom-surgery-cost", "kind": "web", "title": "A Comprehensive Guide to Bottom Surgery Costs", "publisher": "Gender Confirmation Center, San Francisco; page marked medically reviewed 15 October 2024", "url": "https://www.genderconfirmation.com/bottom-surgery-cost/", "accessed": "2026-09-16", "note": "a surgical practice's own published estimates, with its inclusion and exclusion list and its policy that phalloplasty is not offered to cash-paying patients" }, { "id": "s:kamol-srs", "kind": "web", "title": "Gender Reassignment Surgery / SRS — techniques and hospital stay", "publisher": "Kamol Cosmetic Hospital, Bangkok", "url": "https://kamolhospital.com/services/gender-reassignment-surgery-srs/", "accessed": "2026-09-17", "note": "five named techniques with operating times, and a stated stay of 4-6 nights. No price is published on the page." }, { "id": "s:chettawut-srs-faq", "kind": "web", "title": "Frequently asked questions of sex reassignment surgery", "publisher": "Chettawut Plastic Surgery Center, Bangkok", "url": "https://www.chet-plasticsurgery.com/frequent-asked-questions-of-sex-reassignment-surgery/", "accessed": "2026-09-17", "note": "publishes no package price; the only figure on the page is an extra charge of 32,000 THB where additional groin skin grafting is needed. States the dilation schedule: daily for two years to maintain depth, then two to three times a week, for life." }, { "id": "s:suporn-patient-administration", "kind": "web", "title": "Patient administration", "publisher": "Suporn Clinic, Chonburi, Thailand", "url": "https://supornclinic.com/patient-administration/", "accessed": "2026-09-16", "note": "a long-established destination clinic stating that it does not publish prices, and setting out its deposit, payment and cancellation schedule" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:yanhee-plastic-prices", "note": "every price and every clinic's publication policy is read off the named page; the paragraph about why some publish and some do not is marked Inference" }, "text.how": { "tier": "cited", "source": "s:kamol-srs", "note": "operating times and stay from the hospital page; the dilation schedule is quoted from the Chettawut FAQ" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited", "source": "s:yanhee-plastic-prices" }, "metrics": { "tier": "cited", "source": "s:yanhee-plastic-prices" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "bangkok", "type": "hub", "name": "Bangkok", "as": "Bangkok surgeons took this work early, and the city is still where much of it is quoted.", "rel": "procedure" }, { "from": "phuket", "type": "hub", "name": "Phuket", "as": "Thai surgeons took this work up early, and some of it is quoted on the island.", "rel": "procedure" }, { "from": "phalloplasty", "type": "procedure", "name": "Phalloplasty", "as": "The other genital operation: one admission against this one's four.", "rel": "contrast" }, { "from": "top-surgery", "type": "procedure", "name": "Top surgery", "as": "The other end of the same price list, at four times the money and nine nights.", "rel": "kin" }, { "from": "gender-affirming-care-access", "type": "rule", "name": "Access to gender-affirming care", "as": "One of the operations these instruments reach.", "rel": "procedure" } ] }, { "schema": 1, "id": "veneers", "type": "procedure", "names": { "name": "Dental veneers", "aliases": [ "porcelain veneer", "composite veneer", "laminate veneer", "smile makeover" ], "said": "Sold by the tooth and bought by the set. A price list says one veneer; a patient means eight, ten or twenty, and the trade calls that a smile makeover." }, "etymology": { "root": "veneer: from German furnieren, to furnish or overlay, by way of French fournir — a thin facing laid over something plainer, borrowed from cabinetmaking into dentistry in the twentieth century. Laminate is Latin lamina, a thin plate.", "tier": "tradition", "note": "Composite veneers are built up on the tooth in the chair; porcelain and lithium disilicate veneers are made in a laboratory and bonded on. The two words sit in the same column of a price list at a third of the price apart." }, "region": [ "global" ], "facets": { "family": "dental", "setting": "day-case", "anaesthesia": "local" }, "text": { "what": "A thin facing is bonded to the front of a tooth, usually after some enamel is removed. Composite versions are shaped in the chair in one visit; porcelain and glass-ceramic ones are made in a laboratory and fitted at a second appointment. Cosmetic in most jurisdictions, which is why no state schedule read for this record pays for them.", "story": "Veneers are the dental procedure that travels as a set, and the price lists know it.\n\nBangkok International Dental Center prices a porcelain e.max veneer at 17,000 baht for one to five teeth and 16,000 for six or more, against a struck-through 19,000 — the discount arriving exactly at the sixth tooth. Composite veneers on the same page run 6,000 to 7,000 baht, and its Exaclear composite drops from 8,000 to 7,000 at the same threshold. Super-thin veneers are 18,000 to 19,000.\n\nMedicare Dental Clinic in Budapest prints the ceramic veneer as €227 of treatment plus €152 of laboratory work, and the full porcelain veneer at €237 plus €157 — the same two-line habit it applies to crowns, and within a few euro of its own crown prices.\n\nSani Dental Group in Los Algodones lists a porcelain veneer at $450 and a zirconia veneer at $490, each against a US comparison column — $1,100 and $1,500 — of the clinic's own making.\n\nIndex Medica in Kraków lists a porcelain veneer at £549 against what it calls an average UK price of £1,125, and a ceramic veneer at €575 against €1,249 for Ireland.\n\n*Inference —* multiply by the set. Ten upper teeth at the Bangkok six-or-more rate is 160,000 baht; ten in Budapest is €3,940 with the laboratory fees; ten in Los Algodones is $4,500. The per-tooth figure is the only one any of these pages publishes, and it is not the figure anyone pays.", "how": "Shade taken, enamel reduced by a fraction of a millimetre, impressions or scans sent to a laboratory, temporaries fitted, and the set bonded on at a second visit — which for a foreign patient means either a stay of several days or a second flight. Composite veneers avoid the laboratory and the wait, and are quoted at a third to a quarter of the porcelain price on the pages read for this record.\n\nNo state schedule read here pays for any of it. The English NHS charge bands make no provision for cosmetic veneers, and the Australian schedule that pays for a cataract lens explicitly excludes surgery to correct appearance. Veneers are an out-of-pocket purchase wherever they are bought.", "today": "As of 17 September 2026 a single veneer is published at 6,000 to 19,000 baht in Bangkok depending on material and count, €379 to €394 including laboratory fee in Budapest, $450 to $490 in Los Algodones and £549 in Kraków. Every one of those prices is for one tooth.", "notes": "This page describes a dental procedure and the prices published for it. It is not dental advice." }, "metrics": { "stay_days": 0, "days_before_flying": null, "recovery_weeks": null, "note": "Clinic appointments, not an admission. The interval between preparation and fitting — the figure that decides whether a set of veneers is one trip or two — is stated on none of the four price pages read for this record.", "as_of": "2026-09-17", "source": "s:bidc-fees", "url": "https://bangkokdentalcenter.com/fees/" }, "prices": [ { "procedure": "veneers", "country": "TH", "city": "Bangkok", "amount": 6000, "amount_high": 19000, "currency": "THB", "as_of": "2026-09-17", "kind": "list", "includes": [ "one veneer, by material: composite 6,000 to 7,000; Exaclear composite 8,000 for one to five teeth and 7,000 for six or more; porcelain e.max 17,000 and 16,000 on the same scale; super-thin 18,000 to 19,000" ], "excludes": [ "x-rays, medications, sterilisation, nursing fees and clinic service fees, charged separately", "every tooth after the first" ], "source": "s:bidc-fees", "url": "https://bangkokdentalcenter.com/fees/", "note": "the e.max and Exaclear rows are printed against struck-through figures of 19,000 and 10,000, and both drop at the sixth tooth — the page is written for patients buying a set. Package rates stated applicable till 30 September 2026.", "tier": "cited", "usd": 180.0, "usd_high": 571.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "veneers", "country": "HU", "city": "Budapest", "amount": 379, "amount_high": 394, "currency": "EUR", "as_of": "2026-09-17", "kind": "list", "includes": [ "ceramic (zirconium) veneer at €227 treatment plus €152 fabrication; full porcelain veneer at €237 plus €157" ], "excludes": [ "nothing stated beyond the treatment-and-laboratory split" ], "source": "s:mdental-budapest-prices", "url": "https://www.mdentalclinic.eu/prices", "note": "within a few euro of the same clinic's crown prices, which is what a veneer is: the same laboratory, less tooth removed.", "tier": "cited", "usd": 437.0, "usd_high": 455.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "veneers", "country": "MX", "city": "Los Algodones", "amount": 450, "amount_high": 490, "currency": "USD", "as_of": "2026-09-17", "kind": "list", "includes": [ "one porcelain veneer at $450 or one zirconia veneer at $490" ], "excludes": [ "every tooth after the first" ], "source": "s:sani-dental-prices", "url": "https://sanidentalgroup.com/price-list", "note": "MXN $9,000 and $9,800 printed beside the dollar figures, with a US comparison column of $1,100 and $1,500 that carries no source. The page states all prices are a base or starting price.", "tier": "cited", "usd": 450.0, "usd_high": 490.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "veneers", "country": "PL", "city": "Kraków", "amount": 549, "currency": "GBP", "as_of": "2026-09-17", "kind": "list", "includes": [ "one porcelain veneer; examination, x-rays and local anaesthetic listed as free" ], "excludes": [ "every tooth after the first" ], "source": "s:indexmedica-prices", "url": "https://www.indexmedica.com/prices/", "note": "£549 against a column the clinic labels average UK price at £1,125; the euro table gives €575 against an Irish comparison of €1,249. A deposit of 80% of each stage is due on signing the treatment plan.", "tier": "cited", "usd": 740.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "dental-crown", "as": "The full cover, at much the same laboratory price and with far more tooth cut away.", "rel": "contrast" }, { "to": "full-mouth-restoration", "as": "What a set of these becomes when the back teeth are included.", "rel": "whole" }, { "to": "dental-implant", "as": "The other half of a dental travel bill, and the one that needs months rather than days.", "rel": "kin" }, { "to": "thailand", "as": "Where the veneer price drops at the sixth tooth.", "rel": "destination" }, { "to": "hungary", "as": "Where the veneer and the crown are priced within a few euro of each other.", "rel": "destination" }, { "to": "mexico", "as": "Where the veneer is quoted against a US comparison the clinic supplies.", "rel": "destination" }, { "to": "poland", "as": "Where the comparison column is labelled average UK price.", "rel": "destination" }, { "to": "budapest", "as": "The city whose clinics built the European dental trade on work like this.", "rel": "place" }, { "to": "insurance-exclusions", "as": "The reason no payer schedule read for this page carries a line for veneers.", "rel": "rule" }, { "to": "getting-a-quote", "as": "The step where one tooth becomes ten and the quote multiplies.", "rel": "step" }, { "to": "revision-at-home", "as": "Who rebonds a veneer that debonds after the flight, and at whose price.", "rel": "risk" } ], "confusable_with": [ { "id": "dental-crown", "tell": "A veneer faces the front of the tooth; a crown wraps all of it. Price lists put them in adjacent rows at similar figures, and the difference is how much tooth is left underneath." } ], "links": [ { "label": "BIDC dental fees", "url": "https://bangkokdentalcenter.com/fees/" }, { "label": "Sani Dental Group price list", "url": "https://sanidentalgroup.com/price-list" } ], "sources": [ "s:bidc-fees", "s:mdental-budapest-prices", "s:sani-dental-prices", "s:indexmedica-prices", "s:mbs-42702" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:bidc-fees", "note": "figures read off each clinic's own page on the accessed date; the multiplication at the end is marked as this project's arithmetic" }, "text.how": { "tier": "tradition", "note": "standard veneer sequence; the exclusion from state schedules is cited to the NHS bands and the Australian item descriptor" }, "etymology": { "tier": "tradition" }, "metrics": { "tier": "cited", "source": "s:bidc-fees" }, "prices": { "tier": "cited" } } }, "x_commons_files": [ "File:Dental veneers.jpg", "File:Porcelain veneer.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "A thin facing is bonded to the front of a tooth, usually after some enamel is removed.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "The full cover, at much the same laboratory price and with far more tooth cut away.", "rel": "contrast" }, { "to": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "What a set of these becomes when the back teeth are included.", "rel": "whole" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The other half of a dental travel bill, and the one that needs months rather than days.", "rel": "kin" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the veneer price drops at the sixth tooth.", "rel": "destination" }, { "to": "hungary", "type": "destination", "name": "Hungary", "as": "Where the veneer and the crown are priced within a few euro of each other.", "rel": "destination" }, { "to": "mexico", "type": "destination", "name": "Mexico", "as": "Where the veneer is quoted against a US comparison the clinic supplies.", "rel": "destination" }, { "to": "poland", "type": "destination", "name": "Poland", "as": "Where the comparison column is labelled average UK price.", "rel": "destination" }, { "to": "budapest", "type": "hub", "name": "Budapest", "as": "The city whose clinics built the European dental trade on work like this.", "rel": "place" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "The reason no payer schedule read for this page carries a line for veneers.", "rel": "rule" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step where one tooth becomes ten and the quote multiplies.", "rel": "step" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who rebonds a veneer that debonds after the flight, and at whose price.", "rel": "risk" } ], "source_list": [ { "id": "s:bidc-fees", "kind": "web", "title": "Dental Fees — standardised treatment fees", "publisher": "Bangkok International Dental Center", "url": "https://bangkokdentalcenter.com/fees/", "accessed": "2026-09-16", "note": "implant fixture and implant crown priced in separate columns; page states package rates applicable till 30 September 2026" }, { "id": "s:mdental-budapest-prices", "kind": "web", "title": "Treatment Prices", "publisher": "Medicare Dental Clinic, Budapest", "url": "https://www.mdentalclinic.eu/prices", "accessed": "2026-09-16", "note": "treatment price and lab fee shown as separate lines; packages name accommodation and transfers" }, { "id": "s:sani-dental-prices", "kind": "web", "title": "Dental Price List in Mexico", "publisher": "Sani Dental Group, Los Algodones", "url": "https://sanidentalgroup.com/price-list", "accessed": "2026-09-16", "note": "prices in US dollars with a Mexican peso figure beside each; the page states every price is a base or starting price" }, { "id": "s:indexmedica-prices", "kind": "web", "title": "Prices — dental treatment in Kraków", "publisher": "Index Medica, Kraków", "url": "https://www.indexmedica.com/prices/", "accessed": "2026-09-16", "note": "two tables, one in sterling against a column the clinic labels average UK price, one in euro against average Irish price. Read 16 September 2026: complete implant including screw, healing ring, individual abutment and full-ceramic zirconia crown GBP 1,450 or EUR 1,552; implant screw alone GBP 575; full-ceramic zirconia crown GBP 429 or EUR 469; root canal on a front tooth GBP 120. Examination, x-rays and local anaesthetic are listed free. A deposit of 80% of each stage is due on signing the treatment plan; American Express and Diners Club are not accepted." }, { "id": "s:mbs-42702", "kind": "gov", "title": "MBS item 42702 — lens extraction and insertion of intraocular lens", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=42702&qt=item", "accessed": "2026-09-17", "note": "schedule fee $910.35, 75% benefit $682.80, fee shown as applying from 01-Jul-2026. The descriptor excludes 'surgery performed to correct a refractive error, other than anisometropia that exceeds 3 dioptres and develops after the removal of cataract in the first eye'." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:bidc-fees", "note": "figures read off each clinic's own page on the accessed date; the multiplication at the end is marked as this project's arithmetic" }, "text.how": { "tier": "tradition", "note": "standard veneer sequence; the exclusion from state schedules is cited to the NHS bands and the Australian item descriptor" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "tradition" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:bidc-fees" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "The thinner cousin, covering the front of a tooth rather than the whole of it.", "rel": "contrast" }, { "from": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "The cosmetic half of the same quotation, when the back teeth are sound.", "rel": "kin" } ] }, { "schema": 1, "id": "acibadem", "type": "facility", "names": { "name": "Acıbadem Healthcare Group", "aliases": [ "Acibadem", "Acıbadem Sağlık Grubu", "Acıbadem Altunizade Hospital" ], "said": "Ah-juh-BAH-dem, with the soft g of the Turkish ğ swallowed. Acıbadem is a district on the Asian side of Istanbul, where the first hospital stood; the group kept the neighbourhood's name and carried it to five countries." }, "region": [ "west-asia" ], "facets": { "iso2": "TR", "ownership": "private", "founded": 1991, "specialty": [ "oncology", "cardiology", "fertility", "orthopaedics", "transplantation", "health screening" ], "draws": [ "ivf", "executive-health-screening" ], "status": "open", "languages": [ "Turkish", "English", "Arabic", "Russian", "German" ] }, "text": { "what": "A hospital group, not a building: 29 hospitals and 15 medical centres by the Wikipedia count, 45 or more hospitals and clinics by the group's own, spread across Türkiye, the Netherlands, Bulgaria, North Macedonia and Serbia. Mehmet Ali Aydınlar founded it in Istanbul in 1991; the Malaysian company IHH Healthcare has held the majority since 2011. This record is the group, and its point on the map is the flagship at Altunizade in Üsküdar.", "story": "Aydınlar opened the first hospital in 1991 in the Acıbadem district and built outward from it. In 2011 IHH Healthcare, the Malaysian group that also owns Parkway in Singapore and Gleneagles in Kuala Lumpur, bought a majority stake; share conversions in 2018 took its holding to roughly 90 per cent. The shares trade in Istanbul.\n\n*Inference —* that ownership line matters more to a reader of this directory than any clinical fact on the group's own pages. A patient choosing between Istanbul, Kuala Lumpur and Singapore on price may be choosing three times between hospitals with one parent.\n\nThe group reports seven JCI-accredited hospitals out of the forty-five it counts, 3,300 or more specialist physicians, patients from more than 90 countries, and 55 international patient offices across seven world regions. Those are the group's own numbers, published without a method, and the office count is a sales network rather than a measure of care.\n\nThe group also runs its own medical university, Acıbadem Mehmet Ali Aydınlar University, founded 2007, and its IVF centres report treating over 15,000 families a year.", "how": "Enquiries reach the group through the international site rather than through any one hospital, and are routed to whichever hospital holds the programme. *Trade practice —* the estimate comes by email after records are read, and the patient learns which of the forty-five buildings is meant at that point rather than before it.\n\nOn price the group publishes nothing. Its Turkish check-up page is titled Check Up Paketleri ve Fiyatları 2026 — check-up packages and prices — and lists every programme by its contents: a Classic for women with three examinations, five radiology tests, twenty-six laboratory tests; an Executive with a whole-body MRI at nine, nine and fifty-three. Against each one, where a figure would sit, is a button reading Fiyat Sor: ask the price.", "today": "As of 17 September 2026 the group states 45 or more hospitals and clinics in five countries, seven of them JCI-accredited, 3,300 or more specialist physicians in 19 specialties, and support in more than 20 languages. Neither the group site nor the Turkish site publishes a bed count, a patient count for any single hospital, or any price." }, "geo": { "lat": 41.018996, "lon": 29.046255, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "Yurtcan Sokağı, Altunizade Mahallesi, Üsküdar", "city": "Istanbul", "country": "TR", "postcode": "34662" }, "metrics": { "beds": null, "doctors": 3300, "annual_patients": null, "annual_foreign_patients": null, "foreign_patient_countries": 90, "note": "GROUP figures, and the group's own. The doctor count is stated as 3,300+ specialist physicians across every hospital and clinic in five countries, not at the Altunizade flagship pinned above. The country count is where patients come from, not how many patients come; the group publishes no patient count of any kind, and no bed count. Nothing here is a count of operations.", "as_of": "2026", "source": "s:acibadem-int-about", "url": "https://acibademinternational.com/about-us/" }, "tags": [ { "tag": "chain", "source": "s:wp-acibadem", "tier": "cited", "note": "29 hospitals and 15 medical centres by the encyclopaedia's count, 45+ by the group's own, in Türkiye, the Netherlands, Bulgaria, North Macedonia and Serbia" }, { "tag": "listed-company", "source": "s:wp-acibadem", "tier": "cited", "note": "traded in Istanbul; IHH Healthcare of Malaysia holds roughly 90 per cent after the 2018 share conversions" }, { "tag": "international-office", "source": "s:acibadem-int-about", "tier": "cited", "note": "55 international patient offices across seven world regions, and support stated in more than 20 languages" }, { "tag": "interpreter", "source": "s:acibadem-int-about", "tier": "cited" }, { "tag": "no-price-published", "source": "s:acibadem-checkup-packages", "tier": "cited", "note": "the page titled check-up packages and prices prints the contents of every programme and a Fiyat Sor — ask the price — button where each figure would be", "url": "https://www.acibadem.com.tr/check-up-paketleri/" }, { "tag": "teaching", "source": "s:wp-acibadem", "tier": "cited", "note": "Acıbadem Mehmet Ali Aydınlar University, founded 2007" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation held by seven hospitals of the group", "year": null, "valid_until": null, "source": "s:acibadem-int-about", "url": "https://acibademinternational.com/about-us/", "note": "seven of the forty-five hospitals and clinics the group counts, not the group; the group names no year and no hospital" }, { "by": "moh-tr", "what": "Türkiye Ministry of Health health tourism authorisation, the certificate a Turkish facility must hold to treat international patients", "year": null, "valid_until": null, "source": "s:wp-medical-tourism-turkiye", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_Turkey", "note": "the regime came into force on 13 July 2017; the record cites the regime rather than a certificate number read for this group" } ], "kin": [ { "to": "istanbul", "as": "The city the group is named after a district of, and where its flagship stands at Altunizade.", "rel": "place" }, { "to": "turkiye", "as": "The largest private hospital group in the country by hospital count, and the one a foreign enquiry most often lands on first.", "rel": "destination" }, { "to": "gleneagles-kl", "as": "A sister under the same Malaysian parent, IHH Healthcare — a patient comparing Istanbul against Kuala Lumpur may be comparing two hospitals with one owner.", "rel": "contrast" }, { "to": "jci", "as": "The accreditor whose mark seven of its hospitals hold.", "rel": "accredited-by" }, { "to": "turkiye-health-tourism-authorisation", "as": "The licence every Turkish facility treating foreign patients must hold since July 2017.", "rel": "governed-by" }, { "to": "executive-health-screening", "as": "Sold in graded tiers whose contents are published and whose prices are not.", "rel": "performs" }, { "to": "ivf", "as": "Its fertility centres report treating over 15,000 families a year.", "rel": "performs" }, { "to": "getting-a-quote", "as": "Where the Fiyat Sor button leads, and the step at which a price first exists.", "rel": "step" }, { "to": "the-price-that-isnt", "as": "A page headed packages and prices that carries no price.", "rel": "story" } ], "links": [ { "label": "Acıbadem Healthcare Group (international)", "url": "https://acibademinternational.com/" }, { "label": "Check Up Paketleri ve Fiyatları", "url": "https://www.acibadem.com.tr/check-up-paketleri/" } ], "sources": [ "s:wp-acibadem", "s:acibadem-int-about", "s:acibadem-checkup-packages", "s:osm-nominatim", "s:wp-medical-tourism-turkiye" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim", "note": "the OpenStreetMap point for Acıbadem Altunizade Hastanesi, standing for a group with no single building" }, "text.how": { "tier": "tradition", "note": "how an enquiry travels through a multi-hospital group; hedged in the prose. The price paragraph is cited." }, "metrics": { "tier": "cited", "source": "s:acibadem-int-about" } } }, "x_commons_files": [ "File:Acıbadem Hastanesi.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "A hospital group, not a building: 29 hospitals and 15 medical centres by the Wikipedia count, 45 or more hospitals and clinics by the group's own, spread across Türkiye, the Netherlands, Bulgaria, North Macedonia and…", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "The city the group is named after a district of, and where its flagship stands at Altunizade.", "rel": "place" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The largest private hospital group in the country by hospital count, and the one a foreign enquiry most often lands on first.", "rel": "destination" }, { "to": "gleneagles-kl", "type": "facility", "name": "Gleneagles Hospital Kuala Lumpur", "as": "A sister under the same Malaysian parent, IHH Healthcare — a patient comparing Istanbul against Kuala Lumpur may be comparing two hospitals with one owner.", "rel": "contrast" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The accreditor whose mark seven of its hospitals hold.", "rel": "accredited-by" }, { "to": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The licence every Turkish facility treating foreign patients must hold since July 2017.", "rel": "governed-by" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "Sold in graded tiers whose contents are published and whose prices are not.", "rel": "performs" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "Its fertility centres report treating over 15,000 families a year.", "rel": "performs" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "Where the Fiyat Sor button leads, and the step at which a price first exists.", "rel": "step" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "A page headed packages and prices that carries no price.", "rel": "story" } ], "source_list": [ { "id": "s:wp-acibadem", "kind": "wikipedia", "title": "Acıbadem Healthcare Group", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Acibadem_Healthcare_Group", "license": "CC BY-SA 4.0", "accessed": "2026-09-17", "note": "founded 1991 by Mehmet Ali Aydınlar; IHH Healthcare took a majority stake in 2011 and holds about 90 per cent after the 2018 share conversions; 29 hospitals and 15 medical centres; flagship Acıbadem Altunizade, Üsküdar, Istanbul" }, { "id": "s:acibadem-int-about", "kind": "web", "title": "About us — Acıbadem Healthcare Group, international site", "publisher": "Acıbadem Sağlık Grubu", "url": "https://acibademinternational.com/about-us/", "accessed": "2026-09-17", "note": "the group's own figures for international patients: 45+ hospitals and clinics, 7 JCI-accredited hospitals, 3,300+ specialist physicians, patients from 90+ countries, 55 international patient offices" }, { "id": "s:acibadem-checkup-packages", "kind": "web", "title": "Check Up Paketleri ve Fiyatları 2026", "publisher": "Acıbadem Sağlık Grubu", "url": "https://www.acibadem.com.tr/check-up-paketleri/", "accessed": "2026-09-17", "note": "read in the browser on 17 September 2026. The page is titled check-up packages AND PRICES and lists the contents of each programme — examinations, radiology, laboratory and cardiology test counts — with a Fiyat Sor (ask the price) button in place of every figure. No amount is printed anywhere on it." }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." }, { "id": "s:wp-medical-tourism-turkiye", "kind": "wikipedia", "title": "Medical tourism in Turkey", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_Turkey", "accessed": "2026-09-16", "note": "records the 13 July 2017 regulation coming into force and a first-half-2018 figure of nearly 178,000 inbound patients split 67% private, 24% public and 9% university — a count of arrivals stating a health purpose, not of operations" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "how an enquiry travels through a multi-hospital group; hedged in the prose. The price paragraph is cited." }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim", "note": "the OpenStreetMap point for Acıbadem Altunizade Hastanesi, standing for a group with no single building" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:acibadem-int-about" } }, "primary_image": null, "tag_facts": [ { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:wp-acibadem", "note": "29 hospitals and 15 medical centres by the encyclopaedia's count, 45+ by the group's own, in Türkiye, the Netherlands, Bulgaria, North Macedonia and Serbia", "tier": "cited", "url": "" }, { "key": "listed-company", "label": "Publicly listed", "icon": "📈", "group": "ownership", "evidence": "an exchange listing or an annual report", "source": "s:wp-acibadem", "note": "traded in Istanbul; IHH Healthcare of Malaysia holds roughly 90 per cent after the 2018 share conversions", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:acibadem-int-about", "note": "55 international patient offices across seven world regions, and support stated in more than 20 languages", "tier": "cited", "url": "" }, { "key": "interpreter", "label": "Interpreters on staff", "icon": "🗣", "group": "service", "evidence": "the facility's own page naming the languages, or a published inspection or accreditation report", "source": "s:acibadem-int-about", "note": "", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:acibadem-checkup-packages", "note": "the page titled check-up packages and prices prints the contents of every programme and a Fiyat Sor — ask the price — button where each figure would be", "tier": "cited", "url": "https://www.acibadem.com.tr/check-up-paketleri/" }, { "key": "teaching", "label": "Teaching hospital", "icon": "📚", "group": "clinical", "evidence": "a recognised training post list or the hospital's own statement", "source": "s:wp-acibadem", "note": "Acıbadem Mehmet Ali Aydınlar University, founded 2007", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation held by seven hospitals of the group", "url": "https://acibademinternational.com/about-us/", "kind": "international", "year": null, "valid_until": null, "source": "s:acibadem-int-about" }, { "key": "moh-tr", "label": "Türkiye Ministry of Health health-tourism authorisation", "what": "Türkiye Ministry of Health health tourism authorisation, the certificate a Turkish facility must hold to treat international patients", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_Turkey", "kind": "regulator", "year": null, "valid_until": null, "source": "s:wp-medical-tourism-turkiye" } ], "acclaim": 2, "kin_in": [ { "from": "turkiye", "type": "destination", "name": "Türkiye", "as": "The hospital group that carries the complex end of the inbound work.", "rel": "part" }, { "from": "istanbul", "type": "hub", "name": "Istanbul", "as": "The hospital group whose Istanbul sites take the complex work the clinic floors do not.", "rel": "part" }, { "from": "anadolu-medical-center", "type": "facility", "name": "Anadolu Medical Center", "as": "The other Turkish name a foreign oncology enquiry lands on, and a group of forty-five buildings against this one.", "rel": "contrast" }, { "from": "liv-hospital", "type": "facility", "name": "Liv Hospital", "as": "The larger Turkish group, whose page headed packages and prices carries none.", "rel": "contrast" }, { "from": "medicana", "type": "facility", "name": "Medicana Health Group", "as": "The larger group, and the one whose ownership runs back to Malaysia.", "rel": "contrast" }, { "from": "memorial-sisli", "type": "facility", "name": "Memorial Şişli Hospital", "as": "The larger Turkish group, and the other name a foreign enquiry lands on.", "rel": "contrast" }, { "from": "mount-elizabeth", "type": "facility", "name": "Mount Elizabeth Hospital", "as": "The third hospital under the same Malaysian parent, in Istanbul — a price comparison that stays inside one company.", "rel": "contrast" }, { "from": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The kind of hospital group that holds the certificate.", "rel": "facility" }, { "from": "turkiye-health-services-directorate", "type": "org", "name": "Türkiye General Directorate of Health Services", "as": "One of the hospital groups whose international business this certificate governs.", "rel": "facility" } ] }, { "schema": 1, "id": "albert-einstein-sao-paulo", "type": "facility", "names": { "name": "Hospital Israelita Albert Einstein", "aliases": [ "Albert Einstein Israelite Hospital", "Einstein", "Sociedade Beneficente Israelita Brasileira Albert Einstein" ], "said": "ospi-TAU izra-ay-LEE-ta AL-bert ine-SHTINE. In São Paulo it is simply Einstein, and the Morumbi campus is what the name means." }, "region": [ "south-america" ], "facets": { "iso2": "BR", "ownership": "nonprofit", "founded": 1971, "specialty": [ "oncology", "cardiology", "transplantation", "neurosciences", "health screening" ], "draws": [ "kidney-transplant", "liver-transplant", "bone-marrow-transplant", "executive-health-screening" ], "status": "open", "languages": [ "Portuguese", "English", "Spanish" ] }, "text": { "what": "A private nonprofit hospital in Morumbi, on the south side of São Paulo, inaugurated on 28 July 1971 and run by the Sociedade Beneficente Israelita Brasileira Albert Einstein, a charitable society founded in 1955 by members of the city's Jewish community. In 1999 it became the first health institution outside the United States accredited by Joint Commission International.", "story": "The society came first, in 1955; the hospital opened sixteen years later. It has kept the charitable form: a private nonprofit that also treats patients of the SUS, Brazil's public health system, and runs a social assistance programme in the Paraisópolis favela beside its own campus.\n\nThe 1999 JCI accreditation is the fact this hospital is cited for everywhere in the trade, and it is worth being exact about what it was: the first institution outside the United States to be accredited by the body, not the first accredited hospital in Latin America and not a ranking. JCI began accrediting outside the United States that year, and Einstein was the first through the door.\n\n*Inference —* that sequence made Einstein the reference every later Latin American hospital's international department was measured against, and it is why a São Paulo hospital appears in a directory whose Brazilian traffic is mostly Brazilians returning from abroad rather than foreigners arriving.\n\nNewsweek placed it among the top thirty hospitals in the world in 2024. It runs a nursing school, a medical school since 2016 and a health-management degree.", "how": "*Trade practice —* Einstein's international work is referral rather than package: complex oncology, transplantation and cardiology reached through consultants and insurers rather than through a price page. Brazil's inbound flow is regional — the Southern Cone and Portuguese-speaking Africa — and its outbound flow, of Brazilians going elsewhere for cosmetic and fertility work, is larger.\n\nNo bed count, staff count or patient count appears on the encyclopaedia entry read for this record, and no price.", "today": "As of 17 September 2026 the hospital is a private nonprofit under the Sociedade Beneficente Israelita Brasileira Albert Einstein, holds JCI accreditation first granted in 1999, and was placed among the world's top thirty by Newsweek in 2024. No capacity or patient figure was sourced for this record." }, "geo": { "lat": -23.599613, "lon": -46.71488, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "Rua Ruggero Fasano, Morumbi", "city": "São Paulo", "area": "São Paulo", "country": "BR", "postcode": "05650-905" }, "metrics": { "beds": null, "doctors": null, "annual_patients": null, "annual_foreign_patients": null, "note": "Not published in the source read. The encyclopaedia entry carries the hospital's history, its legal form and its accreditation, and no bed, staff or patient figure at all. The hospital's own about page returned a 403 to every fetch attempted for this record, so the gap is this project's and not necessarily the hospital's.", "as_of": "2026", "source": "s:wp-albert-einstein", "url": "https://en.wikipedia.org/wiki/Hospital_Israelita_Albert_Einstein" }, "tags": [ { "tag": "faith-based", "source": "s:wp-albert-einstein", "tier": "cited", "note": "founded by members of the São Paulo Jewish community as the Sociedade Beneficente Israelita Brasileira, 1955" }, { "tag": "teaching", "source": "s:wp-albert-einstein", "tier": "cited", "note": "a nursing school, a medical school since 2016 and a health-management degree" }, { "tag": "public-hospital", "source": "s:wp-albert-einstein", "tier": "cited", "note": "not public, but a private nonprofit that treats SUS patients under Brazil's public system alongside private ones — the tag marks the public-funded work, and the note is the qualifier" }, { "tag": "no-price-published", "source": "s:wp-albert-einstein", "tier": "cited", "note": "no price was found in the sources read for this record" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation — the first health institution outside the United States to hold it", "year": 1999, "valid_until": null, "source": "s:wp-albert-einstein", "url": "https://en.wikipedia.org/wiki/Hospital_Israelita_Albert_Einstein", "note": "first outside the United States, which is a date in JCI's history as much as in the hospital's: the body began accrediting abroad that year" }, { "by": "newsweek-statista", "what": "Placed among the top thirty hospitals in the world in the 2024 Newsweek ranking", "year": 2024, "valid_until": null, "source": "s:wp-albert-einstein", "url": "https://en.wikipedia.org/wiki/Hospital_Israelita_Albert_Einstein", "note": "a survey-and-indicator ranking; counted here, not weighted" } ], "kin": [ { "to": "brazil", "as": "The Brazilian hospital foreign referrals reach first, in a country whose larger flow is Brazilians leaving.", "rel": "destination" }, { "to": "jci", "as": "The first institution outside the United States it accredited, in 1999.", "rel": "accredited-by" }, { "to": "bumrungrad", "as": "Took the same mark three years later in Bangkok, and built a much larger foreign trade on it.", "rel": "contrast" }, { "to": "liver-transplant", "as": "Among the complex programmes its international referrals come for.", "rel": "performs" }, { "to": "executive-health-screening", "as": "Sold here as a referral product rather than a published package.", "rel": "performs" }, { "to": "the-accreditation-question", "as": "1999, first outside the United States — the date the accreditation trade starts from.", "rel": "story" }, { "to": "counting-patients", "as": "A hospital cited everywhere in this field that publishes no count of anything.", "rel": "story" } ], "links": [ { "label": "Hospital Israelita Albert Einstein", "url": "https://www.einstein.br/" } ], "sources": [ "s:wp-albert-einstein", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "text.how": { "tier": "tradition", "note": "how a referral hospital's international work runs, and the direction of Brazil's flows; marked in the prose" }, "metrics": { "tier": "cited", "source": "s:wp-albert-einstein", "note": "a record of what the source does not carry" }, "address": { "tier": "harvested", "source": "s:osm-nominatim", "note": "the street and postcode as OpenStreetMap carries them for the Morumbi campus, not an address the hospital published" } } }, "x_commons_files": [ "File:Hospital Israelita Albert Einstein.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "A private nonprofit hospital in Morumbi, on the south side of São Paulo, inaugurated on 28 July 1971 and run by the Sociedade Beneficente Israelita Brasileira Albert Einstein, a charitable society founded in 1955 by…", "region_terms": [ { "key": "south-america", "name": "South America", "note": "Colombia, Brazil, Argentina, Chile, Peru" } ], "kin_out": [ { "to": "brazil", "type": "destination", "name": "Brazil", "as": "The Brazilian hospital foreign referrals reach first, in a country whose larger flow is Brazilians leaving.", "rel": "destination" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The first institution outside the United States it accredited, in 1999.", "rel": "accredited-by" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Took the same mark three years later in Bangkok, and built a much larger foreign trade on it.", "rel": "contrast" }, { "to": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "Among the complex programmes its international referrals come for.", "rel": "performs" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "Sold here as a referral product rather than a published package.", "rel": "performs" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "1999, first outside the United States — the date the accreditation trade starts from.", "rel": "story" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "A hospital cited everywhere in this field that publishes no count of anything.", "rel": "story" } ], "source_list": [ { "id": "s:wp-albert-einstein", "kind": "wikipedia", "title": "Hospital Israelita Albert Einstein", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Hospital_Israelita_Albert_Einstein", "license": "CC BY-SA 4.0", "accessed": "2026-09-17", "note": "society founded 1955 by members of the São Paulo Jewish community, hospital inaugurated 28 July 1971, run by the Sociedade Beneficente Israelita Brasileira Albert Einstein as a private nonprofit that also treats SUS patients; first health institution outside the United States accredited by JCI, in 1999; Morumbi, São Paulo. No bed, staff or patient counts on the page." }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "how a referral hospital's international work runs, and the direction of Brazil's flows; marked in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "harvested", "source": "s:osm-nominatim", "note": "the street and postcode as OpenStreetMap carries them for the Morumbi campus, not an address the hospital published" }, "metrics": { "tier": "cited", "source": "s:wp-albert-einstein", "note": "a record of what the source does not carry" } }, "primary_image": null, "tag_facts": [ { "key": "faith-based", "label": "Faith-founded", "icon": "✝", "group": "welcome", "evidence": "the founding body's own statement or the hospital's charter", "source": "s:wp-albert-einstein", "note": "founded by members of the São Paulo Jewish community as the Sociedade Beneficente Israelita Brasileira, 1955", "tier": "cited", "url": "" }, { "key": "teaching", "label": "Teaching hospital", "icon": "📚", "group": "clinical", "evidence": "a recognised training post list or the hospital's own statement", "source": "s:wp-albert-einstein", "note": "a nursing school, a medical school since 2016 and a health-management degree", "tier": "cited", "url": "" }, { "key": "public-hospital", "label": "Public hospital", "icon": "🏛", "group": "ownership", "evidence": "a ministry register, a national health service list, or the hospital's own statement", "source": "s:wp-albert-einstein", "note": "not public, but a private nonprofit that treats SUS patients under Brazil's public system alongside private ones — the tag marks the public-funded work, and the note is the qualifier", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:wp-albert-einstein", "note": "no price was found in the sources read for this record", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation — the first health institution outside the United States to hold it", "url": "https://en.wikipedia.org/wiki/Hospital_Israelita_Albert_Einstein", "kind": "international", "year": 1999, "valid_until": null, "source": "s:wp-albert-einstein" }, { "key": "newsweek-statista", "label": "Newsweek / Statista World's Best Hospitals", "what": "Placed among the top thirty hospitals in the world in the 2024 Newsweek ranking", "url": "https://en.wikipedia.org/wiki/Hospital_Israelita_Albert_Einstein", "kind": "listing", "year": 2024, "valid_until": null, "source": "s:wp-albert-einstein" } ], "acclaim": 2, "kin_in": [ { "from": "brazil", "type": "destination", "name": "Brazil", "as": "The São Paulo hospital that takes the complex international work.", "rel": "part" } ] }, { "schema": 1, "id": "american-hospital-dubai", "type": "facility", "names": { "name": "American Hospital Dubai", "aliases": [ "AHD", "المستشفى الأمريكي دبي" ], "said": "The name is a standard, not an ownership: the hospital is Emirati, owned by the Mohamed & Obaid Al Mulla Group, and American means its physicians are American board certified or equivalent." }, "region": [ "gulf" ], "facets": { "iso2": "AE", "ownership": "private", "founded": 1996, "specialty": [ "oncology", "cardiology", "obstetrics", "orthopaedics", "robotic surgery" ], "draws": [ "knee-replacement", "hip-replacement", "executive-health-screening", "gastric-sleeve" ], "status": "open", "languages": [ "Arabic", "English" ] }, "text": { "what": "A 254-bed private acute general medical and surgical hospital in Dubai, established in 1996 by the Mohamed & Obaid Al Mulla Group, working in more than 40 specialties with seven satellite clinics across the emirate. It was the first hospital in the Middle East awarded Joint Commission International accreditation, and the inaugural member of the Mayo Clinic Care Network.", "story": "The hospital states its firsts plainly: first in the Middle East with the JCI, first laboratory in the region's private sector accredited by the College of American Pathologists, the inaugural member of the Mayo Clinic Care Network, the first cancer programme in Dubai offering one-stop care, the first private UAE hospital with an American Heart Association international training centre, the only facility outside the United States with ultrasound practice accreditation from the American Institute of Ultrasound in Medicine in abdomen and breast, the first facility in Dubai to run a fourth-generation da Vinci Xi robot.\n\n*Inference —* every one of those firsts names an American body. That is what an Emirati hospital built in 1996 was for: a recognisable standard for a population of expatriates and regional patients who would otherwise fly to London or Houston. The Gulf is the largest source market in this whole subject, and Dubai's project has been to keep some of its own outflow at home while attracting the region's.\n\nDubai reported more than 691,000 international health travellers in 2023. That is an emirate-wide count of arrivals stating a health purpose, not a count of operations and not this hospital's.", "how": "This is the hospital in the batch that publishes its exclusion lists rather than its prices, and the exclusions are priced where the package is not. The normal delivery package covers delivery, the delivery suite, two blood counts, blood typing, newborn screening, two days' post-delivery room and nursery, obstetrician rounding for two days, paediatrician fees, the six-week postpartum visit, the baby's one-week clinic visit and an audiogram. Outside it: epidural anaesthesia at Dhs 3,770, a twin surcharge of Dhs 2,050, routine medication above Dhs 450 and consumables above Dhs 1,500, baby vaccines at about Dhs 300, circumcision, neonatal intensive care, any resuscitation, and a relative staying overnight at Dhs 193 a day with meals extra.\n\nThe package page also states two terms a reader of this directory should read together: the self-pay patient pays the whole package price in advance at sign-up, and a switch from a normal delivery to a caesarean is charged at the caesarean price. The bundle is fixed; the bill is not.", "today": "As of 17 September 2026 the hospital states 254 beds, more than 40 specialties, seven satellite clinics, JCI accreditation as the first in the Middle East, CAP laboratory accreditation, AIUM ultrasound practice accreditation and Mayo Clinic Care Network membership. It publishes maternity package inclusion and exclusion lists with the exclusions priced, and no package price." }, "geo": { "lat": 25.235574, "lon": 55.313076, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "Street 12B, Oud Metha", "city": "Dubai", "area": "Dubai", "country": "AE" }, "metrics": { "beds": 254, "doctors": null, "annual_patients": null, "annual_foreign_patients": null, "note": "254 beds, the hospital's own figure, acute general medical and surgical. No doctor count, patient count or foreign share is published by the hospital. Dubai's emirate-wide figure of more than 691,000 international health travellers in 2023 belongs to the emirate and counts ARRIVALS stating a health purpose — every expatriate resident's visiting relative with a chest infection included — and is not carried in this record's numbers.", "as_of": "2026", "source": "s:ahd-about", "url": "https://www.ahdubai.com/about-us" }, "tags": [ { "tag": "package", "source": "s:ahd-normal-delivery", "tier": "cited", "note": "maternity packages with written inclusion and exclusion lists; the exclusions carry figures and the package does not", "url": "https://www.ahdubai.com/health-packages/maternity-packages/normal-delivery-package" }, { "tag": "no-price-published", "source": "s:ahd-normal-delivery", "tier": "cited", "note": "the package page prices the epidural, the twin surcharge, the medication and consumable caps, the vaccines and the companion bed, and prints no package price" }, { "tag": "chain", "source": "s:ahd-about", "tier": "cited", "note": "seven satellite clinics in Dubai Media City, Al Barsha, Al Khawaneej, Jumeirah, Mira, Dubai Hills and Nad Al Sheba, plus a Dubai Science Park hospital" }, { "tag": "insurer-direct", "source": "s:ahd-normal-delivery", "tier": "cited", "note": "the package page states pre-authorisation from the insurance company, third-party administrator or corporate payer is required" }, { "tag": "international-office", "source": "s:ahd-about", "tier": "cited", "note": "the site carries a standing international patients offer" }, { "tag": "interpreter", "source": "s:ahd-about", "tier": "cited", "note": "the hospital publishes in Arabic and English" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation — the first hospital in the Middle East to be awarded it", "year": null, "valid_until": null, "source": "s:ahd-about", "url": "https://www.ahdubai.com/about-us", "note": "the hospital's own statement; no year appears on the page" }, { "by": "moh-ae", "what": "Licensed under the UAE health regulators; the site footer carries the licence number MOH#Z8IXYQHM-041025", "year": null, "valid_until": null, "source": "s:ahd-about", "url": "https://www.ahdubai.com/about-us", "note": "a licence, not an accreditation: the emirate-level permission a facility operates under" }, { "by": "other", "what": "College of American Pathologists laboratory accreditation, stated as the first in the region's private sector; American Institute of Ultrasound in Medicine practice accreditation in abdomen and breast; inaugural membership of the Mayo Clinic Care Network; an American Heart Association international training centre", "year": null, "valid_until": null, "source": "s:ahd-about", "url": "https://www.ahdubai.com/about-us", "note": "four American bodies outside this project's recognizer vocabulary, named as the hospital names them and none of them dated" } ], "kin": [ { "to": "dubai", "as": "The hospital the emirate's private sector dates its American standards from, in Oud Metha rather than in Dubai Healthcare City.", "rel": "place" }, { "to": "uae", "as": "The first hospital in the region to take the JCI, in a country that is a source market and a destination at once.", "rel": "destination" }, { "to": "jci", "as": "Its accreditor, and the first award the body made in the Middle East.", "rel": "accredited-by" }, { "to": "reading-the-exclusions", "as": "Its maternity package prices every exclusion and none of the inclusions, which is the whole lesson of that page in one document.", "rel": "step" }, { "to": "the-deposit", "as": "The self-pay patient pays the entire package price in advance at sign-up, in the hospital's own words.", "rel": "step" }, { "to": "uae-clinic-licensing", "as": "Operates under the emirate licensing regime whose number sits in its own footer.", "rel": "governed-by" }, { "to": "package-price", "as": "Sells in this form, and shows what a bundle looks like when the bundle is fixed and the bill is not.", "rel": "term" }, { "to": "counting-patients", "as": "Dubai counted 691,000 international health travellers in 2023, and this hospital counts none of its own in public.", "rel": "story" } ], "links": [ { "label": "American Hospital Dubai", "url": "https://www.ahdubai.com/" }, { "label": "Normal Delivery Package", "url": "https://www.ahdubai.com/health-packages/maternity-packages/normal-delivery-package" } ], "sources": [ "s:ahd-about", "s:ahd-normal-delivery", "s:dubai-media-office-health-2023", "s:dha-sheryan", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "text.story": { "tier": "cited", "source": "s:ahd-about", "note": "the middle paragraph is marked as this project's inference in the prose" }, "metrics": { "tier": "cited", "source": "s:ahd-about" }, "address": { "tier": "harvested", "source": "s:osm-nominatim", "note": "the street as OpenStreetMap carries it, not an address the hospital published" } } }, "x_commons_files": [ "File:American Hospital Dubai.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "A 254-bed private acute general medical and surgical hospital in Dubai, established in 1996 by the Mohamed & Obaid Al Mulla Group, working in more than 40 specialties with seven satellite clinics across the emirate.", "region_terms": [ { "key": "gulf", "name": "The Gulf", "note": "the UAE, Saudi Arabia, Qatar, Kuwait, Oman, Bahrain — a source market that is building itself into a destination" } ], "kin_out": [ { "to": "dubai", "type": "hub", "name": "Dubai", "as": "The hospital the emirate's private sector dates its American standards from, in Oud Metha rather than in Dubai Healthcare City.", "rel": "place" }, { "to": "uae", "type": "destination", "name": "United Arab Emirates", "as": "The first hospital in the region to take the JCI, in a country that is a source market and a destination at once.", "rel": "destination" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "Its accreditor, and the first award the body made in the Middle East.", "rel": "accredited-by" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "Its maternity package prices every exclusion and none of the inclusions, which is the whole lesson of that page in one document.", "rel": "step" }, { "to": "the-deposit", "type": "pathway", "name": "The deposit", "as": "The self-pay patient pays the entire package price in advance at sign-up, in the hospital's own words.", "rel": "step" }, { "to": "uae-clinic-licensing", "type": "rule", "name": "Licensing a clinic in the United Arab Emirates", "as": "Operates under the emirate licensing regime whose number sits in its own footer.", "rel": "governed-by" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "Sells in this form, and shows what a bundle looks like when the bundle is fixed and the bill is not.", "rel": "term" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Dubai counted 691,000 international health travellers in 2023, and this hospital counts none of its own in public.", "rel": "story" } ], "source_list": [ { "id": "s:ahd-about", "kind": "web", "title": "Who We Are — American Hospital Dubai", "publisher": "American Hospital Dubai", "url": "https://www.ahdubai.com/about-us", "accessed": "2026-09-17", "note": "read in the browser on 17 September 2026. Established 1996, part of the Mohamed & Obaid Al Mulla Group; 254 beds, acute general medical and surgical, more than 40 specialties, all physicians American board certified or equivalent; states it is the first hospital in the Middle East awarded the JCI and that its laboratory was the first in the region's private sector accredited by the College of American Pathologists; inaugural member of the Mayo Clinic Care Network; seven satellite clinics. The page footer carries the licence number MOH#Z8IXYQHM-041025." }, { "id": "s:ahd-normal-delivery", "kind": "web", "title": "Normal Delivery Package", "publisher": "American Hospital Dubai", "url": "https://www.ahdubai.com/health-packages/maternity-packages/normal-delivery-package", "accessed": "2026-09-17", "note": "read in the browser on 17 September 2026. The package page prints a full inclusion and exclusion list with no headline figure, and prices the exclusions instead: epidural anaesthesia Dhs 3,770, twin surcharge Dhs 2,050, routine medications capped at Dhs 450 and consumables at Dhs 1,500, baby vaccines about Dhs 300, a relative staying overnight Dhs 193 a day. It states the self-pay patient pays the entire package price in advance at sign-up, that a switch from normal delivery to caesarean is charged at the caesarean price, and that NICU, resuscitation and circumcision fall outside." }, { "id": "s:dubai-media-office-health-2023", "kind": "gov", "title": "Dubai welcomes more than 691,000 international health travellers in 2023", "publisher": "Dubai Media Office, Government of Dubai", "url": "https://mediaoffice.ae/en/news/2024/august/19-08/dubai-welcomes-more-than-691k", "accessed": "2026-09-16", "note": "Dubai Health Authority figures released 19 August 2024; gives arrivals, spend, regional split and the leading specialties. The release does not publish the counting rule behind the headline number." }, { "id": "s:dha-sheryan", "kind": "web", "title": "Sheryan — Dubai Health Licensing System, public search", "publisher": "Dubai Health Authority", "url": "https://services.dha.gov.ae/sheryan/wps/portal/home/public-search", "accessed": "2026-09-16", "note": "public search across Facilities, Professionals and the Dubai Medical Registry" }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:ahd-about", "note": "the middle paragraph is marked as this project's inference in the prose" }, "text.how": { "tier": "cited" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "harvested", "source": "s:osm-nominatim", "note": "the street as OpenStreetMap carries it, not an address the hospital published" }, "metrics": { "tier": "cited", "source": "s:ahd-about" } }, "primary_image": null, "tag_facts": [ { "key": "package", "label": "Sells packages", "icon": "🧳", "group": "money", "evidence": "a bundled price on the facility's own page covering more than the operation", "source": "s:ahd-normal-delivery", "note": "maternity packages with written inclusion and exclusion lists; the exclusions carry figures and the package does not", "tier": "cited", "url": "https://www.ahdubai.com/health-packages/maternity-packages/normal-delivery-package" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:ahd-normal-delivery", "note": "the package page prices the epidural, the twin surcharge, the medication and consumable caps, the vaccines and the companion bed, and prints no package price", "tier": "cited", "url": "" }, { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:ahd-about", "note": "seven satellite clinics in Dubai Media City, Al Barsha, Al Khawaneej, Jumeirah, Mira, Dubai Hills and Nad Al Sheba, plus a Dubai Science Park hospital", "tier": "cited", "url": "" }, { "key": "insurer-direct", "label": "Bills foreign insurers", "icon": "📄", "group": "money", "evidence": "the facility names the insurers or schemes it bills directly", "source": "s:ahd-normal-delivery", "note": "the package page states pre-authorisation from the insurance company, third-party administrator or corporate payer is required", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:ahd-about", "note": "the site carries a standing international patients offer", "tier": "cited", "url": "" }, { "key": "interpreter", "label": "Interpreters on staff", "icon": "🗣", "group": "service", "evidence": "the facility's own page naming the languages, or a published inspection or accreditation report", "source": "s:ahd-about", "note": "the hospital publishes in Arabic and English", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation — the first hospital in the Middle East to be awarded it", "url": "https://www.ahdubai.com/about-us", "kind": "international", "year": null, "valid_until": null, "source": "s:ahd-about" }, { "key": "moh-ae", "label": "UAE health regulators (DHA, DoH, MOHAP)", "what": "Licensed under the UAE health regulators; the site footer carries the licence number MOH#Z8IXYQHM-041025", "url": "https://www.ahdubai.com/about-us", "kind": "regulator", "year": null, "valid_until": null, "source": "s:ahd-about" }, { "key": "other", "label": "Somebody else", "what": "College of American Pathologists laboratory accreditation, stated as the first in the region's private sector; American Institute of Ultrasound in Medicine practice accreditation in abdomen and breast; inaugural membership of the Mayo Clinic Care Network; an American Heart Association international training centre", "url": "https://www.ahdubai.com/about-us", "kind": "other", "year": null, "valid_until": null, "source": "s:ahd-about" } ], "acclaim": 3, "kin_in": [ { "from": "uae", "type": "destination", "name": "United Arab Emirates", "as": "One of the private hospitals the inbound trade is built around.", "rel": "part" }, { "from": "dubai", "type": "hub", "name": "Dubai", "as": "One of the city's large private hospitals, and a destination behind a share of the arrivals described here.", "rel": "part" }, { "from": "uae-clinic-licensing", "type": "rule", "name": "Licensing a clinic in the United Arab Emirates", "as": "A licensed hospital in the emirate.", "rel": "facility" }, { "from": "dha-dubai", "type": "org", "name": "Dubai Health Authority", "as": "One of the private hospitals trading under this licence.", "rel": "facility" } ] }, { "schema": 1, "id": "anadolu-medical-center", "type": "facility", "names": { "name": "Anadolu Medical Center", "aliases": [ "Anadolu Sağlık Merkezi", "Anadolu Health Center" ], "said": "Anadolu is Anatolia — the Asian landmass Türkiye sits on. The hospital is not in Istanbul: it stands at Gebze in Kocaeli province, on the D-100 at the Bayramoğlu exit, about an hour east of the city." }, "region": [ "west-asia" ], "facets": { "iso2": "TR", "ownership": "nonprofit", "founded": 2005, "specialty": [ "oncology", "bone marrow transplantation", "radiation oncology", "haematology" ], "draws": [ "bone-marrow-transplant", "proton-therapy", "gamma-knife", "car-t" ], "status": "open", "languages": [ "Turkish", "English", "Arabic", "Russian", "Romanian" ] }, "text": { "what": "A 209-bed hospital at Gebze in Kocaeli, opened on 12 February 2005 by the Anadolu Foundation and affiliated since 2002 with Johns Hopkins Medicine International. It began as a cancer centre and works as a general hospital built around one: bone marrow transplantation, radiation oncology, haematology. It holds Joint Commission International accreditation first granted in 2007 and renewed six times since.", "story": "The Anadolu Foundation, the charitable arm of the Anadolu Group, built the hospital at Gebze rather than in Istanbul, on the highway between the city and the Marmara industrial belt and near Sabiha Gökçen airport. Its clinical identity was set at the start: a cancer centre with 209 beds, 59 intensive care beds and eight operating rooms, able to run up to 22 stem cell transplants at once.\n\nThe Johns Hopkins Medicine International affiliation dates from 2002, three years before the doors opened. *Inference —* the sequence is the point. The American name was contracted before the building existed, which is what an affiliation of this kind is for: it is a recognisable mark attached to a hospital nobody abroad had yet heard of.\n\nJCI accreditation followed in 2007 and has been re-surveyed every three years since, seven awards in all. The cancer centre also holds Planetree Gold certification for person-centred care and is a designated clinical cancer centre of the Organisation of European Cancer Institutes. The hospital states it treats patients from more than 65 countries.", "how": "The hospital sits outside Istanbul, so the journey has a road leg in it that an Istanbul hospital's does not: transfers from either Istanbul airport are part of what the international office arranges rather than a taxi ride. *Trade practice —* an oncology enquiry here is document-heavy — pathology slides, imaging, prior treatment records — and the estimate follows a tumour board rather than a price list.\n\nNothing is published as a price. The hospital's quality pages carry the accreditations; the treatment pages carry no figure.", "today": "As of 17 September 2026 the hospital states its seventh consecutive JCI accreditation, the Johns Hopkins Medicine affiliation, Planetree Gold certification, ESMO and Association of European Cancer Institutes recognition for the cancer centre, and the Türkiye international health tourism authorisation certificate. The 209-bed figure and the 59 intensive care beds are the counts carried in the encyclopaedia entry rather than a current statement from the hospital." }, "geo": { "lat": 40.817961, "lon": 29.353312, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "Cumhuriyet Mahallesi, D-100 Karayolu, Bayramoğlu exit", "city": "Gebze", "area": "Kocaeli", "country": "TR", "postcode": "34940" }, "metrics": { "beds": 209, "annual_patients": null, "annual_foreign_patients": null, "foreign_patient_countries": 65, "note": "209 inpatient beds, with a further 59 intensive care beds and eight operating rooms counted separately. The country figure is the hospital's own statement of where its patients come from — more than 65 — and is not a count of patients. No patient count of any kind was found published, and no price.", "as_of": "2026", "source": "s:wp-anadolu", "url": "https://en.wikipedia.org/wiki/Anadolu_Medical_Center" }, "tags": [ { "tag": "international-office", "source": "s:anadolu-jci", "tier": "cited", "note": "the hospital holds the Türkiye international health tourism authorisation certificate, which presupposes the department" }, { "tag": "transplant-programme", "source": "s:wp-anadolu", "tier": "cited", "note": "bone marrow transplantation, with capacity stated for up to 22 stem cell transplants at once" }, { "tag": "no-price-published", "source": "s:anadolu-jci", "tier": "cited", "note": "the hospital's quality and treatment pages name accreditations and procedures; no figure appears" }, { "tag": "interpreter", "source": "s:wp-anadolu", "tier": "cited", "note": "outpatient clinics also run in Ataşehir, Istanbul; the hospital states patients from more than 65 countries" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International hospital accreditation, first granted 2007 and re-surveyed every three years to a seventh award", "year": 2007, "valid_until": null, "source": "s:anadolu-jci", "url": "https://www.anadolumedicalcenter.com/quality-certificate/jci-joint-commission-international", "note": "the hospital's own statement; JCI publishes no end date on its directory entry, so valid_until stays empty" }, { "by": "moh-tr", "what": "Türkiye international health tourism authorisation certificate", "year": null, "valid_until": null, "source": "s:anadolu-jci", "url": "https://www.anadolumedicalcenter.com/quality-certificate/jci-joint-commission-international", "note": "named among the hospital's certificates without a date" }, { "by": "other", "what": "Planetree Gold certification for person-centred care, and recognition of the cancer centre by the Association of European Cancer Institutes and the European Society for Medical Oncology", "year": null, "valid_until": null, "source": "s:anadolu-jci", "url": "https://www.anadolumedicalcenter.com/quality-certificate/jci-joint-commission-international", "note": "three bodies not in this project's recognizer vocabulary, named here as the hospital names them" } ], "kin": [ { "to": "turkiye", "as": "The country's cancer hospital with the oldest American affiliation, contracted in 2002 before the building opened.", "rel": "destination" }, { "to": "istanbul", "as": "An hour east of the city and outside it, at Gebze on the D-100 — the trade counts it Istanbul, the map does not.", "rel": "place" }, { "to": "bone-marrow-transplant", "as": "The programme the hospital was built around, with capacity stated for 22 simultaneous stem cell transplants.", "rel": "performs" }, { "to": "jci", "as": "The accreditor whose mark it has held since 2007, re-surveyed every three years to a seventh award.", "rel": "accredited-by" }, { "to": "acibadem", "as": "The other Turkish name a foreign oncology enquiry lands on, and a group of forty-five buildings against this one.", "rel": "contrast" }, { "to": "turkiye-health-tourism-authorisation", "as": "Holds the certificate, which it lists among its quality documents.", "rel": "governed-by" }, { "to": "the-accreditation-question", "as": "An American affiliation signed three years before the hospital opened is what an accreditation mark is bought to do.", "rel": "story" }, { "to": "getting-your-records", "as": "An oncology referral here starts with slides and imaging rather than with a form.", "rel": "step" } ], "links": [ { "label": "Anadolu Medical Center", "url": "https://www.anadolumedicalcenter.com/" } ], "sources": [ "s:wp-anadolu", "s:anadolu-jci", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "text.how": { "tier": "tradition", "note": "the shape of an oncology enquiry from abroad; the last paragraph is cited" }, "metrics": { "tier": "cited", "source": "s:wp-anadolu" } } }, "x_commons_files": [ "File:Anadolu Sağlık Merkezi.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "A 209-bed hospital at Gebze in Kocaeli, opened on 12 February 2005 by the Anadolu Foundation and affiliated since 2002 with Johns Hopkins Medicine International.", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The country's cancer hospital with the oldest American affiliation, contracted in 2002 before the building opened.", "rel": "destination" }, { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "An hour east of the city and outside it, at Gebze on the D-100 — the trade counts it Istanbul, the map does not.", "rel": "place" }, { "to": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "The programme the hospital was built around, with capacity stated for 22 simultaneous stem cell transplants.", "rel": "performs" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The accreditor whose mark it has held since 2007, re-surveyed every three years to a seventh award.", "rel": "accredited-by" }, { "to": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "The other Turkish name a foreign oncology enquiry lands on, and a group of forty-five buildings against this one.", "rel": "contrast" }, { "to": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "Holds the certificate, which it lists among its quality documents.", "rel": "governed-by" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "An American affiliation signed three years before the hospital opened is what an accreditation mark is bought to do.", "rel": "story" }, { "to": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "An oncology referral here starts with slides and imaging rather than with a form.", "rel": "step" } ], "source_list": [ { "id": "s:wp-anadolu", "kind": "wikipedia", "title": "Anadolu Medical Center", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Anadolu_Medical_Center", "license": "CC BY-SA 4.0", "accessed": "2026-09-17", "note": "opened 12 February 2005 by the Anadolu Foundation, affiliated with Johns Hopkins Medicine International; 209 beds plus 59 intensive care beds and 8 operating rooms; Gebze, Kocaeli" }, { "id": "s:anadolu-jci", "kind": "web", "title": "JCI — Joint Commission International", "publisher": "Anadolu Sağlık Merkezi", "url": "https://www.anadolumedicalcenter.com/quality-certificate/jci-joint-commission-international", "accessed": "2026-09-17", "note": "the hospital's own statement: JCI first granted 2007, seventh accreditation earned, three-year re-survey cycle. The same page names Planetree Gold, the Association of European Cancer Institutes, ESMO and the Türkiye international health tourism authorisation certificate." }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "the shape of an oncology enquiry from abroad; the last paragraph is cited" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-anadolu" } }, "primary_image": null, "tag_facts": [ { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:anadolu-jci", "note": "the hospital holds the Türkiye international health tourism authorisation certificate, which presupposes the department", "tier": "cited", "url": "" }, { "key": "transplant-programme", "label": "Transplant programme", "icon": "🫀", "group": "clinical", "evidence": "a national transplant registry, a ministry licence list, or the facility's own programme page", "source": "s:wp-anadolu", "note": "bone marrow transplantation, with capacity stated for up to 22 stem cell transplants at once", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:anadolu-jci", "note": "the hospital's quality and treatment pages name accreditations and procedures; no figure appears", "tier": "cited", "url": "" }, { "key": "interpreter", "label": "Interpreters on staff", "icon": "🗣", "group": "service", "evidence": "the facility's own page naming the languages, or a published inspection or accreditation report", "source": "s:wp-anadolu", "note": "outpatient clinics also run in Ataşehir, Istanbul; the hospital states patients from more than 65 countries", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International hospital accreditation, first granted 2007 and re-surveyed every three years to a seventh award", "url": "https://www.anadolumedicalcenter.com/quality-certificate/jci-joint-commission-international", "kind": "international", "year": 2007, "valid_until": null, "source": "s:anadolu-jci" }, { "key": "moh-tr", "label": "Türkiye Ministry of Health health-tourism authorisation", "what": "Türkiye international health tourism authorisation certificate", "url": "https://www.anadolumedicalcenter.com/quality-certificate/jci-joint-commission-international", "kind": "regulator", "year": null, "valid_until": null, "source": "s:anadolu-jci" }, { "key": "other", "label": "Somebody else", "what": "Planetree Gold certification for person-centred care, and recognition of the cancer centre by the Association of European Cancer Institutes and the European Society for Medical Oncology", "url": "https://www.anadolumedicalcenter.com/quality-certificate/jci-joint-commission-international", "kind": "other", "year": null, "valid_until": null, "source": "s:anadolu-jci" } ], "acclaim": 3, "kin_in": [] }, { "schema": 1, "id": "apollo-chennai", "type": "facility", "names": { "name": "Apollo Hospitals, Greams Road, Chennai", "aliases": [ "Apollo Main Hospital", "Apollo Greams Road", "அப்பல்லோ மருத்துவமனை" ], "said": "Greams Road, or Greams Lane — the hospital is on the lane and the city names it for the road. Within the group it is simply the Main Hospital." }, "region": [ "south-asia" ], "facets": { "iso2": "IN", "ownership": "private", "founded": 1983, "specialty": [ "cardiac sciences", "oncology", "transplants", "orthopaedics", "neurosciences", "gastroenterology" ], "draws": [ "cabg", "liver-transplant", "kidney-transplant", "knee-replacement" ], "status": "open", "languages": [ "English", "Tamil", "Hindi" ] }, "text": { "what": "The first hospital of the Apollo group, opened at Greams Road in Chennai in 1983 and still its flagship. It runs over sixty departments, states 1,500-plus outpatient visits a day and 500-plus international patient consultations a month, and sits within a few hundred metres of the group's children's hospital, women's hospital and heart centre.", "story": "Apollo Hospitals was founded by Prathap C. Reddy in 1983 as the first corporate hospital company in India, and the first branch — this one — was opened by the President of India, Zail Singh. The date matters for the subject: an Indian private hospital company existed before India had a private hospital industry, and the cross-border patient trade that grew around Chennai grew around it.\n\nSeveral of the group's hospitals were among the first in India to take Joint Commission International accreditation, and the group also holds accreditation from NABH, the Indian national board. *Inference —* Apollo's early move on JCI is the same move Bumrungrad made in Bangkok two decades ago and for the same reason: an accreditation is a name a foreign insurer already recognises, attached to a hospital it does not.\n\nThe Chennai cluster around Greams Road is denser than a single hospital. The group lists twelve facilities in the city, including a proton therapy centre at Tharamani — one of a small number in Asia, and the reason a particular kind of cancer patient flies to Chennai rather than Bangkok.", "how": "An international patient reaches a separate lifeline number, quoted on every page, and a consultation is arranged before travel. *Trade practice —* Indian corporate hospitals quote a foreign patient an estimate by email rather than publishing a price, and the estimate is a band with the implant, the ICU nights and the length of stay named as variables. Nothing on this hospital's own pages, read on 16 September 2026, carried a rupee figure for an operation.", "today": "As of 16 September 2026 the hospital's own page states it was established in 1983, runs over sixty departments, and records 1,500-plus daily outpatient visits and 500-plus international patient consultations a month. It publishes no price. Its bed count is rendered by script on that page and did not resolve for this project, so this record carries none." }, "geo": { "lat": 13.0632248, "lon": 80.2515817, "precision": "street", "source": "s:osm" }, "address": { "street": "Greams Lane, 21 Greams Road, Thousand Lights West", "city": "Chennai", "area": "Tamil Nadu", "country": "IN", "postcode": "600006" }, "metrics": { "beds": null, "annual_patients": null, "annual_foreign_patients": null, "inbound_patients_year": "500+ international patient consultations a month, the hospital's own figure", "note": "Both numbers on the hospital's page count EPISODES, not people: 1,500-plus daily outpatient visits and 500-plus international consultations a month. A patient seen three times before surgery is three consultations. The bed count on that page is a script-rendered counter that returned zero to this project and is therefore absent here rather than guessed.", "as_of": "2026-09-16", "source": "s:apollo-greams-road", "url": "https://www.apollohospitals.com/hospitals/apollo-hospitals-greams-road-chennai" }, "tags": [ { "tag": "chain", "source": "s:wp-apollo-hospitals", "tier": "cited", "note": "Apollo Hospitals Enterprise, the first corporate hospital group in India" }, { "tag": "listed-company", "source": "s:wp-apollo-hospitals", "tier": "cited" }, { "tag": "international-office", "source": "s:apollo-greams-road", "tier": "cited", "note": "a separate international patient helpline printed on every page of the hospital's site" }, { "tag": "transplant-programme", "source": "s:apollo-greams-road", "tier": "cited", "note": "the hospital's own specialty list names transplants, including liver and kidney" }, { "tag": "no-price-published", "source": "s:apollo-greams-road", "tier": "cited", "note": "no rupee figure for any operation on the hospital's own pages, checked 16 September 2026" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation; several Apollo hospitals were among the first in India to take it", "year": null, "valid_until": null, "source": "s:wp-apollo-hospitals", "url": "https://en.wikipedia.org/wiki/Apollo_Hospitals", "note": "reported of the group rather than dated to this hospital; the year first granted is not recorded here" }, { "by": "nabh", "what": "NABH accreditation, the Indian national hospital standard", "year": null, "valid_until": null, "source": "s:wp-apollo-hospitals", "url": "https://en.wikipedia.org/wiki/Apollo_Hospitals", "note": "reported of the group; NABH publishes its own register, which this record has not read" } ], "kin": [ { "to": "chennai", "as": "The hospital the Chennai cluster grew around, and the reason the cluster is on Greams Road.", "rel": "place" }, { "to": "india", "as": "The hospital most often meant when India is called a destination for heart surgery.", "rel": "destination" }, { "to": "prathap-reddy", "as": "Its founder, who opened it in 1983 as the first corporate hospital in the country.", "rel": "person" }, { "to": "cabg", "as": "The operation the Chennai cardiac trade was built on.", "rel": "performs" }, { "to": "proton-therapy", "as": "The group runs a proton centre at Tharamani in the same city, which draws a different patient again.", "rel": "procedure" }, { "to": "jci", "as": "An accreditor Apollo hospitals took early for India.", "rel": "accredited-by" }, { "to": "nabh", "as": "The Indian national board whose standard the group holds.", "rel": "accredited-by" }, { "to": "india-e-medical-visa", "as": "The visa class most of its foreign consultations arrive on.", "rel": "governed-by" }, { "to": "getting-a-quote", "as": "Publishes no price; a foreign patient here gets an emailed estimate instead.", "rel": "step" } ], "links": [ { "label": "Apollo Hospitals, Greams Road, Chennai", "url": "https://www.apollohospitals.com/hospitals/apollo-hospitals-greams-road-chennai" }, { "label": "Apollo hospitals in Chennai", "url": "https://www.apollohospitals.com/hospital/chennai" } ], "sources": [ "s:wp-apollo-hospitals", "s:apollo-greams-road", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "tradition", "note": "how Indian corporate hospitals quote a foreign patient; the hedged sentence is marked in the prose" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node Apollo Hospital, Greams Lane" }, "metrics": { "tier": "cited", "source": "s:apollo-greams-road" } } }, "x_commons_files": [ "File:Apollo Hospitals Chennai.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "The first hospital of the Apollo group, opened at Greams Road in Chennai in 1983 and still its flagship.", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" } ], "kin_out": [ { "to": "chennai", "type": "hub", "name": "Chennai", "as": "The hospital the Chennai cluster grew around, and the reason the cluster is on Greams Road.", "rel": "place" }, { "to": "india", "type": "destination", "name": "India", "as": "The hospital most often meant when India is called a destination for heart surgery.", "rel": "destination" }, { "to": "prathap-reddy", "type": "person", "name": "Prathap C. Reddy", "as": "Its founder, who opened it in 1983 as the first corporate hospital in the country.", "rel": "person" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The operation the Chennai cardiac trade was built on.", "rel": "performs" }, { "to": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "The group runs a proton centre at Tharamani in the same city, which draws a different patient again.", "rel": "procedure" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "An accreditor Apollo hospitals took early for India.", "rel": "accredited-by" }, { "to": "nabh", "type": "org", "name": "National Accreditation Board for Hospitals and Healthcare Providers", "as": "The Indian national board whose standard the group holds.", "rel": "accredited-by" }, { "to": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The visa class most of its foreign consultations arrive on.", "rel": "governed-by" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "Publishes no price; a foreign patient here gets an emailed estimate instead.", "rel": "step" } ], "source_list": [ { "id": "s:wp-apollo-hospitals", "kind": "wikipedia", "title": "Apollo Hospitals", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Apollo_Hospitals", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:apollo-greams-road", "kind": "web", "title": "Apollo Hospitals, Greams Road, Chennai — hospital page", "publisher": "Apollo Hospitals", "url": "https://www.apollohospitals.com/hospitals/apollo-hospitals-greams-road-chennai", "accessed": "2026-09-16" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "how Indian corporate hospitals quote a foreign patient; the hedged sentence is marked in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node Apollo Hospital, Greams Lane" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:apollo-greams-road" } }, "primary_image": null, "tag_facts": [ { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:wp-apollo-hospitals", "note": "Apollo Hospitals Enterprise, the first corporate hospital group in India", "tier": "cited", "url": "" }, { "key": "listed-company", "label": "Publicly listed", "icon": "📈", "group": "ownership", "evidence": "an exchange listing or an annual report", "source": "s:wp-apollo-hospitals", "note": "", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:apollo-greams-road", "note": "a separate international patient helpline printed on every page of the hospital's site", "tier": "cited", "url": "" }, { "key": "transplant-programme", "label": "Transplant programme", "icon": "🫀", "group": "clinical", "evidence": "a national transplant registry, a ministry licence list, or the facility's own programme page", "source": "s:apollo-greams-road", "note": "the hospital's own specialty list names transplants, including liver and kidney", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:apollo-greams-road", "note": "no rupee figure for any operation on the hospital's own pages, checked 16 September 2026", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation; several Apollo hospitals were among the first in India to take it", "url": "https://en.wikipedia.org/wiki/Apollo_Hospitals", "kind": "international", "year": null, "valid_until": null, "source": "s:wp-apollo-hospitals" }, { "key": "nabh", "label": "NABH (India)", "what": "NABH accreditation, the Indian national hospital standard", "url": "https://en.wikipedia.org/wiki/Apollo_Hospitals", "kind": "national", "year": null, "valid_until": null, "source": "s:wp-apollo-hospitals" } ], "acclaim": 2, "kin_in": [ { "from": "india", "type": "destination", "name": "India", "as": "The hospital the country's private sector is usually dated from.", "rel": "part" }, { "from": "kenya", "type": "destination", "name": "Kenya", "as": "One of the Indian groups that has kept a liaison presence in East Africa.", "rel": "performed-at" }, { "from": "chennai", "type": "hub", "name": "Chennai", "as": "The Greams Lane hospital the cluster grew out of, opened 1983.", "rel": "part" }, { "from": "kokilaben", "type": "facility", "name": "Kokilaben Dhirubhai Ambani Hospital", "as": "The southern competitor for the same Gulf and East African referrals.", "rel": "contrast" }, { "from": "narayana-health", "type": "facility", "name": "Narayana Health", "as": "The older Indian corporate hospital company, built on referral prestige rather than on volume.", "rel": "contrast" }, { "from": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The kind of hospital whose letterhead the application turns on.", "rel": "facility" }, { "from": "nabh", "type": "org", "name": "National Accreditation Board for Hospitals and Healthcare Providers", "as": "One of the private hospitals whose badge wall carries this mark.", "rel": "accredits" }, { "from": "prathap-reddy", "type": "person", "name": "Prathap C. Reddy", "as": "The hospital he opened in 1983, and the one Apollo still treats as its origin.", "rel": "facility" } ] }, { "schema": 1, "id": "asan-medical-center", "type": "facility", "names": { "name": "Asan Medical Center", "aliases": [ "AMC", "서울아산병원", "Seoul Asan Hospital", "Seoul Jungang Hospital" ], "said": "Asan is the birthplace of Chung Ju-yung, who founded Hyundai and then the Asan Foundation. The hospital opened as Seoul Jungang Hospital in 1989 and took the present name on 27 April 2002." }, "region": [ "east-asia" ], "facets": { "iso2": "KR", "ownership": "nonprofit", "founded": 1989, "specialty": [ "transplantation", "oncology", "cardiology", "gastroenterology", "neurosciences" ], "draws": [ "liver-transplant", "kidney-transplant", "bone-marrow-transplant", "cabg", "proton-therapy" ], "status": "open", "languages": [ "Korean", "English", "Russian", "Arabic", "Mongolian" ] }, "text": { "what": "South Korea's largest hospital: 2,446 beds on 280,000 square metres at 88 Olympic-ro 43-gil in Songpa-gu, Seoul, established in June 1989 by Chung Ju-yung through the charitable Asan Foundation. It averages 11,377 outpatients a day, records 654,536 inpatients and 47,460 complex operations a year, and Newsweek has placed it 22nd in the world and first in Korea for seven consecutive years.", "story": "The hospital is a foundation's, not Hyundai's, though the founder is the same man. It opened in 1989 as Seoul Jungang Hospital and renamed itself Asan Medical Center in 2002.\n\nIts numbers are the largest in this batch and they need separating. 11,377 is a DAILY average of outpatients. 654,536 is an annual count of inpatients — admissions, which means a patient admitted three times in a year is three. 47,460 is an annual count of operations described as highly sophisticated, which is the hospital's own category and not a standard one. None of the three is a count of people.\n\n*Inference —* an outpatient department seeing eleven thousand people a day is the single most striking fact about East Asian tertiary medicine and the hardest for a visitor from a European system to picture. It is also why a foreign patient's experience of one of these hospitals is organised around an international centre that pulls them out of that flow.\n\nThe hospital reports an annual average of 19,482 international patients — which, unusually in this directory, is a named hospital's own count of its foreign caseload rather than a national arrivals total. It was first in Korea for organ transplantation on the national registry's 2012 figures, and its Asan Global Standard, introduced in 2011, was built on JCI's assessment principles.", "how": "*Trade practice —* the Korean route requires the hospital to be registered with the Ministry of Health and Welfare to treat foreign patients, and the work runs through an international healthcare centre that books, translates and bills. Transplantation and oncology carry the serious inbound traffic; Korea's cosmetic trade runs through a separate clinic sector entirely.\n\nNo price is published by the hospital.", "today": "As of 17 September 2026 the hospital states 2,446 beds, 11,377 average daily outpatients, 654,536 inpatients a year and 47,460 complex operations a year, with an annual average of 19,482 international patients. Newsweek placed it 22nd in the world and first in Korea for seven consecutive years to 2025. No price is published." }, "geo": { "lat": 37.526304, "lon": 127.109601, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "88 Olympic-ro 43-gil, Songpa-gu", "city": "Seoul", "country": "KR", "postcode": "05505" }, "metrics": { "beds": 2446, "annual_patients": 654536, "annual_foreign_patients": 19482, "note": "annual_patients here is INPATIENTS and counts ADMISSIONS, not people: 654,536 a year, so a patient admitted three times is three. Outpatients are counted separately and DAILY — an average of 11,377 a day — and are not annualised here because the hospital does not annualise them. Operations, 47,460 a year, are in the hospital's own category of highly sophisticated procedures. The foreign figure, 19,482, is an annual average and is the hospital's own count of its foreign caseload rather than a national arrivals total; whether it counts people or episodes is not stated. Beds are 2,446 on the hospital's page and 2,432 licensed on the encyclopaedia entry.", "as_of": "2026", "source": "s:amc-introduction", "url": "https://eng.amc.seoul.kr/gb/lang/about/contents/introduction.do" }, "tags": [ { "tag": "transplant-programme", "source": "s:wp-asan", "tier": "cited", "note": "first in Korea for organ transplantation on the national registry's 2012 figures; an Organ Transplantation Center" }, { "tag": "teaching", "source": "s:wp-asan", "tier": "cited", "note": "runs training for clinicians from abroad; the source names a 2018 agreement with Huế Central Hospital in Vietnam for training medical professionals" }, { "tag": "international-office", "source": "s:amc-introduction", "tier": "cited", "note": "an annual average of 19,482 international patients on the hospital's own counter", "url": "https://eng.amc.seoul.kr/gb/lang/about/contents/introduction.do" }, { "tag": "no-price-published", "source": "s:amc-introduction", "tier": "cited", "note": "no price list was found on the hospital's own English site" }, { "tag": "outcomes-published", "source": "s:amc-introduction", "tier": "cited", "note": "the hospital cites HIRA's 2012 first-class operative mortality grading for major cancers and KONOS transplant volumes — national registry data about the unit, which is the strongest form of outcome publication in this batch" } ], "recognitions": [ { "by": "kohta", "what": "Registered with the Korean Ministry of Health and Welfare to treat foreign patients", "year": null, "valid_until": null, "source": "s:khidi-medicalkorea", "url": "http://www.medicalkorea.or.kr/en/aboutkhidi", "note": "the compulsory Korean registration; a facility may not lawfully treat foreign patients without it" }, { "by": "newsweek-statista", "what": "22nd in the world and first in Korea for seven consecutive years, 2019 to 2025", "year": 2025, "valid_until": null, "source": "s:amc-introduction", "url": "https://eng.amc.seoul.kr/gb/lang/about/contents/introduction.do", "note": "the hospital's own statement of its placing; counted, not weighted" }, { "by": "jci", "what": "The Asan Global Standard, an internal evaluation guideline the hospital introduced in 2011 built on JCI's assessment principles", "year": 2011, "valid_until": null, "source": "s:wp-asan", "url": "https://en.wikipedia.org/wiki/Asan_Medical_Center", "note": "NOT an accreditation. The hospital built its own standard on the body's principles; no JCI award year was found in the sources read, and this row records the distinction rather than a mark" } ], "kin": [ { "to": "seoul", "as": "The largest of the three Seoul hospitals here, across the river in Songpa by the Olympic park.", "rel": "place" }, { "to": "south-korea", "as": "The country's largest hospital, and one of the few anywhere that publishes its own foreign caseload.", "rel": "destination" }, { "to": "liver-transplant", "as": "The programme its foreign referrals come for, and the one the national registry ranks it first on.", "rel": "performs" }, { "to": "samsung-medical-center", "as": "The Gangnam hospital, five years younger and a third smaller.", "rel": "contrast" }, { "to": "severance", "as": "The oldest of the three, and the first in Korea to take JCI accreditation.", "rel": "contrast" }, { "to": "korea-foreign-patient-registration", "as": "Operates under the registration every Korean facility treating foreign patients must hold.", "rel": "governed-by" }, { "to": "counting-patients", "as": "11,377 a day, 654,536 a year and 19,482 from abroad are three counters measuring three different things.", "rel": "story" }, { "to": "in-hospital", "as": "An outpatient department seeing eleven thousand people a day is the setting a foreign patient's international centre exists to bypass.", "rel": "step" } ], "links": [ { "label": "Asan Medical Center", "url": "https://eng.amc.seoul.kr/" } ], "sources": [ "s:amc-introduction", "s:wp-asan", "s:khidi-medicalkorea", "s:mohw-kr-foreign-patients-2024", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "text.how": { "tier": "tradition", "note": "how the Korean international centre route runs; marked in the prose" }, "metrics": { "tier": "cited", "source": "s:amc-introduction" } } }, "x_commons_files": [ "File:Asan Medical Center.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "South Korea's largest hospital: 2,446 beds on 280,000 square metres at 88 Olympic-ro 43-gil in Songpa-gu, Seoul, established in June 1989 by Chung Ju-yung through the charitable Asan Foundation.", "region_terms": [ { "key": "east-asia", "name": "East Asia", "note": "South Korea, Japan, Taiwan, China" } ], "kin_out": [ { "to": "seoul", "type": "hub", "name": "Seoul", "as": "The largest of the three Seoul hospitals here, across the river in Songpa by the Olympic park.", "rel": "place" }, { "to": "south-korea", "type": "destination", "name": "South Korea", "as": "The country's largest hospital, and one of the few anywhere that publishes its own foreign caseload.", "rel": "destination" }, { "to": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "The programme its foreign referrals come for, and the one the national registry ranks it first on.", "rel": "performs" }, { "to": "samsung-medical-center", "type": "facility", "name": "Samsung Medical Center", "as": "The Gangnam hospital, five years younger and a third smaller.", "rel": "contrast" }, { "to": "severance", "type": "facility", "name": "Severance Hospital", "as": "The oldest of the three, and the first in Korea to take JCI accreditation.", "rel": "contrast" }, { "to": "korea-foreign-patient-registration", "type": "rule", "name": "Korea's foreign patient attraction registration", "as": "Operates under the registration every Korean facility treating foreign patients must hold.", "rel": "governed-by" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "11,377 a day, 654,536 a year and 19,482 from abroad are three counters measuring three different things.", "rel": "story" }, { "to": "in-hospital", "type": "pathway", "name": "In hospital", "as": "An outpatient department seeing eleven thousand people a day is the setting a foreign patient's international centre exists to bypass.", "rel": "step" } ], "source_list": [ { "id": "s:amc-introduction", "kind": "web", "title": "Introduction — About Us", "publisher": "Asan Medical Center, Seoul", "url": "https://eng.amc.seoul.kr/gb/lang/about/contents/introduction.do", "accessed": "2026-09-17", "note": "the hospital's own counters: 2,446 beds, 11,377 average daily outpatients, 654,536 inpatients a year, 47,460 highly sophisticated surgeries a year; established June 1989; 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505. It also carries the Newsweek placing — 22nd in the world and first in Korea for seven consecutive years — and KMAC's most-respected-hospital run." }, { "id": "s:wp-asan", "kind": "web", "title": "Asan Medical Center", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Asan_Medical_Center", "accessed": "2026-09-16" }, { "id": "s:khidi-medicalkorea", "kind": "org", "title": "About KHIDI — Medical Korea", "publisher": "Korea Health Industry Development Institute", "url": "http://www.medicalkorea.or.kr/en/aboutkhidi", "accessed": "2026-09-16", "note": "government-affiliated institution under the Ministry of Health and Welfare; the registration system, registered hospitals and registered facilitators" }, { "id": "s:mohw-kr-foreign-patients-2024", "kind": "web", "title": "Korea Attracts 1.17 Million Foreign Patients in 2024", "publisher": "Ministry of Health and Welfare (Republic of Korea)", "url": "https://www.mohw.go.kr/board.es?mid=a20401000000&bid=0032&act=view&list_no=1485207", "accessed": "2026-09-16", "note": "press release of 3 April 2025; the annual foreign-patient statistics are compiled for the ministry by the Korea Health Industry Development Institute" }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "how the Korean international centre route runs; marked in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:amc-introduction" } }, "primary_image": null, "tag_facts": [ { "key": "transplant-programme", "label": "Transplant programme", "icon": "🫀", "group": "clinical", "evidence": "a national transplant registry, a ministry licence list, or the facility's own programme page", "source": "s:wp-asan", "note": "first in Korea for organ transplantation on the national registry's 2012 figures; an Organ Transplantation Center", "tier": "cited", "url": "" }, { "key": "teaching", "label": "Teaching hospital", "icon": "📚", "group": "clinical", "evidence": "a recognised training post list or the hospital's own statement", "source": "s:wp-asan", "note": "runs training for clinicians from abroad; the source names a 2018 agreement with Huế Central Hospital in Vietnam for training medical professionals", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:amc-introduction", "note": "an annual average of 19,482 international patients on the hospital's own counter", "tier": "cited", "url": "https://eng.amc.seoul.kr/gb/lang/about/contents/introduction.do" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:amc-introduction", "note": "no price list was found on the hospital's own English site", "tier": "cited", "url": "" }, { "key": "outcomes-published", "label": "Publishes outcomes", "icon": "📊", "group": "clinical", "evidence": "a registry submission, an annual clinical report, or a national outcome dataset naming the unit", "source": "s:amc-introduction", "note": "the hospital cites HIRA's 2012 first-class operative mortality grading for major cancers and KONOS transplant volumes — national registry data about the unit, which is the strongest form of outcome publication in this batch", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "kohta", "label": "KOIHA / KAHF (South Korea)", "what": "Registered with the Korean Ministry of Health and Welfare to treat foreign patients", "url": "http://www.medicalkorea.or.kr/en/aboutkhidi", "kind": "national", "year": null, "valid_until": null, "source": "s:khidi-medicalkorea" }, { "key": "newsweek-statista", "label": "Newsweek / Statista World's Best Hospitals", "what": "22nd in the world and first in Korea for seven consecutive years, 2019 to 2025", "url": "https://eng.amc.seoul.kr/gb/lang/about/contents/introduction.do", "kind": "listing", "year": 2025, "valid_until": null, "source": "s:amc-introduction" }, { "key": "jci", "label": "Joint Commission International", "what": "The Asan Global Standard, an internal evaluation guideline the hospital introduced in 2011 built on JCI's assessment principles", "url": "https://en.wikipedia.org/wiki/Asan_Medical_Center", "kind": "international", "year": 2011, "valid_until": null, "source": "s:wp-asan" } ], "acclaim": 3, "kin_in": [ { "from": "south-korea", "type": "destination", "name": "South Korea", "as": "The country's largest hospital, and a transplant centre foreign patients are referred to.", "rel": "part" }, { "from": "seoul", "type": "hub", "name": "Seoul", "as": "At 88 Olympic-ro 43-gil in Songpa-gu, by the Han river.", "rel": "part" }, { "from": "samsung-medical-center", "type": "facility", "name": "Samsung Medical Center", "as": "The larger Seoul hospital, five years older and across the river in Songpa.", "rel": "contrast" }, { "from": "severance", "type": "facility", "name": "Severance Hospital", "as": "The largest Korean hospital, opened a century after this one.", "rel": "contrast" }, { "from": "korea-foreign-patient-registration", "type": "rule", "name": "Korea's foreign patient attraction registration", "as": "One of the registered institutions.", "rel": "facility" } ] }, { "schema": 1, "id": "bangkok-hospital", "type": "facility", "names": { "name": "Bangkok Hospital", "aliases": [ "Bangkok Hospital Headquarters", "BHQ", "โรงพยาบาลกรุงเทพ" ], "said": "Rong-phayaban Krung Thep — literally the Bangkok hospital. Drivers know it as Soi Soonvijai, the lane off New Phetchaburi Road that the whole campus sits on." }, "region": [ "southeast-asia" ], "facets": { "iso2": "TH", "ownership": "private", "founded": 1972, "specialty": [ "cardiology", "oncology", "neurology", "orthopaedics", "health screening", "emergency and air transfer" ], "draws": [ "knee-arthroscopy", "gallbladder-removal", "executive-health-screening" ], "status": "open", "languages": [ "Thai", "English", "Arabic", "Japanese", "Burmese", "Khmer", "Chinese", "German" ] }, "text": { "what": "The flagship of Bangkok Dusit Medical Services, on a campus of specialist buildings down Soi Soonvijai off New Phetchaburi Road. It opened in 1972 with a team of physicians, pharmacists and thirty nurses, and now runs a heart hospital, a cancer hospital and a bone-and-joint hospital on the same site. It prices a long list of operations publicly, each with a stated window during which the price can be bought.", "story": "Bangkok Hospital opened in 1972, among the first private hospitals in Thailand, and grew into the head of a group that runs 53 institutions across the region, fourteen of them holding Joint Commission International accreditation.\n\nThe campus model is the thing to notice. Rather than one building with departments, the site carries separate named hospitals — heart, cancer, bone and joint — each with its own entrance and its own price list. *Inference —* that structure is what lets the group quote a fixed figure for a named operation: a unit that does one class of work all day can predict its own theatre time and its own ward nights closely enough to sell them as a bundle.\n\nThe prices come with dates on them. A package page states a window — usable between two dates — and a struck-through higher figure beside the one being asked. Read on 16 September 2026, the arthroscopic knee packages and the robotic abdominal packages both sat inside a campaign running to 31 October 2026, on terms that required a bill over 100,000 baht and at least one night on the ward.", "how": "An inquiry reaches an international desk that answers in several languages; a package is quoted for a named operation; the ward nights are counted into the price and anything past them is not. The joint and spine packages are quoted with the implant excluded, which is stated in the package title itself rather than buried in a footnote. The hospital also runs an air-ambulance service, which is unusual enough to be part of how it is chosen.", "today": "As of 16 September 2026 the hospital's public package pages list an arthroscopic knee with meniscus repair, one side, implant excluded, at 272,000 baht against a struck-through 286,000, with one night on the ward, usable 31 July to 31 October 2026; and a robotic-assisted cholecystectomy at 330,000 baht against 348,000, also one night. Its awards page states Advanced HA accreditation from the Healthcare Accreditation Institute in 2026 and a Joint Commission International seal without naming its year." }, "geo": { "lat": 13.749195, "lon": 100.5832663, "precision": "street", "source": "s:osm" }, "address": { "street": "2 Soi Soonvijai 7, New Phetchaburi Road, Bang Kapi, Huai Khwang", "city": "Bangkok", "country": "TH", "postcode": "10310" }, "metrics": { "beds": 488, "annual_patients": null, "annual_foreign_patients": null, "foreign_patient_countries": null, "note": "488 inpatient beds is the figure carried on the hospital's Wikipedia entry and read on 16 September 2026; the hospital's own pages read for this record state no bed count, no patient total and no international-patient total. Where a Thai hospital does publish a patient figure it is almost always a count of VISITS rather than of people, and nothing here is audited by this project.", "as_of": "2026-09-16", "source": "s:wp-bangkok-hospital", "url": "https://en.wikipedia.org/wiki/Bangkok_Hospital" }, "tags": [ { "tag": "price-published", "source": "s:bangkokhospital-knee-arthroscopy", "tier": "cited", "note": "package pages carrying a baht figure and a usable-between date", "url": "https://www.bangkokhospital.com/en/bangkok/package/arthroscopic-knee-with-meniscus-repair-1-side-exclude-implant-en" }, { "tag": "package", "source": "s:bangkokhospital-cholecystectomy", "tier": "cited", "note": "surgical packages naming the operation, the side and the nights" }, { "tag": "chain", "source": "s:wp-bangkok-hospital", "tier": "cited", "note": "Bangkok Dusit Medical Services, 53 institutions in the region" } ], "recognitions": [ { "by": "ha-moh-th", "what": "Advanced HA Accreditation from the Healthcare Accreditation Institute of Thailand", "year": 2026, "valid_until": null, "source": "s:bangkokhospital-awards", "url": "https://www.bangkokhospital.com/en/bangkok/about-us/awards-accreditations", "note": "the Thai national standard, run by a public organisation; the hospital's own awards page names it for 2026" }, { "by": "jci", "what": "Joint Commission International accreditation", "year": null, "valid_until": null, "source": "s:bangkokhospital-awards", "url": "https://www.bangkokhospital.com/en/bangkok/about-us/awards-accreditations", "note": "the hospital names the seal but not the year it was first granted; JCI runs in three-year cycles" }, { "by": "newsweek-statista", "what": "Listed in the 2025 Newsweek and Statista hospital ranking", "year": 2025, "valid_until": null, "source": "s:bangkokhospital-awards", "url": "https://www.bangkokhospital.com/en/bangkok/about-us/awards-accreditations", "note": "a survey-and-indicator listing, counted here and never read as a quality score" } ], "prices": [ { "procedure": "knee-arthroscopy", "country": "TH", "city": "Bangkok", "facility": "bangkok-hospital", "amount": 272000, "currency": "THB", "as_of": "2026-09-16", "kind": "package", "includes": [ "arthroscopic knee surgery with meniscus repair, one side", "one night in hospital" ], "excludes": [ "the implant, which the package title states" ], "source": "s:bangkokhospital-knee-arthroscopy", "url": "https://www.bangkokhospital.com/en/bangkok/package/arthroscopic-knee-with-meniscus-repair-1-side-exclude-implant-en", "note": "listed against a struck-through 286,000 baht, usable 31 July 2026 to 31 October 2026. One side means one knee. The campaign terms require a bill of at least 100,000 baht and one night on the ward.", "tier": "cited", "usd": 8170.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "gallbladder-removal", "country": "TH", "city": "Bangkok", "facility": "bangkok-hospital", "amount": 330000, "currency": "THB", "as_of": "2026-09-16", "kind": "package", "includes": [ "robotic-assisted cholecystectomy, level 2", "one night in hospital" ], "excludes": [], "source": "s:bangkokhospital-cholecystectomy", "url": "https://www.bangkokhospital.com/en/bangkok/package/robotic-assisted-cholecystectomy-level-2-en", "note": "listed against a struck-through 348,000 baht, usable 31 July 2026 to 31 October 2026. Level 2 is the hospital's own complexity grade; the page read for this record printed no exclusion list, which is itself worth knowing before comparing it with a package that prints one.", "tier": "cited", "usd": 9912.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "bangkok", "as": "The hospital at the eastern end of the Bangkok cluster, off New Phetchaburi rather than Sukhumvit.", "rel": "place" }, { "to": "thailand", "as": "One of the two Bangkok names a foreign patient is most likely to have been given before arriving.", "rel": "destination" }, { "to": "bumrungrad", "as": "The other large Bangkok private hospital that prices operations publicly; it quotes joints, this one quotes arthroscopy and robotic abdominal work.", "rel": "contrast" }, { "to": "knee-arthroscopy", "as": "Sold here at a fixed price with one ward night counted in and the implant left out.", "rel": "performs" }, { "to": "gallbladder-removal", "as": "Sold here as a robotic package at a fixed price with one ward night.", "rel": "performs" }, { "to": "thai-ha-institute", "as": "The Thai national accreditor whose advanced standard the hospital states for 2026.", "rel": "accredited-by" }, { "to": "jci", "as": "The international accreditor whose seal sits in its footer, undated.", "rel": "accredited-by" }, { "to": "package-price", "as": "Sells in this form, with a usable-between window rather than an open-ended list price.", "rel": "term" }, { "to": "implant-excluded", "as": "Its arthroscopy package says so in the title; the largest line on a joint bill is not in the number.", "rel": "risk" } ], "links": [ { "label": "Bangkok Hospital", "url": "https://www.bangkokhospital.com/" }, { "label": "Packages", "url": "https://www.bangkokhospital.com/en/package" } ], "sources": [ "s:wp-bangkok-hospital", "s:bangkokhospital-ourstory", "s:bangkokhospital-awards", "s:bangkokhospital-knee-arthroscopy", "s:bangkokhospital-cholecystectomy", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "tradition", "note": "the general shape of an international patient department at a large Thai private hospital" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node named Bangkok Hospital on Soi Soonvijai 7" }, "metrics": { "tier": "cited", "source": "s:wp-bangkok-hospital" } } }, "x_commons_files": [ "File:Bangkok Hospital.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "The flagship of Bangkok Dusit Medical Services, on a campus of specialist buildings down Soi Soonvijai off New Phetchaburi Road.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "bangkok", "type": "hub", "name": "Bangkok", "as": "The hospital at the eastern end of the Bangkok cluster, off New Phetchaburi rather than Sukhumvit.", "rel": "place" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "One of the two Bangkok names a foreign patient is most likely to have been given before arriving.", "rel": "destination" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "The other large Bangkok private hospital that prices operations publicly; it quotes joints, this one quotes arthroscopy and robotic abdominal work.", "rel": "contrast" }, { "to": "knee-arthroscopy", "type": "procedure", "name": "Knee arthroscopy", "as": "Sold here at a fixed price with one ward night counted in and the implant left out.", "rel": "performs" }, { "to": "gallbladder-removal", "type": "procedure", "name": "Gallbladder removal", "as": "Sold here as a robotic package at a fixed price with one ward night.", "rel": "performs" }, { "to": "thai-ha-institute", "type": "org", "name": "Healthcare Accreditation Institute", "as": "The Thai national accreditor whose advanced standard the hospital states for 2026.", "rel": "accredited-by" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The international accreditor whose seal sits in its footer, undated.", "rel": "accredited-by" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "Sells in this form, with a usable-between window rather than an open-ended list price.", "rel": "term" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "Its arthroscopy package says so in the title; the largest line on a joint bill is not in the number.", "rel": "risk" } ], "source_list": [ { "id": "s:wp-bangkok-hospital", "kind": "wikipedia", "title": "Bangkok Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Bangkok_Hospital", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:bangkokhospital-ourstory", "kind": "web", "title": "Our Story — Bangkok Hospital", "publisher": "Bangkok Hospital", "url": "https://www.bangkokhospital.com/en/bangkok/about-us/our-story", "accessed": "2026-09-16" }, { "id": "s:bangkokhospital-awards", "kind": "web", "title": "Awards & Accreditations", "publisher": "Bangkok Hospital", "url": "https://www.bangkokhospital.com/en/bangkok/about-us/awards-accreditations", "accessed": "2026-09-16" }, { "id": "s:bangkokhospital-knee-arthroscopy", "kind": "web", "title": "Arthroscopic Knee with Meniscus Repair (1 side, exclude implant) — package page", "publisher": "Bangkok Hospital", "url": "https://www.bangkokhospital.com/en/bangkok/package/arthroscopic-knee-with-meniscus-repair-1-side-exclude-implant-en", "accessed": "2026-09-16", "note": "price read off the hospital's own package page; stated usable 31 Jul 2026 – 31 Oct 2026" }, { "id": "s:bangkokhospital-cholecystectomy", "kind": "web", "title": "Robotic-Assisted Cholecystectomy Level 2 — package page", "publisher": "Bangkok Hospital", "url": "https://www.bangkokhospital.com/en/bangkok/package/robotic-assisted-cholecystectomy-level-2-en", "accessed": "2026-09-16" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "the general shape of an international patient department at a large Thai private hospital" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node named Bangkok Hospital on Soi Soonvijai 7" }, "address": { "tier": "cited" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-bangkok-hospital" } }, "primary_image": null, "tag_facts": [ { "key": "price-published", "label": "Publishes prices", "icon": "💰", "group": "money", "evidence": "a public price list or package page on the facility's own site, read on a dated visit", "source": "s:bangkokhospital-knee-arthroscopy", "note": "package pages carrying a baht figure and a usable-between date", "tier": "cited", "url": "https://www.bangkokhospital.com/en/bangkok/package/arthroscopic-knee-with-meniscus-repair-1-side-exclude-implant-en" }, { "key": "package", "label": "Sells packages", "icon": "🧳", "group": "money", "evidence": "a bundled price on the facility's own page covering more than the operation", "source": "s:bangkokhospital-cholecystectomy", "note": "surgical packages naming the operation, the side and the nights", "tier": "cited", "url": "" }, { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:wp-bangkok-hospital", "note": "Bangkok Dusit Medical Services, 53 institutions in the region", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "ha-moh-th", "label": "Healthcare Accreditation Institute (Thailand)", "what": "Advanced HA Accreditation from the Healthcare Accreditation Institute of Thailand", "url": "https://www.bangkokhospital.com/en/bangkok/about-us/awards-accreditations", "kind": "national", "year": 2026, "valid_until": null, "source": "s:bangkokhospital-awards" }, { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation", "url": "https://www.bangkokhospital.com/en/bangkok/about-us/awards-accreditations", "kind": "international", "year": null, "valid_until": null, "source": "s:bangkokhospital-awards" }, { "key": "newsweek-statista", "label": "Newsweek / Statista World's Best Hospitals", "what": "Listed in the 2025 Newsweek and Statista hospital ranking", "url": "https://www.bangkokhospital.com/en/bangkok/about-us/awards-accreditations", "kind": "listing", "year": 2025, "valid_until": null, "source": "s:bangkokhospital-awards" } ], "acclaim": 3, "kin_in": [ { "from": "bangkok", "type": "hub", "name": "Bangkok", "as": "The Soi Soonvijai campus off New Phetchaburi, the other pole of the cluster.", "rel": "part" }, { "from": "angioplasty-stent", "type": "procedure", "name": "Coronary angioplasty and stent", "as": "Publishes the angiography and intervention packages this page reads, special device excluded.", "rel": "performed-at" }, { "from": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "Publishes the bypass packages this page reads, special device excluded.", "rel": "performed-at" }, { "from": "gallbladder-removal", "type": "procedure", "name": "Gallbladder removal", "as": "Publishes a robotic cholecystectomy package of its own.", "rel": "performed-at" }, { "from": "heart-valve-replacement", "type": "procedure", "name": "Heart valve replacement", "as": "Publishes the valve packages this page reads, prosthesis excluded.", "rel": "performed-at" }, { "from": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "Prices a direct anterior approach hip on its own page, implant excluded.", "rel": "performed-at" }, { "from": "samitivej", "type": "facility", "name": "Samitivej Sukhumvit Hospital", "as": "Same parent company, Bangkok Dusit Medical Services, different campus and different price list.", "rel": "kin" } ] }, { "schema": 1, "id": "bumrungrad", "type": "facility", "names": { "name": "Bumrungrad International Hospital", "aliases": [ "Bumrungrad", "โรงพยาบาลบำรุงราษฎร์" ], "said": "Bam-roong-raat. The name means care of the people; in Bangkok it is simply Bumrungrad, and the taxi knows Sukhumvit Soi 3." }, "region": [ "southeast-asia" ], "facets": { "iso2": "TH", "ownership": "private", "founded": 1980, "specialty": [ "orthopaedics", "cardiology", "oncology", "fertility", "spine", "health screening" ], "draws": [ "knee-replacement", "hip-replacement" ], "status": "open", "languages": [ "Thai", "English", "Arabic", "Japanese", "Mandarin" ] }, "text": { "what": "A private hospital on Sukhumvit Soi 3 in Bangkok, opened in 1980 with 200 beds and listed on the Stock Exchange of Thailand since 1989. It treats more international patients than any other single hospital in the region and publishes fixed package prices for the operations it sells most, which is why it appears throughout this directory's price table.", "story": "Bumrungrad opened on 17 September 1980 as a 200-bed hospital on an initial investment of 90 million baht, and listed on the Thai exchange on 15 December 1989 under the ticker BH. Its major shareholders include Bangkok Bank, Bangkok Insurance and the Sophonpanich family.\n\nIt took Joint Commission International accreditation in 2002, among the first hospitals in Asia to do so, and has been reaccredited five consecutive times. *Inference —* the accreditation mattered less as a clinical fact than as a translation device: it gave an American insurer, and an American patient, a name they already recognised for a hospital eight thousand miles away.\n\nBy 2018 the hospital was reporting more than 1.1 million patients a year, over 520,000 of them international, from more than 190 countries. Those are the hospital's own counts of patient visits, not of individual people, and this directory carries them as such.", "how": "The international patient side works the way most large Asian private hospitals work: an inquiry desk that answers in several languages, a quoted package for standard operations, a deposit, an interpreter for the consultation, and a discharge summary the patient carries home. Prices for its commonest orthopaedic and spinal work sit on public package pages with a stated validity date. The implant is billed separately from the operation on the joint packages.", "today": "As of 16 September 2026 the hospital lists a unilateral total knee replacement at 356,500 baht excluding the implant, and prices its bilateral, robotic and hip packages on the same public pages. The site's footer names the JCI accreditation. Package prices are stated valid until 31 December 2026." }, "geo": { "lat": 13.74639, "lon": 100.5525, "precision": "street", "source": "s:wp-bumrungrad" }, "address": { "street": "33 Sukhumvit Soi 3, Wattana", "city": "Bangkok", "country": "TH", "postcode": "10110" }, "metrics": { "beds": 643, "annual_patients": 1100000, "annual_foreign_patients": 520000, "foreign_patient_countries": 190, "note": "Beds are the 2019 figure — 580 inpatient plus 63 ICU. The patient counts are the hospital's 2018 reporting and count visits rather than people; a patient who comes back three times is three. Nothing here is audited by this project.", "as_of": "2019", "source": "s:wp-bumrungrad", "url": "https://en.wikipedia.org/wiki/Bumrungrad_International_Hospital" }, "tags": [ { "tag": "price-published", "source": "s:bumrungrad-joint04", "tier": "cited", "note": "public package pages with prices and a stated validity date", "url": "https://www.bumrungrad.com/en/packages" }, { "tag": "package", "source": "s:bumrungrad-joint04", "tier": "cited", "note": "fixed-price packages naming inclusions and exclusions" }, { "tag": "international-office", "source": "s:wp-bumrungrad", "tier": "cited" }, { "tag": "listed-company", "source": "s:wp-bumrungrad", "tier": "cited", "note": "Stock Exchange of Thailand, ticker BH, listed 15 December 1989" }, { "tag": "interpreter", "source": "s:wp-bumrungrad", "tier": "cited" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation, first granted 2002 and renewed five consecutive times", "year": 2002, "valid_until": null, "source": "s:wp-bumrungrad", "url": "https://www.jointcommissioninternational.org/", "note": "JCI accreditation runs in three-year cycles; the hospital's own footer states it as current" } ], "kin": [ { "to": "knee-replacement", "as": "One of the operations it sells at a published fixed price, implant excluded.", "rel": "performs" }, { "to": "bangkok", "as": "The hospital the Bangkok cluster is usually named for.", "rel": "place" }, { "to": "thailand", "as": "The single institution most often meant when Thailand is called a destination.", "rel": "destination" }, { "to": "jci", "as": "The accreditor whose mark it took in 2002, early for Asia.", "rel": "accredited-by" }, { "to": "package-price", "as": "Sells in this form, with the inclusions and exclusions written out.", "rel": "term" }, { "to": "implant-excluded", "as": "Its joint packages are priced without the implant, which the page states.", "rel": "risk" } ], "links": [ { "label": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/" }, { "label": "Packages and programs", "url": "https://www.bumrungrad.com/en/packages" } ], "sources": [ "s:wp-bumrungrad", "s:bumrungrad-joint04", "s:bumrungrad-packages" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "tradition", "note": "the general shape of an international patient department at a large Asian private hospital" }, "metrics": { "tier": "cited", "source": "s:wp-bumrungrad" } } }, "x_commons_files": [ "File:Bumrungrad International Hospital.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "A private hospital on Sukhumvit Soi 3 in Bangkok, opened in 1980 with 200 beds and listed on the Stock Exchange of Thailand since 1989.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "One of the operations it sells at a published fixed price, implant excluded.", "rel": "performs" }, { "to": "bangkok", "type": "hub", "name": "Bangkok", "as": "The hospital the Bangkok cluster is usually named for.", "rel": "place" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "The single institution most often meant when Thailand is called a destination.", "rel": "destination" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The accreditor whose mark it took in 2002, early for Asia.", "rel": "accredited-by" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "Sells in this form, with the inclusions and exclusions written out.", "rel": "term" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "Its joint packages are priced without the implant, which the page states.", "rel": "risk" } ], "source_list": [ { "id": "s:wp-bumrungrad", "kind": "wikipedia", "title": "Bumrungrad International Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Bumrungrad_International_Hospital", "accessed": "2026-09-16", "license": "CC BY-SA 4.0" }, { "id": "s:bumrungrad-joint04", "kind": "web", "title": "Total Knee Replacement Surgery (Exclude implant) — package JOINT04", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery", "accessed": "2026-09-16", "note": "read off the hospital's own package page; price stated valid until 31 December 2026" }, { "id": "s:bumrungrad-packages", "kind": "web", "title": "Packages & Programs — joint replacement and spine", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "the general shape of an international patient department at a large Asian private hospital" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-bumrungrad" } }, "primary_image": null, "tag_facts": [ { "key": "price-published", "label": "Publishes prices", "icon": "💰", "group": "money", "evidence": "a public price list or package page on the facility's own site, read on a dated visit", "source": "s:bumrungrad-joint04", "note": "public package pages with prices and a stated validity date", "tier": "cited", "url": "https://www.bumrungrad.com/en/packages" }, { "key": "package", "label": "Sells packages", "icon": "🧳", "group": "money", "evidence": "a bundled price on the facility's own page covering more than the operation", "source": "s:bumrungrad-joint04", "note": "fixed-price packages naming inclusions and exclusions", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:wp-bumrungrad", "note": "", "tier": "cited", "url": "" }, { "key": "listed-company", "label": "Publicly listed", "icon": "📈", "group": "ownership", "evidence": "an exchange listing or an annual report", "source": "s:wp-bumrungrad", "note": "Stock Exchange of Thailand, ticker BH, listed 15 December 1989", "tier": "cited", "url": "" }, { "key": "interpreter", "label": "Interpreters on staff", "icon": "🗣", "group": "service", "evidence": "the facility's own page naming the languages, or a published inspection or accreditation report", "source": "s:wp-bumrungrad", "note": "", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation, first granted 2002 and renewed five consecutive times", "url": "https://www.jointcommissioninternational.org/", "kind": "international", "year": 2002, "valid_until": null, "source": "s:wp-bumrungrad" } ], "acclaim": 1, "kin_in": [ { "from": "thailand", "type": "destination", "name": "Thailand", "as": "The hospital that made the format, and the country's shorthand abroad.", "rel": "part" }, { "from": "bangkok", "type": "hub", "name": "Bangkok", "as": "The hospital on Sukhumvit Soi 3 that the cluster is usually named for.", "rel": "part" }, { "from": "acl-reconstruction", "type": "procedure", "name": "Anterior cruciate ligament reconstruction", "as": "Packages this operation with meniscus work and two nights.", "rel": "performed-at" }, { "from": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "Publishes the phacoemulsification package this page reads, monofocal lens included and the consultation excluded.", "rel": "performed-at" }, { "from": "disc-replacement", "type": "procedure", "name": "Artificial disc replacement", "as": "Publishes the one-level cervical disc replacement package this page reads, prosthesis excluded.", "rel": "performed-at" }, { "from": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "Publishes the executive package this record reads, with its validity date and its exclusions.", "rel": "performed-at" }, { "from": "gallbladder-removal", "type": "procedure", "name": "Gallbladder removal", "as": "Publishes the cholecystectomy packages this page reads, keyhole and robotic.", "rel": "performed-at" }, { "from": "hernia-repair", "type": "procedure", "name": "Hernia repair", "as": "Publishes the eight hernia prices this page reads, mesh unnamed inside the supplies line.", "rel": "performed-at" }, { "from": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "Publishes the four-night hip package this page reads, implant excluded.", "rel": "performed-at" }, { "from": "hysterectomy", "type": "procedure", "name": "Hysterectomy", "as": "Publishes the laparoscopic hysterectomy package this page reads, energy devices excluded.", "rel": "performed-at" }, { "from": "icl", "type": "procedure", "name": "Implantable collamer lens", "as": "Publishes the ICL package this page reads, lens included and screening excluded.", "rel": "performed-at" }, { "from": "knee-arthroscopy", "type": "procedure", "name": "Knee arthroscopy", "as": "Packages repair and resection of the meniscus at one price with one night.", "rel": "performed-at" }, { "from": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "Publishes the knee package this page reads, implant excluded.", "rel": "performed-at" }, { "from": "lasik", "type": "procedure", "name": "LASIK", "as": "Sells the lenticule version of this operation for both eyes, screening excluded.", "rel": "performed-at" }, { "from": "prostatectomy", "type": "procedure", "name": "Prostatectomy", "as": "Publishes both prostate packages this page reads, the ward round excluded from the larger one.", "rel": "performed-at" }, { "from": "shoulder-replacement", "type": "procedure", "name": "Total shoulder replacement", "as": "Publishes arthroscopic shoulder packages and no shoulder replacement price.", "rel": "performed-at" }, { "from": "spinal-fusion", "type": "procedure", "name": "Spinal fusion", "as": "Publishes both the cervical and the lumbar fusion packages this page reads.", "rel": "performed-at" }, { "from": "albert-einstein-sao-paulo", "type": "facility", "name": "Hospital Israelita Albert Einstein", "as": "Took the same mark three years later in Bangkok, and built a much larger foreign trade on it.", "rel": "contrast" }, { "from": "bangkok-hospital", "type": "facility", "name": "Bangkok Hospital", "as": "The other large Bangkok private hospital that prices operations publicly; it quotes joints, this one quotes arthroscopy and robotic abdominal work.", "rel": "contrast" }, { "from": "charite-international", "type": "facility", "name": "Charité International Patients", "as": "A menu against a referral: a published fixed price and an open door, against a clinical decision taken before any figure exists.", "rel": "contrast" }, { "from": "heidelberg-university-hospital", "type": "facility", "name": "Heidelberg University Hospital", "as": "A package caps the patient's exposure at the advertised figure; a pre-payment against an estimate does not.", "rel": "contrast" }, { "from": "medanta", "type": "facility", "name": "Medanta — The Medicity, Gurugram", "as": "The comparison a joint patient actually faces: a Thai package without the implant against an Indian bill with the implant priced.", "rel": "contrast" }, { "from": "samitivej", "type": "facility", "name": "Samitivej Sukhumvit Hospital", "as": "The nearer comparison on price transparency: both publish, one leads with operations and this one with annual check-ups.", "rel": "contrast" }, { "from": "in-hospital", "type": "pathway", "name": "In hospital", "as": "Publishes the package whose ward nights and exclusions this step reads.", "rel": "place" }, { "from": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "Publishes an exclusion list this step quotes.", "rel": "place" }, { "from": "anaesthetic-risk-unscreened", "type": "risk", "name": "Fitness for anaesthesia, assessed on arrival", "as": "Publishes the eligibility list that names ASA III and above.", "rel": "performed-at" }, { "from": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "Publishes the package this record is built on, exclusion stated in the title.", "rel": "performed-at" }, { "from": "jci", "type": "org", "name": "Joint Commission International", "as": "Took this mark in 2002, early for Asia, and has renewed it five times.", "rel": "accredits" }, { "from": "thai-ha-institute", "type": "org", "name": "Healthcare Accreditation Institute", "as": "One of the private hospitals holding this mark alongside the imported one.", "rel": "accredits" }, { "from": "medical-travel", "type": "term", "name": "Medical travel", "as": "A hospital whose foreign-patient services are named in these terms rather than the other.", "rel": "facility" }, { "from": "jci-accredited-list", "type": "dataset", "name": "The JCI list of accredited organizations", "as": "On the list since 2002, the first hospital in Asia to be.", "rel": "facility" }, { "from": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "Publishes the Bangkok package that forms one half of the comparison.", "rel": "facility" }, { "from": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Took the mark in 2002, early for Asia, and states it in its own footer.", "rel": "facility" } ] }, { "schema": 1, "id": "charite-international", "type": "facility", "names": { "name": "Charité International Patients", "aliases": [ "Charité Healthcare Services GmbH", "CHS", "Charité — Universitätsmedizin Berlin" ], "said": "sha-ree-TAY, French for charity, from the 1710 plague house the name survives from. The international arm is Charité Healthcare Services GmbH, a company wholly owned by the hospital, and it is an administration rather than a ward." }, "region": [ "europe-west" ], "facets": { "iso2": "DE", "ownership": "university", "founded": 1710, "specialty": [ "oncology", "cardiac surgery", "neurosurgery", "transplantation", "rare disease" ], "draws": [ "car-t", "proton-therapy", "kidney-transplant", "liver-transplant", "bone-marrow-transplant" ], "status": "open", "languages": [ "German", "English", "Arabic", "Russian", "Polish", "Ukrainian" ] }, "text": { "what": "The international-patient arm of Charité — Universitätsmedizin Berlin, the joint medical faculty of the Free University and the Humboldt University and, at about 3,000 beds across four campuses, the largest university hospital in Europe. The arm itself is Charité Healthcare Services GmbH, a wholly owned subsidiary that handles the administration for patients living outside Germany. This record pins Campus Charité Mitte.", "story": "Charité was founded in 1710 as a plague house outside the Berlin city wall and became a teaching hospital. It employs 18,217 people including 5,242 academic staff and 307 professors, teaches 9,485 students, and runs on a budget of 2.3 billion euro across Campus Charité Mitte, Campus Benjamin Franklin in Lichterfelde, Campus Virchow-Klinikum in Wedding and Campus Berlin-Buch.\n\nThe international arm is a separate company and that separation is the point. A German public university hospital cannot run a sales department; it can own a GmbH that arranges travel, translation and billing for patients its clinics have agreed to treat. Native speakers of English, Arabic and Russian staff it, and the office publishes its telephone hours — Monday to Friday, ten until two — rather than a brochure.\n\n*Inference —* the German model inverts the Asian one. Bumrungrad publishes a knee replacement at a fixed price and admits the patient who buys it; Charité publishes no price at all, and the clinical decision on whether to accept a case is taken before any figure exists. One is a menu and the other is a referral.\n\nNo price, tariff or deposit schedule appears on the international pages read for this record.", "how": "*Trade practice —* the German route runs on records first: reports and imaging go to the relevant clinic, a specialist decides whether treatment is possible and what it would be, and only then does an administrative office put a figure on it. Payment from a self-funding patient abroad is settled in advance and reconciled after discharge against the actual bill, which is the general German practice for a patient outside the statutory insurance system.\n\nWhat a patient from abroad buys at Charité is capacity that the German statutory system also uses, and every arrangement runs alongside a domestic queue rather than instead of one.", "today": "As of 17 September 2026 Charité states about 3,000 beds over four campuses, 18,217 employees, 5,242 academic staff, 307 professors and a 2.3 billion euro budget, and appears in Newsweek's 2026 list in the top 250. Charité Healthcare Services publishes what its office does and its telephone hours, and publishes no price." }, "geo": { "lat": 52.525852, "lon": 13.377758, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "Charitéplatz 1, Mitte", "city": "Berlin", "country": "DE", "postcode": "10117" }, "metrics": { "beds": 3000, "staff": 18217, "annual_patients": null, "annual_foreign_patients": null, "note": "Beds and staff are the WHOLE hospital's across four Berlin campuses — about 3,000 beds, 18,217 employees of whom 5,242 are academic staff and 307 professors — not the international arm's, which has no beds of its own. No patient count of any kind, and no count of international patients, is published by either. The 2.3 billion euro figure in the text is an annual budget, not revenue from foreign patients.", "as_of": "2026", "source": "s:wp-charite", "url": "https://en.wikipedia.org/wiki/Charit%C3%A9" }, "tags": [ { "tag": "university-hospital", "source": "s:wp-charite", "tier": "cited", "note": "joint medical faculty of the Free University of Berlin and the Humboldt University of Berlin" }, { "tag": "public-hospital", "source": "s:wp-charite", "tier": "cited", "note": "a public university hospital; the international arm is a wholly owned company beside it, not a private hospital" }, { "tag": "teaching", "source": "s:wp-charite", "tier": "cited", "note": "9,485 students, 307 professors" }, { "tag": "international-office", "source": "s:chs-charite-int", "tier": "cited", "note": "Charité Healthcare Services GmbH, a wholly owned subsidiary handling administration for patients living outside Germany", "url": "https://chs.charite.de/en/charite_international_patients" }, { "tag": "interpreter", "source": "s:chs-charite-int", "tier": "cited", "note": "native speakers of English, Arabic and Russian on the office staff" }, { "tag": "no-price-published", "source": "s:chs-charite-int", "tier": "cited", "note": "the international pages carry no price, no tariff and no deposit schedule" } ], "recognitions": [ { "by": "newsweek-statista", "what": "Placed in the top 250 of the 2026 Newsweek world hospital list", "year": 2026, "valid_until": null, "source": "s:wp-charite", "url": "https://en.wikipedia.org/wiki/Charit%C3%A9", "note": "a ranking by survey and published indicators; counted, not weighted" } ], "kin": [ { "to": "germany", "as": "The country's largest university hospital, and the shape its inbound work takes: a public hospital with a company beside it.", "rel": "destination" }, { "to": "heidelberg-university-hospital", "as": "The other German university hospital here, which publishes its payment terms where this one publishes its telephone hours.", "rel": "contrast" }, { "to": "bumrungrad", "as": "A menu against a referral: a published fixed price and an open door, against a clinical decision taken before any figure exists.", "rel": "contrast" }, { "to": "car-t", "as": "Among the therapies a patient crosses a border for because it is unavailable at home rather than cheaper.", "rel": "performs" }, { "to": "eu-directive-2011-24", "as": "Governs how an EU patient's home system pays for planned treatment here, which is a different route from the self-funder's.", "rel": "governed-by" }, { "to": "s2-route", "as": "The prior-authorisation route by which a European system sends a patient here and pays the German tariff directly.", "rel": "governed-by" }, { "to": "getting-your-records", "as": "The German route starts with reports and imaging, and nothing else happens until a specialist has read them.", "rel": "step" }, { "to": "second-opinion", "as": "Much of what reaches a European university hospital from abroad arrives as a request for a second reading.", "rel": "step" }, { "to": "the-price-that-isnt", "as": "A hospital that publishes nothing is a different problem from one that publishes a figure with from in front of it.", "rel": "story" } ], "links": [ { "label": "Charité International Patients", "url": "https://chs.charite.de/en/charite_international_patients" }, { "label": "Charité — Universitätsmedizin Berlin", "url": "https://www.charite.de/en/" } ], "sources": [ "s:wp-charite", "s:chs-charite-int", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim", "note": "the OpenStreetMap point for Campus Charité Mitte, one of four campuses" }, "text.how": { "tier": "tradition", "note": "the German records-first route and the advance-settlement practice; marked in the prose and read across from the Heidelberg terms rather than from a Charité page" }, "metrics": { "tier": "cited", "source": "s:wp-charite" } } }, "x_commons_files": [ "File:Charité Campus Charité Mitte.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "The international-patient arm of Charité — Universitätsmedizin Berlin, the joint medical faculty of the Free University and the Humboldt University and, at about 3,000 beds across four campuses, the largest university…", "region_terms": [ { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "germany", "type": "destination", "name": "Germany", "as": "The country's largest university hospital, and the shape its inbound work takes: a public hospital with a company beside it.", "rel": "destination" }, { "to": "heidelberg-university-hospital", "type": "facility", "name": "Heidelberg University Hospital", "as": "The other German university hospital here, which publishes its payment terms where this one publishes its telephone hours.", "rel": "contrast" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "A menu against a referral: a published fixed price and an open door, against a clinical decision taken before any figure exists.", "rel": "contrast" }, { "to": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "Among the therapies a patient crosses a border for because it is unavailable at home rather than cheaper.", "rel": "performs" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "Governs how an EU patient's home system pays for planned treatment here, which is a different route from the self-funder's.", "rel": "governed-by" }, { "to": "s2-route", "type": "rule", "name": "The S2 route", "as": "The prior-authorisation route by which a European system sends a patient here and pays the German tariff directly.", "rel": "governed-by" }, { "to": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "The German route starts with reports and imaging, and nothing else happens until a specialist has read them.", "rel": "step" }, { "to": "second-opinion", "type": "pathway", "name": "The second opinion", "as": "Much of what reaches a European university hospital from abroad arrives as a request for a second reading.", "rel": "step" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "A hospital that publishes nothing is a different problem from one that publishes a figure with from in front of it.", "rel": "story" } ], "source_list": [ { "id": "s:wp-charite", "kind": "wikipedia", "title": "Charité — Universitätsmedizin Berlin", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Charit%C3%A9", "license": "CC BY-SA 4.0", "accessed": "2026-09-17", "note": "founded 1710; joint medical faculty of the Free University of Berlin and the Humboldt University; about 3,000 beds over four campuses — Charité Mitte, Benjamin Franklin in Lichterfelde, Virchow-Klinikum in Wedding and Berlin-Buch; 18,217 employees including 5,242 academic staff and 307 professors; annual budget 2.3 billion euro; Newsweek's 2026 list places it in the top 250" }, { "id": "s:chs-charite-int", "kind": "web", "title": "Charité International Patients — Charité Healthcare Services", "publisher": "Charité Healthcare Services GmbH, Berlin", "url": "https://chs.charite.de/en/charite_international_patients", "accessed": "2026-09-17", "note": "the wholly owned subsidiary that handles administration for patients living outside Germany. The page states what the office does and gives its telephone hours, Monday to Friday 10:00 to 14:00. It publishes no price, no tariff and no deposit schedule." }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "the German records-first route and the advance-settlement practice; marked in the prose and read across from the Heidelberg terms rather than from a Charité page" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim", "note": "the OpenStreetMap point for Campus Charité Mitte, one of four campuses" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-charite" } }, "primary_image": null, "tag_facts": [ { "key": "university-hospital", "label": "University hospital", "icon": "🎓", "group": "ownership", "evidence": "the affiliated university's own page or the hospital's charter", "source": "s:wp-charite", "note": "joint medical faculty of the Free University of Berlin and the Humboldt University of Berlin", "tier": "cited", "url": "" }, { "key": "public-hospital", "label": "Public hospital", "icon": "🏛", "group": "ownership", "evidence": "a ministry register, a national health service list, or the hospital's own statement", "source": "s:wp-charite", "note": "a public university hospital; the international arm is a wholly owned company beside it, not a private hospital", "tier": "cited", "url": "" }, { "key": "teaching", "label": "Teaching hospital", "icon": "📚", "group": "clinical", "evidence": "a recognised training post list or the hospital's own statement", "source": "s:wp-charite", "note": "9,485 students, 307 professors", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:chs-charite-int", "note": "Charité Healthcare Services GmbH, a wholly owned subsidiary handling administration for patients living outside Germany", "tier": "cited", "url": "https://chs.charite.de/en/charite_international_patients" }, { "key": "interpreter", "label": "Interpreters on staff", "icon": "🗣", "group": "service", "evidence": "the facility's own page naming the languages, or a published inspection or accreditation report", "source": "s:chs-charite-int", "note": "native speakers of English, Arabic and Russian on the office staff", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:chs-charite-int", "note": "the international pages carry no price, no tariff and no deposit schedule", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "newsweek-statista", "label": "Newsweek / Statista World's Best Hospitals", "what": "Placed in the top 250 of the 2026 Newsweek world hospital list", "url": "https://en.wikipedia.org/wiki/Charit%C3%A9", "kind": "listing", "year": 2026, "valid_until": null, "source": "s:wp-charite" } ], "acclaim": 1, "kin_in": [ { "from": "germany", "type": "destination", "name": "Germany", "as": "The Berlin university hospital's international office, one of the main inbound doors.", "rel": "part" }, { "from": "heidelberg-university-hospital", "type": "facility", "name": "Heidelberg University Hospital", "as": "Berlin's arrangement: a company beside the hospital, publishing its telephone hours where this one publishes its refund rule.", "rel": "contrast" } ] }, { "schema": 1, "id": "clinica-biblica", "type": "facility", "names": { "name": "Hospital Clínica Bíblica", "aliases": [ "Clínica Bíblica", "Hospital Clínico Bíblico" ], "said": "KLEE-nee-ka BEE-blee-ka — the Bible Clinic. Henry and Susan Strachan of the Latin American Mission founded it in 1929 under the older name Hospital Clínico Bíblico, and the mission's name stayed on the building after the mission left it." }, "region": [ "central-america" ], "facets": { "iso2": "CR", "ownership": "private", "founded": 1929, "specialty": [ "orthopaedics", "bariatric surgery", "cosmetic surgery", "dentistry", "cardiology" ], "draws": [ "gastric-sleeve", "gastric-bypass", "dental-implant", "knee-replacement", "abdominoplasty" ], "status": "open", "languages": [ "Spanish", "English", "French" ] }, "text": { "what": "A private hospital in central San José, on Avenida 14, founded in 1929 by Henry and Susan Strachan of the Latin American Mission and now the largest private hospital in Costa Rica. It is one of the two San José hospitals an American or Canadian patient is routed to, and it is the older of them by seventy years.", "story": "The Strachans built a mission clinic. What grew on the site is a general hospital that sells surgery to North Americans four hours' flight from Miami, and the mission name survived the change of purpose intact.\n\nThe hospital states ninety-six years of operation and leads its own front page with recognitions rather than with capacity: the Joint Commission International gold seal, a MERCO ranking, an Intellat listing among Latin American hospitals for 2025, an América Economía ranking, a Newsweek rating. *Inference —* a hospital that puts five listings above the fold and no bed count below it is selling reassurance to a buyer who cannot inspect the building.\n\nIt publishes no price. The Spanish site carries a page headed Presupuestos — estimates — which is a request form covering surgery, imaging, pharmacy and maternity, and prints no figure on any of them. The one number on the public site is an emergency insurance plan from 16,500 colones.\n\nCosta Rica's own answer to that gap is PROMED, the national council run out of the Cámara Costarricense de la Salud, which certifies providers for international patients. It is a membership scheme with a seal, not a price register.", "how": "*Trade practice —* the Costa Rican route runs through the hospital's international desk or through a facilitator in the patient's own country: records by email, a surgeon's opinion, a written estimate, a deposit, and a recovery stay in San José or Escazú before the flight home. Dental and bariatric work carries the shortest chain and the largest share of the traffic.\n\nWhat the hospital publishes is what it is accredited by and what it is ranked by. What it does not publish is what any of it costs.", "today": "As of 17 September 2026 the hospital states ninety-six years of operation and holds the Joint Commission International gold seal, with no year given for the first award on the page read here. Reported bed counts range from 96 to 250 across secondary sources and none is stated on the hospital's own site; the figure is left empty here rather than picked." }, "geo": { "lat": 9.92748, "lon": -84.079144, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "Avenida 14, Calle Central y Primera", "city": "San José", "country": "CR", "postcode": "10104" }, "metrics": { "beds": null, "annual_patients": null, "annual_foreign_patients": null, "note": "No bed count, no patient count and no foreign share is published on the hospital's own site. Secondary sources give 96, 150 and 250 beds; three numbers that disagree are not a number, so this stays a gap. The hospital's own front page states ninety-six years of operation, which dates the founding to 1929 and is the only quantity on it.", "as_of": "2026", "source": "s:clinica-biblica", "url": "https://www.clinicabiblica.com/en/" }, "tags": [ { "tag": "faith-based", "source": "s:wp-clinica-biblica", "tier": "cited", "note": "founded 1929 as the Hospital Clínico Bíblico by Henry and Susan Strachan of the Latin American Mission" }, { "tag": "no-price-published", "source": "s:clinica-biblica-presupuestos", "tier": "cited", "note": "the Presupuestos page is a quotation request form for surgery, imaging, pharmacy and maternity; no figure is printed", "url": "https://www.clinicabiblica.com/es/presupuestos" }, { "tag": "international-office", "source": "s:clinica-biblica", "tier": "cited", "note": "the hospital runs an international programme and a quotation desk; the site is published in English alongside Spanish" }, { "tag": "interpreter", "source": "s:clinica-biblica", "tier": "cited", "note": "an English-language site and bilingual clinical staff; the languages are not enumerated on the page" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation, shown on the hospital's own front page as the gold seal", "year": null, "valid_until": null, "source": "s:clinica-biblica", "url": "https://www.clinicabiblica.com/en/", "note": "the hospital is widely described as the first in Costa Rica to take JCI, and secondary sources date it to 2007; no year appears on the hospital's own page and none is asserted here" }, { "by": "newsweek-statista", "what": "Listed in the Newsweek global hospital rating, named among the recognitions on the hospital's own front page", "year": null, "valid_until": null, "source": "s:clinica-biblica", "url": "https://www.clinicabiblica.com/en/", "note": "a survey-and-indicator ranking, counted here and not weighted" }, { "by": "promed", "what": "Costa Rica's national council for international-patient providers, run from the Cámara Costarricense de la Salud", "year": null, "valid_until": null, "source": "s:promed-salud-cr", "url": "https://salud.co.cr/english/", "note": "a membership and seal scheme rather than a clinical inspection; the record cites the scheme, not a certificate read for this hospital" } ], "kin": [ { "to": "san-jose-cr", "as": "The older of the two private hospitals the San José cluster is built around, and the one in the city centre rather than the western suburbs.", "rel": "place" }, { "to": "costa-rica", "as": "The country's largest private hospital, and the institution most often meant when Costa Rica is named as a destination.", "rel": "destination" }, { "to": "hospital-cima-san-jose", "as": "The other San José hospital in this directory: American-built, in Escazú, opened seventy-one years later.", "rel": "contrast" }, { "to": "promed", "as": "The national certification council a Costa Rican provider joins to sell to foreign patients.", "rel": "accredited-by" }, { "to": "jci", "as": "Its accreditor, shown as the gold seal on its own front page without a date.", "rel": "accredited-by" }, { "to": "gastric-sleeve", "as": "Among the operations the Costa Rican route is bought for, and one of the shortest chains from enquiry to flight.", "rel": "performs" }, { "to": "dental-implant", "as": "The other short chain, and the one that brings back the same patient in stages.", "rel": "performs" }, { "to": "getting-a-quote", "as": "The Presupuestos form is where the price starts existing, and the only place it does.", "rel": "step" }, { "to": "the-accreditation-question", "as": "Five listings above the fold and no bed count below it.", "rel": "story" } ], "links": [ { "label": "Hospital Clínica Bíblica", "url": "https://www.clinicabiblica.com/en/" }, { "label": "Presupuestos", "url": "https://www.clinicabiblica.com/es/presupuestos" } ], "sources": [ "s:clinica-biblica", "s:clinica-biblica-presupuestos", "s:wp-clinica-biblica", "s:promed-salud-cr", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "text.how": { "tier": "tradition", "note": "the Costa Rican route as the trade runs it; marked in the prose" }, "metrics": { "tier": "cited", "source": "s:clinica-biblica", "note": "a record of what is NOT published" } } }, "x_commons_files": [ "File:Hospital Clínica Bíblica.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "A private hospital in central San José, on Avenida 14, founded in 1929 by Henry and Susan Strachan of the Latin American Mission and now the largest private hospital in Costa Rica.", "region_terms": [ { "key": "central-america", "name": "Central America", "note": "Costa Rica, Panama, Guatemala, Belize" } ], "kin_out": [ { "to": "san-jose-cr", "type": "hub", "name": "San José, Costa Rica", "as": "The older of the two private hospitals the San José cluster is built around, and the one in the city centre rather than the western suburbs.", "rel": "place" }, { "to": "costa-rica", "type": "destination", "name": "Costa Rica", "as": "The country's largest private hospital, and the institution most often meant when Costa Rica is named as a destination.", "rel": "destination" }, { "to": "hospital-cima-san-jose", "type": "facility", "name": "Hospital CIMA San José", "as": "The other San José hospital in this directory: American-built, in Escazú, opened seventy-one years later.", "rel": "contrast" }, { "to": "promed", "type": "org", "name": "PROMED", "as": "The national certification council a Costa Rican provider joins to sell to foreign patients.", "rel": "accredited-by" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "Its accreditor, shown as the gold seal on its own front page without a date.", "rel": "accredited-by" }, { "to": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "Among the operations the Costa Rican route is bought for, and one of the shortest chains from enquiry to flight.", "rel": "performs" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The other short chain, and the one that brings back the same patient in stages.", "rel": "performs" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The Presupuestos form is where the price starts existing, and the only place it does.", "rel": "step" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Five listings above the fold and no bed count below it.", "rel": "story" } ], "source_list": [ { "id": "s:clinica-biblica", "kind": "web", "title": "Hospital Clínica Bíblica", "publisher": "Hospital Clínica Bíblica, San José, Costa Rica", "url": "https://www.clinicabiblica.com/en/", "accessed": "2026-09-16" }, { "id": "s:clinica-biblica-presupuestos", "kind": "web", "title": "Presupuestos", "publisher": "Hospital Clínica Bíblica, San José", "url": "https://www.clinicabiblica.com/es/presupuestos", "accessed": "2026-09-16", "note": "a quotation request form for surgery, imaging, pharmacy and maternity; no figure is printed" }, { "id": "s:wp-clinica-biblica", "kind": "web", "title": "Hospital Clínica Bíblica", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Hospital_Cl%C3%ADnica_B%C3%ADblica", "accessed": "2026-09-16", "note": "founded 1929 as the Hospital Clínico Bíblico by Henry and Susan Strachan of the Latin American Mission" }, { "id": "s:promed-salud-cr", "kind": "web", "title": "PROMED — English", "publisher": "Cámara Costarricense de la Salud", "url": "https://salud.co.cr/english/", "accessed": "2026-09-16", "note": "promedcostarica.org now redirects here; membership categories and the Seal of Quality are described on this page" }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "the Costa Rican route as the trade runs it; marked in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:clinica-biblica", "note": "a record of what is NOT published" } }, "primary_image": null, "tag_facts": [ { "key": "faith-based", "label": "Faith-founded", "icon": "✝", "group": "welcome", "evidence": "the founding body's own statement or the hospital's charter", "source": "s:wp-clinica-biblica", "note": "founded 1929 as the Hospital Clínico Bíblico by Henry and Susan Strachan of the Latin American Mission", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:clinica-biblica-presupuestos", "note": "the Presupuestos page is a quotation request form for surgery, imaging, pharmacy and maternity; no figure is printed", "tier": "cited", "url": "https://www.clinicabiblica.com/es/presupuestos" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:clinica-biblica", "note": "the hospital runs an international programme and a quotation desk; the site is published in English alongside Spanish", "tier": "cited", "url": "" }, { "key": "interpreter", "label": "Interpreters on staff", "icon": "🗣", "group": "service", "evidence": "the facility's own page naming the languages, or a published inspection or accreditation report", "source": "s:clinica-biblica", "note": "an English-language site and bilingual clinical staff; the languages are not enumerated on the page", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation, shown on the hospital's own front page as the gold seal", "url": "https://www.clinicabiblica.com/en/", "kind": "international", "year": null, "valid_until": null, "source": "s:clinica-biblica" }, { "key": "newsweek-statista", "label": "Newsweek / Statista World's Best Hospitals", "what": "Listed in the Newsweek global hospital rating, named among the recognitions on the hospital's own front page", "url": "https://www.clinicabiblica.com/en/", "kind": "listing", "year": null, "valid_until": null, "source": "s:clinica-biblica" }, { "key": "promed", "label": "PROMED (Costa Rica)", "what": "Costa Rica's national council for international-patient providers, run from the Cámara Costarricense de la Salud", "url": "https://salud.co.cr/english/", "kind": "national", "year": null, "valid_until": null, "source": "s:promed-salud-cr" } ], "acclaim": 3, "kin_in": [ { "from": "costa-rica", "type": "destination", "name": "Costa Rica", "as": "The San José private hospital that carries the JCI mark and the longest history.", "rel": "part" }, { "from": "san-jose-cr", "type": "hub", "name": "San José, Costa Rica", "as": "The hospital the cluster is usually named for, and the oldest part of it.", "rel": "place" }, { "from": "hospital-cima-san-jose", "type": "facility", "name": "Hospital CIMA San José", "as": "The older San José hospital, a 1929 mission clinic in the city centre against this 2000 development in the suburbs.", "rel": "contrast" }, { "from": "promed", "type": "org", "name": "PROMED", "as": "One of the hospitals the scheme is built around.", "rel": "org" } ] }, { "schema": 1, "id": "clinica-las-americas", "type": "facility", "names": { "name": "Clínica Las Américas", "aliases": [ "Las Américas Auna", "Clínica Las Américas Auna" ], "said": "KLEE-nee-ka las a-MEH-ree-kas. Now trading as Las Américas Auna, after the Peruvian healthcare group Auna that owns Grupo Las Américas; the clinic sits on Diagonal 75B in western Medellín." }, "region": [ "south-america" ], "facets": { "iso2": "CO", "ownership": "private", "founded": 1994, "specialty": [ "oncology", "cardiovascular", "orthopaedics", "health screening", "transplantation" ], "draws": [ "executive-health-screening", "knee-replacement", "hip-replacement", "bone-marrow-transplant" ], "status": "open", "languages": [ "Spanish", "English" ] }, "text": { "what": "A high-complexity private clinic in western Medellín, part of Grupo Las Américas and owned by the Peruvian healthcare group Auna. Its international office is the part of it this directory is about: a department that handles entry to Colombia, the health visa, yellow fever vaccination and flights alongside the medical arrangements.", "story": "Medellín is the second Colombian city in this directory and it sells differently from Bogotá. The Bogotá hospital is a foundation with no shareholders and an academic accreditation. Las Américas is a commercial clinic inside a regional group that runs hospitals in Peru, Colombia and Mexico.\n\nWhat its international office publishes is not clinical. It is a procedure: how to enter Colombia, which visa class covers medical treatment, where the yellow fever vaccination is needed, how the flights work, and which insurers it deals with. Executive check-ups head its service list.\n\n*Inference —* an international department that leads with the visa and the vaccination rather than with the surgery is describing its actual work. The clinical decision is made once; the paperwork is made continuously, and it is the part a patient abroad cannot do alone.\n\nNo bed count, no patient count and no accreditation was found published in the pages read for this record.", "how": "*Trade practice —* the Medellín route runs on Colombians abroad, on the Caribbean and on the Andean republics, with cosmetic surgery drawing a separate and largely unaccredited trade in the same city that does not pass through a clinic of this kind. The international office is the funnel: enquiry, records, estimate, visa letter, arrival.\n\nNo price is published on any page read here.", "today": "As of 17 September 2026 the international office states its services — executive check-ups, a service portfolio, insurer arrangements, travel planning, medical visa guidance and yellow fever advice — at Diagonal 75B No. 2A-80/140, Medellín. No bed count, patient count, accreditation or price was found." }, "geo": { "lat": 6.213953, "lon": -75.595759, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "Diagonal 75B No. 2A-80/140", "city": "Medellín", "area": "Antioquia", "country": "CO", "postcode": "050024" }, "metrics": { "beds": null, "annual_patients": null, "annual_foreign_patients": null, "note": "None published in the pages read. The clinic's international office describes what it does and where it is; it gives no capacity figure, no patient count and no count of the countries its patients come from. Absence here means absence from these pages, not from the clinic's records.", "as_of": "2026", "source": "s:lasamericas-international", "url": "https://www.lasamericas.com.co/oficina-internacional" }, "tags": [ { "tag": "international-office", "source": "s:lasamericas-international", "tier": "cited", "note": "a dedicated office for national and international patients handling the whole journey, not only the treatment", "url": "https://www.lasamericas.com.co/oficina-internacional" }, { "tag": "visa-support", "source": "s:lasamericas-visa", "tier": "cited", "note": "the office publishes a step-by-step page on Colombia's medical visa", "url": "https://www.lasamericas.com.co/oficina-internacional/paso-a-paso/visa-medica-en-colombia" }, { "tag": "chain", "source": "s:lasamericas-international", "tier": "cited", "note": "part of Grupo Las Américas, owned by the regional healthcare group Auna" }, { "tag": "insurer-direct", "source": "s:lasamericas-international", "tier": "cited", "note": "the international office publishes its insurance company arrangements as one of its listed services" }, { "tag": "no-price-published", "source": "s:lasamericas-international", "tier": "cited", "note": "the service portfolio is published; no figure is attached to any of it" } ], "kin": [ { "to": "medellin", "as": "The high-complexity clinic at the centre of the city's formal medical traffic, distinct from its cosmetic trade.", "rel": "place" }, { "to": "colombia", "as": "The Medellín route into Colombian private medicine, run through an international office that starts with the visa.", "rel": "destination" }, { "to": "fundacion-santa-fe", "as": "Bogotá's foundation hospital: no shareholders and an academic accreditation, against a commercial clinic in a regional group.", "rel": "contrast" }, { "to": "the-visa", "as": "Publishes a step-by-step page on Colombia's medical visa, which is the step its office exists for.", "rel": "step" }, { "to": "executive-health-screening", "as": "Heads its own service list, ahead of any operation.", "rel": "performs" }, { "to": "choosing-a-facilitator", "as": "An in-house international office is the alternative to a broker, and it is the clinic's own staff.", "rel": "step" }, { "to": "bbl", "as": "Medellín's cosmetic trade runs beside this clinic and not through it, which is the distinction a reader of a city page needs.", "rel": "contrast" } ], "links": [ { "label": "Oficina Internacional Las Américas", "url": "https://www.lasamericas.com.co/oficina-internacional" } ], "sources": [ "s:lasamericas-international", "s:lasamericas-visa", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim", "note": "the OpenStreetMap point for the Torre Médica Las Américas on Diagonal 75B" }, "text.how": { "tier": "tradition", "note": "where Medellín's inbound traffic comes from; marked in the prose" }, "metrics": { "tier": "cited", "source": "s:lasamericas-international" } } }, "x_commons_files": [], "confidence": "low", "needs_verification": true, "updated": "2026-09-17", "blurb": "A high-complexity private clinic in western Medellín, part of Grupo Las Américas and owned by the Peruvian healthcare group Auna.", "region_terms": [ { "key": "south-america", "name": "South America", "note": "Colombia, Brazil, Argentina, Chile, Peru" } ], "kin_out": [ { "to": "medellin", "type": "hub", "name": "Medellín", "as": "The high-complexity clinic at the centre of the city's formal medical traffic, distinct from its cosmetic trade.", "rel": "place" }, { "to": "colombia", "type": "destination", "name": "Colombia", "as": "The Medellín route into Colombian private medicine, run through an international office that starts with the visa.", "rel": "destination" }, { "to": "fundacion-santa-fe", "type": "facility", "name": "Fundación Santa Fe de Bogotá", "as": "Bogotá's foundation hospital: no shareholders and an academic accreditation, against a commercial clinic in a regional group.", "rel": "contrast" }, { "to": "the-visa", "type": "pathway", "name": "The visa", "as": "Publishes a step-by-step page on Colombia's medical visa, which is the step its office exists for.", "rel": "step" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "Heads its own service list, ahead of any operation.", "rel": "performs" }, { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "An in-house international office is the alternative to a broker, and it is the clinic's own staff.", "rel": "step" }, { "to": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "Medellín's cosmetic trade runs beside this clinic and not through it, which is the distinction a reader of a city page needs.", "rel": "contrast" } ], "source_list": [ { "id": "s:lasamericas-international", "kind": "web", "title": "Oficina Internacional Las Américas", "publisher": "Clínica Las Américas Auna, Medellín", "url": "https://www.lasamericas.com.co/oficina-internacional", "accessed": "2026-09-16", "note": "the hospital's international office, its step-by-step pages on entry to Colombia, the health visa, yellow fever vaccination and flights, and the address Diagonal 75B N. 2A-80/140, Medellín" }, { "id": "s:lasamericas-visa", "kind": "web", "title": "Visa Médica en Colombia", "publisher": "Clínica Las Américas Auna, Medellín", "url": "https://www.lasamericas.com.co/oficina-internacional/paso-a-paso/visa-medica-en-colombia", "accessed": "2026-09-16", "note": "states that a non-resident foreigner coming for treatment, and any companion, needs a Colombian health visa where the stay is expected to exceed 90 days, and points at the Cancillería de Colombia" }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "where Medellín's inbound traffic comes from; marked in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim", "note": "the OpenStreetMap point for the Torre Médica Las Américas on Diagonal 75B" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:lasamericas-international" } }, "primary_image": null, "tag_facts": [ { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:lasamericas-international", "note": "a dedicated office for national and international patients handling the whole journey, not only the treatment", "tier": "cited", "url": "https://www.lasamericas.com.co/oficina-internacional" }, { "key": "visa-support", "label": "Helps with the visa", "icon": "🛂", "group": "service", "evidence": "the facility or ministry names the letter or invitation it issues, with the visa class", "source": "s:lasamericas-visa", "note": "the office publishes a step-by-step page on Colombia's medical visa", "tier": "cited", "url": "https://www.lasamericas.com.co/oficina-internacional/paso-a-paso/visa-medica-en-colombia" }, { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:lasamericas-international", "note": "part of Grupo Las Américas, owned by the regional healthcare group Auna", "tier": "cited", "url": "" }, { "key": "insurer-direct", "label": "Bills foreign insurers", "icon": "📄", "group": "money", "evidence": "the facility names the insurers or schemes it bills directly", "source": "s:lasamericas-international", "note": "the international office publishes its insurance company arrangements as one of its listed services", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:lasamericas-international", "note": "the service portfolio is published; no figure is attached to any of it", "tier": "cited", "url": "" } ], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "colombia", "type": "destination", "name": "Colombia", "as": "One of the Medellín institutions the trade routes patients to.", "rel": "part" }, { "from": "medellin", "type": "hub", "name": "Medellín", "as": "The hospital group whose international office this record reads.", "rel": "place" }, { "from": "fundacion-santa-fe", "type": "facility", "name": "Fundación Santa Fe de Bogotá", "as": "Medellín's answer: a commercial group with an international office against a foundation with no shareholders.", "rel": "contrast" } ] }, { "schema": 1, "id": "fortis-gurgaon", "type": "facility", "names": { "name": "Fortis Memorial Research Institute, Gurugram", "aliases": [ "FMRI", "Fortis Gurgaon", "Fortis Memorial Research Institute" ], "said": "FMRI in the trade. The city is Gurugram on paper and Gurgaon in every address ever written; both appear on the hospital's own pages." }, "region": [ "south-asia" ], "facets": { "iso2": "IN", "ownership": "private", "founded": null, "specialty": [ "neurosciences", "oncology", "cardiac sciences", "orthopaedics", "bone marrow transplant", "renal sciences" ], "draws": [ "bone-marrow-transplant", "kidney-transplant", "cabg", "knee-replacement" ], "status": "open", "languages": [ "English", "Hindi" ] }, "text": { "what": "The headquarters hospital of Fortis Healthcare, in Sector 44 of Gurugram on the southern edge of Delhi. It is the group's referral centre for neurosciences, oncology and transplant work, and it sits in the Delhi National Capital Region cluster that competes with Chennai for India's inbound patient trade.", "story": "Fortis Healthcare is the second of India's large corporate hospital companies, and IHH Healthcare — the Malaysian group that also owns Gleneagles, Mount Elizabeth, Prince Court and Acibadem — held a 31.1 per cent controlling stake in it as of the reporting read for this record. That single fact links this hospital to four others in this directory across three countries.\n\nThe hospital appeared in the 2022 Newsweek and Statista listing for India and has been described as a smart hospital in its own reporting.\n\n*Inference —* the Gurugram location is not incidental. Sector 44 is twenty minutes from the international airport at Delhi and on the same road as the corporate offices whose staff insurance pays for a good part of the private bed base. A hospital sited for an airport is sited for people who arrive by plane, whichever passport they hold.", "how": "*Trade practice —* the Delhi NCR hospitals work the inbound trade through facilitators and through embassies: a large share of the foreign patients in this corridor come from Bangladesh, Afghanistan, Iraq and East Africa, arrive on a medical visa arranged around an emailed estimate, and are met at the airport. This record carries no figure for that trade, because none was found published by the hospital or by a regulator.", "today": "As of 16 September 2026 the hospital's own website refused this project's requests, so nothing here is read off it. The bed count, the opening year, the accreditations and any published price are therefore absent rather than estimated, and this record is marked for verification. What is carried is the address and the point, from OpenStreetMap, and the group's ownership and listing from reporting." }, "geo": { "lat": 28.4571214, "lon": 77.072768, "precision": "street", "source": "s:osm" }, "address": { "street": "Fortis Hospital Road, Sector 44", "city": "Gurugram", "area": "Haryana", "country": "IN", "postcode": "122002" }, "metrics": { "beds": null, "doctors": null, "annual_patients": null, "annual_foreign_patients": null, "note": "No number on this record. The hospital's own site returned a refusal to every request made on 16 September 2026 and no regulator's register read here names its bed count. Absence here means not found by this project, not that the hospital publishes nothing.", "as_of": "2026-09-16", "source": "s:wp-fortis-healthcare", "url": "https://en.wikipedia.org/wiki/Fortis_Healthcare" }, "tags": [ { "tag": "chain", "source": "s:wp-fortis-healthcare", "tier": "cited", "note": "Fortis Healthcare, whose headquarters this hospital is" }, { "tag": "listed-company", "source": "s:wp-fortis-healthcare", "tier": "cited", "note": "IHH Healthcare held a 31.1 per cent controlling stake at the time of the reporting read here" } ], "recognitions": [ { "by": "newsweek-statista", "what": "Listed in the 2022 Newsweek and Statista ranking for India", "year": 2022, "valid_until": null, "source": "s:wp-fortis-healthcare", "url": "https://en.wikipedia.org/wiki/Fortis_Healthcare", "note": "a survey-and-indicator listing, counted here and never read as a quality score. No clinical accreditation is recorded on this record because none was sourced." } ], "kin": [ { "to": "delhi-ncr", "as": "One of the two hospitals the Gurugram end of the Delhi cluster is usually named for.", "rel": "place" }, { "to": "india", "as": "The northern half of India's inbound trade, against Chennai's southern half.", "rel": "destination" }, { "to": "medanta", "as": "Its neighbour and direct competitor, eight kilometres away in Sector 38, which does publish prices.", "rel": "contrast" }, { "to": "bone-marrow-transplant", "as": "One of the referral programmes the group runs here.", "rel": "performs" }, { "to": "india-e-medical-visa", "as": "The visa class that brings most of this corridor's foreign patients.", "rel": "governed-by" }, { "to": "nabh", "as": "The Indian national board; this record holds no dated grant for this hospital.", "rel": "accredited-by" }, { "to": "choosing-a-facilitator", "as": "Much of the Delhi NCR inbound trade reaches hospitals like this one through brokers rather than directly.", "rel": "step" } ], "links": [ { "label": "Fortis Healthcare", "url": "https://www.fortishealthcare.com/" } ], "sources": [ "s:wp-fortis-healthcare", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "tradition", "note": "the shape of the Delhi NCR inbound trade; hedged in the prose and carrying no figure" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node Fortis Memorial Research Institute, Sector 44" }, "facets.founded": { "tier": "inference", "note": "left null: no source read for this record dates the hospital's opening" } } }, "x_commons_files": [], "confidence": "low", "needs_verification": true, "updated": "2026-09-16", "blurb": "The headquarters hospital of Fortis Healthcare, in Sector 44 of Gurugram on the southern edge of Delhi.", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" } ], "kin_out": [ { "to": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "One of the two hospitals the Gurugram end of the Delhi cluster is usually named for.", "rel": "place" }, { "to": "india", "type": "destination", "name": "India", "as": "The northern half of India's inbound trade, against Chennai's southern half.", "rel": "destination" }, { "to": "medanta", "type": "facility", "name": "Medanta — The Medicity, Gurugram", "as": "Its neighbour and direct competitor, eight kilometres away in Sector 38, which does publish prices.", "rel": "contrast" }, { "to": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "One of the referral programmes the group runs here.", "rel": "performs" }, { "to": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The visa class that brings most of this corridor's foreign patients.", "rel": "governed-by" }, { "to": "nabh", "type": "org", "name": "National Accreditation Board for Hospitals and Healthcare Providers", "as": "The Indian national board; this record holds no dated grant for this hospital.", "rel": "accredited-by" }, { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "Much of the Delhi NCR inbound trade reaches hospitals like this one through brokers rather than directly.", "rel": "step" } ], "source_list": [ { "id": "s:wp-fortis-healthcare", "kind": "web", "title": "Fortis Healthcare", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Fortis_Healthcare", "accessed": "2026-09-16" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "the shape of the Delhi NCR inbound trade; hedged in the prose and carrying no figure" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node Fortis Memorial Research Institute, Sector 44" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [ { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:wp-fortis-healthcare", "note": "Fortis Healthcare, whose headquarters this hospital is", "tier": "cited", "url": "" }, { "key": "listed-company", "label": "Publicly listed", "icon": "📈", "group": "ownership", "evidence": "an exchange listing or an annual report", "source": "s:wp-fortis-healthcare", "note": "IHH Healthcare held a 31.1 per cent controlling stake at the time of the reporting read here", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "newsweek-statista", "label": "Newsweek / Statista World's Best Hospitals", "what": "Listed in the 2022 Newsweek and Statista ranking for India", "url": "https://en.wikipedia.org/wiki/Fortis_Healthcare", "kind": "listing", "year": 2022, "valid_until": null, "source": "s:wp-fortis-healthcare" } ], "acclaim": 1, "kin_in": [ { "from": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "Eight kilometres north of Medanta on Fortis Hospital Road, Sector 44.", "rel": "part" }, { "from": "medanta", "type": "facility", "name": "Medanta — The Medicity, Gurugram", "as": "Its neighbour and competitor in the same city, which publishes neither.", "rel": "contrast" }, { "from": "nabh", "type": "org", "name": "National Accreditation Board for Hospitals and Healthcare Providers", "as": "Another, in the Delhi cluster.", "rel": "accredits" } ] }, { "schema": 1, "id": "fundacion-santa-fe", "type": "facility", "names": { "name": "Fundación Santa Fe de Bogotá", "aliases": [ "Hospital Universitario Fundación Santa Fe de Bogotá", "FSFB" ], "said": "fun-da-SYON SAN-ta FEH. A foundation before it is a hospital: created 2 November 1972 as a private body with no owners and no shareholders, and the university hospital is what the foundation runs." }, "region": [ "south-america" ], "facets": { "iso2": "CO", "ownership": "nonprofit", "founded": 1972, "specialty": [ "oncology", "cardiovascular", "orthopaedics", "transplantation", "neurosciences" ], "draws": [ "kidney-transplant", "knee-replacement", "hip-replacement", "bone-marrow-transplant" ], "status": "open", "languages": [ "Spanish", "English" ] }, "text": { "what": "A private nonprofit foundation in northern Bogotá, created on 2 November 1972 with no owners and no shareholders, whose university hospital on Calle 119 was the first organisation in Colombia accredited by Joint Commission International as an academic medical centre. It has held that accreditation through six consecutive cycles.", "story": "Gloria González de Esguerra, Pedro Gómez Valderrama and the physicians Alfonso Esguerra Fajardo, Enrique Urdaneta Holguín, Alejandro Jiménez Arango and José Félix Patiño Restrepo founded the body in 1972. Its legal form — a foundation with no proprietors — is the fact that separates it from every listed hospital group elsewhere in this directory.\n\nThe JCI record is unusually complete because the hospital publishes it as a timeline rather than as a seal: first cycle 2010, then 2013, 2016, 2019, 2022 and 2025. The hospital states it was the first in Colombia to be certified, in 2009, and that twenty-one of its clinical care programmes hold separate JCI certification as clinical care centres.\n\n*Inference —* that is the difference between an accreditation and a certificate. A hospital-wide accreditation says the building meets a standard; twenty-one programme certifications say twenty-one named pathways were examined one at a time. Both are voluntary and the applicant pays.\n\nIn November 2016 the foundation opened a twelve-storey extension adding 148 hospitalisation beds.", "how": "*Trade practice —* Bogotá's international traffic runs on the Caribbean, the Andean republics and the Colombian diaspora rather than on North American self-payers, and a foundation hospital with an academic accreditation sells complexity rather than price: transplants, oncology, cardiovascular surgery. The enquiry goes to the international patient service, the records are read, and an estimate follows.\n\nNo price is published.", "today": "As of 17 September 2026 the hospital states six JCI cycles — 2010, 2013, 2016, 2019, 2022 and 2025 — and twenty-one JCI-certified clinical care centres. The 148 beds added in November 2016 are an addition and not a total; no total bed count, patient count or foreign share was found published." }, "geo": { "lat": 4.696564, "lon": -74.032925, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "Calle 119 No. 7-75", "city": "Bogotá", "area": "Bogotá D.C.", "country": "CO", "postcode": "110111" }, "metrics": { "beds": null, "annual_patients": null, "annual_foreign_patients": null, "note": "The only bed figure sourced is an INCREMENT, not a total: 148 hospitalisation beds added by the twelve-storey extension opened in November 2016. A hospital's total is not the sum of its extensions, so the total stays empty. No patient count and no foreign share was found published.", "as_of": "2026", "source": "s:fsfb-jci", "url": "https://fundacionsantafedebogota.com/publicaciones/certificacion-joint-comission-international-jci" }, "tags": [ { "tag": "university-hospital", "source": "s:fsfb-jci", "tier": "cited", "note": "accredited by JCI in the academic medical centre category, the first organisation in Colombia in that category" }, { "tag": "teaching", "source": "s:fsfb-jci", "tier": "cited" }, { "tag": "international-office", "source": "s:fsfb-jci", "tier": "cited", "note": "the foundation runs a paciente internacional service alongside the hospital" }, { "tag": "no-price-published", "source": "s:fsfb-jci", "tier": "cited", "note": "no price list was found on the foundation's own pages" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation as an academic medical centre hospital, through six consecutive cycles — 2010, 2013, 2016, 2019, 2022 and 2025 — plus separate JCI certification of twenty-one clinical care centres", "year": 2010, "valid_until": null, "source": "s:fsfb-jci", "url": "https://fundacionsantafedebogota.com/publicaciones/certificacion-joint-comission-international-jci", "note": "the hospital states it was first certified in Colombia in 2009 and dates its first accreditation cycle to 2010; the year carried here is the first cycle as the hospital's own timeline prints it" } ], "kin": [ { "to": "bogota", "as": "The academic hospital the Bogotá cluster is anchored on, in the north of the city on Calle 119.", "rel": "place" }, { "to": "colombia", "as": "The country's first JCI-accredited organisation, and the one that sells complexity rather than a price.", "rel": "destination" }, { "to": "clinica-las-americas", "as": "Medellín's answer: a commercial group with an international office against a foundation with no shareholders.", "rel": "contrast" }, { "to": "jci", "as": "Its accreditor since 2010, in the academic medical centre category, renewed five times.", "rel": "accredited-by" }, { "to": "kidney-transplant", "as": "Among the programmes carrying a separate JCI clinical care centre certification.", "rel": "performs" }, { "to": "the-accreditation-question", "as": "One hospital-wide accreditation and twenty-one programme certifications, all voluntary and all paid for by the applicant.", "rel": "story" }, { "to": "getting-a-quote", "as": "With no price published, the estimate after the records are read is the only figure.", "rel": "step" } ], "links": [ { "label": "Fundación Santa Fe de Bogotá", "url": "https://fundacionsantafedebogota.com/" }, { "label": "Certificación Joint Commission International", "url": "https://fundacionsantafedebogota.com/publicaciones/certificacion-joint-comission-international-jci" } ], "sources": [ "s:fsfb-jci", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "text.how": { "tier": "tradition", "note": "where Bogotá's inbound traffic comes from and how an enquiry is handled; marked in the prose" }, "metrics": { "tier": "cited", "source": "s:fsfb-jci" } } }, "x_commons_files": [ "File:Fundación Santa Fe de Bogotá.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "A private nonprofit foundation in northern Bogotá, created on 2 November 1972 with no owners and no shareholders, whose university hospital on Calle 119 was the first organisation in Colombia accredited by Joint…", "region_terms": [ { "key": "south-america", "name": "South America", "note": "Colombia, Brazil, Argentina, Chile, Peru" } ], "kin_out": [ { "to": "bogota", "type": "hub", "name": "Bogotá", "as": "The academic hospital the Bogotá cluster is anchored on, in the north of the city on Calle 119.", "rel": "place" }, { "to": "colombia", "type": "destination", "name": "Colombia", "as": "The country's first JCI-accredited organisation, and the one that sells complexity rather than a price.", "rel": "destination" }, { "to": "clinica-las-americas", "type": "facility", "name": "Clínica Las Américas", "as": "Medellín's answer: a commercial group with an international office against a foundation with no shareholders.", "rel": "contrast" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "Its accreditor since 2010, in the academic medical centre category, renewed five times.", "rel": "accredited-by" }, { "to": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "Among the programmes carrying a separate JCI clinical care centre certification.", "rel": "performs" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "One hospital-wide accreditation and twenty-one programme certifications, all voluntary and all paid for by the applicant.", "rel": "story" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "With no price published, the estimate after the records are read is the only figure.", "rel": "step" } ], "source_list": [ { "id": "s:fsfb-jci", "kind": "web", "title": "Certificación Joint Comission International (JCI)", "publisher": "Fundación Santa Fe de Bogotá", "url": "https://fundacionsantafedebogota.com/publicaciones/certificacion-joint-comission-international-jci", "accessed": "2026-09-16", "note": "the hospital's own accreditation timeline: first cycle 2010, then 2013, 2016, 2019, 2022 and 2025" }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "where Bogotá's inbound traffic comes from and how an enquiry is handled; marked in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:fsfb-jci" } }, "primary_image": null, "tag_facts": [ { "key": "university-hospital", "label": "University hospital", "icon": "🎓", "group": "ownership", "evidence": "the affiliated university's own page or the hospital's charter", "source": "s:fsfb-jci", "note": "accredited by JCI in the academic medical centre category, the first organisation in Colombia in that category", "tier": "cited", "url": "" }, { "key": "teaching", "label": "Teaching hospital", "icon": "📚", "group": "clinical", "evidence": "a recognised training post list or the hospital's own statement", "source": "s:fsfb-jci", "note": "", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:fsfb-jci", "note": "the foundation runs a paciente internacional service alongside the hospital", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:fsfb-jci", "note": "no price list was found on the foundation's own pages", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation as an academic medical centre hospital, through six consecutive cycles — 2010, 2013, 2016, 2019, 2022 and 2025 — plus separate JCI certification of twenty-one clinical care centres", "url": "https://fundacionsantafedebogota.com/publicaciones/certificacion-joint-comission-international-jci", "kind": "international", "year": 2010, "valid_until": null, "source": "s:fsfb-jci" } ], "acclaim": 1, "kin_in": [ { "from": "colombia", "type": "destination", "name": "Colombia", "as": "The Bogotá hospital on the complex end of the same country.", "rel": "part" }, { "from": "bogota", "type": "hub", "name": "Bogotá", "as": "The hospital whose six dated accreditation cycles this record reads.", "rel": "place" }, { "from": "clinica-las-americas", "type": "facility", "name": "Clínica Las Américas", "as": "Bogotá's foundation hospital: no shareholders and an academic accreditation, against a commercial clinic in a regional group.", "rel": "contrast" } ] }, { "schema": 1, "id": "gleneagles-kl", "type": "facility", "names": { "name": "Gleneagles Hospital Kuala Lumpur", "aliases": [ "Gleneagles KL", "Gleneagles Kuala Lumpur", "Hospital Gleneagles Kuala Lumpur" ], "said": "Gleneagles, after the Scottish name Parkway took to Singapore and then across the region; Kuala Lumpur says Gleneagles Ampang, for the road." }, "region": [ "southeast-asia" ], "facets": { "iso2": "MY", "ownership": "private", "founded": 1996, "specialty": [ "cardiology", "oncology", "orthopaedics", "general surgery", "paediatrics", "gastroenterology" ], "draws": [ "angioplasty-stent", "knee-replacement", "cataract-surgery" ], "status": "open", "languages": [ "Malay", "English", "Mandarin", "Tamil", "Arabic", "Indonesian" ] }, "text": { "what": "A 376-bed private hospital on Jalan Ampang in Kuala Lumpur, which began operating on 1 August 1996. It is a subsidiary of Pantai Medical Centre, owned by IHH Healthcare, and one of four Gleneagles hospitals in Malaysia. It holds accreditation from the Malaysian Society for Quality in Health and from Joint Commission International.", "story": "Gleneagles Kuala Lumpur is part of the largest single ownership block in this directory. IHH Healthcare owns Gleneagles, Pantai and Prince Court in Malaysia, Mount Elizabeth and Parkway in Singapore, Acibadem in Türkiye and a controlling stake in Fortis in India — so a patient comparing a Kuala Lumpur quote with a Singapore one, or with a Delhi one, may be comparing two subsidiaries of the same company.\n\nThe hospital won an award for customer service at the 2015 International Medical Travel Journal awards, the year Malaysia was named that scheme's destination of the year.\n\n*Inference —* Malaysia's inbound trade is shaped by its neighbours' prices more than by its own. Kuala Lumpur is an hour from Singapore by air and a bus ride from Johor, and it prices below both Singapore and, for some work, Thailand. A hospital on Jalan Ampang is competing with Mount Elizabeth on the same operation at a different number.", "how": "Malaysia runs its inbound trade through the Malaysia Healthcare Travel Council, a government agency that lists and promotes member hospitals. *Trade practice —* the quote a foreign patient receives from a Malaysian private hospital is an estimate band naming the surgeon's fee, the ward class and the length of stay separately, because those are the lines that move.", "today": "As of 16 September 2026 the hospital's group page states 376 beds and gives its address as blocks A, B and the medical office block at 282, 286 and 288 Jalan Ampang. No price for any procedure appears on the Gleneagles Malaysia pages read for this record." }, "geo": { "lat": 3.161265, "lon": 101.739183, "precision": "street", "source": "s:wp-gleneagles-kl" }, "address": { "street": "282, 286 & 288 Block A, B and Medical Office Block, Jalan Ampang", "city": "Kuala Lumpur", "country": "MY", "postcode": "50450" }, "metrics": { "beds": 376, "doctors": null, "annual_patients": null, "annual_foreign_patients": null, "note": "376 beds is the group's own figure for the Kuala Lumpur hospital, read 16 September 2026. No patient count and no foreign-patient count is published on the pages read here; where Malaysian figures are published nationally by the Malaysia Healthcare Travel Council they count arrivals and hospital VISITS, not individual people.", "as_of": "2026-09-16", "source": "s:gleneagles-my", "url": "https://gleneagles.com.my/hospitals/gleneagles-hospital-kuala-lumpur" }, "tags": [ { "tag": "chain", "source": "s:wp-gleneagles-kl", "tier": "cited", "note": "a subsidiary of Pantai Medical Centre, owned by IHH Healthcare; four Gleneagles hospitals in Malaysia" }, { "tag": "no-price-published", "source": "s:gleneagles-my", "tier": "cited", "note": "no price or package figure on the Gleneagles Malaysia hospital pages, checked 16 September 2026" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation", "year": null, "valid_until": null, "source": "s:wp-gleneagles-kl", "url": "https://en.wikipedia.org/wiki/Gleneagles_Hospital_Kuala_Lumpur", "note": "reported rather than dated; the year first granted is not recorded here" }, { "by": "other", "what": "Accreditation by the Malaysian Society for Quality in Health (MSQH), the Malaysian national hospital standard", "year": null, "valid_until": null, "source": "s:wp-gleneagles-kl", "url": "https://en.wikipedia.org/wiki/Gleneagles_Hospital_Kuala_Lumpur", "note": "MSQH has no key of its own in this project's recognizer list and is recorded here as a named other body" }, { "by": "other", "what": "Award for Excellence in Customer Service at the 2015 International Medical Travel Journal awards", "year": 2015, "valid_until": null, "source": "s:wp-gleneagles-kl", "url": "https://en.wikipedia.org/wiki/Gleneagles_Hospital_Kuala_Lumpur", "note": "a trade-press award, counted and not weighted" } ], "kin": [ { "to": "kuala-lumpur", "as": "One of the two hospitals the Kuala Lumpur cluster is usually named for.", "rel": "place" }, { "to": "malaysia", "as": "A hospital whose pricing exists in the gap between Singapore's and Thailand's.", "rel": "destination" }, { "to": "mount-elizabeth", "as": "Same ultimate owner, an hour's flight away, at a different number for the same operation.", "rel": "contrast" }, { "to": "prince-court", "as": "Its Kuala Lumpur competitor, also IHH-owned, which does publish package prices.", "rel": "contrast" }, { "to": "mhtc", "as": "The government agency that lists and promotes Malaysia's inbound hospitals.", "rel": "org" }, { "to": "malaysia-mhtc-licence", "as": "The national arrangement under which Malaysian hospitals take foreign patients.", "rel": "governed-by" }, { "to": "jci", "as": "The international accreditor whose mark it holds alongside the Malaysian national one.", "rel": "accredited-by" } ], "links": [ { "label": "Gleneagles Hospitals Malaysia", "url": "https://gleneagles.com.my/" }, { "label": "Gleneagles Hospital Kuala Lumpur", "url": "https://gleneagles.com.my/hospitals/gleneagles-hospital-kuala-lumpur" } ], "sources": [ "s:wp-gleneagles-kl", "s:gleneagles-my" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "tradition", "note": "the shape of a Malaysian private hospital estimate; hedged in the prose" }, "geo": { "tier": "cited", "source": "s:wp-gleneagles-kl", "note": "coordinates as published on the hospital's Wikipedia entry" }, "metrics": { "tier": "cited", "source": "s:gleneagles-my" } } }, "x_commons_files": [ "File:Gleneagles Hospital Kuala Lumpur.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "A 376-bed private hospital on Jalan Ampang in Kuala Lumpur, which began operating on 1 August 1996. It is a subsidiary of Pantai Medical Centre, owned by IHH Healthcare, and one of four Gleneagles hospitals in Malaysia.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "One of the two hospitals the Kuala Lumpur cluster is usually named for.", "rel": "place" }, { "to": "malaysia", "type": "destination", "name": "Malaysia", "as": "A hospital whose pricing exists in the gap between Singapore's and Thailand's.", "rel": "destination" }, { "to": "mount-elizabeth", "type": "facility", "name": "Mount Elizabeth Hospital", "as": "Same ultimate owner, an hour's flight away, at a different number for the same operation.", "rel": "contrast" }, { "to": "prince-court", "type": "facility", "name": "Prince Court Medical Centre", "as": "Its Kuala Lumpur competitor, also IHH-owned, which does publish package prices.", "rel": "contrast" }, { "to": "mhtc", "type": "org", "name": "Malaysia Healthcare Travel Council", "as": "The government agency that lists and promotes Malaysia's inbound hospitals.", "rel": "org" }, { "to": "malaysia-mhtc-licence", "type": "rule", "name": "Malaysia's healthcare travel registration", "as": "The national arrangement under which Malaysian hospitals take foreign patients.", "rel": "governed-by" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The international accreditor whose mark it holds alongside the Malaysian national one.", "rel": "accredited-by" } ], "source_list": [ { "id": "s:wp-gleneagles-kl", "kind": "wikipedia", "title": "Gleneagles Hospital Kuala Lumpur", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Gleneagles_Hospital_Kuala_Lumpur", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:gleneagles-my", "kind": "web", "title": "Gleneagles Hospitals Malaysia — hospital list and bed counts", "publisher": "Gleneagles Hospitals Malaysia (IHH Healthcare)", "url": "https://gleneagles.com.my/hospitals/gleneagles-hospital-kuala-lumpur", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "the shape of a Malaysian private hospital estimate; hedged in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited", "source": "s:wp-gleneagles-kl", "note": "coordinates as published on the hospital's Wikipedia entry" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:gleneagles-my" } }, "primary_image": null, "tag_facts": [ { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:wp-gleneagles-kl", "note": "a subsidiary of Pantai Medical Centre, owned by IHH Healthcare; four Gleneagles hospitals in Malaysia", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:gleneagles-my", "note": "no price or package figure on the Gleneagles Malaysia hospital pages, checked 16 September 2026", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation", "url": "https://en.wikipedia.org/wiki/Gleneagles_Hospital_Kuala_Lumpur", "kind": "international", "year": null, "valid_until": null, "source": "s:wp-gleneagles-kl" }, { "key": "other", "label": "Somebody else", "what": "Accreditation by the Malaysian Society for Quality in Health (MSQH), the Malaysian national hospital standard", "url": "https://en.wikipedia.org/wiki/Gleneagles_Hospital_Kuala_Lumpur", "kind": "other", "year": null, "valid_until": null, "source": "s:wp-gleneagles-kl" }, { "key": "other", "label": "Somebody else", "what": "Award for Excellence in Customer Service at the 2015 International Medical Travel Journal awards", "url": "https://en.wikipedia.org/wiki/Gleneagles_Hospital_Kuala_Lumpur", "kind": "other", "year": 2015, "valid_until": null, "source": "s:wp-gleneagles-kl" } ], "acclaim": 2, "kin_in": [ { "from": "malaysia", "type": "destination", "name": "Malaysia", "as": "One of the private hospitals the council's figures are assembled from.", "rel": "part" }, { "from": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "On Jalan Ampang at Ampang Hilir, 376 beds, open since 1996.", "rel": "part" }, { "from": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "A sister under the same Malaysian parent, IHH Healthcare — a patient comparing Istanbul against Kuala Lumpur may be comparing two hospitals with one owner.", "rel": "contrast" }, { "from": "island-hospital-penang", "type": "facility", "name": "Island Hospital", "as": "The Kuala Lumpur competitor under the same owner since 2024, which publishes no price.", "rel": "contrast" }, { "from": "mount-elizabeth", "type": "facility", "name": "Mount Elizabeth Hospital", "as": "A sister under the same parent, IHH Healthcare, two hundred miles up the peninsula and priced differently.", "rel": "contrast" }, { "from": "prince-court", "type": "facility", "name": "Prince Court Medical Centre", "as": "Its neighbour and competitor under the same ultimate owner, which publishes no price.", "rel": "contrast" }, { "from": "malaysia-mhtc-licence", "type": "rule", "name": "Malaysia's healthcare travel registration", "as": "One of the member hospitals.", "rel": "facility" }, { "from": "mhtc", "type": "org", "name": "Malaysia Healthcare Travel Council", "as": "One of the private hospitals on its member roster.", "rel": "org" } ] }, { "schema": 1, "id": "hadassah", "type": "facility", "names": { "name": "Hadassah Medical Center", "aliases": [ "Hadassah Ein Kerem", "Hadassah Mount Scopus", "הדסה" ], "said": "ha-DAH-sa. The name is the organisation's before it is the hospital's: Hadassah, the Women's Zionist Organization of America, founded the medical work in Jerusalem and still underwrites a large part of its budget." }, "region": [ "west-asia" ], "facets": { "iso2": "IL", "ownership": "nonprofit", "founded": 1934, "specialty": [ "oncology", "neurosurgery", "cardiology", "transplantation", "ophthalmology" ], "draws": [ "bone-marrow-transplant", "gamma-knife", "kidney-transplant", "ivf" ], "status": "open", "languages": [ "Hebrew", "English", "Arabic", "Russian" ] }, "text": { "what": "A Jerusalem hospital on two campuses — Mount Scopus, opened 1939, and Ein Kerem, established 1961 — with more than 1,300 beds between them, 31 operating theatres and nine intensive care units. It is owned and part-funded by the Hadassah Women's Zionist Organization of America, and it is the teaching hospital of the Hebrew University of Jerusalem for medicine, dentistry, nursing, public health and pharmacology.", "story": "An American membership organisation owning and subsidising a hospital in another country is a form this directory meets nowhere else. Hadassah founded the medical work in 1934 and still underwrites a large part of the budget; the fundraising is in the United States and the beds are in Jerusalem.\n\nEin Kerem carried 700 beds before 2012 and added about 500 more with a tower that opened that year. Mount Scopus carries over 300. Since 27 February 2025 the Jerusalem light rail's Red Line has served Ein Kerem with two stations.\n\nThe hospital is Israel's most productive in research by the Nature Index for 2024 to 2025, at around 900 peer-reviewed papers a year. Newsweek's 2025 list placed it fourth in Israel and 242nd in the world. *Inference —* that pair of placings, one national and one global, is the more useful reading of a ranking: the same institution is near the top of a small system and in the middle of a large list, and neither number says anything about a particular operation.\n\nIsrael's 2018 medical tourism legislation governs how its hospitals may treat foreign patients, and the argument it settled — whether foreign work in a subsidised hospital displaces citizens — applies here with an extra turn, because the subsidy is foreign too.", "how": "*Trade practice —* foreign patients reach Hadassah through its international department and through the Hadassah organisation's own networks abroad, which is a referral route no commercial group has. Neurosurgery, oncology and transplantation carry most of it.\n\nNo price schedule was found published for either campus.", "today": "As of 17 September 2026 the two campuses carry over 1,300 beds, 31 operating theatres and nine intensive care units. Newsweek's 2025 list placed the hospital fourth in Israel and 242nd in the world, and the Nature Index named it Israel's leading hospital for scientific output in 2024 to 2025. No patient count, foreign share or price was sourced for this record." }, "geo": { "lat": 31.764957, "lon": 35.150017, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "Ein Kerem campus, Kiryat Hadassah", "city": "Jerusalem", "country": "IL", "postcode": "9574320" }, "metrics": { "beds": 1300, "annual_patients": null, "annual_foreign_patients": null, "note": "Over 1,300 beds across BOTH campuses — Ein Kerem, which held 700 before the 2012 tower added about 500 more, and Mount Scopus, which holds over 300. The record pins Ein Kerem; the bed figure is the pair. No patient count of any kind, and no foreign share, was found published. Research output, about 900 peer-reviewed papers a year, is the only annual number sourced here, and it counts papers.", "as_of": "2025", "source": "s:wp-hadassah", "url": "https://en.wikipedia.org/wiki/Hadassah_Medical_Center" }, "tags": [ { "tag": "university-hospital", "source": "s:wp-hadassah", "tier": "cited", "note": "teaching hospital of the Hebrew University of Jerusalem for medicine, dentistry, nursing, public health and pharmacology" }, { "tag": "teaching", "source": "s:wp-hadassah", "tier": "cited" }, { "tag": "outcomes-published", "source": "s:wp-hadassah", "tier": "cited", "note": "about 900 peer-reviewed publications a year and Israel's top hospital by the 2024-2025 Nature Index — research output, which is not the same thing as clinical outcome reporting, and the note says so" }, { "tag": "international-office", "source": "s:israel-moh-medical-tourism", "tier": "cited", "note": "operates under the framework the Israeli Ministry of Health publishes for hospitals treating foreign patients" }, { "tag": "no-price-published", "source": "s:wp-hadassah", "tier": "cited", "note": "no schedule was found for either campus in the sources read" } ], "recognitions": [ { "by": "newsweek-statista", "what": "Fourth in Israel and 242nd in the world in the 2025 Newsweek list", "year": 2025, "valid_until": null, "source": "s:wp-hadassah", "url": "https://en.wikipedia.org/wiki/Hadassah_Medical_Center", "note": "the national and the global placing for the same hospital in the same year, carried together because neither means much alone" } ], "kin": [ { "to": "israel", "as": "Jerusalem's teaching hospital, owned by an American organisation and governed by Israel's 2018 medical tourism law.", "rel": "destination" }, { "to": "sheba", "as": "The larger Israeli hospital, government-founded by an army, against a hospital founded and part-funded by a women's organisation abroad.", "rel": "contrast" }, { "to": "tel-aviv", "as": "The cluster an hour west; Jerusalem has no hub record of its own in this directory.", "rel": "place" }, { "to": "gamma-knife", "as": "Among the neurosurgical work its foreign referrals come for.", "rel": "performs" }, { "to": "bone-marrow-transplant", "as": "Among the programmes that draw regional and diaspora referrals.", "rel": "performs" }, { "to": "the-accreditation-question", "as": "Fourth in a small country and 242nd in the world, from one ranking in one year.", "rel": "story" }, { "to": "second-opinion", "as": "A hospital reached through a diaspora organisation's networks is often reached for a second reading first.", "rel": "step" } ], "links": [ { "label": "Hadassah Medical Organization", "url": "https://www.hadassah.org.il/en/" } ], "sources": [ "s:wp-hadassah", "s:israel-moh-medical-tourism", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim", "note": "the OpenStreetMap point for the Ein Kerem campus, which this record pins of the two" }, "text.how": { "tier": "tradition", "note": "how referrals reach a diaspora-funded hospital; marked in the prose" }, "metrics": { "tier": "cited", "source": "s:wp-hadassah" } } }, "x_commons_files": [ "File:Hadassah Ein Kerem.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "A Jerusalem hospital on two campuses — Mount Scopus, opened 1939, and Ein Kerem, established 1961 — with more than 1,300 beds between them, 31 operating theatres and nine intensive care units.", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "israel", "type": "destination", "name": "Israel", "as": "Jerusalem's teaching hospital, owned by an American organisation and governed by Israel's 2018 medical tourism law.", "rel": "destination" }, { "to": "sheba", "type": "facility", "name": "Sheba Medical Center", "as": "The larger Israeli hospital, government-founded by an army, against a hospital founded and part-funded by a women's organisation abroad.", "rel": "contrast" }, { "to": "tel-aviv", "type": "hub", "name": "Tel Aviv", "as": "The cluster an hour west; Jerusalem has no hub record of its own in this directory.", "rel": "place" }, { "to": "gamma-knife", "type": "procedure", "name": "Gamma knife radiosurgery", "as": "Among the neurosurgical work its foreign referrals come for.", "rel": "performs" }, { "to": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "Among the programmes that draw regional and diaspora referrals.", "rel": "performs" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Fourth in a small country and 242nd in the world, from one ranking in one year.", "rel": "story" }, { "to": "second-opinion", "type": "pathway", "name": "The second opinion", "as": "A hospital reached through a diaspora organisation's networks is often reached for a second reading first.", "rel": "step" } ], "source_list": [ { "id": "s:wp-hadassah", "kind": "wikipedia", "title": "Hadassah Medical Center", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Hadassah_Medical_Center", "license": "CC BY-SA 4.0", "accessed": "2026-09-17", "note": "founded 1934, owned and largely funded by the Hadassah Women's Zionist Organization of America; two Jerusalem campuses, Mount Scopus opened 1939 and Ein Kerem established 1961; over 1,300 beds in total, 31 operating theatres, 9 intensive care units; teaching hospital of the Hebrew University; Newsweek 2025 placed it 242nd in the world" }, { "id": "s:israel-moh-medical-tourism", "kind": "gov", "title": "Medical Tourism in Israel", "publisher": "Israel Ministry of Health", "url": "https://www.gov.il/en/pages/medical-tourism-israel", "accessed": "2026-09-16", "note": "published 15 November 2021, updated 20 March 2023; carries the Ministry of Tourism's arrivals estimate and the ministry's account of the 2018 law" }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "how referrals reach a diaspora-funded hospital; marked in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim", "note": "the OpenStreetMap point for the Ein Kerem campus, which this record pins of the two" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-hadassah" } }, "primary_image": null, "tag_facts": [ { "key": "university-hospital", "label": "University hospital", "icon": "🎓", "group": "ownership", "evidence": "the affiliated university's own page or the hospital's charter", "source": "s:wp-hadassah", "note": "teaching hospital of the Hebrew University of Jerusalem for medicine, dentistry, nursing, public health and pharmacology", "tier": "cited", "url": "" }, { "key": "teaching", "label": "Teaching hospital", "icon": "📚", "group": "clinical", "evidence": "a recognised training post list or the hospital's own statement", "source": "s:wp-hadassah", "note": "", "tier": "cited", "url": "" }, { "key": "outcomes-published", "label": "Publishes outcomes", "icon": "📊", "group": "clinical", "evidence": "a registry submission, an annual clinical report, or a national outcome dataset naming the unit", "source": "s:wp-hadassah", "note": "about 900 peer-reviewed publications a year and Israel's top hospital by the 2024-2025 Nature Index — research output, which is not the same thing as clinical outcome reporting, and the note says so", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:israel-moh-medical-tourism", "note": "operates under the framework the Israeli Ministry of Health publishes for hospitals treating foreign patients", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:wp-hadassah", "note": "no schedule was found for either campus in the sources read", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "newsweek-statista", "label": "Newsweek / Statista World's Best Hospitals", "what": "Fourth in Israel and 242nd in the world in the 2025 Newsweek list", "url": "https://en.wikipedia.org/wiki/Hadassah_Medical_Center", "kind": "listing", "year": 2025, "valid_until": null, "source": "s:wp-hadassah" } ], "acclaim": 1, "kin_in": [ { "from": "israel", "type": "destination", "name": "Israel", "as": "The Jerusalem teaching hospital that takes referrals from across the region and beyond it.", "rel": "part" }, { "from": "sheba", "type": "facility", "name": "Sheba Medical Center", "as": "Jerusalem's teaching hospital, funded by an American women's organisation, against a government hospital founded by an army.", "rel": "contrast" } ] }, { "schema": 1, "id": "heidelberg-university-hospital", "type": "facility", "names": { "name": "Heidelberg University Hospital", "aliases": [ "Universitätsklinikum Heidelberg", "UKHD" ], "said": "Universitätsklinikum Heidelberg. Medical teaching in the town dates to 1388; the hospital is a separate legal body from the university, an Anstalt des öffentlichen Rechts with its own board and its own accounts." }, "region": [ "europe-west" ], "facets": { "iso2": "DE", "ownership": "university", "founded": 1388, "specialty": [ "oncology", "heavy ion therapy", "surgery", "internal medicine", "paediatrics" ], "draws": [ "proton-therapy", "car-t", "bone-marrow-transplant", "liver-transplant" ], "status": "open", "languages": [ "German", "English", "Arabic", "Russian" ] }, "text": { "what": "A 1,991-bed public university hospital at Im Neuenheimer Feld in Heidelberg, treating over a million patients a year. It is an independent public-law institution with its own board, administratively and financially separate from Heidelberg University. Its international office runs an English-language site for patients from abroad, and that site publishes the payment terms rather than the prices.", "story": "The hospital dates its medical teaching to 1388 and its present form to a campus in the Neuenheimer Feld north of the Neckar. It holds the National Center for Tumor Diseases jointly with the German Cancer Research Center, and a heavy ion therapy facility whose 600-tonne rotating gantry is the piece of equipment the hospital is most often named for abroad. Newsweek's 2026 list placed it twelfth in the world.\n\nWhat it publishes about money is worth reading closely, because it is the German answer to the package price and the closest thing in this batch to a German tariff.\n\nA cost estimate exists only after the hospital's specialists have read the submitted records — \"An overview of the expected treatment costs will be generated based on the treatment offer submitted by the expert\" — and the hospital says plainly that the estimate may move. Then: \"Once you've committed to receiving treatment at Heidelberg University Hospital, we ask that the entire sum be transferred to the account of Heidelberg University Hospital as given on the cost estimate.\" The appointment is confirmed on receipt of that transfer. After discharge the actual cost is worked out, and \"if these costs are below the pre-payment, the balance will be refunded immediately\" by the same route it arrived. Complications can require a further payment.\n\n*Inference —* that is the opposite instrument from a fixed package. A package transfers the risk of the bill to the hospital and caps the patient's exposure at the advertised figure. A pre-payment against an estimate transfers the risk to the patient and reconciles afterwards. Neither is hidden; they are different contracts, and a reader comparing a Bangkok package with a Heidelberg estimate is comparing two different things.", "how": "Records first, decision second, estimate third, whole sum in advance, treatment, then reconciliation. Payment by bank transfer, by cash at the cashier's office on the ground floor of the Kopfklinik, or by card online or at the office.\n\nNo schedule of amounts is published for any procedure, so nothing here can be compared against a price list elsewhere without the hospital's own estimate in hand.", "today": "As of 17 September 2026 the hospital carries 1,991 beds, the 2020 figure, and states over a million patients a year. Newsweek's 2026 list placed it twelfth in the world. The finance page publishes the advance-payment and refund terms in full and publishes no amount." }, "geo": { "lat": 49.417152, "lon": 8.664723, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "Im Neuenheimer Feld", "city": "Heidelberg", "area": "Baden-Württemberg", "country": "DE", "postcode": "69120" }, "metrics": { "beds": 1991, "annual_patients": 1000000, "annual_foreign_patients": null, "note": "annual_patients counts TREATMENTS, not people: the hospital states over a million patients a year treated across a campus whose outpatient work dwarfs its inpatient work, and does not separate the two. Beds are 1,991 as of 2020 and are not restated in the source. No count of international patients is published.", "as_of": "2020", "source": "s:wp-heidelberg-uh", "url": "https://en.wikipedia.org/wiki/Heidelberg_University_Hospital" }, "tags": [ { "tag": "university-hospital", "source": "s:wp-heidelberg-uh", "tier": "cited", "note": "an independent public-law institution with its own board, separate from Heidelberg University in administration and finance" }, { "tag": "public-hospital", "source": "s:wp-heidelberg-uh", "tier": "cited" }, { "tag": "teaching", "source": "s:wp-heidelberg-uh", "tier": "cited", "note": "medical teaching in Heidelberg dated by the hospital to 1388" }, { "tag": "international-office", "source": "s:heidelberg-finance", "tier": "cited", "note": "a Medical International Office with its own English-language site and its own bank account", "url": "https://www.heidelberg-university-hospital.com/finance" }, { "tag": "no-price-published", "source": "s:heidelberg-finance", "tier": "cited", "note": "the finance page publishes the payment mechanism in full — estimate, whole sum in advance, reconciliation, refund — and no amount for anything" }, { "tag": "complication-cover", "source": "s:heidelberg-finance", "tier": "cited", "note": "the opposite of cover, and named here so the page says so: the hospital states that complications may require a further payment beyond the estimate" } ], "recognitions": [ { "by": "newsweek-statista", "what": "Ranked twelfth in the world in the 2026 Newsweek list", "year": 2026, "valid_until": null, "source": "s:wp-heidelberg-uh", "url": "https://en.wikipedia.org/wiki/Heidelberg_University_Hospital", "note": "a ranking by survey and published indicators; counted, not weighted" } ], "kin": [ { "to": "germany", "as": "The German university hospital that publishes its payment terms, which is as close as this country gets to a tariff for a foreign self-payer.", "rel": "destination" }, { "to": "charite-international", "as": "Berlin's arrangement: a company beside the hospital, publishing its telephone hours where this one publishes its refund rule.", "rel": "contrast" }, { "to": "the-deposit", "as": "The whole estimated sum before the appointment is confirmed, refunded to source if the final bill is lower.", "rel": "step" }, { "to": "getting-a-quote", "as": "No estimate exists until its specialists have read the records, and the hospital says the estimate may move.", "rel": "step" }, { "to": "deposit-and-refund", "as": "Publishes the refund rule as well as the deposit rule, which is the half most deposit pages leave out.", "rel": "risk" }, { "to": "proton-therapy", "as": "Its heavy ion facility is what its name travels on, and the 600-tonne gantry is the reason.", "rel": "performs" }, { "to": "reading-the-exclusions", "as": "The exclusion here is open-ended: a complication is charged beyond the estimate, and the page says so.", "rel": "step" }, { "to": "bumrungrad", "as": "A package caps the patient's exposure at the advertised figure; a pre-payment against an estimate does not.", "rel": "contrast" }, { "to": "is-it-cheaper", "as": "A Bangkok package and a Heidelberg estimate are two different contracts, and comparing their numbers compares nothing.", "rel": "story" } ], "links": [ { "label": "Heidelberg University Hospital — International Patients", "url": "https://www.heidelberg-university-hospital.com/" }, { "label": "Finance", "url": "https://www.heidelberg-university-hospital.com/finance" } ], "sources": [ "s:wp-heidelberg-uh", "s:heidelberg-finance", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "metrics": { "tier": "cited", "source": "s:wp-heidelberg-uh" } } }, "x_commons_files": [ "File:Universitätsklinikum Heidelberg.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "A 1,991-bed public university hospital at Im Neuenheimer Feld in Heidelberg, treating over a million patients a year.", "region_terms": [ { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "germany", "type": "destination", "name": "Germany", "as": "The German university hospital that publishes its payment terms, which is as close as this country gets to a tariff for a foreign self-payer.", "rel": "destination" }, { "to": "charite-international", "type": "facility", "name": "Charité International Patients", "as": "Berlin's arrangement: a company beside the hospital, publishing its telephone hours where this one publishes its refund rule.", "rel": "contrast" }, { "to": "the-deposit", "type": "pathway", "name": "The deposit", "as": "The whole estimated sum before the appointment is confirmed, refunded to source if the final bill is lower.", "rel": "step" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "No estimate exists until its specialists have read the records, and the hospital says the estimate may move.", "rel": "step" }, { "to": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "Publishes the refund rule as well as the deposit rule, which is the half most deposit pages leave out.", "rel": "risk" }, { "to": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "Its heavy ion facility is what its name travels on, and the 600-tonne gantry is the reason.", "rel": "performs" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The exclusion here is open-ended: a complication is charged beyond the estimate, and the page says so.", "rel": "step" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "A package caps the patient's exposure at the advertised figure; a pre-payment against an estimate does not.", "rel": "contrast" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "A Bangkok package and a Heidelberg estimate are two different contracts, and comparing their numbers compares nothing.", "rel": "story" } ], "source_list": [ { "id": "s:wp-heidelberg-uh", "kind": "wikipedia", "title": "Heidelberg University Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Heidelberg_University_Hospital", "license": "CC BY-SA 4.0", "accessed": "2026-09-17", "note": "medical teaching at Heidelberg from 1388; an independent public-law institution with its own board, financially separate from the university; 1,991 beds as of 2020; over one million patients a year; Im Neuenheimer Feld; the heavy ion therapy centre and the National Center for Tumor Diseases; Newsweek 2026 placed it 12th in the world" }, { "id": "s:heidelberg-finance", "kind": "web", "title": "Finance — International Patients", "publisher": "Heidelberg University Hospital (Universitätsklinikum Heidelberg)", "url": "https://www.heidelberg-university-hospital.com/finance", "accessed": "2026-09-17", "note": "the hospital's own money page for patients from abroad. A cost estimate is written only after its specialists have read the submitted records; the whole estimated sum is transferred before treatment and the appointment is confirmed on receipt; actual costs are settled afterwards and a balance below the pre-payment is refunded by the same route it came. Payment by bank transfer, by cash at the Kopfklinik cashier, or by card. No schedule of amounts is published." }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "cited" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-heidelberg-uh" } }, "primary_image": null, "tag_facts": [ { "key": "university-hospital", "label": "University hospital", "icon": "🎓", "group": "ownership", "evidence": "the affiliated university's own page or the hospital's charter", "source": "s:wp-heidelberg-uh", "note": "an independent public-law institution with its own board, separate from Heidelberg University in administration and finance", "tier": "cited", "url": "" }, { "key": "public-hospital", "label": "Public hospital", "icon": "🏛", "group": "ownership", "evidence": "a ministry register, a national health service list, or the hospital's own statement", "source": "s:wp-heidelberg-uh", "note": "", "tier": "cited", "url": "" }, { "key": "teaching", "label": "Teaching hospital", "icon": "📚", "group": "clinical", "evidence": "a recognised training post list or the hospital's own statement", "source": "s:wp-heidelberg-uh", "note": "medical teaching in Heidelberg dated by the hospital to 1388", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:heidelberg-finance", "note": "a Medical International Office with its own English-language site and its own bank account", "tier": "cited", "url": "https://www.heidelberg-university-hospital.com/finance" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:heidelberg-finance", "note": "the finance page publishes the payment mechanism in full — estimate, whole sum in advance, reconciliation, refund — and no amount for anything", "tier": "cited", "url": "" }, { "key": "complication-cover", "label": "Complication cover included", "icon": "🛡", "group": "money", "evidence": "the written terms of the package, naming what is covered and for how long", "source": "s:heidelberg-finance", "note": "the opposite of cover, and named here so the page says so: the hospital states that complications may require a further payment beyond the estimate", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "newsweek-statista", "label": "Newsweek / Statista World's Best Hospitals", "what": "Ranked twelfth in the world in the 2026 Newsweek list", "url": "https://en.wikipedia.org/wiki/Heidelberg_University_Hospital", "kind": "listing", "year": 2026, "valid_until": null, "source": "s:wp-heidelberg-uh" } ], "acclaim": 1, "kin_in": [ { "from": "germany", "type": "destination", "name": "Germany", "as": "The other, with the proton centre attached.", "rel": "part" }, { "from": "charite-international", "type": "facility", "name": "Charité International Patients", "as": "The other German university hospital here, which publishes its payment terms where this one publishes its telephone hours.", "rel": "contrast" } ] }, { "schema": 1, "id": "hospital-angeles-tijuana", "type": "facility", "names": { "name": "Hospital Angeles Tijuana", "aliases": [ "Hospital Ángeles Tijuana", "Grupo Ángeles Servicios de Salud" ], "said": "ospi-TAL AN-hel-es. Eleven storeys on Paseo de los Héroes in the Zona Río, the built-up river district of Tijuana, with a heliport on the roof of the tower beside it." }, "region": [ "mexico" ], "facets": { "iso2": "MX", "ownership": "private", "founded": 2005, "specialty": [ "bariatric surgery", "orthopaedics", "oncology", "cardiology", "general surgery" ], "draws": [ "gastric-sleeve", "gastric-bypass", "knee-replacement", "hip-replacement", "abdominoplasty" ], "status": "open", "languages": [ "Spanish", "English" ] }, "text": { "what": "An eleven-storey private hospital of 29,108 square metres in the Zona Río of Tijuana, opened in 2005 and run by Grupo Ángeles, Mexico's largest private hospital company. It stands about twenty minutes' drive from the San Ysidro border crossing, which is the fact that puts it in this directory.", "story": "The hospital was built between 2002 and 2004 and opened in 2005, mixed-use — medical centre and office space — and among the tallest buildings in Tijuana's central business district. It was the first hospital in the city with a heliport, on the roof of a connected five-storey tower.\n\nWhat the encyclopaedia entry does not carry, and what could not be sourced for this record, is a bed count, an accreditation, or a patient number of any kind.\n\n*Inference —* the gap is worth stating rather than filling. Tijuana is the most-written-about border medical market in the world and its largest private hospital publishes less about itself than a 209-bed cancer centre outside Istanbul does. The traffic across San Ysidro is measured by border agencies and by researchers, not by the hospitals.\n\nWhat is measured, and measured carefully, is what goes wrong. The United States Centers for Disease Control investigated an outbreak of extensively drug-resistant carbapenemase-producing Pseudomonas aeruginosa among American patients who had bariatric surgery in Tijuana, and published it in Emerging Infectious Diseases. That investigation names clinics in the city; it does not name this hospital.", "how": "*Trade practice —* the Tijuana route is short and largely unaccompanied by an airline: a patient drives or walks across at San Ysidro or Otay Mesa, is collected on the Mexican side, is operated on within a day or two, and returns across the border within a week. Bariatric surgery and dentistry carry most of it. The consequence is structural rather than clinical — the follow-up happens in another country's health system, and the surgeon who operated has no way to see the patient again.\n\nGrupo Ángeles publishes no price for the Tijuana hospital.", "today": "As of 17 September 2026 no bed count, no accreditation, no patient count and no price for this hospital was found published in any source read for this record. The building facts — eleven floors, 49 metres, 29,108 square metres, opened 2005, the first heliport in the city — are what the public record carries." }, "geo": { "lat": 32.518123, "lon": -117.007772, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "Paseo de los Héroes 10999, Zona Urbana Río Tijuana", "city": "Tijuana", "area": "Baja California", "country": "MX", "postcode": "22010" }, "metrics": { "beds": null, "annual_patients": null, "annual_foreign_patients": null, "note": "Nothing. No bed count, no patient count, no foreign share and no accreditation was found published for this hospital. That is a statement about this disk and these sources, not proof that the hospital publishes nothing; the building measurements are the only quantities in the public record read here.", "as_of": "2026", "source": "s:wp-angeles-tijuana", "url": "https://en.wikipedia.org/wiki/Hospital_Angeles_Tijuana" }, "tags": [ { "tag": "chain", "source": "s:wp-angeles-tijuana", "tier": "cited", "note": "owned and run by Grupo Ángeles, Mexico's largest private hospital company" }, { "tag": "no-price-published", "source": "s:wp-angeles-tijuana", "tier": "cited", "note": "no price and no accreditation was found for this hospital in the sources read" } ], "kin": [ { "to": "tijuana", "as": "The largest private hospital in the city, twenty minutes from the San Ysidro crossing.", "rel": "place" }, { "to": "mexico", "as": "The border-town end of Mexican private medicine, where the patient walks across rather than flies in.", "rel": "destination" }, { "to": "gastric-sleeve", "as": "The operation the Tijuana market is built on, and the one the CDC's outbreak investigation followed.", "rel": "performs" }, { "to": "los-algodones", "as": "The other Mexican border cluster: dentistry in a village of surgeries against surgery in a city hospital.", "rel": "contrast" }, { "to": "antimicrobial-resistance", "as": "American bariatric patients operated on in this city carried extensively drug-resistant Pseudomonas home, which the CDC investigated and published.", "rel": "risk" }, { "to": "follow-up-gap", "as": "A border crossing between the operating surgeon and every subsequent appointment.", "rel": "risk" }, { "to": "revision-at-home", "as": "The revision happens on the American side, at American prices, with no record from the Mexican side.", "rel": "risk" }, { "to": "what-the-data-cannot-see", "as": "The most-written-about border medical market in the world, and its largest hospital publishes no number about itself.", "rel": "story" } ], "links": [ { "label": "Hospital Angeles Tijuana", "url": "https://en.hospitalangeles.com/tijuana" } ], "sources": [ "s:wp-angeles-tijuana", "s:cdc-eid-tijuana-vim", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "text.how": { "tier": "tradition", "note": "the shape of a border crossing for surgery; marked in the prose" }, "metrics": { "tier": "cited", "source": "s:wp-angeles-tijuana", "note": "a record of what could not be found published" } } }, "x_commons_files": [ "File:Hospital Angeles Tijuana.jpg" ], "confidence": "low", "needs_verification": true, "updated": "2026-09-17", "blurb": "An eleven-storey private hospital of 29,108 square metres in the Zona Río of Tijuana, opened in 2005 and run by Grupo Ángeles, Mexico's largest private hospital company.", "region_terms": [ { "key": "mexico", "name": "Mexico", "note": "its own entry because the border towns are a category of their own" } ], "kin_out": [ { "to": "tijuana", "type": "hub", "name": "Tijuana", "as": "The largest private hospital in the city, twenty minutes from the San Ysidro crossing.", "rel": "place" }, { "to": "mexico", "type": "destination", "name": "Mexico", "as": "The border-town end of Mexican private medicine, where the patient walks across rather than flies in.", "rel": "destination" }, { "to": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "The operation the Tijuana market is built on, and the one the CDC's outbreak investigation followed.", "rel": "performs" }, { "to": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "The other Mexican border cluster: dentistry in a village of surgeries against surgery in a city hospital.", "rel": "contrast" }, { "to": "antimicrobial-resistance", "type": "risk", "name": "Antimicrobial resistance acquired abroad", "as": "American bariatric patients operated on in this city carried extensively drug-resistant Pseudomonas home, which the CDC investigated and published.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "A border crossing between the operating surgeon and every subsequent appointment.", "rel": "risk" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The revision happens on the American side, at American prices, with no record from the Mexican side.", "rel": "risk" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "The most-written-about border medical market in the world, and its largest hospital publishes no number about itself.", "rel": "story" } ], "source_list": [ { "id": "s:wp-angeles-tijuana", "kind": "wikipedia", "title": "Hospital Angeles Tijuana", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Hospital_Angeles_Tijuana", "license": "CC BY-SA 4.0", "accessed": "2026-09-17", "note": "opened 2005, Grupo Ángeles, Zona Río, eleven floors, 49 metres, 29,108 square metres, built 2002 to 2004, the first hospital in the city with a heliport. The article carries no bed count and no accreditation." }, { "id": "s:cdc-eid-tijuana-vim", "kind": "journal", "title": "Extensively Drug-Resistant Carbapenemase-Producing Pseudomonas aeruginosa and Medical Tourism from the United States to Mexico, 2018–2019", "publisher": "Emerging Infectious Diseases (US Centers for Disease Control and Prevention), 2022;28(1):51–61", "url": "https://wwwnc.cdc.gov/eid/article/28/1/21-1880_article", "accessed": "2026-09-16", "note": "Kracalik I, et al. doi:10.3201/eid2801.211880" }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "the shape of a border crossing for surgery; marked in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-angeles-tijuana", "note": "a record of what could not be found published" } }, "primary_image": null, "tag_facts": [ { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:wp-angeles-tijuana", "note": "owned and run by Grupo Ángeles, Mexico's largest private hospital company", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:wp-angeles-tijuana", "note": "no price and no accreditation was found for this hospital in the sources read", "tier": "cited", "url": "" } ], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "mexico", "type": "destination", "name": "Mexico", "as": "One of the named hospitals on the Tijuana side.", "rel": "part" }, { "from": "tijuana", "type": "hub", "name": "Tijuana", "as": "One of the private hospitals the international trade runs through.", "rel": "place" } ] }, { "schema": 1, "id": "hospital-cima-san-jose", "type": "facility", "names": { "name": "Hospital CIMA San José", "aliases": [ "Hospital CIMA", "CIMA San José" ], "said": "SEE-ma — the summit. The hospital stands in Escazú, the western suburb of San José where the embassies and the American residents are, on the Próspero Fernández motorway." }, "region": [ "central-america" ], "facets": { "iso2": "CR", "ownership": "private", "founded": 2000, "specialty": [ "orthopaedics", "general surgery", "cardiology", "emergency medicine", "cosmetic surgery" ], "draws": [ "knee-replacement", "hip-replacement", "gastric-sleeve", "abdominoplasty", "dental-implant" ], "status": "open", "languages": [ "Spanish", "English" ] }, "text": { "what": "A 103-bed tertiary acute-care hospital in Escazú, west of San José, opened in 2000 and owned by International Hospital Corporation, a Texas company that builds hospitals in Latin America. It holds Joint Commission International accreditation. It is the newer of the two San José hospitals in this directory and the one built, from the start, for a patient arriving from the north.", "story": "The ownership is the story. International Hospital Corporation is an American developer; CIMA San José is one of its projects, opened in 2000 as a three-storey tertiary acute-care hospital with 103 beds, a large outpatient department, an emergency department with a trauma room, and surgery with its own recovery floor.\n\n*Inference —* that is a small hospital by the standards of the groups elsewhere in this batch, and the smallness is the design. A hundred beds in Escazú, twenty minutes from the international airport and inside the suburb where English is already spoken, is a different proposition from a thousand-bed university hospital in Berlin or Seoul. It is closer to a well-equipped district hospital that happens to sit at the end of a four-hour flight.\n\nCosta Rica's national scheme, PROMED, certifies providers for international patients out of the Cámara Costarricense de la Salud. It is membership with a seal.\n\nThe hospital states a sixth consecutive JCI Gold Seal, against more than 1,200 standards, and gives no year for the first. It also holds ANCC Pathway to Excellence certification and says no other private hospital in Costa Rica or Central America does. Its payments page names the departments that verify and process a bill and prints no figure for anything.", "how": "*Trade practice —* Escazú works as a single unit: the hospital, the medical office towers attached to it, the hotels along the motorway, and the surgeons who consult in one and operate in the other. A patient arriving for orthopaedic or bariatric surgery is admitted from a hotel a few minutes away and discharged back to it, which is why the recovery stay rather than the ward stay is the long part of a Costa Rican trip.\n\nNo figure is published for any of it.", "today": "As of 17 September 2026 the hospital is recorded at 103 beds, opened 2000, owned by International Hospital Corporation, and states a sixth consecutive JCI Gold Seal and ANCC Pathway to Excellence certification, neither dated on its own page. No patient count, no foreign share and no price was found published." }, "geo": { "lat": 9.939643, "lon": -84.144329, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "Autopista Próspero Fernández, San Rafael de Escazú", "city": "San José", "area": "San José", "country": "CR", "postcode": "10203" }, "metrics": { "beds": 103, "annual_patients": null, "annual_foreign_patients": null, "note": "103 beds, the installed capacity recorded in the encyclopaedia entry. No patient count of any kind is published — not visits, not people — and no foreign share. A hospital this size in a suburb of 60,000 is not counting its arrivals in public.", "as_of": "2026", "source": "s:wp-hospital-cima", "url": "https://en.wikipedia.org/wiki/Hospital_CIMA" }, "tags": [ { "tag": "chain", "source": "s:wp-hospital-cima", "tier": "cited", "note": "owned by International Hospital Corporation, an American developer of hospitals in Latin America" }, { "tag": "no-price-published", "source": "s:cima-accreditations", "tier": "cited", "note": "the hospital's payments page names the departments that verify and process a bill and prints no figure for anything", "url": "https://hospitalcima.com/en/information-center/accreditations/" }, { "tag": "international-office", "source": "s:promed-salud-cr", "tier": "cited", "note": "certified under Costa Rica's PROMED scheme for providers serving international patients" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International Gold Seal, earned for the sixth consecutive time against more than 1,200 standards", "year": null, "valid_until": null, "source": "s:cima-accreditations", "url": "https://hospitalcima.com/en/information-center/accreditations/", "note": "the hospital states a sixth consecutive award and no year for the first; secondary accounts date that first award to May 2008 and the date is not asserted here" }, { "by": "other", "what": "ANCC Pathway to Excellence certification, stated as held by no other private hospital in Costa Rica or Central America", "year": null, "valid_until": null, "source": "s:cima-accreditations", "url": "https://hospitalcima.com/en/information-center/accreditations/", "note": "an American nursing-environment certification against six standards; outside this project's recognizer vocabulary" }, { "by": "promed", "what": "PROMED, Costa Rica's national council certifying providers for international patients", "year": null, "valid_until": null, "source": "s:promed-salud-cr", "url": "https://salud.co.cr/english/", "note": "the record cites the scheme, not a certificate read for this hospital" } ], "kin": [ { "to": "san-jose-cr", "as": "The Escazú half of the San José cluster — motorway, medical towers, hotels, and the hospital in the middle of them.", "rel": "place" }, { "to": "costa-rica", "as": "An American-built hospital on Costa Rican soil, which is what the country's route to North American patients largely is.", "rel": "destination" }, { "to": "clinica-biblica", "as": "The older San José hospital, a 1929 mission clinic in the city centre against this 2000 development in the suburbs.", "rel": "contrast" }, { "to": "promed", "as": "The national council a Costa Rican provider joins to sell abroad.", "rel": "accredited-by" }, { "to": "jci", "as": "Its accreditor, undated in the sources read here.", "rel": "accredited-by" }, { "to": "knee-replacement", "as": "Among the operations the Escazú cluster sells, with the recovery stay in a hotel rather than a ward.", "rel": "performs" }, { "to": "the-companion", "as": "A hundred-bed hospital discharges early, and the recovery hotel is where the escort's week actually goes.", "rel": "step" }, { "to": "aftercare-at-home", "as": "Four hours from Miami, close enough that the follow-up is a flight and not a relocation.", "rel": "step" } ], "links": [ { "label": "Hospital CIMA San José", "url": "https://hospitalcima.com/" } ], "sources": [ "s:wp-hospital-cima", "s:cima-accreditations", "s:promed-salud-cr", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "text.how": { "tier": "tradition", "note": "how the Escazú cluster works; marked in the prose" }, "metrics": { "tier": "cited", "source": "s:wp-hospital-cima" } } }, "x_commons_files": [], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "A 103-bed tertiary acute-care hospital in Escazú, west of San José, opened in 2000 and owned by International Hospital Corporation, a Texas company that builds hospitals in Latin America.", "region_terms": [ { "key": "central-america", "name": "Central America", "note": "Costa Rica, Panama, Guatemala, Belize" } ], "kin_out": [ { "to": "san-jose-cr", "type": "hub", "name": "San José, Costa Rica", "as": "The Escazú half of the San José cluster — motorway, medical towers, hotels, and the hospital in the middle of them.", "rel": "place" }, { "to": "costa-rica", "type": "destination", "name": "Costa Rica", "as": "An American-built hospital on Costa Rican soil, which is what the country's route to North American patients largely is.", "rel": "destination" }, { "to": "clinica-biblica", "type": "facility", "name": "Hospital Clínica Bíblica", "as": "The older San José hospital, a 1929 mission clinic in the city centre against this 2000 development in the suburbs.", "rel": "contrast" }, { "to": "promed", "type": "org", "name": "PROMED", "as": "The national council a Costa Rican provider joins to sell abroad.", "rel": "accredited-by" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "Its accreditor, undated in the sources read here.", "rel": "accredited-by" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "Among the operations the Escazú cluster sells, with the recovery stay in a hotel rather than a ward.", "rel": "performs" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "A hundred-bed hospital discharges early, and the recovery hotel is where the escort's week actually goes.", "rel": "step" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "Four hours from Miami, close enough that the follow-up is a flight and not a relocation.", "rel": "step" } ], "source_list": [ { "id": "s:wp-hospital-cima", "kind": "wikipedia", "title": "Hospital CIMA", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Hospital_CIMA", "license": "CC BY-SA 4.0", "accessed": "2026-09-17", "note": "opened 2000, owned by International Hospital Corporation, 103 beds, tertiary acute care, JCI accredited with no year given" }, { "id": "s:cima-accreditations", "kind": "web", "title": "Accreditations — Hospital CIMA San José", "publisher": "Hospital CIMA San José, Escazú", "url": "https://hospitalcima.com/en/information-center/accreditations/", "accessed": "2026-09-17", "note": "read in the browser on 17 September 2026 after WebFetch failed on the site's certificate chain. States a sixth consecutive JCI Gold Seal against more than 1,200 standards, with no year for the first award, and ANCC Pathway to Excellence certification described as the only one held by a private hospital in Costa Rica or Central America. The page's payments section names the departments that process payment and prints no figure." }, { "id": "s:promed-salud-cr", "kind": "web", "title": "PROMED — English", "publisher": "Cámara Costarricense de la Salud", "url": "https://salud.co.cr/english/", "accessed": "2026-09-16", "note": "promedcostarica.org now redirects here; membership categories and the Seal of Quality are described on this page" }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "how the Escazú cluster works; marked in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-hospital-cima" } }, "primary_image": null, "tag_facts": [ { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:wp-hospital-cima", "note": "owned by International Hospital Corporation, an American developer of hospitals in Latin America", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:cima-accreditations", "note": "the hospital's payments page names the departments that verify and process a bill and prints no figure for anything", "tier": "cited", "url": "https://hospitalcima.com/en/information-center/accreditations/" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:promed-salud-cr", "note": "certified under Costa Rica's PROMED scheme for providers serving international patients", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International Gold Seal, earned for the sixth consecutive time against more than 1,200 standards", "url": "https://hospitalcima.com/en/information-center/accreditations/", "kind": "international", "year": null, "valid_until": null, "source": "s:cima-accreditations" }, { "key": "other", "label": "Somebody else", "what": "ANCC Pathway to Excellence certification, stated as held by no other private hospital in Costa Rica or Central America", "url": "https://hospitalcima.com/en/information-center/accreditations/", "kind": "other", "year": null, "valid_until": null, "source": "s:cima-accreditations" }, { "key": "promed", "label": "PROMED (Costa Rica)", "what": "PROMED, Costa Rica's national council certifying providers for international patients", "url": "https://salud.co.cr/english/", "kind": "national", "year": null, "valid_until": null, "source": "s:promed-salud-cr" } ], "acclaim": 3, "kin_in": [ { "from": "costa-rica", "type": "destination", "name": "Costa Rica", "as": "The other San José hospital the trade routes complex work to.", "rel": "part" }, { "from": "san-jose-cr", "type": "hub", "name": "San José, Costa Rica", "as": "The other large private hospital in the Escazú cluster.", "rel": "place" }, { "from": "clinica-biblica", "type": "facility", "name": "Hospital Clínica Bíblica", "as": "The other San José hospital in this directory: American-built, in Escazú, opened seventy-one years later.", "rel": "contrast" } ] }, { "schema": 1, "id": "island-hospital-penang", "type": "facility", "names": { "name": "Island Hospital", "aliases": [ "Island Hospital Penang", "Hospital Pulau" ], "said": "Island Hospital, on Jalan Macalister in George Town. Indonesian patients, who are most of its foreign trade, say Penang and mean this street." }, "region": [ "southeast-asia" ], "facets": { "iso2": "MY", "ownership": "private", "founded": 1996, "specialty": [ "oncology", "cardiology", "gastroenterology", "health screening", "orthopaedics", "dentistry" ], "draws": [ "executive-health-screening", "cataract-surgery", "angioplasty-stent" ], "status": "open", "languages": [ "Malay", "English", "Mandarin", "Hokkien", "Indonesian", "Tamil" ] }, "text": { "what": "A 600-bed private hospital on Jalan Macalister in George Town, Penang, founded in 1996 and bought by IHH Healthcare in 2024. It treats about 400,000 patients and performs about 15,000 operations a year, and it sells health screening off a public online store with the ringgit price and the redemption date on every product page.", "story": "Penang's inbound trade is a ferry and a short flight from Medan and Aceh, and it is one of the few cross-border corridors in this subject that is genuinely regional rather than intercontinental. Island Hospital was built in 1996 in ten months and grew into that corridor.\n\nIt holds hospital-wide accreditation from the Malaysian Society for Quality in Health and from the Australian Council on Healthcare Standards International, and in 2025 the Malaysia Healthcare Travel Council named it, in the council's own words, \"Malaysia's first Flagship Medical Tourism Hospital\". The hospital states more than 90 full-time specialists, 1,300 healthcare workers, and that 88 per cent of its doctors trained abroad.\n\n*Inference —* the online store is the most revealing thing about it. A hospital that sells a screening package the way a shop sells a shirt — add to basket, pay, redeem by a stated date — has decided that a share of its demand is discretionary and price-comparing. That is a different business from a referral hospital, and it is the business that regional cross-border care actually is.", "how": "Screening packages are bought online at a fixed price with the inclusion list printed and the redemption deadline stated. The Executive Health Screening Package, read on 16 September 2026, priced a physical examination, a specialist consultation, a full blood picture, lipid profile, liver and kidney function, diabetes and thyroid screening, hepatitis B and C and syphilis testing, an ECG, a chest X-ray, an upper abdomen ultrasound and eye tests, with refreshments and a hospital bag. Its exclusion is a single sentence, and it is the important one: anything the screening finds is charged separately.", "today": "As of 16 September 2026 the store lists the Executive Health Screening Package at 760 ringgit, a Comprehensive Plus package at 2,499 ringgit for men and 2,799 for women, a heart screening package at 1,288 ringgit, a paediatric screening at 380 ringgit, teeth whitening at 1,500 ringgit and a pre-university student screening at 138 ringgit. Packages bought now are redeemable to 31 December 2026." }, "geo": { "lat": 5.4241354, "lon": 100.3148674, "precision": "street", "source": "s:osm" }, "address": { "street": "308 Jalan Macalister", "city": "George Town", "area": "Penang", "country": "MY", "postcode": "10450" }, "metrics": { "beds": 600, "doctors": 90, "annual_patients": 400000, "annual_foreign_patients": null, "note": "About 400,000 patients a year and about 15,000 operations a year are the hospital's own figures. The patient number counts VISITS, not people: a screening patient who returns for a follow-up is two. The doctor figure is more than 90 full-time specialists, a headcount of people, alongside 1,300 healthcare workers in total. No foreign-patient count is published on the pages read here, despite Penang's trade being largely Indonesian.", "as_of": "2026-09-16", "source": "s:islandhospital-about", "url": "https://www.islandhospital.com/about-us/" }, "tags": [ { "tag": "price-published", "source": "s:islandhospital-exec-screening", "tier": "cited", "note": "an online store with a ringgit price, an inclusion list and a redemption date on each product page", "url": "https://packages.islandhospital.com/" }, { "tag": "package", "source": "s:islandhospital-packages", "tier": "cited" }, { "tag": "international-office", "source": "s:islandhospital-about", "tier": "cited", "note": "an International Patient Services department offering second opinions before travel" }, { "tag": "chain", "source": "s:wp-island-hospital", "tier": "cited", "note": "bought by IHH Healthcare in 2024" } ], "recognitions": [ { "by": "achsi", "what": "Full hospital-wide accreditation by the Australian Council on Healthcare Standards International", "year": null, "valid_until": null, "source": "s:islandhospital-about", "url": "https://www.islandhospital.com/about-us/", "note": "the Australian scheme run abroad; the year first granted is not stated on the page read here" }, { "by": "mhtc", "what": "Named by the Malaysia Healthcare Travel Council as, in the council's words, \"Malaysia's first Flagship Medical Tourism Hospital\"", "year": 2025, "valid_until": null, "source": "s:islandhospital-about", "url": "https://www.islandhospital.com/about-us/", "note": "a government agency's designation, not a clinical inspection" }, { "by": "other", "what": "Full hospital-wide accreditation by the Malaysian Society for Quality in Health (MSQH)", "year": null, "valid_until": null, "source": "s:islandhospital-about", "url": "https://www.islandhospital.com/about-us/", "note": "the Malaysian national standard; MSQH has no key of its own in this project's recognizer list" } ], "prices": [ { "procedure": "executive-health-screening", "country": "MY", "city": "George Town", "facility": "island-hospital-penang", "amount": 760, "currency": "MYR", "as_of": "2026-09-16", "kind": "package", "includes": [ "physical examination", "consultation by health screening physician or specialist", "complete medical report", "full blood picture, lipid profile, liver and kidney function", "diabetes and thyroid screening", "hepatitis B and C and syphilis testing", "ECG", "chest X-ray and upper abdomen ultrasound", "eye tests", "light refreshments", "an Island Hospital woven bag" ], "excludes": [ "any follow-up investigation, treatment or medication arising from the screening, charged separately by cash or card", "stress testing, gynaecological assessment, cancer markers, mammogram and bone densitometry, all sold as add-ons" ], "source": "s:islandhospital-exec-screening", "url": "https://packages.islandhospital.com/product/executive-health-screening-package/", "note": "The page states packages purchased are redeemable up to 31 December 2026 and that the screening is not recommended for under-18s. The exclusion sentence is the whole story of screening pricing: the screen is cheap and what it finds is not.", "tier": "cited", "usd": 186.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "executive-health-screening", "country": "MY", "city": "George Town", "facility": "island-hospital-penang", "amount": 2499, "amount_high": 2799, "currency": "MYR", "as_of": "2026-09-16", "kind": "package", "includes": [ "the hospital's Comprehensive Plus screening, male version at the lower figure and female at the higher" ], "excludes": [ "anything the screening then finds" ], "source": "s:islandhospital-packages", "url": "https://packages.islandhospital.com/", "note": "the same hospital's top screening tier, more than three times the Executive package. The male and female versions differ by 300 ringgit, which is the gynaecological and breast imaging the female version adds.", "tier": "cited", "usd": 612.0, "usd_high": 685.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "penang", "as": "The hospital the Penang cluster is usually named for, on Jalan Macalister in George Town.", "rel": "place" }, { "to": "malaysia", "as": "The clearest case in Malaysia of regional rather than intercontinental cross-border care.", "rel": "destination" }, { "to": "executive-health-screening", "as": "Sold here off an online store, priced, itemised and dated.", "rel": "performs" }, { "to": "mhtc", "as": "The government agency that named it a flagship hospital in 2025.", "rel": "accredited-by" }, { "to": "malaysia-mhtc-licence", "as": "The national arrangement under which it takes foreign patients.", "rel": "governed-by" }, { "to": "gleneagles-kl", "as": "The Kuala Lumpur competitor under the same owner since 2024, which publishes no price.", "rel": "contrast" }, { "to": "package-price", "as": "Sells in this form, down to a redemption deadline printed on each product page.", "rel": "term" }, { "to": "reading-the-exclusions", "as": "Its screening package excludes everything the screening finds, in one sentence.", "rel": "step" } ], "links": [ { "label": "Island Hospital", "url": "https://www.islandhospital.com/" }, { "label": "Island Hospital packages store", "url": "https://packages.islandhospital.com/" } ], "sources": [ "s:wp-island-hospital", "s:islandhospital-about", "s:islandhospital-packages", "s:islandhospital-exec-screening", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node Island Hospital, 308 Jalan Macalister" }, "metrics": { "tier": "cited", "source": "s:islandhospital-about" } } }, "x_commons_files": [ "File:Island Hospital Penang.jpg" ], "confidence": "high", "updated": "2026-09-16", "blurb": "A 600-bed private hospital on Jalan Macalister in George Town, Penang, founded in 1996 and bought by IHH Healthcare in 2024.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "penang", "type": "hub", "name": "Penang", "as": "The hospital the Penang cluster is usually named for, on Jalan Macalister in George Town.", "rel": "place" }, { "to": "malaysia", "type": "destination", "name": "Malaysia", "as": "The clearest case in Malaysia of regional rather than intercontinental cross-border care.", "rel": "destination" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "Sold here off an online store, priced, itemised and dated.", "rel": "performs" }, { "to": "mhtc", "type": "org", "name": "Malaysia Healthcare Travel Council", "as": "The government agency that named it a flagship hospital in 2025.", "rel": "accredited-by" }, { "to": "malaysia-mhtc-licence", "type": "rule", "name": "Malaysia's healthcare travel registration", "as": "The national arrangement under which it takes foreign patients.", "rel": "governed-by" }, { "to": "gleneagles-kl", "type": "facility", "name": "Gleneagles Hospital Kuala Lumpur", "as": "The Kuala Lumpur competitor under the same owner since 2024, which publishes no price.", "rel": "contrast" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "Sells in this form, down to a redemption deadline printed on each product page.", "rel": "term" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "Its screening package excludes everything the screening finds, in one sentence.", "rel": "step" } ], "source_list": [ { "id": "s:wp-island-hospital", "kind": "wikipedia", "title": "Island Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Island_Hospital", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:islandhospital-about", "kind": "web", "title": "About Us — Island Hospital", "publisher": "Island Hospital", "url": "https://www.islandhospital.com/about-us/", "accessed": "2026-09-16" }, { "id": "s:islandhospital-packages", "kind": "web", "title": "Packages store — Island Hospital", "publisher": "Island Hospital", "url": "https://packages.islandhospital.com/", "accessed": "2026-09-16" }, { "id": "s:islandhospital-exec-screening", "kind": "web", "title": "Executive Health Screening Package", "publisher": "Island Hospital", "url": "https://packages.islandhospital.com/product/executive-health-screening-package/", "accessed": "2026-09-16", "note": "price, inclusion list and redemption date read off the product page" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "cited" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node Island Hospital, 308 Jalan Macalister" }, "address": { "tier": "cited" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:islandhospital-about" } }, "primary_image": null, "tag_facts": [ { "key": "price-published", "label": "Publishes prices", "icon": "💰", "group": "money", "evidence": "a public price list or package page on the facility's own site, read on a dated visit", "source": "s:islandhospital-exec-screening", "note": "an online store with a ringgit price, an inclusion list and a redemption date on each product page", "tier": "cited", "url": "https://packages.islandhospital.com/" }, { "key": "package", "label": "Sells packages", "icon": "🧳", "group": "money", "evidence": "a bundled price on the facility's own page covering more than the operation", "source": "s:islandhospital-packages", "note": "", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:islandhospital-about", "note": "an International Patient Services department offering second opinions before travel", "tier": "cited", "url": "" }, { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:wp-island-hospital", "note": "bought by IHH Healthcare in 2024", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "achsi", "label": "Australian Council on Healthcare Standards International", "what": "Full hospital-wide accreditation by the Australian Council on Healthcare Standards International", "url": "https://www.islandhospital.com/about-us/", "kind": "international", "year": null, "valid_until": null, "source": "s:islandhospital-about" }, { "key": "mhtc", "label": "Malaysia Healthcare Travel Council", "what": "Named by the Malaysia Healthcare Travel Council as, in the council's words, \"Malaysia's first Flagship Medical Tourism Hospital\"", "url": "https://www.islandhospital.com/about-us/", "kind": "national", "year": 2025, "valid_until": null, "source": "s:islandhospital-about" }, { "key": "other", "label": "Somebody else", "what": "Full hospital-wide accreditation by the Malaysian Society for Quality in Health (MSQH)", "url": "https://www.islandhospital.com/about-us/", "kind": "other", "year": null, "valid_until": null, "source": "s:islandhospital-about" } ], "acclaim": 3, "kin_in": [ { "from": "malaysia", "type": "destination", "name": "Malaysia", "as": "The Penang hospital that made the Sumatra route ordinary.", "rel": "part" }, { "from": "penang", "type": "hub", "name": "Penang", "as": "At 308 Jalan Macalister, 600 beds, the anchor of the George Town cluster.", "rel": "part" }, { "from": "malaysia-mhtc-licence", "type": "rule", "name": "Malaysia's healthcare travel registration", "as": "Another, in the northern cluster.", "rel": "facility" }, { "from": "mhtc", "type": "org", "name": "Malaysia Healthcare Travel Council", "as": "The Penang hospital the agency's Indonesian corridor is built around.", "rel": "org" } ] }, { "schema": 1, "id": "king-hussein-cancer-center", "type": "facility", "names": { "name": "King Hussein Cancer Center", "aliases": [ "KHCC", "مركز الحسين للسرطان", "King Hussein Cancer Foundation and Center" ], "said": "Said KHCC in the trade. Named for King Hussein bin Talal, who died of cancer in 1999; the centre took his name in 2001 and sits on Queen Rania Street in Amman." }, "region": [ "west-asia" ], "facets": { "iso2": "JO", "ownership": "nonprofit", "founded": 2001, "specialty": [ "oncology", "paediatric oncology", "bone marrow transplantation", "radiation oncology", "surgical oncology" ], "draws": [ "bone-marrow-transplant", "car-t", "proton-therapy", "gamma-knife" ], "status": "open", "languages": [ "Arabic", "English" ] }, "text": { "what": "A 352-bed independent non-governmental, non-profit cancer centre on Queen Rania Street in Amman, established in 2001 and chaired by Princess Ghida Talal. It treats patients from across the Arab world and states that it was the first institution in the developing world accredited by Joint Commission International as a disease-specific cancer centre, and the sixth in the world.", "story": "The centre is the reason Jordan appears in this directory as a destination rather than only as a source market. About 7,000 new patients a year, 14,000 admissions and roughly 250,000 outpatient clinic visits, staffed by over 400 oncology doctors, 1,100 oncology nurses, about 100 pharmacists and 1,500 administrators and technicians, across three buildings of 108,700 square metres.\n\nWhat is unusual is where the foreign patients come from and why. The published research on KHCC's non-Jordanian caseload is a literature of displacement: a study of 968 non-Jordanian children treated between 2011 and 2022 found them Syrian (29 per cent), Palestinian (26 per cent), Iraqi (23 per cent) and Yemeni (17 per cent); there are separate published series on Palestinian patients, on Libyan patients over more than a decade, and on central nervous system tumours in patients from conflict areas of the Middle East and North Africa.\n\n*Inference —* that is cross-border care, and it belongs in the same directory as a knee in Bangkok, but it is not the same transaction. A child brought from Syria for leukaemia treatment is not comparing prices. The field's headline counts of millions of medical travellers absorb both, which is one of the reasons those counts say so little.\n\nJordan's private hospital sector reports about a billion dollars of annual earnings from patients arriving for care, driven by the region; the association that publishes that figure is a trade body and the figure is revenue rather than patients.\n\nNo overall foreign share for the centre is published in the sources read here.", "how": "*Trade practice —* a regional cancer referral to Amman is arranged through embassies, government health offices, charitable funds and the centre's own foundation as often as by the family directly, and the money question is answered by a sponsor rather than by a patient. Treatment is a course rather than an episode, so the stay is months and the escort is a family that moves.\n\nNo price schedule is published.", "today": "As of 17 September 2026 the centre carries 352 beds, states about 7,000 new patients a year, 14,000 admissions and about 250,000 outpatient visits, and names JCI, College of American Pathologists and ANCC Magnet accreditation with no year against any of them on the pages read here. It states it was the first in the developing world accredited by JCI as a disease-specific cancer centre and the sixth in the world." }, "geo": { "lat": 32.004421, "lon": 35.876506, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "Queen Rania Street, Al Jubeiha", "city": "Amman", "country": "JO", "postcode": "11196" }, "metrics": { "beds": 352, "doctors": 400, "annual_patients": 7000, "annual_foreign_patients": null, "note": "annual_patients here counts PEOPLE, not visits, and it counts NEW people: about 7,000 new patients a year. The centre separately reports 14,000 admissions and about 250,000 outpatient clinic visits a year, which do count episodes and attendances. The doctor figure is over 400 oncology physicians, alongside 1,100 oncology nurses, about 100 pharmacists and 1,500 administrators and technicians. No overall foreign share is published; the only quantified foreign series read here is a study of 968 non-Jordanian CHILDREN treated between 2011 and 2022.", "as_of": "2026", "source": "s:wp-khcc", "url": "https://en.wikipedia.org/wiki/King_Hussein_Cancer_Center" }, "tags": [ { "tag": "paediatric", "source": "s:wp-khcc", "tier": "cited", "note": "treats cancer across all ages; its non-Jordanian paediatric caseload is the part with published research behind it" }, { "tag": "transplant-programme", "source": "s:wp-khcc", "tier": "cited", "note": "bone marrow transplantation and stem cell banking" }, { "tag": "international-office", "source": "s:khcc-why", "tier": "cited", "note": "the centre states it serves patients from Jordan and across the Middle East", "url": "https://www.khcc.jo/en/why-khcc" }, { "tag": "no-price-published", "source": "s:khcc-why", "tier": "cited", "note": "no schedule appears on the centre's own pages read for this record" }, { "tag": "teaching", "source": "s:wp-khcc", "tier": "cited", "note": "AAHRPP accreditation of its human research protection programme is named among its certifications" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation as a disease-specific cancer centre — the first in the developing world and the sixth in the world, by the centre's own statement", "year": null, "valid_until": null, "source": "s:khcc-why", "url": "https://www.khcc.jo/en/why-khcc", "note": "the centre's own page carries the claim and no year; secondary accounts date the award to February 2006 and that year is not asserted here" }, { "by": "other", "what": "College of American Pathologists laboratory accreditation, stated as the first in Jordan and the fifth in the Arab world, and ANCC Magnet recognition for nursing", "year": null, "valid_until": null, "source": "s:wp-khcc", "url": "https://en.wikipedia.org/wiki/King_Hussein_Cancer_Center", "note": "two American bodies outside this project's recognizer vocabulary, named as the centre names them and undated on the page" } ], "kin": [ { "to": "amman", "as": "The institution the Amman cluster is built around, on Queen Rania Street.", "rel": "place" }, { "to": "jordan", "as": "The reason the country is a destination and not only a source market.", "rel": "destination" }, { "to": "bone-marrow-transplant", "as": "Among the programmes that bring children across borders to Amman.", "rel": "performs" }, { "to": "jci", "as": "Its accreditor, in the disease-specific category rather than the hospital-wide one.", "rel": "accredited-by" }, { "to": "sheba", "as": "The other regional cancer centre in this batch, an hour's drive and a closed border away.", "rel": "contrast" }, { "to": "who-travels", "as": "A caseload that is Syrian, Palestinian, Iraqi and Yemeni before it is anything else, and a literature of displacement rather than of price.", "rel": "story" }, { "to": "counting-patients", "as": "7,000 new patients, 14,000 admissions and 250,000 outpatient visits are three different numbers about the same year.", "rel": "story" }, { "to": "the-companion", "as": "A course of cancer treatment measured in months moves a family, not an escort.", "rel": "step" } ], "links": [ { "label": "King Hussein Cancer Center", "url": "https://www.khcc.jo/en" }, { "label": "Why KHCC", "url": "https://www.khcc.jo/en/why-khcc" } ], "sources": [ "s:wp-khcc", "s:khcc-why", "s:agbi-jordan-2026", "s:wp-health-in-jordan", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "text.how": { "tier": "tradition", "note": "how a sponsored regional cancer referral is arranged; marked in the prose" }, "metrics": { "tier": "cited", "source": "s:wp-khcc" } } }, "x_commons_files": [ "File:King Hussein Cancer Center.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "A 352-bed independent non-governmental, non-profit cancer centre on Queen Rania Street in Amman, established in 2001 and chaired by Princess Ghida Talal.", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "amman", "type": "hub", "name": "Amman", "as": "The institution the Amman cluster is built around, on Queen Rania Street.", "rel": "place" }, { "to": "jordan", "type": "destination", "name": "Jordan", "as": "The reason the country is a destination and not only a source market.", "rel": "destination" }, { "to": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "Among the programmes that bring children across borders to Amman.", "rel": "performs" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "Its accreditor, in the disease-specific category rather than the hospital-wide one.", "rel": "accredited-by" }, { "to": "sheba", "type": "facility", "name": "Sheba Medical Center", "as": "The other regional cancer centre in this batch, an hour's drive and a closed border away.", "rel": "contrast" }, { "to": "who-travels", "type": "story", "name": "Who travels", "as": "A caseload that is Syrian, Palestinian, Iraqi and Yemeni before it is anything else, and a literature of displacement rather than of price.", "rel": "story" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "7,000 new patients, 14,000 admissions and 250,000 outpatient visits are three different numbers about the same year.", "rel": "story" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "A course of cancer treatment measured in months moves a family, not an escort.", "rel": "step" } ], "source_list": [ { "id": "s:wp-khcc", "kind": "wikipedia", "title": "King Hussein Cancer Center", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/King_Hussein_Cancer_Center", "accessed": "2026-09-16", "note": "Queen Rania Street, Amman; 352 beds; JCI accreditation, College of American Pathologists, ANCC Magnet and AAHRPP, none of them dated on the page; coordinates 32.0045, 35.8750" }, { "id": "s:khcc-why", "kind": "web", "title": "Why KHCC", "publisher": "King Hussein Cancer Center, Amman", "url": "https://www.khcc.jo/en/why-khcc", "accessed": "2026-09-17", "note": "the centre's own claim to be the first institution in the developing world accredited by JCI as a disease-specific cancer centre, and the sixth in the world. The page gives no year, no bed count and no patient numbers." }, { "id": "s:agbi-jordan-2026", "kind": "news", "title": "Middle East drives Jordan's medical tourism earnings to $1bn", "publisher": "AGBI (Arabian Gulf Business Insight)", "url": "https://www.agbi.com/tourism/2026/06/middle-east-drives-jordans-medical-tourism-earnings-to-1bn/", "accessed": "2026-09-16", "note": "published 17 June 2026, reporting Fawzi Hammouri, president of the Private Hospitals Association, as carried by the Jordan Times" }, { "id": "s:wp-health-in-jordan", "kind": "wikipedia", "title": "Health in Jordan", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Health_in_Jordan", "accessed": "2026-09-16", "note": "carries the 2007 and 2008 inbound patient counts of roughly 250,000 and the World Bank's regional ranking; the counts are nearly two decades old and their method is not stated on the page" }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "how a sponsored regional cancer referral is arranged; marked in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-khcc" } }, "primary_image": null, "tag_facts": [ { "key": "paediatric", "label": "Treats children", "icon": "🧸", "group": "clinical", "evidence": "the facility's own paediatric department page or a ministry register", "source": "s:wp-khcc", "note": "treats cancer across all ages; its non-Jordanian paediatric caseload is the part with published research behind it", "tier": "cited", "url": "" }, { "key": "transplant-programme", "label": "Transplant programme", "icon": "🫀", "group": "clinical", "evidence": "a national transplant registry, a ministry licence list, or the facility's own programme page", "source": "s:wp-khcc", "note": "bone marrow transplantation and stem cell banking", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:khcc-why", "note": "the centre states it serves patients from Jordan and across the Middle East", "tier": "cited", "url": "https://www.khcc.jo/en/why-khcc" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:khcc-why", "note": "no schedule appears on the centre's own pages read for this record", "tier": "cited", "url": "" }, { "key": "teaching", "label": "Teaching hospital", "icon": "📚", "group": "clinical", "evidence": "a recognised training post list or the hospital's own statement", "source": "s:wp-khcc", "note": "AAHRPP accreditation of its human research protection programme is named among its certifications", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation as a disease-specific cancer centre — the first in the developing world and the sixth in the world, by the centre's own statement", "url": "https://www.khcc.jo/en/why-khcc", "kind": "international", "year": null, "valid_until": null, "source": "s:khcc-why" }, { "key": "other", "label": "Somebody else", "what": "College of American Pathologists laboratory accreditation, stated as the first in Jordan and the fifth in the Arab world, and ANCC Magnet recognition for nursing", "url": "https://en.wikipedia.org/wiki/King_Hussein_Cancer_Center", "kind": "other", "year": null, "valid_until": null, "source": "s:wp-khcc" } ], "acclaim": 2, "kin_in": [ { "from": "jordan", "type": "destination", "name": "Jordan", "as": "The specialist centre regional oncology referrals go to.", "rel": "part" }, { "from": "amman", "type": "hub", "name": "Amman", "as": "The hospital the city is named for abroad, on Queen Rania Street.", "rel": "part" }, { "from": "sheba", "type": "facility", "name": "Sheba Medical Center", "as": "The other regional cancer centre in this batch, an hour's drive and a closed border away.", "rel": "contrast" }, { "from": "gcc-sponsored-treatment-abroad", "type": "rule", "name": "Gulf state-sponsored treatment abroad", "as": "One of the regional hospitals such schemes buy from.", "rel": "facility" } ] }, { "schema": 1, "id": "kokilaben", "type": "facility", "names": { "name": "Kokilaben Dhirubhai Ambani Hospital", "aliases": [ "KDAH", "Kokilaben Hospital", "कोकिलाबेन धीरूभाई अंबानी हॉस्पिटल" ], "said": "Kokilaben, for Kokilaben Ambani. Mumbai says Kokilaben and means Four Bungalows in Andheri West." }, "region": [ "south-asia" ], "facets": { "iso2": "IN", "ownership": "private", "founded": 2009, "specialty": [ "cardiac sciences", "oncology", "orthopaedics", "neurosciences", "robotic surgery", "transplants" ], "draws": [ "knee-replacement", "kidney-transplant", "gamma-knife", "cabg" ], "status": "open", "languages": [ "English", "Hindi", "Marathi" ] }, "text": { "what": "A 750-bed hospital at Four Bungalows in Andheri West, Mumbai, opened in 2009 and built by the Reliance Anil Dhirubhai Ambani Group. It runs over thirty departments and states more than 410 doctors, and it holds four accreditations at once: Joint Commission International, NABH, NABL for its laboratories and the College of American Pathologists.", "story": "The hospital was conceived by the cardiac surgeon Nitu Mandke and completed after his death in 2003 under Anil Ambani, opening in 2009. It has since been described as carrying a run of firsts for India and for Asia, among them a three-room intra-operative MRI suite and an EDGE radiosurgery system.\n\n*Inference —* the equipment list is the hospital's pitch, and it aims at a particular patient. A three-room intra-operative MRI is not bought to compete on the price of a knee; it is bought to keep neurosurgical referrals in Mumbai that would otherwise leave the country. That is the other direction of this subject — a hospital built to stop outbound travel rather than to attract inbound.\n\nThe four-accreditation stack is worth reading as what it is. Joint Commission International inspects the hospital, NABH inspects it against the Indian national standard, NABL accredits the laboratories and the College of American Pathologists accredits pathology specifically. Four bodies, four fees, four scopes — and none of them a ranking.", "how": "*Trade practice —* Mumbai's corporate hospitals work the Gulf and East African referral routes through an international desk and a quoted estimate, with the visa letter issued against a confirmed appointment. This hospital publishes an international patient section describing what to expect and no price list.", "today": "As of 16 September 2026 the hospital states more than 410 doctors across all departments and names Joint Commission International, NABH, NABL and College of American Pathologists accreditation on its own front page. It publishes no price for any procedure. The bed count carried here, 750, comes from reporting rather than from the hospital's own pages." }, "geo": { "lat": 19.13105, "lon": 72.8250528, "precision": "street", "source": "s:wp-kokilaben" }, "address": { "street": "Four Bungalows, Andheri West", "city": "Mumbai", "area": "Maharashtra", "country": "IN" }, "metrics": { "beds": 750, "doctors": 410, "annual_patients": null, "annual_foreign_patients": null, "note": "750 beds is from reporting; the doctor figure is the hospital's own front-page statement of more than 410 doctors across all departments, which counts affiliated consultants as well as salaried staff and is a headcount of PEOPLE, not of appointments. No patient count of any kind is published on the pages read here.", "as_of": "2026-09-16", "source": "s:kokilaben-home", "url": "https://www.kokilabenhospital.com/" }, "tags": [ { "tag": "chain", "source": "s:kokilaben-home", "tier": "cited", "note": "further hospitals at Navi Mumbai, Indore, Akola, Gondia and Solapur" }, { "tag": "international-office", "source": "s:kokilaben-home", "tier": "cited", "note": "a separate international patients section describing what to expect", "url": "https://www.kokilabenhospital.com/patients/internationalpatients/what_to_expect.html" }, { "tag": "no-price-published", "source": "s:kokilaben-home", "tier": "cited", "note": "no price or implant list on the hospital's own pages, checked 16 September 2026" }, { "tag": "transplant-programme", "source": "s:wp-kokilaben", "tier": "cited" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation, named on the hospital's own front page", "year": null, "valid_until": null, "source": "s:kokilaben-home", "url": "https://www.kokilabenhospital.com/", "note": "the year first granted is not stated on the page read here" }, { "by": "nabh", "what": "NABH accreditation, the Indian national hospital standard", "year": null, "valid_until": null, "source": "s:kokilaben-home", "url": "https://www.kokilabenhospital.com/" }, { "by": "other", "what": "NABL laboratory accreditation and College of American Pathologists accreditation for pathology", "year": null, "valid_until": null, "source": "s:kokilaben-home", "url": "https://www.kokilabenhospital.com/", "note": "two laboratory schemes rather than hospital-wide ones; NABL is the Indian testing and calibration board, CAP is American and inspects pathology specifically" } ], "kin": [ { "to": "mumbai", "as": "The hospital the Andheri end of the Mumbai cluster is named for.", "rel": "place" }, { "to": "india", "as": "A Mumbai hospital built to hold referrals inside the country as much as to attract them from outside.", "rel": "destination" }, { "to": "gamma-knife", "as": "Its radiosurgery programme is the kind of work its equipment list is built around.", "rel": "performs" }, { "to": "jci", "as": "One of four bodies whose marks it carries on its own front page.", "rel": "accredited-by" }, { "to": "nabh", "as": "The Indian national board, inspecting against a domestic standard rather than an international one.", "rel": "accredited-by" }, { "to": "the-accreditation-question", "as": "Four accreditations at once, four fees, four scopes, and no ranking among them.", "rel": "story" }, { "to": "apollo-chennai", "as": "The southern competitor for the same Gulf and East African referrals.", "rel": "contrast" } ], "links": [ { "label": "Kokilaben Dhirubhai Ambani Hospital", "url": "https://www.kokilabenhospital.com/" }, { "label": "International patients — what to expect", "url": "https://www.kokilabenhospital.com/patients/internationalpatients/what_to_expect.html" } ], "sources": [ "s:wp-kokilaben", "s:kokilaben-home" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "tradition", "note": "how Mumbai corporate hospitals work the Gulf and East African referral routes; hedged in the prose" }, "metrics": { "tier": "cited", "source": "s:kokilaben-home" } } }, "x_commons_files": [ "File:Kokilaben Dhirubhai Ambani Hospital.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "A 750-bed hospital at Four Bungalows in Andheri West, Mumbai, opened in 2009 and built by the Reliance Anil Dhirubhai Ambani Group.", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" } ], "kin_out": [ { "to": "mumbai", "type": "hub", "name": "Mumbai", "as": "The hospital the Andheri end of the Mumbai cluster is named for.", "rel": "place" }, { "to": "india", "type": "destination", "name": "India", "as": "A Mumbai hospital built to hold referrals inside the country as much as to attract them from outside.", "rel": "destination" }, { "to": "gamma-knife", "type": "procedure", "name": "Gamma knife radiosurgery", "as": "Its radiosurgery programme is the kind of work its equipment list is built around.", "rel": "performs" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "One of four bodies whose marks it carries on its own front page.", "rel": "accredited-by" }, { "to": "nabh", "type": "org", "name": "National Accreditation Board for Hospitals and Healthcare Providers", "as": "The Indian national board, inspecting against a domestic standard rather than an international one.", "rel": "accredited-by" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Four accreditations at once, four fees, four scopes, and no ranking among them.", "rel": "story" }, { "to": "apollo-chennai", "type": "facility", "name": "Apollo Hospitals, Greams Road, Chennai", "as": "The southern competitor for the same Gulf and East African referrals.", "rel": "contrast" } ], "source_list": [ { "id": "s:wp-kokilaben", "kind": "wikipedia", "title": "Kokilaben Dhirubhai Ambani Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Kokilaben_Dhirubhai_Ambani_Hospital", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:kokilaben-home", "kind": "web", "title": "Kokilaben Dhirubhai Ambani Hospital — hospital site", "publisher": "Kokilaben Dhirubhai Ambani Hospital", "url": "https://www.kokilabenhospital.com/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "how Mumbai corporate hospitals work the Gulf and East African referral routes; hedged in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "cited" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:kokilaben-home" } }, "primary_image": null, "tag_facts": [ { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:kokilaben-home", "note": "further hospitals at Navi Mumbai, Indore, Akola, Gondia and Solapur", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:kokilaben-home", "note": "a separate international patients section describing what to expect", "tier": "cited", "url": "https://www.kokilabenhospital.com/patients/internationalpatients/what_to_expect.html" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:kokilaben-home", "note": "no price or implant list on the hospital's own pages, checked 16 September 2026", "tier": "cited", "url": "" }, { "key": "transplant-programme", "label": "Transplant programme", "icon": "🫀", "group": "clinical", "evidence": "a national transplant registry, a ministry licence list, or the facility's own programme page", "source": "s:wp-kokilaben", "note": "", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation, named on the hospital's own front page", "url": "https://www.kokilabenhospital.com/", "kind": "international", "year": null, "valid_until": null, "source": "s:kokilaben-home" }, { "key": "nabh", "label": "NABH (India)", "what": "NABH accreditation, the Indian national hospital standard", "url": "https://www.kokilabenhospital.com/", "kind": "national", "year": null, "valid_until": null, "source": "s:kokilaben-home" }, { "key": "other", "label": "Somebody else", "what": "NABL laboratory accreditation and College of American Pathologists accreditation for pathology", "url": "https://www.kokilabenhospital.com/", "kind": "other", "year": null, "valid_until": null, "source": "s:kokilaben-home" } ], "acclaim": 3, "kin_in": [ { "from": "mumbai", "type": "hub", "name": "Mumbai", "as": "The 750-bed private hospital at Four Bungalows, Versova, opened 2009.", "rel": "part" } ] }, { "schema": 1, "id": "liv-hospital", "type": "facility", "names": { "name": "Liv Hospital", "aliases": [ "Liv Hospital Ulus", "Liv Hastanesi" ], "said": "Liv, said as the English word live. The brand was built for patients arriving from abroad; the flagship is the Ulus campus above the Bosphorus in Beşiktaş, and the group's other buildings carry the same name with a district after it." }, "region": [ "west-asia" ], "facets": { "iso2": "TR", "ownership": "private", "founded": 2013, "specialty": [ "oncology", "orthopaedics", "cardiac surgery", "transplantation", "health screening", "fertility" ], "draws": [ "executive-health-screening", "knee-replacement", "kidney-transplant", "gastric-sleeve", "ivf" ], "status": "open", "languages": [ "Turkish", "English", "Arabic", "Russian" ] }, "text": { "what": "A Turkish private hospital brand with more than twenty locations, whose flagship is the Ulus campus in Beşiktaş, Istanbul. It is one of the few hospitals in this directory that prints prices: fifteen screening packages in US dollars sit on its own international site, each with its test counts and a starting figure. This record is the brand and pins Ulus.", "story": "Liv was assembled as an export brand. Its public site is in English before it is in Turkish, its call centre answers around the clock, and its statistics block leads with doctors, patients and locations rather than with beds: 723 or more doctors, more than a million patients, more than twenty locations.\n\n*Inference —* the absence of a bed count from a hospital group's own front page is itself a choice. Beds are the number a ministry counts; doctors and locations are the numbers a buyer counts.\n\nOn accreditation the site names Joint Commission International without a year, ISO certification, the Türkiye international health tourism authorisation, an authorisation from the Ministry of Culture and Tourism, and a four-star rating from a hospital rating scheme. Four of those five are a licence or a purchase rather than an inspection of care, and this project counts them without weighting them.\n\nWhat separates Liv from every other Turkish group in this batch is the screening page. Acıbadem heads a page \"check-up packages and prices\" and prints no price. Liv prints fifteen.", "how": "Screening is sold the way an airline sells fares: a grid of named packages, each with a count of examinations, radiology, cardiology and laboratory tests, and a starting price per person in dollars. LIV STANDARD MEN begins at 600 dollars for three examinations, three imaging tests, one cardiology test and eleven laboratory tests. LIV GOLD CANCER SCREENING FOR MEN begins at 3,200 for seven examinations, four endoscopic and pathology studies, five imaging tests, three cardiology examinations and forty-five laboratory tests. The page states the price includes the medical reports.\n\nEvery figure is a starting price — the word on the page is from — which is a quotation floor and not a bill. Surgery is not priced anywhere on the site.", "today": "As of 17 September 2026 the international site states 723 or more doctors, more than a million patients, more than twenty locations, and fifteen screening packages priced from 590 to 3,200 US dollars. No bed count, no foreign patient count and no surgical price is published." }, "geo": { "lat": 41.060889, "lon": 29.028479, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "Canan Sokağı, Ulus Mahallesi, Beşiktaş", "city": "Istanbul", "country": "TR", "postcode": "34340" }, "metrics": { "beds": null, "doctors": 723, "annual_patients": null, "annual_foreign_patients": null, "note": "GROUP figures from the group's own front page: 723+ doctors and 1M+ patients across more than twenty locations. The patient figure carries no period — it is not stated as annual, and it is not stated as people rather than visits — so it is left out of annual_patients rather than guessed at. No bed count is published anywhere on the site.", "as_of": "2026", "source": "s:liv-int-home", "url": "https://int.livhospital.com/" }, "tags": [ { "tag": "price-published", "source": "s:liv-checkup", "tier": "cited", "note": "fifteen screening packages priced in US dollars on the hospital's own international site, each with its test counts", "url": "https://int.livhospital.com/full-body-checkup/" }, { "tag": "package", "source": "s:liv-checkup", "tier": "cited", "note": "the screening packages are bundles; every figure is a starting price" }, { "tag": "chain", "source": "s:liv-int-home", "tier": "cited", "note": "more than twenty locations, named as Ulus, Vadistanbul, Ankara, Gaziantep, Bona Dea and Istinye University Bahçeşehir Liv" }, { "tag": "international-office", "source": "s:liv-int-home", "tier": "cited", "note": "an English-first international site and a call centre stated as open around the clock" }, { "tag": "interpreter", "source": "s:liv-int-home", "tier": "cited" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation, named on the group's international site", "year": null, "valid_until": null, "source": "s:liv-int-home", "url": "https://int.livhospital.com/", "note": "no year is given and no campus is named against it; a group site naming JCI does not say which building holds it" }, { "by": "moh-tr", "what": "Türkiye international health tourism authorisation, and a separate Ministry of Culture and Tourism authorisation", "year": null, "valid_until": null, "source": "s:liv-int-home", "url": "https://int.livhospital.com/", "note": "the health tourism certificate is compulsory for a Turkish facility treating foreign patients; the tourism ministry authorisation is a separate document" }, { "by": "other", "what": "A four-star Global Hospital Rating, and ISO quality certification", "year": null, "valid_until": null, "source": "s:liv-int-home", "url": "https://int.livhospital.com/", "note": "a rating scheme and a management standard, neither an inspection of clinical care; counted, not weighted" } ], "prices": [ { "procedure": "executive-health-screening", "country": "TR", "city": "Istanbul", "facility": "liv-hospital", "amount": 600, "currency": "USD", "as_of": "2026-09-17", "kind": "package", "includes": [ "3 examinations", "3 radiological imaging studies", "1 cardiology test", "blood fat profile", "hepatitis and infectious disease screening", "2 haematology tests", "1 hormone test", "medical reports" ], "excludes": [ "anything the page does not list — the package is defined by its test counts, and no exclusion list is printed" ], "source": "s:liv-checkup", "url": "https://int.livhospital.com/full-body-checkup/", "note": "LIV STANDARD MEN, the entry tier, stated as starting at 600 US dollars per person and read off the hospital's own page on 17 September 2026. LIV STANDARD WOMEN starts at 590. The word on the page is from, so this is a floor and not a bill.", "tier": "cited", "usd": 600.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "executive-health-screening", "country": "TR", "city": "Istanbul", "facility": "liv-hospital", "amount": 590, "amount_high": 3200, "currency": "USD", "as_of": "2026-09-17", "kind": "quoted-range", "includes": [ "the fifteen packages the page lists, from LIV STANDARD WOMEN to LIV GOLD CANCER SCREENING", "medical reports" ], "excludes": [ "surgery of any kind, which the site does not price", "anything outside the named test counts" ], "source": "s:liv-checkup", "url": "https://int.livhospital.com/full-body-checkup/", "note": "The whole published range on one page on 17 September 2026: LIV STANDARD WOMEN from 590 US dollars at the bottom, LIV GOLD CANCER SCREENING for either sex from 3,200 at the top, with LIV ONLINE at 980 to 1,300, LIV SHAPE heart programmes at 1,470 and 2,240 and LIV SILVER cancer screening at 2,300 in between. Every one is a starting price.", "tier": "cited", "usd": 590.0, "usd_high": 3200.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "istanbul", "as": "Its flagship stands at Ulus in Beşiktaş, above the Bosphorus.", "rel": "place" }, { "to": "turkiye", "as": "The Turkish group that prints its screening prices where the others print a contact form.", "rel": "destination" }, { "to": "executive-health-screening", "as": "Sold here in fifteen graded packages with published starting prices, which is rare enough in this directory to be the reason the record exists.", "rel": "performs" }, { "to": "acibadem", "as": "The larger Turkish group, whose page headed packages and prices carries none.", "rel": "contrast" }, { "to": "package-price", "as": "Sells in this form, and states what each package contains by test count rather than by name.", "rel": "term" }, { "to": "jci", "as": "Named on its site as its accreditor, without a year or a campus.", "rel": "accredited-by" }, { "to": "turkiye-health-tourism-authorisation", "as": "Holds the certificate, and a separate tourism ministry authorisation alongside it.", "rel": "governed-by" }, { "to": "getting-a-quote", "as": "A published starting price is where a quotation begins, not where it ends.", "rel": "step" }, { "to": "the-price-that-isnt", "as": "Fifteen prices, every one of them prefixed with the word from.", "rel": "story" } ], "links": [ { "label": "Liv Hospital (international)", "url": "https://int.livhospital.com/" }, { "label": "Check-Up Packages", "url": "https://int.livhospital.com/full-body-checkup/" } ], "sources": [ "s:liv-int-home", "s:liv-checkup", "s:osm-nominatim", "s:acibadem-checkup-packages" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "text.story": { "tier": "cited", "source": "s:liv-int-home", "note": "the middle paragraph is marked as this project's inference in the prose" } } }, "x_commons_files": [], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "A Turkish private hospital brand with more than twenty locations, whose flagship is the Ulus campus in Beşiktaş, Istanbul.", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "Its flagship stands at Ulus in Beşiktaş, above the Bosphorus.", "rel": "place" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The Turkish group that prints its screening prices where the others print a contact form.", "rel": "destination" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "Sold here in fifteen graded packages with published starting prices, which is rare enough in this directory to be the reason the record exists.", "rel": "performs" }, { "to": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "The larger Turkish group, whose page headed packages and prices carries none.", "rel": "contrast" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "Sells in this form, and states what each package contains by test count rather than by name.", "rel": "term" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "Named on its site as its accreditor, without a year or a campus.", "rel": "accredited-by" }, { "to": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "Holds the certificate, and a separate tourism ministry authorisation alongside it.", "rel": "governed-by" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "A published starting price is where a quotation begins, not where it ends.", "rel": "step" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "Fifteen prices, every one of them prefixed with the word from.", "rel": "story" } ], "source_list": [ { "id": "s:liv-int-home", "kind": "web", "title": "Liv Hospital — international site", "publisher": "Liv Hospital, Istanbul", "url": "https://int.livhospital.com/", "accessed": "2026-09-17", "note": "the group's own counters read on 17 September 2026: 723+ doctors, 1M+ patients, 20+ locations. Names Liv Hospital Ulus, Vadistanbul, Ankara, Gaziantep, Bona Dea and Istinye University Bahçeşehir Liv. Lists JCI accreditation with no year, ISO certification, the Türkiye international health tourism authorisation, a Ministry of Culture and Tourism authorisation and a four-star Global Hospital Rating." }, { "id": "s:liv-checkup", "kind": "web", "title": "Check-Up Packages — Complete Health Screening Services", "publisher": "Liv Hospital (MLP Care), Istanbul", "url": "https://int.livhospital.com/full-body-checkup/", "accessed": "2026-09-17", "note": "fifteen screening packages priced in US dollars on the hospital's own international site and read there on 17 September 2026, each stated as a starting price per person and each listing its test counts by category. LIV STANDARD MEN from 600 USD and LIV STANDARD WOMEN from 590 USD are the entry tier; LIV GOLD CANCER SCREENING from 3,200 USD is the top. The page states the prices include medical reports." }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." }, { "id": "s:acibadem-checkup-packages", "kind": "web", "title": "Check Up Paketleri ve Fiyatları 2026", "publisher": "Acıbadem Sağlık Grubu", "url": "https://www.acibadem.com.tr/check-up-paketleri/", "accessed": "2026-09-17", "note": "read in the browser on 17 September 2026. The page is titled check-up packages AND PRICES and lists the contents of each programme — examinations, radiology, laboratory and cardiology test counts — with a Fiyat Sor (ask the price) button in place of every figure. No amount is printed anywhere on it." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:liv-int-home", "note": "the middle paragraph is marked as this project's inference in the prose" }, "text.how": { "tier": "cited" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "cited" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited" } }, "primary_image": null, "tag_facts": [ { "key": "price-published", "label": "Publishes prices", "icon": "💰", "group": "money", "evidence": "a public price list or package page on the facility's own site, read on a dated visit", "source": "s:liv-checkup", "note": "fifteen screening packages priced in US dollars on the hospital's own international site, each with its test counts", "tier": "cited", "url": "https://int.livhospital.com/full-body-checkup/" }, { "key": "package", "label": "Sells packages", "icon": "🧳", "group": "money", "evidence": "a bundled price on the facility's own page covering more than the operation", "source": "s:liv-checkup", "note": "the screening packages are bundles; every figure is a starting price", "tier": "cited", "url": "" }, { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:liv-int-home", "note": "more than twenty locations, named as Ulus, Vadistanbul, Ankara, Gaziantep, Bona Dea and Istinye University Bahçeşehir Liv", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:liv-int-home", "note": "an English-first international site and a call centre stated as open around the clock", "tier": "cited", "url": "" }, { "key": "interpreter", "label": "Interpreters on staff", "icon": "🗣", "group": "service", "evidence": "the facility's own page naming the languages, or a published inspection or accreditation report", "source": "s:liv-int-home", "note": "", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation, named on the group's international site", "url": "https://int.livhospital.com/", "kind": "international", "year": null, "valid_until": null, "source": "s:liv-int-home" }, { "key": "moh-tr", "label": "Türkiye Ministry of Health health-tourism authorisation", "what": "Türkiye international health tourism authorisation, and a separate Ministry of Culture and Tourism authorisation", "url": "https://int.livhospital.com/", "kind": "regulator", "year": null, "valid_until": null, "source": "s:liv-int-home" }, { "key": "other", "label": "Somebody else", "what": "A four-star Global Hospital Rating, and ISO quality certification", "url": "https://int.livhospital.com/", "kind": "other", "year": null, "valid_until": null, "source": "s:liv-int-home" } ], "acclaim": 3, "kin_in": [] }, { "schema": 1, "id": "max-saket", "type": "facility", "names": { "name": "Max Super Speciality Hospital, Saket", "aliases": [ "Max Saket", "Max Smart Super Speciality Hospital", "Max Healthcare Saket" ], "said": "Max Saket. The Saket complex holds more than one Max building on the same Press Enclave Road frontage, and the group's own signage distinguishes them by block." }, "region": [ "south-asia" ], "facets": { "iso2": "IN", "ownership": "private", "founded": 2004, "specialty": [ "oncology", "cardiac sciences", "orthopaedics", "neurosciences", "transplants" ], "draws": [ "knee-replacement", "cabg", "kidney-transplant" ], "status": "open", "languages": [ "English", "Hindi" ] }, "text": { "what": "The flagship tertiary hospital of Max Healthcare, on Press Enclave Road in Saket, South Delhi. Its East Block was completed in 2004. The group was founded in 2001, listed on the Indian exchanges in August 2020, and ran 22 hospitals with over 5,000 beds, mostly in northern India, as of June 2025.", "story": "Max Saket is the northern counterpart to the Gurugram campuses: a South Delhi address rather than an airport-road one, and a patient base drawn from the city as much as from abroad.\n\nOne piece of its history belongs in a directory about who pays. In 2016 the hospital was fined, along with four other Delhi hospitals, for failing to provide free treatment to poor patients as required by the land concession agreements under which the sites were granted. *Inference —* that obligation is the thing a foreign patient never sees on a price list and the thing that shapes the bed base underneath it: a private Delhi hospital built on concessional public land owes a share of its capacity to patients who pay nothing, and the paying beds carry that share.\n\nThe group's growth since listing has been in bed count rather than in transparency. No rupee figure for any operation at this hospital was found published.", "how": "*Trade practice —* the Delhi private hospitals quote foreign patients by email against a named surgeon and a named length of stay, and the estimate moves with the implant and with ICU nights. Nothing about that process is published on this hospital's own pages, which refused every request made by this project on 16 September 2026.", "today": "As of 16 September 2026 this record carries no bed count, no accreditation and no price for the Saket hospital, because the group's website refused this project's requests and no other source read here supplies them. What is carried is the group's founding, listing and size, the opening year of the East Block, and the point and address from OpenStreetMap." }, "geo": { "lat": 28.5273506, "lon": 77.2116849, "precision": "street", "source": "s:osm" }, "address": { "street": "Press Enclave Road, Saket", "city": "New Delhi", "area": "Delhi", "country": "IN", "postcode": "110017" }, "metrics": { "beds": null, "doctors": null, "annual_patients": null, "annual_foreign_patients": null, "note": "Nothing site-specific. Max Healthcare reported over 5,000 beds across 22 hospitals as of June 2025; that is the GROUP and it is not broken out per hospital in any source read here. The Saket bed count is therefore absent rather than apportioned, and absence means not found by this project.", "as_of": "2025-06", "source": "s:wp-max-healthcare", "url": "https://en.wikipedia.org/wiki/Max_Healthcare" }, "tags": [ { "tag": "chain", "source": "s:wp-max-healthcare", "tier": "cited", "note": "Max Healthcare, 22 hospitals as of June 2025" }, { "tag": "listed-company", "source": "s:wp-max-healthcare", "tier": "cited", "note": "listed on the Indian exchanges in August 2020" } ], "recognitions": [], "kin": [ { "to": "delhi-ncr", "as": "The South Delhi end of the cluster, against the two Gurugram campuses on the airport road.", "rel": "place" }, { "to": "india", "as": "A northern Indian tertiary hospital whose foreign trade is not separately reported.", "rel": "destination" }, { "to": "medanta", "as": "The Gurugram competitor that publishes its check-up prices and its implant ceilings; this one publishes neither.", "rel": "contrast" }, { "to": "knee-replacement", "as": "One of the operations the Delhi corridor sells to foreign patients, quoted rather than listed.", "rel": "performs" }, { "to": "india-e-medical-visa", "as": "The visa class most of this corridor's foreign patients arrive on.", "rel": "governed-by" }, { "to": "getting-a-quote", "as": "Publishes no price; the quote is an email against a named surgeon and a named stay.", "rel": "step" }, { "to": "the-accreditation-question", "as": "No accreditation is recorded here, which is a gap in this project's reading rather than a finding about the hospital.", "rel": "story" } ], "links": [ { "label": "Max Healthcare", "url": "https://www.maxhealthcare.in/" } ], "sources": [ "s:wp-max-healthcare", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "tradition", "note": "how Delhi private hospitals quote foreign patients; hedged in the prose and carrying no figure" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node MAX Hospital on Press Enclave Marg, Saket" }, "metrics": { "tier": "cited", "source": "s:wp-max-healthcare" } } }, "x_commons_files": [], "confidence": "low", "needs_verification": true, "updated": "2026-09-16", "blurb": "The flagship tertiary hospital of Max Healthcare, on Press Enclave Road in Saket, South Delhi. Its East Block was completed in 2004.", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" } ], "kin_out": [ { "to": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "The South Delhi end of the cluster, against the two Gurugram campuses on the airport road.", "rel": "place" }, { "to": "india", "type": "destination", "name": "India", "as": "A northern Indian tertiary hospital whose foreign trade is not separately reported.", "rel": "destination" }, { "to": "medanta", "type": "facility", "name": "Medanta — The Medicity, Gurugram", "as": "The Gurugram competitor that publishes its check-up prices and its implant ceilings; this one publishes neither.", "rel": "contrast" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "One of the operations the Delhi corridor sells to foreign patients, quoted rather than listed.", "rel": "performs" }, { "to": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The visa class most of this corridor's foreign patients arrive on.", "rel": "governed-by" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "Publishes no price; the quote is an email against a named surgeon and a named stay.", "rel": "step" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "No accreditation is recorded here, which is a gap in this project's reading rather than a finding about the hospital.", "rel": "story" } ], "source_list": [ { "id": "s:wp-max-healthcare", "kind": "wikipedia", "title": "Max Healthcare", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Max_Healthcare", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "how Delhi private hospitals quote foreign patients; hedged in the prose and carrying no figure" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node MAX Hospital on Press Enclave Marg, Saket" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-max-healthcare" } }, "primary_image": null, "tag_facts": [ { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:wp-max-healthcare", "note": "Max Healthcare, 22 hospitals as of June 2025", "tier": "cited", "url": "" }, { "key": "listed-company", "label": "Publicly listed", "icon": "📈", "group": "ownership", "evidence": "an exchange listing or an annual report", "source": "s:wp-max-healthcare", "note": "listed on the Indian exchanges in August 2020", "tier": "cited", "url": "" } ], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "The Delhi-side flagship, off Press Enclave Road in Saket.", "rel": "part" } ] }, { "schema": 1, "id": "medanta", "type": "facility", "names": { "name": "Medanta — The Medicity, Gurugram", "aliases": [ "Medanta", "The Medicity", "मेदांता" ], "said": "Medanta, stress on the second syllable. The hospital calls the campus The Medicity; the group is listed as MEDANTA on the National Stock Exchange." }, "region": [ "south-asia" ], "facets": { "iso2": "IN", "ownership": "private", "founded": 2009, "specialty": [ "cardiac sciences", "liver transplant", "neurosciences", "oncology", "orthopaedics", "health screening" ], "draws": [ "cabg", "liver-transplant", "knee-replacement", "executive-health-screening" ], "status": "open", "languages": [ "English", "Hindi", "Arabic" ] }, "text": { "what": "A 1,250-bed hospital on 43 acres in Sector 38 of Gurugram, founded in 2009 by the cardiac surgeon Naresh Trehan and Sunil Sachdeva and built for about 1,200 crore rupees. The group listed on both Indian exchanges in November 2022 and now runs five hospitals. It publishes its health-check prices, and it publishes the maximum retail price of the coronary stents and knee implants it fits.", "story": "Medanta was built as a single campus rather than a chain: one 43-acre site in Gurugram with a named surgeon at the top of it, opened in 2009. The group reported revenue of 3,771 crore rupees for 2025 and ran five hospitals — Gurugram, Lucknow, Patna, Indore and Ranchi — between 160 and 1,250 beds each. It was ranked second among India's hospitals in the 2020 and 2021 Newsweek and Statista listings and 132nd globally in 2022.\n\nThe implant price disclosure is the part of this record that matters most to a foreign patient, and it is not a marketing decision. India's drug pricing regulator capped the price of coronary stents in 2017 and of knee implants shortly after, and hospitals display the maximum retail price of each device against the cap. Medanta's policies page carries both lists, the coronary stent prices dated to notifications from April 2018 onward and a further update effective April 2023.\n\n*Inference —* a hospital that must publish what the metal costs has less room to move the cost of an operation between the surgery line and the implant line. The published cap is the reason an Indian joint quote and a Thai joint quote are not comparing the same object: the Thai package usually leaves the implant out, and the Indian bill usually has it priced against a ceiling.", "how": "Health-check programmes are bought off a public list with the rupee price beside each name; the tests inside each one sit a click deeper. Surgical work is quoted rather than listed. The stent and knee-implant price lists sit under Policies and Forms rather than under prices, which is where a regulator's disclosure requirement tends to put them.", "today": "As of 16 September 2026 the Gurugram health-check list runs from 5,500 rupees for a basic diabetes package to 28,000 for the group's longest whole-body programme, with the Medanta Whole Body Package at 25,000 rupees for men and for women. The policies page names current documents for coronary stent and orthopaedic knee-system maximum retail prices; the figures themselves sit inside linked files this record has not opened." }, "geo": { "lat": 28.4389467, "lon": 77.0402727, "precision": "street", "source": "s:osm" }, "address": { "street": "CH Baktawar Singh Road, Sector 38", "city": "Gurugram", "area": "Haryana", "country": "IN", "postcode": "122001" }, "metrics": { "beds": 1250, "doctors": null, "annual_patients": null, "annual_foreign_patients": null, "revenue_usd": 390000000, "note": "1,250 beds is the Gurugram campus, not the group, which runs five hospitals between 160 and 1,250 beds. The revenue figure is the group's reported 2025 revenue of 3,771 crore rupees, given in the source as about 390 million US dollars at that year's rate; this project has not reconverted it. No patient count and no foreign-patient count was found published.", "as_of": "2025", "source": "s:wp-medanta", "url": "https://en.wikipedia.org/wiki/Medanta" }, "tags": [ { "tag": "price-published", "source": "s:medanta-healthcheck", "tier": "cited", "note": "health-check packages priced in rupees on a public list", "url": "https://www.medanta.org/healthcheckup/gurugram-hospital" }, { "tag": "package", "source": "s:medanta-healthcheck", "tier": "cited" }, { "tag": "listed-company", "source": "s:wp-medanta", "tier": "cited", "note": "National Stock Exchange ticker MEDANTA and BSE 543654, listed November 2022" }, { "tag": "chain", "source": "s:wp-medanta", "tier": "cited", "note": "five hospitals: Gurugram, Lucknow, Patna, Indore, Ranchi" }, { "tag": "transplant-programme", "source": "s:wp-medanta", "tier": "cited", "note": "the hospital's liver transplant programme is one of the campus's named units" } ], "recognitions": [ { "by": "newsweek-statista", "what": "Second among India's hospitals in the 2020 and 2021 listings, 132nd globally in 2022", "year": 2020, "valid_until": null, "source": "s:wp-medanta", "url": "https://en.wikipedia.org/wiki/Medanta", "note": "a survey-and-indicator listing, counted here and never read as a quality score" } ], "prices": [ { "procedure": "executive-health-screening", "country": "IN", "city": "Gurugram", "facility": "medanta", "amount": 25000, "currency": "INR", "as_of": "2026-09-16", "kind": "package", "includes": [ "whole body check, men's or women's version" ], "excludes": [ "anything the screening then finds" ], "source": "s:medanta-healthcheck", "url": "https://www.medanta.org/healthcheckup/gurugram-hospital", "note": "the Medanta Whole Body Package, priced identically for men and women. The list it sits on runs from 5,500 rupees for a basic diabetes package to 28,000 for the longest programme. The listing page carries the price only; the test list sits on the individual package page.", "tier": "cited", "usd": 260.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "delhi-ncr", "as": "One of the two Gurugram campuses the Delhi cluster is named for, eight kilometres from the other.", "rel": "place" }, { "to": "india", "as": "An Indian hospital that publishes what the implant costs as well as what the check-up costs.", "rel": "destination" }, { "to": "fortis-gurgaon", "as": "Its neighbour and competitor in the same city, which publishes neither.", "rel": "contrast" }, { "to": "liver-transplant", "as": "One of the campus's named referral programmes.", "rel": "performs" }, { "to": "executive-health-screening", "as": "Sold here off a public list at a stated rupee price.", "rel": "performs" }, { "to": "implant-excluded", "as": "The counter-example: here the implant price is published against a regulator's ceiling instead of left out of the quote.", "rel": "risk" }, { "to": "package-price", "as": "Sells check-ups in this form; operations are still quoted case by case.", "rel": "term" }, { "to": "bumrungrad", "as": "The comparison a joint patient actually faces: a Thai package without the implant against an Indian bill with the implant priced.", "rel": "contrast" } ], "links": [ { "label": "Medanta", "url": "https://www.medanta.org/" }, { "label": "Health checkup packages, Gurugram", "url": "https://www.medanta.org/healthcheckup/gurugram-hospital" }, { "label": "Policies and forms, including implant and stent prices", "url": "https://www.medanta.org/policy-and-forms" } ], "sources": [ "s:wp-medanta", "s:medanta-healthcheck", "s:medanta-policy-forms", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node Medanta The Medicity, Sector 38" }, "metrics": { "tier": "cited", "source": "s:wp-medanta" } } }, "x_commons_files": [ "File:Medanta The Medicity.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "A 1,250-bed hospital on 43 acres in Sector 38 of Gurugram, founded in 2009 by the cardiac surgeon Naresh Trehan and Sunil Sachdeva and built for about 1,200 crore rupees.", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" } ], "kin_out": [ { "to": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "One of the two Gurugram campuses the Delhi cluster is named for, eight kilometres from the other.", "rel": "place" }, { "to": "india", "type": "destination", "name": "India", "as": "An Indian hospital that publishes what the implant costs as well as what the check-up costs.", "rel": "destination" }, { "to": "fortis-gurgaon", "type": "facility", "name": "Fortis Memorial Research Institute, Gurugram", "as": "Its neighbour and competitor in the same city, which publishes neither.", "rel": "contrast" }, { "to": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "One of the campus's named referral programmes.", "rel": "performs" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "Sold here off a public list at a stated rupee price.", "rel": "performs" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The counter-example: here the implant price is published against a regulator's ceiling instead of left out of the quote.", "rel": "risk" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "Sells check-ups in this form; operations are still quoted case by case.", "rel": "term" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "The comparison a joint patient actually faces: a Thai package without the implant against an Indian bill with the implant priced.", "rel": "contrast" } ], "source_list": [ { "id": "s:wp-medanta", "kind": "wikipedia", "title": "Medanta", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medanta", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:medanta-healthcheck", "kind": "web", "title": "Health Checkup Packages — Gurugram hospital", "publisher": "Medanta", "url": "https://www.medanta.org/healthcheckup/gurugram-hospital", "accessed": "2026-09-16", "note": "package names and rupee prices printed on the listing page" }, { "id": "s:medanta-policy-forms", "kind": "web", "title": "Policies & Forms — MRP of coronary stents and orthopaedic knee systems", "publisher": "Medanta", "url": "https://www.medanta.org/policy-and-forms", "accessed": "2026-09-16", "note": "the index names the price documents; the figures themselves sit in linked files" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "cited" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node Medanta The Medicity, Sector 38" }, "address": { "tier": "cited" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-medanta" } }, "primary_image": null, "tag_facts": [ { "key": "price-published", "label": "Publishes prices", "icon": "💰", "group": "money", "evidence": "a public price list or package page on the facility's own site, read on a dated visit", "source": "s:medanta-healthcheck", "note": "health-check packages priced in rupees on a public list", "tier": "cited", "url": "https://www.medanta.org/healthcheckup/gurugram-hospital" }, { "key": "package", "label": "Sells packages", "icon": "🧳", "group": "money", "evidence": "a bundled price on the facility's own page covering more than the operation", "source": "s:medanta-healthcheck", "note": "", "tier": "cited", "url": "" }, { "key": "listed-company", "label": "Publicly listed", "icon": "📈", "group": "ownership", "evidence": "an exchange listing or an annual report", "source": "s:wp-medanta", "note": "National Stock Exchange ticker MEDANTA and BSE 543654, listed November 2022", "tier": "cited", "url": "" }, { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:wp-medanta", "note": "five hospitals: Gurugram, Lucknow, Patna, Indore, Ranchi", "tier": "cited", "url": "" }, { "key": "transplant-programme", "label": "Transplant programme", "icon": "🫀", "group": "clinical", "evidence": "a national transplant registry, a ministry licence list, or the facility's own programme page", "source": "s:wp-medanta", "note": "the hospital's liver transplant programme is one of the campus's named units", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "newsweek-statista", "label": "Newsweek / Statista World's Best Hospitals", "what": "Second among India's hospitals in the 2020 and 2021 listings, 132nd globally in 2022", "url": "https://en.wikipedia.org/wiki/Medanta", "kind": "listing", "year": 2020, "valid_until": null, "source": "s:wp-medanta" } ], "acclaim": 1, "kin_in": [ { "from": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "The Sector 38 hospital in Gurugram, 1,250 beds on 43 acres, opened 2009.", "rel": "part" }, { "from": "angioplasty-stent", "type": "procedure", "name": "Coronary angioplasty and stent", "as": "Publishes an index of its coronary stent prices beside the price regulator's notifications.", "rel": "performed-at" }, { "from": "fortis-gurgaon", "type": "facility", "name": "Fortis Memorial Research Institute, Gurugram", "as": "Its neighbour and direct competitor, eight kilometres away in Sector 38, which does publish prices.", "rel": "contrast" }, { "from": "max-saket", "type": "facility", "name": "Max Super Speciality Hospital, Saket", "as": "The Gurugram competitor that publishes its check-up prices and its implant ceilings; this one publishes neither.", "rel": "contrast" } ] }, { "schema": 1, "id": "medicana", "type": "facility", "names": { "name": "Medicana Health Group", "aliases": [ "Medicana Sağlık Grubu", "Medicana International Istanbul" ], "said": "Med-ee-JAH-na. The group is Medicana; the building this record pins is Medicana International İstanbul at Beylikdüzü, on the western edge of the city where the E-5 runs out towards Thrace." }, "region": [ "west-asia" ], "facets": { "iso2": "TR", "ownership": "private", "founded": 1992, "specialty": [ "oncology", "organ transplantation", "bone marrow transplantation", "cardiovascular surgery", "fertility", "bariatric surgery" ], "draws": [ "kidney-transplant", "liver-transplant", "bone-marrow-transplant", "ivf", "gastric-sleeve" ], "status": "open", "languages": [ "Turkish", "English", "Russian", "Arabic", "Kurdish", "Somali" ] }, "text": { "what": "A Turkish hospital group of eighteen hospitals — sixteen across seven Turkish cities, one at Winchester in England and one at Sarajevo — trading since 1992. This record is the group, and it pins Medicana International İstanbul at Beylikdüzü, the hospital the group presents first to patients from abroad.", "story": "Medicana began in 1992 and grew into Istanbul, Ankara, Izmir, Konya, Samsun, Sivas and Bursa, then outward to Winchester and Sarajevo. It states more than 5.5 million patients a year from Türkiye and elsewhere.\n\nThat figure needs its qualifier. It is a group total for eighteen hospitals in three countries, it is not separated into foreign and domestic, and it counts encounters rather than people: a Turkish patient with a chronic condition who attends an outpatient clinic monthly is twelve of the 5.5 million. This directory carries it as the group's own count of its own attendances and nothing more.\n\nThe Beylikdüzü hospital reads like a building designed for arrivals: 30,000 square metres, eight operating theatres, twenty-six observation beds, twenty-six or more clinical services, and an international patient centre with full-time interpreters in English, Russian, Arabic, Kurdish and Somali working around the clock. *Inference —* the language list is the itinerary. Kurdish and Somali are not on the signage of a hospital selling to Western Europe.\n\nThe group's about page, unusually, names no accreditation at all. The Beylikdüzü page carries one image, of the Türkiye health tourism authorisation certificate.", "how": "*Trade practice —* a Turkish group with an international patient centre works by routing: the enquiry lands centrally, the records are read, a hospital is assigned, and a figure follows by email. Medicana publishes no bed count for the group, no bed count for the flagship — the sentence on its own page has the number missing from it — and no price for anything.", "today": "As of 17 September 2026 the group states eighteen hospitals in three countries and more than 5.5 million patients a year. Its flagship page states eight operating theatres, twenty-six observation beds and 30,000 square metres, and leaves the inpatient bed figure blank. No JCI or other international accreditation is named on either page read here." }, "geo": { "lat": 41.012918, "lon": 28.645091, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "Beylikdüzü Caddesi, Büyükşehir Mahallesi, Beylikdüzü", "city": "Istanbul", "country": "TR", "postcode": "34521" }, "metrics": { "beds": null, "annual_patients": 5500000, "annual_foreign_patients": null, "note": "A GROUP figure and a count of VISITS, not of people: more than 5.5 million patients a year across eighteen hospitals in Türkiye, England and Bosnia and Herzegovina, domestic and foreign together, as stated on the group's own about page. A patient attending monthly is counted twelve times. No bed count is published for the group or for the flagship — the flagship's own sentence leaves the figure out — and no foreign share is given.", "as_of": "2026", "source": "s:medicana-about", "url": "https://www.medicanainternational.com/en/our-corporate/about-us" }, "tags": [ { "tag": "chain", "source": "s:medicana-about", "tier": "cited", "note": "eighteen hospitals: sixteen across Istanbul, Ankara, Izmir, Konya, Samsun, Sivas and Bursa, plus Winchester and Sarajevo" }, { "tag": "international-office", "source": "s:medicana-int-istanbul", "tier": "cited", "note": "an international patient centre office at the Beylikdüzü hospital", "url": "https://www.medicanainternational.com/en/international-istanbul" }, { "tag": "interpreter", "source": "s:medicana-int-istanbul", "tier": "cited", "note": "full-time English, Russian, Arabic, Kurdish and Somali interpreters stated as working around the clock" }, { "tag": "transplant-programme", "source": "s:medicana-about", "tier": "cited", "note": "organ transplantation and bone marrow transplantation named among the group's specialties" }, { "tag": "no-price-published", "source": "s:medicana-about", "tier": "cited", "note": "neither the group page nor the flagship page carries a figure for anything" } ], "recognitions": [ { "by": "moh-tr", "what": "Türkiye health tourism authorisation certificate, displayed on the flagship's own page", "year": null, "valid_until": null, "source": "s:medicana-int-istanbul", "url": "https://www.medicanainternational.com/en/international-istanbul", "note": "the certificate appears as an image with no number or date legible in the page text; it is the licence a Turkish facility must hold to treat international patients" } ], "kin": [ { "to": "istanbul", "as": "Its flagship stands at Beylikdüzü, on the western edge of the city rather than in it.", "rel": "place" }, { "to": "turkiye", "as": "One of the four private groups a foreign enquiry to Türkiye is routed through.", "rel": "destination" }, { "to": "turkiye-health-tourism-authorisation", "as": "The one certificate its flagship page displays.", "rel": "governed-by" }, { "to": "kidney-transplant", "as": "Named among the group's specialties, without a hospital or a volume against it.", "rel": "performs" }, { "to": "acibadem", "as": "The larger group, and the one whose ownership runs back to Malaysia.", "rel": "contrast" }, { "to": "counting-patients", "as": "5.5 million a year, across eighteen hospitals in three countries, domestic and foreign together, counting attendances.", "rel": "story" }, { "to": "getting-a-quote", "as": "With nothing published, the quotation is the only price that exists here.", "rel": "step" } ], "links": [ { "label": "Medicana Health Group", "url": "https://www.medicanainternational.com/en/our-corporate/about-us" }, { "label": "Medicana International İstanbul", "url": "https://www.medicanainternational.com/en/international-istanbul" } ], "sources": [ "s:medicana-about", "s:medicana-int-istanbul", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim", "note": "the OpenStreetMap point for Medicana International Hastanesi, Beylikdüzü Caddesi" }, "text.how": { "tier": "tradition", "note": "the routing is trade practice and marked so in the prose; the publication facts are cited" }, "metrics": { "tier": "cited", "source": "s:medicana-about" } } }, "x_commons_files": [], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "A Turkish hospital group of eighteen hospitals — sixteen across seven Turkish cities, one at Winchester in England and one at Sarajevo — trading since 1992.", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "Its flagship stands at Beylikdüzü, on the western edge of the city rather than in it.", "rel": "place" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "One of the four private groups a foreign enquiry to Türkiye is routed through.", "rel": "destination" }, { "to": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The one certificate its flagship page displays.", "rel": "governed-by" }, { "to": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "Named among the group's specialties, without a hospital or a volume against it.", "rel": "performs" }, { "to": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "The larger group, and the one whose ownership runs back to Malaysia.", "rel": "contrast" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "5.5 million a year, across eighteen hospitals in three countries, domestic and foreign together, counting attendances.", "rel": "story" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "With nothing published, the quotation is the only price that exists here.", "rel": "step" } ], "source_list": [ { "id": "s:medicana-about", "kind": "web", "title": "About Us — Medicana Health Group", "publisher": "Medicana Sağlık Grubu", "url": "https://www.medicanainternational.com/en/our-corporate/about-us", "accessed": "2026-09-17", "note": "the group's own account: services begun 1992, 18 hospitals of which 16 across seven Turkish cities and two abroad at Winchester and Sarajevo, and more than 5.5 million patients a year. No bed count, no doctor count and no accreditation is named on the page." }, { "id": "s:medicana-int-istanbul", "kind": "web", "title": "Medicana International Istanbul Hospital", "publisher": "Medicana Sağlık Grubu", "url": "https://www.medicanainternational.com/en/international-istanbul", "accessed": "2026-09-17", "note": "the flagship's own page: 30,000 square metres, eight operating theatres, 26 observation beds, 26-plus clinical services, an international patient centre with full-time English, Russian, Arabic, Kurdish and Somali interpreters, and an image of the Türkiye health tourism authorisation certificate. The inpatient bed figure is blank in the page's own text." }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "the routing is trade practice and marked so in the prose; the publication facts are cited" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim", "note": "the OpenStreetMap point for Medicana International Hastanesi, Beylikdüzü Caddesi" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:medicana-about" } }, "primary_image": null, "tag_facts": [ { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:medicana-about", "note": "eighteen hospitals: sixteen across Istanbul, Ankara, Izmir, Konya, Samsun, Sivas and Bursa, plus Winchester and Sarajevo", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:medicana-int-istanbul", "note": "an international patient centre office at the Beylikdüzü hospital", "tier": "cited", "url": "https://www.medicanainternational.com/en/international-istanbul" }, { "key": "interpreter", "label": "Interpreters on staff", "icon": "🗣", "group": "service", "evidence": "the facility's own page naming the languages, or a published inspection or accreditation report", "source": "s:medicana-int-istanbul", "note": "full-time English, Russian, Arabic, Kurdish and Somali interpreters stated as working around the clock", "tier": "cited", "url": "" }, { "key": "transplant-programme", "label": "Transplant programme", "icon": "🫀", "group": "clinical", "evidence": "a national transplant registry, a ministry licence list, or the facility's own programme page", "source": "s:medicana-about", "note": "organ transplantation and bone marrow transplantation named among the group's specialties", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:medicana-about", "note": "neither the group page nor the flagship page carries a figure for anything", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "moh-tr", "label": "Türkiye Ministry of Health health-tourism authorisation", "what": "Türkiye health tourism authorisation certificate, displayed on the flagship's own page", "url": "https://www.medicanainternational.com/en/international-istanbul", "kind": "regulator", "year": null, "valid_until": null, "source": "s:medicana-int-istanbul" } ], "acclaim": 1, "kin_in": [] }, { "schema": 1, "id": "memorial-sisli", "type": "facility", "names": { "name": "Memorial Şişli Hospital", "aliases": [ "Memorial Şişli Hastanesi", "Memorial Healthcare Group", "Memorial Hospitals Group" ], "said": "SHISH-li, the Istanbul district it stands in, on Piyalepaşa Bulvarı. The group is Memorial; the Şişli hospital is the one that opened first and the one the group's firsts are dated from." }, "region": [ "west-asia" ], "facets": { "iso2": "TR", "ownership": "private", "founded": 2000, "specialty": [ "organ transplantation", "fertility", "oncology", "bone marrow transplantation", "cardiac surgery", "bariatric surgery" ], "draws": [ "ivf", "icsi", "pgt", "kidney-transplant", "liver-transplant", "bone-marrow-transplant", "gastric-sleeve" ], "status": "open", "languages": [ "Turkish", "English", "Arabic", "Russian", "Romanian", "Albanian" ] }, "text": { "what": "The first hospital of the Memorial Healthcare Group, opened in 2000 on Piyalepaşa Bulvarı in Şişli, Istanbul, and the first hospital in Türkiye to take Joint Commission International accreditation — the 21st in the world, by the group's own count. This record is the Şişli hospital and pins it; where a figure belongs to the whole group of twelve hospitals, the record says so.", "story": "Memorial Şişli opened in 2000. Its IVF, andrology and genetics centre followed, then the heart health centre, then the JCI certificate that the group's founder Turgut Aydın still leads with: \"We accomplished great things with pride of obtaining JCI Accreditation Certificate, which is the international quality certificate in the Health Care, as first in Turkey and 21st in the world.\"\n\nIn March 2004 the hospital took the first Ministry of Health licence granted to a private Turkish hospital for liver and kidney transplantation and the laboratory services that go with them. Its transplant centre, its tissue typing and immunology laboratory — the first private Turkish laboratory accredited by the European Federation for Immunogenetics — and its IVF laboratory, accredited by TÜRKAK to ISO 15189, are the units the group dates its firsts from.\n\nThe group grew outward: Ataşehir, Antalya, Diyarbakır, Kayseri, Ankara, Bahçelievler, and information offices in Baku, Tirana, Sarajevo, Tashkent, Abuja, Constanța and Northern Cyprus. *Inference —* the office list is a map of where the patients come from, and it points east and south rather than west.\n\nThe group reports patients from 167 countries. That is a count of countries, not of patients, and the group publishes neither a patient count nor a price.", "how": "An enquiry reaches the group rather than the hospital, through one of the overseas information offices or the website, and is placed at whichever of the twelve hospitals holds the programme. *Trade practice —* transplant and fertility work, which is what Memorial is known for abroad, is quoted after records are read and not from a list.\n\nThe Şişli hospital's own page links health packages — cancer control programmes, heart control programmes — behind a contact form. No figure is printed on it.", "today": "As of 17 September 2026 the group states 12 hospitals, 92 medical units, more than 7,300 employees and more than 1,510 beds across the group, and patients from 167 countries. The Şişli hospital is reported elsewhere at 252 beds on a 53,000 square metre site; that figure is not on the hospital's own page read here and is carried as unverified." }, "geo": { "lat": 41.06165, "lon": 28.972695, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "Piyalepaşa Bulvarı, Okmeydanı, Şişli", "city": "Istanbul", "country": "TR", "postcode": "34385" }, "metrics": { "beds": 1510, "staff": 7300, "annual_patients": null, "annual_foreign_patients": null, "foreign_patient_countries": 167, "note": "GROUP figures, not this hospital's: more than 1,510 beds and more than 7,300 employees across twelve hospitals and 92 medical units. The Şişli hospital's own bed count is not stated on its page. The country figure is where patients come from, not how many come; a patient who returns is not counted twice because nobody is counting patients at all here.", "as_of": "2026", "source": "s:memorial-about", "url": "https://www.memorial.com.tr/en/about-us" }, "tags": [ { "tag": "chain", "source": "s:memorial-about", "tier": "cited", "note": "twelve hospitals and 92 medical units in Istanbul, Antalya, Ankara, Kayseri and Diyarbakır, with information offices in Baku, Tirana, Sarajevo, Tashkent, Abuja, Constanța and Northern Cyprus" }, { "tag": "transplant-programme", "source": "s:memorial-about", "tier": "cited", "note": "the first private Turkish hospital licensed by the Ministry of Health for liver and kidney transplantation, March 2004" }, { "tag": "international-office", "source": "s:memorial-about", "tier": "cited", "note": "seven named overseas information offices and patients stated from 167 countries" }, { "tag": "no-price-published", "source": "s:memorial-sisli", "tier": "cited", "note": "the hospital page lists cancer control and heart control packages behind a contact form, with no figure", "url": "https://www.memorial.com.tr/en/hospitals/memorial-sisli-hospital" }, { "tag": "outcomes-published", "source": "s:memorial-about", "tier": "cited", "note": "the group's own firsts page states outcomes for individual operations rather than a unit-level series; read as a claim, not a registry" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation — the first Turkish hospital to hold it, and the 21st in the world by the group's count", "year": null, "valid_until": null, "source": "s:memorial-about", "url": "https://www.memorial.com.tr/en/about-us", "note": "the group's timeline places the award between the 2000 opening and the 2004 transplant licence but prints no year against it" }, { "by": "moh-tr", "what": "Ministry of Health licence for liver and kidney transplantation and the related laboratory services, the first granted to a private hospital in Türkiye", "year": 2004, "valid_until": null, "source": "s:memorial-about", "url": "https://www.memorial.com.tr/en/about-us", "note": "March 2004; a transplant licence rather than a health tourism authorisation, recorded under the same regulator" }, { "by": "other", "what": "European Federation for Immunogenetics accreditation of the tissue typing and immunology laboratory, and TÜRKAK ISO 15189 accreditation of the IVF laboratory", "year": null, "valid_until": null, "source": "s:memorial-about", "url": "https://www.memorial.com.tr/en/about-us", "note": "laboratory accreditations, stated by the group as firsts in Türkiye" } ], "kin": [ { "to": "istanbul", "as": "Stands in Şişli, on the European side, and is the hospital the group's firsts are dated from.", "rel": "place" }, { "to": "turkiye", "as": "The first Turkish hospital to hold JCI accreditation, which is the date Turkish private medicine abroad is usually counted from.", "rel": "destination" }, { "to": "jci", "as": "The accreditor whose mark it took first in the country and 21st in the world.", "rel": "accredited-by" }, { "to": "ivf", "as": "Its fertility, andrology and genetics centre is the unit foreign patients reach it through most.", "rel": "performs" }, { "to": "kidney-transplant", "as": "Licensed for it in March 2004, the first private Turkish hospital to be.", "rel": "performs" }, { "to": "surrogacy", "as": "Turkish law bars third-party reproduction, so a fertility centre here sells its own citizens a narrower menu than its foreign patients may expect.", "rel": "contrast" }, { "to": "acibadem", "as": "The larger Turkish group, and the other name a foreign enquiry lands on.", "rel": "contrast" }, { "to": "turkiye-health-tourism-authorisation", "as": "Operates under the regime every Turkish facility treating foreign patients has needed since July 2017.", "rel": "governed-by" }, { "to": "counting-patients", "as": "167 countries is the group's headline figure, and it counts countries because nobody publishes patients.", "rel": "story" } ], "links": [ { "label": "Memorial Şişli Hospital", "url": "https://www.memorial.com.tr/en/hospitals/memorial-sisli-hospital" }, { "label": "Memorial Hospitals Group — About Us", "url": "https://www.memorial.com.tr/en/about-us" } ], "sources": [ "s:memorial-about", "s:memorial-sisli", "s:osm-nominatim", "s:gurtin-2011-turkey" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "text.how": { "tier": "tradition", "note": "how an enquiry travels through a Turkish group with overseas offices; the last paragraph is cited" }, "metrics": { "tier": "cited", "source": "s:memorial-about" } } }, "x_commons_files": [ "File:Memorial Şişli Hastanesi.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "The first hospital of the Memorial Healthcare Group, opened in 2000 on Piyalepaşa Bulvarı in Şişli, Istanbul, and the first hospital in Türkiye to take Joint Commission International accreditation — the 21st in the…", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "Stands in Şişli, on the European side, and is the hospital the group's firsts are dated from.", "rel": "place" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The first Turkish hospital to hold JCI accreditation, which is the date Turkish private medicine abroad is usually counted from.", "rel": "destination" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The accreditor whose mark it took first in the country and 21st in the world.", "rel": "accredited-by" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "Its fertility, andrology and genetics centre is the unit foreign patients reach it through most.", "rel": "performs" }, { "to": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "Licensed for it in March 2004, the first private Turkish hospital to be.", "rel": "performs" }, { "to": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "Turkish law bars third-party reproduction, so a fertility centre here sells its own citizens a narrower menu than its foreign patients may expect.", "rel": "contrast" }, { "to": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "The larger Turkish group, and the other name a foreign enquiry lands on.", "rel": "contrast" }, { "to": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "Operates under the regime every Turkish facility treating foreign patients has needed since July 2017.", "rel": "governed-by" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "167 countries is the group's headline figure, and it counts countries because nobody publishes patients.", "rel": "story" } ], "source_list": [ { "id": "s:memorial-about", "kind": "web", "title": "About Us — Memorial Hospitals Group", "publisher": "Memorial Sağlık Grubu", "url": "https://www.memorial.com.tr/en/about-us", "accessed": "2026-09-17", "note": "read in the browser on 17 September 2026. The group's own counters: 92 medical units, 12 hospitals, 7,300+ employees, 1,510+ bed capacity, patients from 167 countries. Founder Turgut Aydın's message states the group took the JCI accreditation certificate first in Turkey and 21st in the world. The timeline page dates Memorial Şişli's opening, its heart centre, its transplant licence of March 2004 and the group's overseas offices." }, { "id": "s:memorial-sisli", "kind": "web", "title": "Şişli Hospital — Memorial", "publisher": "Memorial Sağlık Grubu", "url": "https://www.memorial.com.tr/en/hospitals/memorial-sisli-hospital", "accessed": "2026-09-17", "note": "read in the browser on 17 September 2026 for the address Piyalepaşa Bulvarı 34385, Şişli, Istanbul. The hospital page links health packages — cancer control and heart control programmes — under a contact form; no price appears on it." }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." }, { "id": "s:gurtin-2011-turkey", "kind": "paper", "title": "Banning reproductive travel: Turkey's ART legislation and third-party assisted reproduction", "publisher": "Reproductive BioMedicine Online (Gurtin ZB)", "url": "https://www.rbmojournal.com/article/S1472-6483(11)00470-6/fulltext", "accessed": "2026-09-16", "note": "citation and the 2010 regulation's extraterritorial clause verified from the journal's own article listing; the full text returned HTTP 403 and was not read. Treated as needing verification wherever it is relied on." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "how an enquiry travels through a Turkish group with overseas offices; the last paragraph is cited" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:memorial-about" } }, "primary_image": null, "tag_facts": [ { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:memorial-about", "note": "twelve hospitals and 92 medical units in Istanbul, Antalya, Ankara, Kayseri and Diyarbakır, with information offices in Baku, Tirana, Sarajevo, Tashkent, Abuja, Constanța and Northern Cyprus", "tier": "cited", "url": "" }, { "key": "transplant-programme", "label": "Transplant programme", "icon": "🫀", "group": "clinical", "evidence": "a national transplant registry, a ministry licence list, or the facility's own programme page", "source": "s:memorial-about", "note": "the first private Turkish hospital licensed by the Ministry of Health for liver and kidney transplantation, March 2004", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:memorial-about", "note": "seven named overseas information offices and patients stated from 167 countries", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:memorial-sisli", "note": "the hospital page lists cancer control and heart control packages behind a contact form, with no figure", "tier": "cited", "url": "https://www.memorial.com.tr/en/hospitals/memorial-sisli-hospital" }, { "key": "outcomes-published", "label": "Publishes outcomes", "icon": "📊", "group": "clinical", "evidence": "a registry submission, an annual clinical report, or a national outcome dataset naming the unit", "source": "s:memorial-about", "note": "the group's own firsts page states outcomes for individual operations rather than a unit-level series; read as a claim, not a registry", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation — the first Turkish hospital to hold it, and the 21st in the world by the group's count", "url": "https://www.memorial.com.tr/en/about-us", "kind": "international", "year": null, "valid_until": null, "source": "s:memorial-about" }, { "key": "moh-tr", "label": "Türkiye Ministry of Health health-tourism authorisation", "what": "Ministry of Health licence for liver and kidney transplantation and the related laboratory services, the first granted to a private hospital in Türkiye", "url": "https://www.memorial.com.tr/en/about-us", "kind": "regulator", "year": 2004, "valid_until": null, "source": "s:memorial-about" }, { "key": "other", "label": "Somebody else", "what": "European Federation for Immunogenetics accreditation of the tissue typing and immunology laboratory, and TÜRKAK ISO 15189 accreditation of the IVF laboratory", "url": "https://www.memorial.com.tr/en/about-us", "kind": "other", "year": null, "valid_until": null, "source": "s:memorial-about" } ], "acclaim": 3, "kin_in": [ { "from": "istanbul", "type": "hub", "name": "Istanbul", "as": "A large private hospital inside the belt, in Şişli itself.", "rel": "part" } ] }, { "schema": 1, "id": "mount-elizabeth", "type": "facility", "names": { "name": "Mount Elizabeth Hospital", "aliases": [ "Mount E", "Mount Elizabeth Orchard", "Mount Elizabeth Novena" ], "said": "Mount E, in Singapore. The address is the name: 3 Mount Elizabeth, the short road off Orchard Road, and the newer sister hospital at 38 Irrawaddy Road is Mount Elizabeth Novena." }, "region": [ "southeast-asia" ], "facets": { "iso2": "SG", "ownership": "private", "founded": 1979, "specialty": [ "cardiology", "oncology", "neuroscience", "orthopaedics" ], "draws": [ "cabg", "angioplasty-stent", "knee-replacement", "hip-replacement", "gamma-knife" ], "status": "open", "languages": [ "English", "Mandarin", "Malay", "Bahasa Indonesia" ] }, "text": { "what": "A 345-bed private hospital off Orchard Road in Singapore, opened on 8 December 1979 and owned since 1995 by Parkway Holdings, now part of the Malaysian group IHH Healthcare. Its Medical Centre houses clinics in 31 specialties. The 313-bed Mount Elizabeth Novena opened at 38 Irrawaddy Road on 2 July 2012, and about 30 per cent of its patients come from abroad.", "story": "Mount Elizabeth was the first private hospital in Singapore to perform open-heart surgery and the first to set up a nuclear medicine centre, and its identity has stayed cardiac, oncological and neurological since. The royal family of Brunei built a Royal Suite in it for their own use, later opened to other patients — a detail that says more about the hospital's regional market than any brochure would.\n\nThe ownership line runs to Kuala Lumpur and then to the same parent as Acıbadem in Istanbul and Gleneagles in Kuala Lumpur. *Inference —* a patient shopping across Istanbul, Kuala Lumpur and Singapore on price may be shopping three times inside one company, and none of the three sites says so.\n\nThe Novena figure is the one worth holding: about 30 per cent of patients at the newer hospital come from outside Singapore. That is a share of a named hospital's own caseload, which is a far narrower and more useful number than any national arrivals count.\n\nNeither hospital publishes a price. Singapore is unusual in that the Ministry of Health publishes hospital bill data and fee benchmarks by procedure and by hospital, so a figure for an operation at a named Singapore private hospital exists — it is published by the regulator rather than by the hospital.", "how": "*Trade practice —* the Singapore route is the expensive end of Asian private medicine and is bought for the system rather than the saving: a regulator that publishes bill data, an English-language legal system, and a concentration of specialists who consult in the medical centre and admit to the hospital next door. The patient's surgeon is usually a private practitioner with rooms in the tower, not an employee of the hospital, which is a fee structure a visitor from a salaried system does not expect.\n\nNo package price is published by the hospital.", "today": "As of 17 September 2026 the Orchard hospital carries 345 beds and the Novena hospital 313, both under IHH Healthcare through Parkway. Mount Elizabeth Medical Centre lists clinics in 31 specialties. About 30 per cent of Novena's patients are stated to come from abroad. No price is published by either hospital." }, "geo": { "lat": 1.305196, "lon": 103.835536, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "3 Mount Elizabeth", "city": "Singapore", "country": "SG", "postcode": "228510" }, "metrics": { "beds": 345, "annual_patients": null, "annual_foreign_patients": null, "note": "345 beds at the Orchard hospital this record pins; the sister hospital at Novena carries a further 313 and is a separate building. The only foreign figure published is a SHARE and it belongs to Novena, not here: about 30 per cent of its patients come from abroad. No count of patients — visits or people — is published for either.", "as_of": "2026", "source": "s:wp-mount-elizabeth", "url": "https://en.wikipedia.org/wiki/Mount_Elizabeth_Hospital" }, "tags": [ { "tag": "chain", "source": "s:wp-mount-elizabeth", "tier": "cited", "note": "owned by Parkway Holdings since 1995, operated under Parkway Pantai, part of IHH Healthcare" }, { "tag": "international-office", "source": "s:wp-mount-elizabeth", "tier": "cited", "note": "patients stated from Singapore, Southeast Asia and further; about 30 per cent of the Novena hospital's patients come from abroad" }, { "tag": "no-price-published", "source": "s:wp-mount-elizabeth", "tier": "cited", "note": "no price list was found on the hospital's own pages; Singapore's Ministry of Health publishes bill data and fee benchmarks instead" }, { "tag": "interpreter", "source": "s:wp-mount-elizabeth", "tier": "cited" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation", "year": null, "valid_until": null, "source": "s:wp-mount-elizabeth", "url": "https://en.wikipedia.org/wiki/Mount_Elizabeth_Hospital", "note": "the source names the accreditation and no year; none is asserted here" } ], "kin": [ { "to": "singapore-city", "as": "The Orchard Road hospital the Singapore cluster is usually named for.", "rel": "place" }, { "to": "singapore", "as": "The expensive end of Asian private medicine, bought for the regulator as much as for the surgeon.", "rel": "destination" }, { "to": "gleneagles-kl", "as": "A sister under the same parent, IHH Healthcare, two hundred miles up the peninsula and priced differently.", "rel": "contrast" }, { "to": "acibadem", "as": "The third hospital under the same Malaysian parent, in Istanbul — a price comparison that stays inside one company.", "rel": "contrast" }, { "to": "raffles-hospital", "as": "The other Singapore hospital here, which publishes its screening prices where this one publishes none.", "rel": "contrast" }, { "to": "cabg", "as": "The first private hospital in Singapore to do open-heart surgery, and still known for the cardiac work.", "rel": "performs" }, { "to": "jci", "as": "Named as its accreditor, undated in the source read here.", "rel": "accredited-by" }, { "to": "getting-a-quote", "as": "The surgeon has rooms in the medical centre and bills separately from the hospital, which is two quotations and not one.", "rel": "step" }, { "to": "counting-patients", "as": "About 30 per cent of one named hospital's patients from abroad is worth more than any national arrivals total.", "rel": "story" } ], "links": [ { "label": "Mount Elizabeth Hospitals", "url": "https://www.mountelizabeth.com.sg/" } ], "sources": [ "s:wp-mount-elizabeth", "s:wp-healthcare-singapore", "s:moh-sg-medical-travellers-2009", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "text.how": { "tier": "tradition", "note": "the Singapore fee structure and what the route is bought for; marked in the prose" }, "metrics": { "tier": "cited", "source": "s:wp-mount-elizabeth" } } }, "x_commons_files": [ "File:Mount Elizabeth Hospital.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "A 345-bed private hospital off Orchard Road in Singapore, opened on 8 December 1979 and owned since 1995 by Parkway Holdings, now part of the Malaysian group IHH Healthcare.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "singapore-city", "type": "hub", "name": "Singapore", "as": "The Orchard Road hospital the Singapore cluster is usually named for.", "rel": "place" }, { "to": "singapore", "type": "destination", "name": "Singapore", "as": "The expensive end of Asian private medicine, bought for the regulator as much as for the surgeon.", "rel": "destination" }, { "to": "gleneagles-kl", "type": "facility", "name": "Gleneagles Hospital Kuala Lumpur", "as": "A sister under the same parent, IHH Healthcare, two hundred miles up the peninsula and priced differently.", "rel": "contrast" }, { "to": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "The third hospital under the same Malaysian parent, in Istanbul — a price comparison that stays inside one company.", "rel": "contrast" }, { "to": "raffles-hospital", "type": "facility", "name": "Raffles Hospital", "as": "The other Singapore hospital here, which publishes its screening prices where this one publishes none.", "rel": "contrast" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The first private hospital in Singapore to do open-heart surgery, and still known for the cardiac work.", "rel": "performs" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "Named as its accreditor, undated in the source read here.", "rel": "accredited-by" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The surgeon has rooms in the medical centre and bills separately from the hospital, which is two quotations and not one.", "rel": "step" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "About 30 per cent of one named hospital's patients from abroad is worth more than any national arrivals total.", "rel": "story" } ], "source_list": [ { "id": "s:wp-mount-elizabeth", "kind": "wikipedia", "title": "Mount Elizabeth Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Mount_Elizabeth_Hospital", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-healthcare-singapore", "kind": "wikipedia", "title": "Healthcare in Singapore", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Healthcare_in_Singapore", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:moh-sg-medical-travellers-2009", "kind": "web", "title": "Medical Travellers Update", "publisher": "Ministry of Health, Singapore", "url": "https://www.moh.gov.sg/newsroom/medical-travellers-update/", "accessed": "2026-09-16", "note": "written answer to a parliamentary question from Dr Lam Pin Min, 22 January 2009, giving the Singapore Tourism Board's airport exit-survey estimates and the ministry's own doubt about the method" }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "the Singapore fee structure and what the route is bought for; marked in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-mount-elizabeth" } }, "primary_image": null, "tag_facts": [ { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:wp-mount-elizabeth", "note": "owned by Parkway Holdings since 1995, operated under Parkway Pantai, part of IHH Healthcare", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:wp-mount-elizabeth", "note": "patients stated from Singapore, Southeast Asia and further; about 30 per cent of the Novena hospital's patients come from abroad", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:wp-mount-elizabeth", "note": "no price list was found on the hospital's own pages; Singapore's Ministry of Health publishes bill data and fee benchmarks instead", "tier": "cited", "url": "" }, { "key": "interpreter", "label": "Interpreters on staff", "icon": "🗣", "group": "service", "evidence": "the facility's own page naming the languages, or a published inspection or accreditation report", "source": "s:wp-mount-elizabeth", "note": "", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation", "url": "https://en.wikipedia.org/wiki/Mount_Elizabeth_Hospital", "kind": "international", "year": null, "valid_until": null, "source": "s:wp-mount-elizabeth" } ], "acclaim": 1, "kin_in": [ { "from": "singapore", "type": "destination", "name": "Singapore", "as": "The private hospital most often named in the region's referrals.", "rel": "part" }, { "from": "singapore-city", "type": "hub", "name": "Singapore", "as": "At 3 Mount Elizabeth in Cairnhill, 345 beds, the anchor of the Orchard belt.", "rel": "part" }, { "from": "gleneagles-kl", "type": "facility", "name": "Gleneagles Hospital Kuala Lumpur", "as": "Same ultimate owner, an hour's flight away, at a different number for the same operation.", "rel": "contrast" }, { "from": "raffles-hospital", "type": "facility", "name": "Raffles Hospital", "as": "The other Singapore hospital in this directory: Orchard Road, IHH-owned, and priced nowhere in public.", "rel": "contrast" } ] }, { "schema": 1, "id": "narayana-health", "type": "facility", "names": { "name": "Narayana Health", "aliases": [ "Narayana Hrudayalaya", "NH", "ನಾರಾಯಣ ಹೃದಯಾಲಯ" ], "said": "Narayana Hrudayalaya — hrudayalaya is Kannada and Sanskrit for temple of the heart. The group renamed itself Narayana Health; the cardiac hospital at Bommasandra keeps the older name." }, "region": [ "south-asia" ], "facets": { "iso2": "IN", "ownership": "private", "founded": 2000, "specialty": [ "cardiac surgery", "paediatric cardiac surgery", "oncology", "transplants", "neurosciences" ], "draws": [ "cabg", "heart-valve-replacement", "angioplasty-stent", "bone-marrow-transplant" ], "status": "open", "languages": [ "English", "Kannada", "Hindi" ] }, "text": { "what": "A hospital group rather than a single building: 24 hospitals and seven heart centres in India plus Health City Cayman Islands, founded by the cardiac surgeon Devi Shetty and listed on both Indian exchanges since January 2016. This record is the group. Its point on the map is the cardiac hospital at Bommasandra on the southern edge of Bengaluru, which is where the group started and which holds its Joint Commission International accreditation.", "story": "Devi Shetty founded Narayana Hrudayalaya at Bommasandra, outside Bangalore, in 2001 — the company dates itself to 2000 — with an argument about volume rather than about technology: surgeons who operate thirty to thirty-five times a day, the group has said, against one or two in an American hospital, and the fixed costs of a theatre spread across all of them.\n\nThe number the group is famous for follows from that argument, and it is a group figure, not a price list. Bloomberg reported in 2013 that Narayana had brought coronary bypass surgery to 95,000 rupees, about 1,583 US dollars at the time, half what it had been twenty years earlier, and set the same procedure at the Cleveland Clinic in Ohio at 106,385 dollars. Shetty said then that he aimed to reach 800 dollars within a decade.\n\n*Inference —* that pair of numbers is the single most-quoted comparison in this whole subject, and it is quoted almost everywhere without its date, its currency, or the fact that it describes an Indian patient's bill at an Indian hospital rather than a package sold to somebody who flew in. It is carried here as what it is: a figure published in 2013, thirteen years before this record was written.\n\nThe Cayman Islands hospital is the other half of the story. A group that had already built the cheapest cardiac surgery in India built a hospital an hour's flight from Miami, which is what the trade calls arbitrage and what the group's own filings call expansion.", "how": "The group's model is stated openly: high volume, standardised surgical steps, in-house manufacture and procurement where it can, and cross-subsidy between paying and non-paying patients. *Trade practice —* a foreign patient reaches the group through an international office, gets an estimate by email, and is treated at whichever of the 24 hospitals holds the relevant programme; the price is not published per hospital.", "today": "As of 16 September 2026 the group reports 5,483 crore rupees of revenue for the 2025 financial year and 19,214 employees as of 2024. Two of its hospitals — the cardiac hospital at Bommasandra and Health City Cayman Islands — hold Joint Commission International accreditation. The famous bypass figure has not been restated by the group in a source read here since 2013." }, "geo": { "lat": 12.808022, "lon": 77.6947837, "precision": "street", "source": "s:osm" }, "address": { "street": "Bommasandra Industrial Area, Anekal Taluk", "city": "Bengaluru", "area": "Karnataka", "country": "IN", "postcode": "560099" }, "metrics": { "beds": null, "staff": 19214, "annual_patients": null, "annual_foreign_patients": null, "revenue_usd": 570000000, "note": "Staff and revenue are the GROUP's, not the Bommasandra hospital's: 19,214 employees as of 2024 and 5,483 crore rupees of revenue for the 2025 financial year, given in the source as about 570 million US dollars at that year's rate. No bed count for the flagship and no patient count of any kind was found published, and a group total would in any case count visits across 24 hospitals rather than people.", "as_of": "2025", "source": "s:wp-narayana-health", "url": "https://en.wikipedia.org/wiki/Narayana_Health" }, "tags": [ { "tag": "chain", "source": "s:wp-narayana-health", "tier": "cited", "note": "24 hospitals and seven heart centres in India, plus Health City Cayman Islands" }, { "tag": "listed-company", "source": "s:wp-narayana-health", "tier": "cited", "note": "listed on the BSE and NSE on 6 January 2016 at a valuation above one billion US dollars" }, { "tag": "transplant-programme", "source": "s:wp-narayana-health", "tier": "cited", "note": "the group's cardiac and bone-marrow transplant programmes" }, { "tag": "no-price-published", "source": "s:wp-narayana-health", "tier": "cited", "note": "no per-hospital price list was found; the figure the group is known by is a 2013 press report, carried in prices[] as an estimate" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation held by Narayana Institute of Cardiac Sciences, Bangalore, and by Health City Cayman Islands", "year": null, "valid_until": null, "source": "s:wp-narayana-health", "url": "https://en.wikipedia.org/wiki/Narayana_Health", "note": "two hospitals of twenty-five, not the group; the year first granted is not recorded here" } ], "prices": [ { "procedure": "cabg", "country": "IN", "city": "Bengaluru", "facility": "narayana-health", "amount": 95000, "currency": "INR", "as_of": "2013", "kind": "estimate", "includes": [ "coronary bypass surgery, as reported" ], "excludes": [ "unstated — the report names no inclusion list" ], "source": "s:wp-devi-shetty", "url": "https://en.wikipedia.org/wiki/Devi_Shetty", "note": "A GROUP figure, not a package price at a named hospital and not a current one. Bloomberg reported in 2013 that Narayana had brought coronary bypass to 95,000 rupees, about 1,583 US dollars then, and set the same operation at the Cleveland Clinic at 106,385 dollars. It is the number the group is famous for and the number most often reprinted without its date. Thirteen years old at the time this record was written.", "tier": "cited", "usd": 990.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "bengaluru", "as": "The city its first hospital was built outside, at Bommasandra on the Hosur road.", "rel": "place" }, { "to": "india", "as": "The group whose volume argument is what people mean when they say Indian heart surgery is cheap.", "rel": "destination" }, { "to": "devi-shetty", "as": "Its founder and the author of the volume argument.", "rel": "person" }, { "to": "cabg", "as": "The operation the group is known for, and the one the 2013 figure describes.", "rel": "performs" }, { "to": "is-it-cheaper", "as": "The 95,000-rupee figure against the Cleveland Clinic's 106,385 dollars is the comparison that essay exists to take apart.", "rel": "story" }, { "to": "the-price-that-isnt", "as": "A group figure from 2013, reprinted as a current price ever since.", "rel": "story" }, { "to": "apollo-chennai", "as": "The older Indian corporate hospital company, built on referral prestige rather than on volume.", "rel": "contrast" }, { "to": "jci", "as": "The accreditor whose mark two of its twenty-five hospitals hold.", "rel": "accredited-by" } ], "links": [ { "label": "Narayana Health", "url": "https://www.narayanahealth.org/" } ], "sources": [ "s:wp-narayana-health", "s:wp-devi-shetty", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "tradition", "note": "how a foreign patient reaches a multi-hospital Indian group; hedged in the prose" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node Narayana Hrudayalaya, Bommasandra — the group's flagship, standing for a group that has no single building" }, "metrics": { "tier": "cited", "source": "s:wp-narayana-health" } } }, "x_commons_files": [ "File:Narayana Hrudayalaya.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "A hospital group rather than a single building: 24 hospitals and seven heart centres in India plus Health City Cayman Islands, founded by the cardiac surgeon Devi Shetty and listed on both Indian exchanges since January…", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" } ], "kin_out": [ { "to": "bengaluru", "type": "hub", "name": "Bengaluru", "as": "The city its first hospital was built outside, at Bommasandra on the Hosur road.", "rel": "place" }, { "to": "india", "type": "destination", "name": "India", "as": "The group whose volume argument is what people mean when they say Indian heart surgery is cheap.", "rel": "destination" }, { "to": "devi-shetty", "type": "person", "name": "Devi Prasad Shetty", "as": "Its founder and the author of the volume argument.", "rel": "person" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The operation the group is known for, and the one the 2013 figure describes.", "rel": "performs" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The 95,000-rupee figure against the Cleveland Clinic's 106,385 dollars is the comparison that essay exists to take apart.", "rel": "story" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "A group figure from 2013, reprinted as a current price ever since.", "rel": "story" }, { "to": "apollo-chennai", "type": "facility", "name": "Apollo Hospitals, Greams Road, Chennai", "as": "The older Indian corporate hospital company, built on referral prestige rather than on volume.", "rel": "contrast" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The accreditor whose mark two of its twenty-five hospitals hold.", "rel": "accredited-by" } ], "source_list": [ { "id": "s:wp-narayana-health", "kind": "wikipedia", "title": "Narayana Health", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Narayana_Health", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:wp-devi-shetty", "kind": "web", "title": "Devi Shetty", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Devi_Shetty", "accessed": "2026-09-16", "note": "carries the Bloomberg 2013 bypass figure of 95,000 rupees and the Cleveland Clinic comparison" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "how a foreign patient reaches a multi-hospital Indian group; hedged in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node Narayana Hrudayalaya, Bommasandra — the group's flagship, standing for a group that has no single building" }, "address": { "tier": "cited" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-narayana-health" } }, "primary_image": null, "tag_facts": [ { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:wp-narayana-health", "note": "24 hospitals and seven heart centres in India, plus Health City Cayman Islands", "tier": "cited", "url": "" }, { "key": "listed-company", "label": "Publicly listed", "icon": "📈", "group": "ownership", "evidence": "an exchange listing or an annual report", "source": "s:wp-narayana-health", "note": "listed on the BSE and NSE on 6 January 2016 at a valuation above one billion US dollars", "tier": "cited", "url": "" }, { "key": "transplant-programme", "label": "Transplant programme", "icon": "🫀", "group": "clinical", "evidence": "a national transplant registry, a ministry licence list, or the facility's own programme page", "source": "s:wp-narayana-health", "note": "the group's cardiac and bone-marrow transplant programmes", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:wp-narayana-health", "note": "no per-hospital price list was found; the figure the group is known by is a 2013 press report, carried in prices[] as an estimate", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation held by Narayana Institute of Cardiac Sciences, Bangalore, and by Health City Cayman Islands", "url": "https://en.wikipedia.org/wiki/Narayana_Health", "kind": "international", "year": null, "valid_until": null, "source": "s:wp-narayana-health" } ], "acclaim": 1, "kin_in": [ { "from": "india", "type": "destination", "name": "India", "as": "The chain that made cardiac surgery a volume calculation.", "rel": "part" }, { "from": "bengaluru", "type": "hub", "name": "Bengaluru", "as": "The Hosur Road campus at Bommasandra the southern pole is built on.", "rel": "part" }, { "from": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The group whose 2013 figure made this operation the subject's standard comparison.", "rel": "performed-at" }, { "from": "devi-shetty", "type": "person", "name": "Devi Prasad Shetty", "as": "The group he founded, and the record carrying its volume argument and its 2013 bypass figure.", "rel": "facility" } ] }, { "schema": 1, "id": "prince-court", "type": "facility", "names": { "name": "Prince Court Medical Centre", "aliases": [ "Prince Court", "PCMC" ], "said": "Prince Court, for Jalan Kia Peng where it stands, a few streets from the Kuala Lumpur city centre towers." }, "region": [ "southeast-asia" ], "facets": { "iso2": "MY", "ownership": "private", "founded": null, "specialty": [ "plastic surgery", "orthopaedics", "cardiology", "fertility", "health screening", "dentistry" ], "draws": [ "breast-augmentation", "ivf", "executive-health-screening", "knee-replacement" ], "status": "open", "languages": [ "Malay", "English", "Arabic", "Indonesian", "Mandarin" ] }, "text": { "what": "A private hospital in central Kuala Lumpur with 277 single-bed rooms and no shared wards, now part of IHH Healthcare. It states that it treats patients from over 140 countries, and it is one of the few hospitals in this directory that puts a fixed price on cosmetic surgery on its own public pages, with the implant brand named.", "story": "The all-single-room bed base is the hospital's whole proposition and it shapes who arrives. A hospital with no four-bed bays has no cheap tier; every patient is in a room, and the price of that room is in every bill.\n\nIt is now an IHH Healthcare hospital, which places it under the same ownership as Gleneagles Kuala Lumpur eight kilometres away, as Mount Elizabeth in Singapore and as Fortis in India.\n\nThe promotions page is where a directory earns its keep. Read on 16 September 2026, the breast augmentation package was 26,888 ringgit including two Mentor implants, a pre-surgery consultation, the day-care procedure with refreshments and a post-surgery ward round — with a 2,000-ringgit top-up if the patient wants Motiva implants instead, and with take-home medication, complications and other morbidities all excluded. *Inference —* an implant brand named in a price is doing two jobs: it tells a patient what they are buying, and it tells them what a different answer costs.", "how": "Packages are advertised on a promotions page with a price, an inclusion list and a short exclusion line. The cosmetic packages state that they are for self-paying patients only and cannot be combined with other promotions. The complication line is the one to read twice: a package that excludes complications is priced for the operation going as planned.", "today": "As of 16 September 2026 the hospital lists breast augmentation at 26,888 ringgit, an HPV vaccine course of three doses at 1,598 ringgit, Invisalign from 18,000 ringgit, a multi-cancer early detection test at 1,499 ringgit as an add-on, and a home sleep test at 250 ringgit. It states 277 single beds and patients from over 140 countries. Its opening year and its accreditations are not recorded here: the pages carrying them did not resolve for this project." }, "geo": { "lat": 3.1491465, "lon": 101.7213053, "precision": "street", "source": "s:osm" }, "address": { "city": "Kuala Lumpur", "country": "MY" }, "metrics": { "beds": 277, "doctors": null, "annual_patients": null, "annual_foreign_patients": null, "foreign_patient_countries": 140, "note": "277 is the hospital's own count of single beds, which for this hospital is the whole bed base. The 140-country figure is the hospital's own statement of countries its patients come from and carries no year and no patient total; it counts COUNTRIES, not people, and a single patient makes a country count. No annual patient figure is published on the pages read here.", "as_of": "2026-09-16", "source": "s:princecourt-home", "url": "https://princecourt.com/" }, "tags": [ { "tag": "price-published", "source": "s:princecourt-breast-aug", "tier": "cited", "note": "package prices in ringgit on the hospital's own promotions pages, with implant brands named", "url": "https://princecourt.com/our-services/highlights-and-promotions/breast-augmentation-package" }, { "tag": "package", "source": "s:princecourt-breast-aug", "tier": "cited", "note": "inclusion list, brand top-up and exclusion line printed together" }, { "tag": "chain", "source": "s:princecourt-home", "tier": "cited", "note": "part of IHH Healthcare" }, { "tag": "international-office", "source": "s:princecourt-home", "tier": "cited", "note": "the hospital states it takes patients from over 140 countries" } ], "recognitions": [], "prices": [ { "procedure": "breast-augmentation", "country": "MY", "city": "Kuala Lumpur", "facility": "prince-court", "amount": 26888, "currency": "MYR", "as_of": "2026-09-16", "kind": "package", "includes": [ "2 units Mentor breast implants", "pre-surgery consultation", "daycare procedure inclusive of refreshments", "post-surgery ward round and consultation" ], "excludes": [ "take-home medications", "complications", "other morbidities" ], "source": "s:princecourt-breast-aug", "url": "https://princecourt.com/our-services/highlights-and-promotions/breast-augmentation-package", "note": "A 2,000-ringgit top-up buys Motiva implants instead of Mentor; other brands may cost more again. The package is for self-paying patients only and cannot be combined with other promotions. No expiry date is printed on the page. The exclusion of complications means the number describes the operation going as planned.", "tier": "cited", "usd": 6583.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "kuala-lumpur", "as": "The city-centre hospital of the Kuala Lumpur cluster, all single rooms.", "rel": "place" }, { "to": "malaysia", "as": "A Malaysian hospital that publishes cosmetic surgery prices with the implant brand named.", "rel": "destination" }, { "to": "gleneagles-kl", "as": "Its neighbour and competitor under the same ultimate owner, which publishes no price.", "rel": "contrast" }, { "to": "breast-augmentation", "as": "Sold here at a fixed price with two named implant brands and a top-up between them.", "rel": "performs" }, { "to": "package-price", "as": "Sells in this form: a price, four inclusions, three exclusions and no expiry date.", "rel": "term" }, { "to": "reading-the-exclusions", "as": "Its cosmetic package excludes complications, which is the line that decides what happens if the operation does not go as planned.", "rel": "step" }, { "to": "mhtc", "as": "The Malaysian government agency that lists and promotes hospitals taking foreign patients.", "rel": "org" } ], "links": [ { "label": "Prince Court Medical Centre", "url": "https://princecourt.com/" }, { "label": "Highlights and promotions", "url": "https://princecourt.com/our-services/highlights-and-promotions/breast-augmentation-package" } ], "sources": [ "s:princecourt-home", "s:princecourt-breast-aug", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node Prince Court Medical Centre; the street line is omitted because the addresses read for this record disagreed and none was taken off the hospital's own page" }, "metrics": { "tier": "cited", "source": "s:princecourt-home" }, "facets.founded": { "tier": "inference", "note": "left null: no source read for this record dates the hospital's opening" } } }, "x_commons_files": [], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "A private hospital in central Kuala Lumpur with 277 single-bed rooms and no shared wards, now part of IHH Healthcare.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "The city-centre hospital of the Kuala Lumpur cluster, all single rooms.", "rel": "place" }, { "to": "malaysia", "type": "destination", "name": "Malaysia", "as": "A Malaysian hospital that publishes cosmetic surgery prices with the implant brand named.", "rel": "destination" }, { "to": "gleneagles-kl", "type": "facility", "name": "Gleneagles Hospital Kuala Lumpur", "as": "Its neighbour and competitor under the same ultimate owner, which publishes no price.", "rel": "contrast" }, { "to": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "Sold here at a fixed price with two named implant brands and a top-up between them.", "rel": "performs" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "Sells in this form: a price, four inclusions, three exclusions and no expiry date.", "rel": "term" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "Its cosmetic package excludes complications, which is the line that decides what happens if the operation does not go as planned.", "rel": "step" }, { "to": "mhtc", "type": "org", "name": "Malaysia Healthcare Travel Council", "as": "The Malaysian government agency that lists and promotes hospitals taking foreign patients.", "rel": "org" } ], "source_list": [ { "id": "s:princecourt-home", "kind": "web", "title": "Prince Court Medical Centre — hospital site", "publisher": "Prince Court Medical Centre", "url": "https://princecourt.com/", "accessed": "2026-09-16" }, { "id": "s:princecourt-breast-aug", "kind": "web", "title": "Breast Augmentation Package", "publisher": "Prince Court Medical Centre", "url": "https://princecourt.com/our-services/highlights-and-promotions/breast-augmentation-package", "accessed": "2026-09-16", "note": "price, implant brand and the exclusion line read off the package page" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "cited" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node Prince Court Medical Centre; the street line is omitted because the addresses read for this record disagreed and none was taken off the hospital's own page" }, "address": { "tier": "cited" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:princecourt-home" } }, "primary_image": null, "tag_facts": [ { "key": "price-published", "label": "Publishes prices", "icon": "💰", "group": "money", "evidence": "a public price list or package page on the facility's own site, read on a dated visit", "source": "s:princecourt-breast-aug", "note": "package prices in ringgit on the hospital's own promotions pages, with implant brands named", "tier": "cited", "url": "https://princecourt.com/our-services/highlights-and-promotions/breast-augmentation-package" }, { "key": "package", "label": "Sells packages", "icon": "🧳", "group": "money", "evidence": "a bundled price on the facility's own page covering more than the operation", "source": "s:princecourt-breast-aug", "note": "inclusion list, brand top-up and exclusion line printed together", "tier": "cited", "url": "" }, { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:princecourt-home", "note": "part of IHH Healthcare", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:princecourt-home", "note": "the hospital states it takes patients from over 140 countries", "tier": "cited", "url": "" } ], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "malaysia", "type": "destination", "name": "Malaysia", "as": "The Kuala Lumpur hospital most often named in the country's marketing.", "rel": "part" }, { "from": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "Off Jalan Bukit Bintang beside the Tun Razak Exchange.", "rel": "part" }, { "from": "gleneagles-kl", "type": "facility", "name": "Gleneagles Hospital Kuala Lumpur", "as": "Its Kuala Lumpur competitor, also IHH-owned, which does publish package prices.", "rel": "contrast" } ] }, { "schema": 1, "id": "raffles-hospital", "type": "facility", "names": { "name": "Raffles Hospital", "aliases": [ "Raffles Medical Group", "RafflesHospital" ], "said": "RAF-uls, for Stamford Raffles, whose name is on half the institutions in Singapore. The hospital is the group's one hospital; the group is 106 clinics, and the clinics came first." }, "region": [ "southeast-asia" ], "facets": { "iso2": "SG", "ownership": "private", "founded": 2001, "specialty": [ "obstetrics", "cardiology", "oncology", "orthopaedics", "health screening" ], "draws": [ "executive-health-screening", "knee-replacement", "hip-replacement", "ivf" ], "status": "open", "languages": [ "English", "Mandarin", "Malay", "Tamil", "Bahasa Indonesia" ] }, "text": { "what": "A 380-bed private hospital at the corner of North Bridge Road and Ophir Road in Singapore, opened on 31 March 2001 on the site of the converted Blanco Court. It is the hospital of Raffles Medical Group, a company listed on the Singapore Exchange that began as two clinics in 1976 and now runs 106 multi-disciplinary clinics in Singapore and hospitals and medical centres in China, Japan, Vietnam, Cambodia and Hong Kong.", "story": "Loo Choon Yong and Alfred Loh founded the practice in 1976. The order of growth matters: clinics first, then a hospital, then clinics abroad. Raffles Medical is a primary-care company that built a hospital, and it shows in what it sells and how it prices it.\n\nThe group reported S$723.8 million of revenue in 2021 with S$83.7 million of net income, employs more than 2,900 people, and runs the airport clinics at Changi and at Hong Kong's Chek Lap Kok. In China it has tertiary hospitals in Beijing, Shanghai and Chongqing; in Vietnam it took a majority stake in American International Hospital in 2023.\n\n*Inference —* a hospital owned by a clinic company prices like a clinic company. Raffles is one of the few institutions in this directory that sells screening across a counter at a fixed, published, online-payable price, and it is the only one whose published price list runs from a statutory medical examination for a migrant domestic worker at S$52.30 to a women's screening package at S$563.16. The same retail machinery handles both.", "how": "Health screening is sold through the group's own online store as well as through the hospital. The published entry package, Raffles Classic, is S$138. Raffles Treasure Ladies is S$361.31 and adds a gynaecologist consultation, a Pap smear and a transvaginal pelvic ultrasound; Raffles Treasure Ladies Plus is S$563.16 and adds screening mammography and breast ultrasound. The Plus package states its own exclusions plainly: not for women under forty, and not for women with a pre-existing gynaecological or breast condition. The base Ladies package excludes women under twenty-five on the same principle.\n\nThose exclusions are the interesting half. A screening package is priced on the assumption that the buyer is well, and the terms say so.\n\nSurgery is not priced on the group's public pages. Singapore's Ministry of Health publishes hospital bill data and fee benchmarks separately, which is where a figure for an operation at a named Singapore hospital comes from.", "today": "As of 17 September 2026 the hospital carries 380 beds and 24 specialist centres, and the group runs 106 clinics in Singapore with operations in China, Japan, Vietnam, Cambodia and Hong Kong. Screening prices are published and payable online; no surgical price is published." }, "geo": { "lat": 1.301136, "lon": 103.857148, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "585 North Bridge Road", "city": "Singapore", "country": "SG", "postcode": "188770" }, "metrics": { "beds": 380, "staff": 2900, "annual_patients": null, "annual_foreign_patients": null, "revenue_usd": null, "note": "380 beds at the hospital and 24 specialist centres. Staff is the GROUP's — more than 2,900 across 106 Singapore clinics, the hospital, and operations in five other territories — not the hospital's. Group revenue was S$723.8 million in 2021 with S$83.7 million net income; that is Singapore dollars and is left out of the US dollar field rather than converted by hand. No patient count and no foreign share is published.", "as_of": "2021", "source": "s:wp-raffles-medical", "url": "https://en.wikipedia.org/wiki/Raffles_Medical_Group" }, "tags": [ { "tag": "price-published", "source": "s:raffles-screening-store", "tier": "cited", "note": "screening packages priced in Singapore dollars and payable online through the group's own store", "url": "https://www.raffleshealth.com/services/health-screening.html" }, { "tag": "package", "source": "s:raffles-screening-ladies", "tier": "cited", "note": "named screening packages with stated inclusions and stated exclusions by age and by pre-existing condition" }, { "tag": "listed-company", "source": "s:wp-raffles-medical", "tier": "cited", "note": "Singapore Exchange, ticker BSL" }, { "tag": "chain", "source": "s:wp-raffles-medical", "tier": "cited", "note": "106 clinics in Singapore, tertiary hospitals in Beijing, Shanghai and Chongqing, medical centres in Hong Kong, Shanghai and Osaka, clinics in Vietnam and Cambodia" }, { "tag": "international-office", "source": "s:raffles-hospital", "tier": "cited", "note": "the hospital serves patients from the region; the group also runs the Changi and Chek Lap Kok airport clinics" }, { "tag": "interpreter", "source": "s:raffles-hospital", "tier": "cited" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation", "year": null, "valid_until": null, "source": "s:raffles-hospital", "url": "https://www.rafflesmedicalgroup.com/hospital/", "note": "no year was found on the group's own pages read for this record and none is asserted" } ], "prices": [ { "procedure": "executive-health-screening", "country": "SG", "city": "Singapore", "facility": "raffles-hospital", "amount": 138, "currency": "SGD", "as_of": "2026-09-17", "kind": "list", "includes": [ "the Raffles Classic screening package as the store lists it" ], "excludes": [ "the store does not state whether GST is included in the listed figure" ], "source": "s:raffles-screening-store", "url": "https://www.raffleshealth.com/services/health-screening.html", "note": "Raffles Classic, the entry general screening package, listed at S$138 on the group's own retail store and read there on 17 September 2026. The same price list runs from a S$48 vocational licence medical and a S$52.30 six-monthly examination for a migrant domestic worker up through the screening packages, which is what it looks like when a hospital group sells medicine across a counter.", "tier": "cited", "usd": 108.0, "usd_high": null, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "executive-health-screening", "country": "SG", "city": "Singapore", "facility": "raffles-hospital", "amount": 361.31, "amount_high": 563.16, "currency": "SGD", "as_of": "2026-09-17", "kind": "package", "includes": [ "Raffles Treasure Ladies at S$361.31: gynaecologist consultation, Pap smear, transvaginal pelvic ultrasound", "Raffles Treasure Ladies Plus at S$563.16: the above plus screening mammogram and breast ultrasound" ], "excludes": [ "women under 25 for the base package", "women under 40 for the Plus package", "women with a pre-existing gynaecological condition, for both", "women with a pre-existing breast condition, for the Plus package", "GST status not stated on the page" ], "source": "s:raffles-screening-ladies", "url": "https://www.rafflesmedicalgroup.com/health-screening/health-screening-packages/", "note": "Two published women's screening packages read off the group's own page on 17 September 2026. The exclusions are the point: a screening price assumes a well buyer, and both packages say in terms that a woman with an existing condition is outside them. The Plus package also asks that mammography and breast ultrasound wait at least six weeks after a second COVID-19 vaccine dose.", "tier": "cited", "usd": 284.0, "usd_high": 442.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "singapore-city", "as": "The private hospital at the Bugis end of the city, on the Blanco Court site.", "rel": "place" }, { "to": "singapore", "as": "The country's clinic company that built a hospital, against the country's hospital companies that acquired clinics.", "rel": "destination" }, { "to": "mount-elizabeth", "as": "The other Singapore hospital in this directory: Orchard Road, IHH-owned, and priced nowhere in public.", "rel": "contrast" }, { "to": "executive-health-screening", "as": "Sold across a counter at a published price, which almost nothing else in this directory is.", "rel": "performs" }, { "to": "package-price", "as": "Sells in this form, with the exclusions written as eligibility rules rather than as extras.", "rel": "term" }, { "to": "reading-the-exclusions", "as": "Not for women under forty, not for women with a pre-existing condition — a screening price is a price for the well.", "rel": "step" }, { "to": "jci", "as": "Named as its accreditor, undated on the pages read here.", "rel": "accredited-by" }, { "to": "the-price-that-isnt", "as": "A published screening price is real, and it is also the cheapest thing the hospital does.", "rel": "story" } ], "links": [ { "label": "Raffles Hospital", "url": "https://www.rafflesmedicalgroup.com/hospital/" }, { "label": "Health Screening — packages and prices", "url": "https://www.raffleshealth.com/services/health-screening.html" } ], "sources": [ "s:wp-raffles-medical", "s:wp-raffles-hospital", "s:raffles-hospital", "s:raffles-screening-store", "s:raffles-screening-ladies", "s:wp-healthcare-singapore", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "metrics": { "tier": "cited", "source": "s:wp-raffles-medical" } } }, "x_commons_files": [ "File:Raffles Hospital Singapore.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "A 380-bed private hospital at the corner of North Bridge Road and Ophir Road in Singapore, opened on 31 March 2001 on the site of the converted Blanco Court.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "singapore-city", "type": "hub", "name": "Singapore", "as": "The private hospital at the Bugis end of the city, on the Blanco Court site.", "rel": "place" }, { "to": "singapore", "type": "destination", "name": "Singapore", "as": "The country's clinic company that built a hospital, against the country's hospital companies that acquired clinics.", "rel": "destination" }, { "to": "mount-elizabeth", "type": "facility", "name": "Mount Elizabeth Hospital", "as": "The other Singapore hospital in this directory: Orchard Road, IHH-owned, and priced nowhere in public.", "rel": "contrast" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "Sold across a counter at a published price, which almost nothing else in this directory is.", "rel": "performs" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "Sells in this form, with the exclusions written as eligibility rules rather than as extras.", "rel": "term" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "Not for women under forty, not for women with a pre-existing condition — a screening price is a price for the well.", "rel": "step" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "Named as its accreditor, undated on the pages read here.", "rel": "accredited-by" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "A published screening price is real, and it is also the cheapest thing the hospital does.", "rel": "story" } ], "source_list": [ { "id": "s:wp-raffles-medical", "kind": "web", "title": "Raffles Medical Group", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Raffles_Medical_Group", "accessed": "2026-09-16" }, { "id": "s:wp-raffles-hospital", "kind": "wikipedia", "title": "Raffles Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Raffles_Hospital", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:raffles-hospital", "kind": "web", "title": "Raffles Hospital — hospital page", "publisher": "Raffles Medical Group", "url": "https://www.rafflesmedicalgroup.com/hospital/", "accessed": "2026-09-16" }, { "id": "s:raffles-screening-store", "kind": "web", "title": "Health Screening — packages and prices", "publisher": "Raffles Health (Raffles Medical Group)", "url": "https://www.raffleshealth.com/services/health-screening.html", "accessed": "2026-09-16", "note": "the group's retail screening store, priced online in Singapore dollars" }, { "id": "s:raffles-screening-ladies", "kind": "web", "title": "Health Screening Packages", "publisher": "Raffles Medical Group, Singapore", "url": "https://www.rafflesmedicalgroup.com/health-screening/health-screening-packages/", "accessed": "2026-09-16" }, { "id": "s:wp-healthcare-singapore", "kind": "wikipedia", "title": "Healthcare in Singapore", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Healthcare_in_Singapore", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "cited" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "cited" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-raffles-medical" } }, "primary_image": null, "tag_facts": [ { "key": "price-published", "label": "Publishes prices", "icon": "💰", "group": "money", "evidence": "a public price list or package page on the facility's own site, read on a dated visit", "source": "s:raffles-screening-store", "note": "screening packages priced in Singapore dollars and payable online through the group's own store", "tier": "cited", "url": "https://www.raffleshealth.com/services/health-screening.html" }, { "key": "package", "label": "Sells packages", "icon": "🧳", "group": "money", "evidence": "a bundled price on the facility's own page covering more than the operation", "source": "s:raffles-screening-ladies", "note": "named screening packages with stated inclusions and stated exclusions by age and by pre-existing condition", "tier": "cited", "url": "" }, { "key": "listed-company", "label": "Publicly listed", "icon": "📈", "group": "ownership", "evidence": "an exchange listing or an annual report", "source": "s:wp-raffles-medical", "note": "Singapore Exchange, ticker BSL", "tier": "cited", "url": "" }, { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:wp-raffles-medical", "note": "106 clinics in Singapore, tertiary hospitals in Beijing, Shanghai and Chongqing, medical centres in Hong Kong, Shanghai and Osaka, clinics in Vietnam and Cambodia", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:raffles-hospital", "note": "the hospital serves patients from the region; the group also runs the Changi and Chek Lap Kok airport clinics", "tier": "cited", "url": "" }, { "key": "interpreter", "label": "Interpreters on staff", "icon": "🗣", "group": "service", "evidence": "the facility's own page naming the languages, or a published inspection or accreditation report", "source": "s:raffles-hospital", "note": "", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation", "url": "https://www.rafflesmedicalgroup.com/hospital/", "kind": "international", "year": null, "valid_until": null, "source": "s:raffles-hospital" } ], "acclaim": 1, "kin_in": [ { "from": "singapore", "type": "destination", "name": "Singapore", "as": "The other name a regional referral usually lands on.", "rel": "part" }, { "from": "singapore-city", "type": "hub", "name": "Singapore", "as": "At 585 North Bridge Road, 380 beds, the group's own hospital away from both clusters.", "rel": "part" }, { "from": "mount-elizabeth", "type": "facility", "name": "Mount Elizabeth Hospital", "as": "The other Singapore hospital here, which publishes its screening prices where this one publishes none.", "rel": "contrast" } ] }, { "schema": 1, "id": "samitivej", "type": "facility", "names": { "name": "Samitivej Sukhumvit Hospital", "aliases": [ "Samitivej", "โรงพยาบาลสมิติเวช สุขุมวิท" ], "said": "Sa-mi-ti-wet. Bangkok residents say Samitivej and mean the Sukhumvit 49 hospital; the group runs six more, and the children's hospital next door is the one families mean." }, "region": [ "southeast-asia" ], "facets": { "iso2": "TH", "ownership": "private", "founded": 1979, "specialty": [ "paediatrics", "spine", "health screening", "obstetrics", "orthopaedics", "sports medicine" ], "draws": [ "executive-health-screening" ], "status": "open", "languages": [ "Thai", "English", "Japanese", "Burmese", "Arabic", "Indonesian", "Chinese" ] }, "text": { "what": "A 275-bed private hospital on Sukhumvit Soi 49 in Bangkok, opened in June 1979 and now owned by Bangkok Dusit Medical Services. It runs a children's hospital on the same site and a second general hospital at Srinakarin, and publishes an unusually long price list of check-up programmes broken down by sex and by decade of life.", "story": "Samitivej's first hospital opened in June 1979. The group now runs seven facilities in Thailand — Sukhumvit, Srinakarin, Sriracha, Thonburi, Chonburi, Chinatown and the children's hospitals — plus an international clinic in Yangon, and it belongs to Bangkok Dusit Medical Services, the largest private hospital company in the country.\n\nSukhumvit 49 sits in the part of Bangkok where the Japanese community lives, and the hospital's language list reflects it. As of 2009, 40 per cent of the patients seen across Samitivej's centres were not Thai — a figure reported about the group and about visits, not about individual people, and not refreshed since.\n\n*Inference —* the shape of the published price list says something about who is buying. A hospital that prices knees sells operations to people who fly in for them; a hospital that prices fifteen different annual check-ups by age band sells a yearly appointment to people who already live nearby. Samitivej publishes both, but the check-up list is far longer.", "how": "Check-up programmes are bought off the page, each with a promotional price beside a struck-through regular price and a date by which the voucher must be used. Surgical packages are quoted the same way: the endoscopic discectomy programme for senior patients read on 16 September 2026 named two nights in a standard room and then excluded pre-operative screening, laboratory work, special X-rays, medication for underlying conditions, complications, implanted screws, take-home medicine, physiotherapy and orthoses. The exclusion list is four times the length of the inclusion list.", "today": "As of 16 September 2026 the hospital lists a Basic Check-up Program for men or women at 3,500 baht against a regular 7,500, usable to 31 January 2027, and runs the same list up through age bands to 74,500 baht for a longevity and brain-health programme for women over 60. Its spinal package is 365,000 baht for endoscopic discectomy, screws not included. The site names Joint Commission International accreditation without a year." }, "geo": { "lat": 13.7348588, "lon": 100.5765266, "precision": "street", "source": "s:osm" }, "address": { "street": "133 Sukhumvit Soi 49, Khlong Tan Nuea, Watthana", "city": "Bangkok", "country": "TH", "postcode": "10110" }, "metrics": { "beds": 275, "doctors": null, "annual_patients": null, "annual_foreign_patients": null, "note": "275 beds and more than 400 care specialists are the hospital's own figures for the Sukhumvit site, read on 16 September 2026; the group's other hospitals are counted separately. The only foreign-patient figure found is the 2009 statement that 40 per cent of patients seen at Samitivej centres were not Thai — a share of VISITS across the group, not a count of people, and seventeen years old.", "as_of": "2026-09-16", "source": "s:samitivej-hospitals", "url": "https://www.samitivejhospitals.com/about-us/hospital" }, "tags": [ { "tag": "price-published", "source": "s:samitivej-checkup-sukhumvit", "tier": "cited", "note": "check-up and surgical packages priced in baht with redemption dates", "url": "https://www.samitivejhospitals.com/package/detail/annual-health-check-up-packages-samitivej-sukhumvit" }, { "tag": "package", "source": "s:samitivej-disc-package", "tier": "cited", "note": "the spinal package names its nights and then names nine exclusions" }, { "tag": "paediatric", "source": "s:samitivej-hospitals", "tier": "cited", "note": "a separate children's hospital on the same site, with its own specialist staff" }, { "tag": "chain", "source": "s:wp-samitivej", "tier": "cited", "note": "Bangkok Dusit Medical Services" }, { "tag": "interpreter", "source": "s:samitivej-medical-travel", "tier": "cited", "note": "the hospital states complimentary interpretation in many languages" } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation, named on the hospital's own international-patient pages", "year": null, "valid_until": null, "source": "s:samitivej-medical-travel", "url": "https://www.samitivejhospitals.com/about-us/medical-tourism", "note": "the hospital's accreditation page is rendered by script and returned no list to this project; the year first granted is not recorded here" } ], "prices": [ { "procedure": "executive-health-screening", "country": "TH", "city": "Bangkok", "facility": "samitivej", "amount": 3500, "amount_high": 7500, "currency": "THB", "as_of": "2026-09-16", "kind": "package", "includes": [ "basic check-up programme for men or women" ], "excludes": [ "anything the screening then finds" ], "source": "s:samitivej-checkup-sukhumvit", "url": "https://www.samitivejhospitals.com/package/detail/annual-health-check-up-packages-samitivej-sukhumvit", "note": "3,500 baht is the promotional price and 7,500 the regular price printed beside it; the page states the service can be used until 31 January 2027. The same list runs to 45,000 baht for a woman over 60 and 74,500 for the longevity programme, so the cheapest row on a screening page is rarely the one being sold.", "tier": "cited", "usd": 105.0, "usd_high": 225.0, "rate_date": "Wed, 16 Sep 2026" } ], "kin": [ { "to": "bangkok", "as": "The Sukhumvit end of the Bangkok cluster, four soi east of Bumrungrad.", "rel": "place" }, { "to": "thailand", "as": "A Bangkok hospital whose foreign trade is largely residents of Bangkok rather than arrivals.", "rel": "destination" }, { "to": "bumrungrad", "as": "The nearer comparison on price transparency: both publish, one leads with operations and this one with annual check-ups.", "rel": "contrast" }, { "to": "bangkok-hospital", "as": "Same parent company, Bangkok Dusit Medical Services, different campus and different price list.", "rel": "kin" }, { "to": "executive-health-screening", "as": "Priced here in fifteen versions, split by sex and by decade of life.", "rel": "performs" }, { "to": "jci", "as": "The accreditor it names, without a year.", "rel": "accredited-by" }, { "to": "reading-the-exclusions", "as": "Its spinal package prints two nights and nine exclusions, screws among them.", "rel": "step" } ], "links": [ { "label": "Samitivej Hospitals", "url": "https://www.samitivejhospitals.com/" }, { "label": "Annual health check-up packages, Sukhumvit", "url": "https://www.samitivejhospitals.com/package/detail/annual-health-check-up-packages-samitivej-sukhumvit" } ], "sources": [ "s:wp-samitivej", "s:samitivej-hospitals", "s:samitivej-medical-travel", "s:samitivej-checkup-sukhumvit", "s:samitivej-disc-package", "s:osm" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node โรงพยาบาลสมิติเวช สุขุมวิท on Soi Sukhumvit 49" }, "metrics": { "tier": "cited", "source": "s:samitivej-hospitals" } } }, "x_commons_files": [ "File:Samitivej Sukhumvit Hospital.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "A 275-bed private hospital on Sukhumvit Soi 49 in Bangkok, opened in June 1979 and now owned by Bangkok Dusit Medical Services.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "bangkok", "type": "hub", "name": "Bangkok", "as": "The Sukhumvit end of the Bangkok cluster, four soi east of Bumrungrad.", "rel": "place" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "A Bangkok hospital whose foreign trade is largely residents of Bangkok rather than arrivals.", "rel": "destination" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "The nearer comparison on price transparency: both publish, one leads with operations and this one with annual check-ups.", "rel": "contrast" }, { "to": "bangkok-hospital", "type": "facility", "name": "Bangkok Hospital", "as": "Same parent company, Bangkok Dusit Medical Services, different campus and different price list.", "rel": "kin" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "Priced here in fifteen versions, split by sex and by decade of life.", "rel": "performs" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The accreditor it names, without a year.", "rel": "accredited-by" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "Its spinal package prints two nights and nine exclusions, screws among them.", "rel": "step" } ], "source_list": [ { "id": "s:wp-samitivej", "kind": "wikipedia", "title": "Samitivej Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Samitivej_Hospital", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" }, { "id": "s:samitivej-hospitals", "kind": "web", "title": "About Us — Our Hospitals", "publisher": "Samitivej Hospitals", "url": "https://www.samitivejhospitals.com/about-us/hospital", "accessed": "2026-09-16" }, { "id": "s:samitivej-medical-travel", "kind": "web", "title": "About Us — international patients", "publisher": "Samitivej Hospitals", "url": "https://www.samitivejhospitals.com/about-us/medical-tourism", "accessed": "2026-09-16" }, { "id": "s:samitivej-checkup-sukhumvit", "kind": "web", "title": "Annual Health Check-up Packages — Samitivej Sukhumvit", "publisher": "Samitivej Hospitals", "url": "https://www.samitivejhospitals.com/package/detail/annual-health-check-up-packages-samitivej-sukhumvit", "accessed": "2026-09-16", "note": "promotional and regular prices both printed on the page" }, { "id": "s:samitivej-disc-package", "kind": "web", "title": "Endoscopic discectomy package for senior patients", "publisher": "Samitivej Hospitals", "url": "https://www.samitivejhospitals.com/package/detail/spinal-disc-surgery-for-elderly", "accessed": "2026-09-16" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "cited" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm", "note": "OpenStreetMap node โรงพยาบาลสมิติเวช สุขุมวิท on Soi Sukhumvit 49" }, "address": { "tier": "cited" }, "prices": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:samitivej-hospitals" } }, "primary_image": null, "tag_facts": [ { "key": "price-published", "label": "Publishes prices", "icon": "💰", "group": "money", "evidence": "a public price list or package page on the facility's own site, read on a dated visit", "source": "s:samitivej-checkup-sukhumvit", "note": "check-up and surgical packages priced in baht with redemption dates", "tier": "cited", "url": "https://www.samitivejhospitals.com/package/detail/annual-health-check-up-packages-samitivej-sukhumvit" }, { "key": "package", "label": "Sells packages", "icon": "🧳", "group": "money", "evidence": "a bundled price on the facility's own page covering more than the operation", "source": "s:samitivej-disc-package", "note": "the spinal package names its nights and then names nine exclusions", "tier": "cited", "url": "" }, { "key": "paediatric", "label": "Treats children", "icon": "🧸", "group": "clinical", "evidence": "the facility's own paediatric department page or a ministry register", "source": "s:samitivej-hospitals", "note": "a separate children's hospital on the same site, with its own specialist staff", "tier": "cited", "url": "" }, { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:wp-samitivej", "note": "Bangkok Dusit Medical Services", "tier": "cited", "url": "" }, { "key": "interpreter", "label": "Interpreters on staff", "icon": "🗣", "group": "service", "evidence": "the facility's own page naming the languages, or a published inspection or accreditation report", "source": "s:samitivej-medical-travel", "note": "the hospital states complimentary interpretation in many languages", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation, named on the hospital's own international-patient pages", "url": "https://www.samitivejhospitals.com/about-us/medical-tourism", "kind": "international", "year": null, "valid_until": null, "source": "s:samitivej-medical-travel" } ], "acclaim": 1, "kin_in": [ { "from": "bangkok", "type": "hub", "name": "Bangkok", "as": "The Soi 49 hospital at the Thonglor end of the Sukhumvit corridor.", "rel": "part" } ] }, { "schema": 1, "id": "samsung-medical-center", "type": "facility", "names": { "name": "Samsung Medical Center", "aliases": [ "SMC", "삼성서울병원", "Samsung Seoul Hospital" ], "said": "Samsung Seoul Byeongwon in Korean — Samsung Seoul Hospital. It stands at 81 Ilwon-ro in Gangnam, and it is owned by a welfare foundation of the Samsung group rather than by the company." }, "region": [ "east-asia" ], "facets": { "iso2": "KR", "ownership": "nonprofit", "founded": 1994, "specialty": [ "oncology", "cardiology", "neurosciences", "transplantation", "proton therapy" ], "draws": [ "proton-therapy", "car-t", "bone-marrow-transplant", "kidney-transplant", "liver-transplant" ], "status": "open", "languages": [ "Korean", "English", "Russian", "Arabic", "Mandarin" ] }, "text": { "what": "A 1,766-bed hospital in Gangnam, Seoul, opened on 9 November 1994 and run by the Samsung Life Public Welfare Foundation. It employs 7,929 people including 915 physicians and 3,337 nurses, and has been the teaching hospital of the Sungkyunkwan University School of Medicine since 1997.", "story": "The hospital is a corporate foundation's, not a company's, and it arrived late — 1994, decades after Severance and five years after Asan. What it built instead of history was systems: it holds Stage 7 validation, the top level, across all four HIMSS digital maturity models and took a 2024 Davies Award for the use of that record system.\n\n*Inference —* that is an unusual thing for a hospital to lead with, and it is the Korean pattern. The three Seoul hospitals in this directory compete on measurement and on rank rather than on price, and none of them publishes one.\n\nIts major clinical institutes are the Samsung Comprehensive Cancer Center, opened 2008, and the Heart Vascular Stroke Institute, opened 2014.\n\nThe hospital is also known for a failure. It was the centre of South Korea's 2015 Middle East respiratory syndrome outbreak and was criticised over its handling of it — a reminder that an outbreak inside a hospital is a hazard of hospitals, including large ones with good systems, and that this directory reports it the same way anywhere.\n\nKorea regulates foreign-patient work directly: a facility must register with the Ministry of Health and Welfare to treat foreign patients, and the ministry publishes the national count. It reported 1.17 million foreign patients for 2024, which counts registered treatment episodes across every registered provider from a university hospital to a skin clinic.", "how": "*Trade practice —* the Korean route for a foreign patient runs through an international healthcare centre inside the hospital, and the hospital must be registered with the ministry to run one. Screening and oncology carry most of the serious inbound work; cosmetic and dermatological work runs through a separate and far larger clinic sector in the same districts.\n\nNo price is published by the hospital.", "today": "As of 17 September 2026 the hospital carries 1,766 beds and 7,929 employees including 915 physicians and 3,337 nurses, on the figures published as of 31 December 2024. It holds HIMSS Stage 7 across DIAM, EMRAM and INFRAM and a 2024 Davies Award. No price and no foreign patient count of its own is published." }, "geo": { "lat": 37.488452, "lon": 127.085341, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "81 Ilwon-ro, Gangnam-gu", "city": "Seoul", "country": "KR", "postcode": "06351" }, "metrics": { "beds": 1766, "doctors": 915, "staff": 7929, "annual_patients": null, "annual_foreign_patients": null, "note": "1,766 beds, 7,929 employees, 915 physicians and 3,337 nurses, all as of 31 December 2024. No patient count of any kind is published by the hospital — not visits, not people — and no foreign patient count. South Korea's ministry reported 1.17 million foreign patients nationally for 2024, which counts registered treatment episodes across every registered provider in the country and is not this hospital's.", "as_of": "2024", "source": "s:wp-samsung-medical", "url": "https://en.wikipedia.org/wiki/Samsung_Medical_Center" }, "tags": [ { "tag": "university-hospital", "source": "s:wp-samsung-medical", "tier": "cited", "note": "teaching hospital of the Sungkyunkwan University School of Medicine since 1997" }, { "tag": "teaching", "source": "s:wp-samsung-medical", "tier": "cited" }, { "tag": "international-office", "source": "s:khidi-medicalkorea", "tier": "cited", "note": "Korean facilities treating foreign patients must register with the Ministry of Health and Welfare; the promotion runs through KHIDI's Medical Korea programme" }, { "tag": "no-price-published", "source": "s:smc-home", "tier": "cited", "note": "no price list was found on the hospital's own site" }, { "tag": "outcomes-published", "source": "s:wp-samsung-medical", "tier": "cited", "note": "HIMSS Stage 7 across four digital maturity models and a 2024 Davies Award — a measure of the record system, not of clinical outcome, and the note says so" } ], "recognitions": [ { "by": "kohta", "what": "Registered with the Korean Ministry of Health and Welfare to treat foreign patients, the registration that is compulsory there", "year": null, "valid_until": null, "source": "s:khidi-medicalkorea", "url": "http://www.medicalkorea.or.kr/en/aboutkhidi", "note": "a registration, not an accreditation: a Korean facility may not lawfully treat foreign patients without it" }, { "by": "other", "what": "HIMSS Stage 7 validation across DIAM, EMRAM and INFRAM, and the 2024 HIMSS Davies Award", "year": 2024, "valid_until": null, "source": "s:wp-samsung-medical", "url": "https://en.wikipedia.org/wiki/Samsung_Medical_Center", "note": "a health information systems maturity scheme, outside this project's recognizer vocabulary and outside clinical accreditation altogether" } ], "kin": [ { "to": "seoul", "as": "The Gangnam hospital of the three the Seoul cluster is built on.", "rel": "place" }, { "to": "south-korea", "as": "A corporate foundation's hospital in a system where every foreign patient is registered with the ministry.", "rel": "destination" }, { "to": "asan-medical-center", "as": "The larger Seoul hospital, five years older and across the river in Songpa.", "rel": "contrast" }, { "to": "severance", "as": "The oldest of the three, founded 1885, against this one opened in 1994.", "rel": "contrast" }, { "to": "korea-foreign-patient-registration", "as": "Operates under the registration a Korean facility must hold to treat a foreign patient at all.", "rel": "governed-by" }, { "to": "proton-therapy", "as": "Among the oncology programmes its foreign referrals come for.", "rel": "performs" }, { "to": "surgical-site-infection", "as": "The 2015 MERS outbreak centred here is the reminder that a hospital is also a place infections happen.", "rel": "risk" }, { "to": "counting-patients", "as": "1.17 million foreign patients in Korea for 2024 counts registered episodes at every provider, from this hospital to a skin clinic.", "rel": "story" } ], "links": [ { "label": "Samsung Medical Center", "url": "http://www.samsunghospital.com/home/main/index.do" } ], "sources": [ "s:wp-samsung-medical", "s:smc-home", "s:khidi-medicalkorea", "s:mohw-kr-foreign-patients-2024", "s:wp-medical-tourism-south-korea", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "text.how": { "tier": "tradition", "note": "how the Korean route runs through an in-hospital international centre; marked in the prose" }, "metrics": { "tier": "cited", "source": "s:wp-samsung-medical" } } }, "x_commons_files": [ "File:Samsung Medical Center.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "A 1,766-bed hospital in Gangnam, Seoul, opened on 9 November 1994 and run by the Samsung Life Public Welfare Foundation.", "region_terms": [ { "key": "east-asia", "name": "East Asia", "note": "South Korea, Japan, Taiwan, China" } ], "kin_out": [ { "to": "seoul", "type": "hub", "name": "Seoul", "as": "The Gangnam hospital of the three the Seoul cluster is built on.", "rel": "place" }, { "to": "south-korea", "type": "destination", "name": "South Korea", "as": "A corporate foundation's hospital in a system where every foreign patient is registered with the ministry.", "rel": "destination" }, { "to": "asan-medical-center", "type": "facility", "name": "Asan Medical Center", "as": "The larger Seoul hospital, five years older and across the river in Songpa.", "rel": "contrast" }, { "to": "severance", "type": "facility", "name": "Severance Hospital", "as": "The oldest of the three, founded 1885, against this one opened in 1994.", "rel": "contrast" }, { "to": "korea-foreign-patient-registration", "type": "rule", "name": "Korea's foreign patient attraction registration", "as": "Operates under the registration a Korean facility must hold to treat a foreign patient at all.", "rel": "governed-by" }, { "to": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "Among the oncology programmes its foreign referrals come for.", "rel": "performs" }, { "to": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The 2015 MERS outbreak centred here is the reminder that a hospital is also a place infections happen.", "rel": "risk" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "1.17 million foreign patients in Korea for 2024 counts registered episodes at every provider, from this hospital to a skin clinic.", "rel": "story" } ], "source_list": [ { "id": "s:wp-samsung-medical", "kind": "web", "title": "Samsung Medical Center", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Samsung_Medical_Center", "accessed": "2026-09-16" }, { "id": "s:smc-home", "kind": "web", "title": "Samsung Medical Center — hospital site", "publisher": "Samsung Medical Center", "url": "http://www.samsunghospital.com/home/main/index.do", "accessed": "2026-09-16" }, { "id": "s:khidi-medicalkorea", "kind": "org", "title": "About KHIDI — Medical Korea", "publisher": "Korea Health Industry Development Institute", "url": "http://www.medicalkorea.or.kr/en/aboutkhidi", "accessed": "2026-09-16", "note": "government-affiliated institution under the Ministry of Health and Welfare; the registration system, registered hospitals and registered facilitators" }, { "id": "s:mohw-kr-foreign-patients-2024", "kind": "web", "title": "Korea Attracts 1.17 Million Foreign Patients in 2024", "publisher": "Ministry of Health and Welfare (Republic of Korea)", "url": "https://www.mohw.go.kr/board.es?mid=a20401000000&bid=0032&act=view&list_no=1485207", "accessed": "2026-09-16", "note": "press release of 3 April 2025; the annual foreign-patient statistics are compiled for the ministry by the Korea Health Industry Development Institute" }, { "id": "s:wp-medical-tourism-south-korea", "kind": "wikipedia", "title": "Medical tourism in South Korea", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_South_Korea", "license": "CC BY-SA 4.0", "accessed": "2026-09-16", "note": "quotes the Korea Health Industry Development Institute's annual counts of registered foreign patients; the article does not break them down by district." }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "how the Korean route runs through an in-hospital international centre; marked in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-samsung-medical" } }, "primary_image": null, "tag_facts": [ { "key": "university-hospital", "label": "University hospital", "icon": "🎓", "group": "ownership", "evidence": "the affiliated university's own page or the hospital's charter", "source": "s:wp-samsung-medical", "note": "teaching hospital of the Sungkyunkwan University School of Medicine since 1997", "tier": "cited", "url": "" }, { "key": "teaching", "label": "Teaching hospital", "icon": "📚", "group": "clinical", "evidence": "a recognised training post list or the hospital's own statement", "source": "s:wp-samsung-medical", "note": "", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:khidi-medicalkorea", "note": "Korean facilities treating foreign patients must register with the Ministry of Health and Welfare; the promotion runs through KHIDI's Medical Korea programme", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:smc-home", "note": "no price list was found on the hospital's own site", "tier": "cited", "url": "" }, { "key": "outcomes-published", "label": "Publishes outcomes", "icon": "📊", "group": "clinical", "evidence": "a registry submission, an annual clinical report, or a national outcome dataset naming the unit", "source": "s:wp-samsung-medical", "note": "HIMSS Stage 7 across four digital maturity models and a 2024 Davies Award — a measure of the record system, not of clinical outcome, and the note says so", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "kohta", "label": "KOIHA / KAHF (South Korea)", "what": "Registered with the Korean Ministry of Health and Welfare to treat foreign patients, the registration that is compulsory there", "url": "http://www.medicalkorea.or.kr/en/aboutkhidi", "kind": "national", "year": null, "valid_until": null, "source": "s:khidi-medicalkorea" }, { "key": "other", "label": "Somebody else", "what": "HIMSS Stage 7 validation across DIAM, EMRAM and INFRAM, and the 2024 HIMSS Davies Award", "url": "https://en.wikipedia.org/wiki/Samsung_Medical_Center", "kind": "other", "year": 2024, "valid_until": null, "source": "s:wp-samsung-medical" } ], "acclaim": 2, "kin_in": [ { "from": "south-korea", "type": "destination", "name": "South Korea", "as": "One of the large hospitals at the other end of the market from the Gangnam clinics.", "rel": "part" }, { "from": "seoul", "type": "hub", "name": "Seoul", "as": "At 81 Irwon-ro in Irwon-dong, the Gangnam-gu end of the university hospital pair.", "rel": "part" }, { "from": "asan-medical-center", "type": "facility", "name": "Asan Medical Center", "as": "The Gangnam hospital, five years younger and a third smaller.", "rel": "contrast" }, { "from": "severance", "type": "facility", "name": "Severance Hospital", "as": "The newest of the three, and the one that leads with its record systems.", "rel": "contrast" } ] }, { "schema": 1, "id": "severance", "type": "facility", "names": { "name": "Severance Hospital", "aliases": [ "세브란스병원", "Yonsei University Health System", "Gwanghyewon" ], "said": "SEV-er-ance, for Louis Severance of Standard Oil, who paid for the building. It opened in 1885 as Gwanghyewon, the House of Extended Grace, a royal hospital founded by the American doctor Horace Newton Allen, and took the donor's name on 3 September 1904." }, "region": [ "east-asia" ], "facets": { "iso2": "KR", "ownership": "university", "founded": 1885, "specialty": [ "robotic surgery", "cardiology", "oncology", "transplantation", "neurosciences" ], "draws": [ "proton-therapy", "car-t", "kidney-transplant", "liver-transplant", "prostatectomy" ], "status": "open", "languages": [ "Korean", "English", "Russian", "Arabic", "Mongolian", "Mandarin" ] }, "text": { "what": "The oldest hospital in South Korea and part of the Yonsei University Health System: 2,437 beds in Seodaemun-gu, Seoul, seeing about 2.5 million outpatients and 840,000 inpatients a year. It was founded in 1885 by Horace Newton Allen as Gwanghyewon, the country's first western-style hospital, renamed for its American donor in 1904, and joined to Yonsei University in 1957. It was the first Korean hospital accredited by Joint Commission International, in 2007.", "story": "The 1885 date makes Severance the only hospital in this batch older than the countries most of its patients fly from, and the sequence of its names is a history of Korean medicine in three words: a royal hospital, an American donor's hospital, a national university's hospital.\n\nIt is a system rather than a building — Severance at Sinchon, Gangnam Severance, Yongin Severance, Wonju Severance Christian, and Songdo Severance under construction. The record pins Sinchon.\n\nThe volumes are the East Asian ones: 2.5 million outpatients a year and 840,000 inpatients. Both count attendances, not people. The robotic surgery programme reached twenty thousand operations by 2018, the first unit in the world to do so; the hospital reports about two thousand coronary artery operations and about thirteen hundred arrhythmia treatments a year.\n\n*Inference —* a hospital that reports its unit volumes by operation is doing something the accreditation marks elsewhere in this batch do not: saying how often it does the thing. Volume is not outcome, and this directory does not read it as one, but it is a fact about the unit rather than about the building.\n\nThe 2007 JCI accreditation was the first in Korea, three years before the country's foreign-patient registration regime began in earnest, and it dates the start of Korean hospitals selling abroad.", "how": "Foreign patients reach it through the International Health Care Center, which states that an estimate of the cost of treatment can be provided on request before medical consent is given. *Trade practice —* that is the Korean shape: registration with the ministry, an in-hospital international centre, an estimate on request, and no published figure.\n\nNothing is priced on the public pages read for this record.", "today": "As of 17 September 2026 the hospital carries 2,437 beds, about 2.5 million outpatients and 840,000 inpatients a year. Its own overview names JCI accreditation without a year; the accreditor's own account dates the first award to 2007 and calls it Korea's first. No price is published." }, "geo": { "lat": 37.562262, "lon": 126.940392, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "50-1 Yonsei-ro, Seodaemun-gu", "city": "Seoul", "country": "KR", "postcode": "03722" }, "metrics": { "beds": 2437, "annual_patients": 2500000, "annual_foreign_patients": null, "note": "annual_patients counts OUTPATIENT ATTENDANCES, not people: about 2.5 million a year, with 840,000 inpatients counted separately and also as episodes rather than as individuals. A patient attending a clinic monthly is twelve. Beds are 2,437 at the Sinchon hospital this record pins; the Yonsei system runs four further hospitals. No foreign patient count is published by the hospital.", "as_of": "2026", "source": "s:wp-severance", "url": "https://en.wikipedia.org/wiki/Severance_Hospital" }, "tags": [ { "tag": "university-hospital", "source": "s:wp-severance", "tier": "cited", "note": "part of the Yonsei University Health System, joined to the university in 1957" }, { "tag": "teaching", "source": "s:severance-overview", "tier": "cited", "note": "the country's first western-style hospital, founded 1885, and a teaching hospital since" }, { "tag": "faith-based", "source": "s:wp-severance", "tier": "cited", "note": "founded by the American medical missionary Horace Newton Allen; the system still includes Wonju Severance Christian Hospital" }, { "tag": "international-office", "source": "s:severance-ihc", "tier": "cited", "note": "an International Health Care Center that states it can provide an estimated cost of treatment on request before medical consent", "url": "https://sev.severance.healthcare/sev-en/ihc/overview.do" }, { "tag": "no-price-published", "source": "s:severance-ihc", "tier": "cited", "note": "an estimate on request; no figure is published" }, { "tag": "outcomes-published", "source": "s:severance-overview", "tier": "cited", "note": "unit volumes by operation — the first 20,000 robotic operations in the world by 2018, about 2,000 coronary artery operations and about 1,300 arrhythmia treatments a year. Volume is not outcome and this project does not read it as one." } ], "recognitions": [ { "by": "jci", "what": "Joint Commission International accreditation, first granted 2007 — the first Korean hospital to hold it", "year": 2007, "valid_until": null, "source": "s:wp-medical-tourism-south-korea", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_South_Korea", "note": "the hospital's own overview page names the accreditation and no year; 2007 and the first-in-Korea claim come from the accreditor's own account and from the Korean medical travel literature" }, { "by": "kohta", "what": "Registered with the Korean Ministry of Health and Welfare to treat foreign patients", "year": null, "valid_until": null, "source": "s:khidi-medicalkorea", "url": "http://www.medicalkorea.or.kr/en/aboutkhidi", "note": "the compulsory registration, not an accreditation" } ], "kin": [ { "to": "seoul", "as": "The oldest of the three Seoul hospitals here, at Sinchon in the north-west of the city.", "rel": "place" }, { "to": "south-korea", "as": "The first Korean hospital to take JCI accreditation, in 2007, which dates the country's selling abroad.", "rel": "destination" }, { "to": "asan-medical-center", "as": "The largest Korean hospital, opened a century after this one.", "rel": "contrast" }, { "to": "samsung-medical-center", "as": "The newest of the three, and the one that leads with its record systems.", "rel": "contrast" }, { "to": "jci", "as": "Its accreditor since 2007, the first award the body made in Korea.", "rel": "accredited-by" }, { "to": "korea-foreign-patient-registration", "as": "Operates under the registration every Korean facility treating foreign patients must hold.", "rel": "governed-by" }, { "to": "prostatectomy", "as": "Among the robotic work its unit volumes are reported for, the first programme in the world past twenty thousand operations.", "rel": "performs" }, { "to": "getting-a-quote", "as": "Its international centre states it can give an estimated cost before medical consent, which is where the price starts existing.", "rel": "step" }, { "to": "counting-patients", "as": "2.5 million outpatients and 840,000 inpatients, both counting attendances at one hospital in one system of five.", "rel": "story" } ], "links": [ { "label": "Severance Hospital", "url": "https://sev.severance.healthcare/sev-en/index.do" }, { "label": "International Health Care Center", "url": "https://sev.severance.healthcare/sev-en/ihc/overview.do" } ], "sources": [ "s:wp-severance", "s:severance-en", "s:severance-overview", "s:severance-ihc", "s:khidi-medicalkorea", "s:wp-medical-tourism-south-korea", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "text.how": { "tier": "tradition", "note": "the Korean route's shape; the estimate-on-request sentence is cited" }, "metrics": { "tier": "cited", "source": "s:wp-severance" } } }, "x_commons_files": [ "File:Severance Hospital.jpg" ], "confidence": "high", "updated": "2026-09-17", "blurb": "The oldest hospital in South Korea and part of the Yonsei University Health System: 2,437 beds in Seodaemun-gu, Seoul, seeing about 2.5 million outpatients and 840,000 inpatients a year.", "region_terms": [ { "key": "east-asia", "name": "East Asia", "note": "South Korea, Japan, Taiwan, China" } ], "kin_out": [ { "to": "seoul", "type": "hub", "name": "Seoul", "as": "The oldest of the three Seoul hospitals here, at Sinchon in the north-west of the city.", "rel": "place" }, { "to": "south-korea", "type": "destination", "name": "South Korea", "as": "The first Korean hospital to take JCI accreditation, in 2007, which dates the country's selling abroad.", "rel": "destination" }, { "to": "asan-medical-center", "type": "facility", "name": "Asan Medical Center", "as": "The largest Korean hospital, opened a century after this one.", "rel": "contrast" }, { "to": "samsung-medical-center", "type": "facility", "name": "Samsung Medical Center", "as": "The newest of the three, and the one that leads with its record systems.", "rel": "contrast" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "Its accreditor since 2007, the first award the body made in Korea.", "rel": "accredited-by" }, { "to": "korea-foreign-patient-registration", "type": "rule", "name": "Korea's foreign patient attraction registration", "as": "Operates under the registration every Korean facility treating foreign patients must hold.", "rel": "governed-by" }, { "to": "prostatectomy", "type": "procedure", "name": "Prostatectomy", "as": "Among the robotic work its unit volumes are reported for, the first programme in the world past twenty thousand operations.", "rel": "performs" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "Its international centre states it can give an estimated cost before medical consent, which is where the price starts existing.", "rel": "step" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "2.5 million outpatients and 840,000 inpatients, both counting attendances at one hospital in one system of five.", "rel": "story" } ], "source_list": [ { "id": "s:wp-severance", "kind": "web", "title": "Severance Hospital", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Severance_Hospital", "accessed": "2026-09-16" }, { "id": "s:severance-en", "kind": "web", "title": "Severance Hospital — English site, hospital figures", "publisher": "Yonsei University Health System", "url": "https://sev.severance.healthcare/sev-en/index.do", "accessed": "2026-09-16" }, { "id": "s:severance-overview", "kind": "web", "title": "Overview", "publisher": "Severance Hospital, Yonsei University Health System", "url": "https://sev.severance.healthcare/sev-en/about/overview.do", "accessed": "2026-09-17", "note": "founded 1885 by H. N. Allen as the country's first western-style hospital; names JCI accreditation without a year; carries unit volumes — the first 20,000 robotic operations in the world by 2018, about 2,000 coronary artery operations and about 1,300 arrhythmia treatments a year" }, { "id": "s:severance-ihc", "kind": "web", "title": "International Health Care Center — overview", "publisher": "Yonsei University Health System", "url": "https://sev.severance.healthcare/sev-en/ihc/overview.do", "accessed": "2026-09-16" }, { "id": "s:khidi-medicalkorea", "kind": "org", "title": "About KHIDI — Medical Korea", "publisher": "Korea Health Industry Development Institute", "url": "http://www.medicalkorea.or.kr/en/aboutkhidi", "accessed": "2026-09-16", "note": "government-affiliated institution under the Ministry of Health and Welfare; the registration system, registered hospitals and registered facilitators" }, { "id": "s:wp-medical-tourism-south-korea", "kind": "wikipedia", "title": "Medical tourism in South Korea", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_South_Korea", "license": "CC BY-SA 4.0", "accessed": "2026-09-16", "note": "quotes the Korea Health Industry Development Institute's annual counts of registered foreign patients; the article does not break them down by district." }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "the Korean route's shape; the estimate-on-request sentence is cited" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-severance" } }, "primary_image": null, "tag_facts": [ { "key": "university-hospital", "label": "University hospital", "icon": "🎓", "group": "ownership", "evidence": "the affiliated university's own page or the hospital's charter", "source": "s:wp-severance", "note": "part of the Yonsei University Health System, joined to the university in 1957", "tier": "cited", "url": "" }, { "key": "teaching", "label": "Teaching hospital", "icon": "📚", "group": "clinical", "evidence": "a recognised training post list or the hospital's own statement", "source": "s:severance-overview", "note": "the country's first western-style hospital, founded 1885, and a teaching hospital since", "tier": "cited", "url": "" }, { "key": "faith-based", "label": "Faith-founded", "icon": "✝", "group": "welcome", "evidence": "the founding body's own statement or the hospital's charter", "source": "s:wp-severance", "note": "founded by the American medical missionary Horace Newton Allen; the system still includes Wonju Severance Christian Hospital", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:severance-ihc", "note": "an International Health Care Center that states it can provide an estimated cost of treatment on request before medical consent", "tier": "cited", "url": "https://sev.severance.healthcare/sev-en/ihc/overview.do" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:severance-ihc", "note": "an estimate on request; no figure is published", "tier": "cited", "url": "" }, { "key": "outcomes-published", "label": "Publishes outcomes", "icon": "📊", "group": "clinical", "evidence": "a registry submission, an annual clinical report, or a national outcome dataset naming the unit", "source": "s:severance-overview", "note": "unit volumes by operation — the first 20,000 robotic operations in the world by 2018, about 2,000 coronary artery operations and about 1,300 arrhythmia treatments a year. Volume is not outcome and this project does not read it as one.", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "jci", "label": "Joint Commission International", "what": "Joint Commission International accreditation, first granted 2007 — the first Korean hospital to hold it", "url": "https://en.wikipedia.org/wiki/Medical_tourism_in_South_Korea", "kind": "international", "year": 2007, "valid_until": null, "source": "s:wp-medical-tourism-south-korea" }, { "key": "kohta", "label": "KOIHA / KAHF (South Korea)", "what": "Registered with the Korean Ministry of Health and Welfare to treat foreign patients", "url": "http://www.medicalkorea.or.kr/en/aboutkhidi", "kind": "national", "year": null, "valid_until": null, "source": "s:khidi-medicalkorea" } ], "acclaim": 2, "kin_in": [ { "from": "south-korea", "type": "destination", "name": "South Korea", "as": "The oldest of the university hospitals taking international referrals.", "rel": "part" }, { "from": "seoul", "type": "hub", "name": "Seoul", "as": "North of the river at 50-1 Yonsei-ro, Sinchon, and on the other side of the city from the clinics.", "rel": "part" }, { "from": "asan-medical-center", "type": "facility", "name": "Asan Medical Center", "as": "The oldest of the three, and the first in Korea to take JCI accreditation.", "rel": "contrast" }, { "from": "samsung-medical-center", "type": "facility", "name": "Samsung Medical Center", "as": "The oldest of the three, founded 1885, against this one opened in 1994.", "rel": "contrast" }, { "from": "wooridul", "type": "facility", "name": "Wooridul Spine Hospital", "as": "The other early Korean entrant, a 2,437-bed university hospital where this one is a single specialty.", "rel": "contrast" }, { "from": "korea-foreign-patient-registration", "type": "rule", "name": "Korea's foreign patient attraction registration", "as": "Another, with its own international centre.", "rel": "facility" } ] }, { "schema": 1, "id": "sheba", "type": "facility", "names": { "name": "Sheba Medical Center", "aliases": [ "Tel HaShomer", "המרכז הרפואי שיבא", "Chaim Sheba Medical Center" ], "said": "SHEE-va, for Chaim Sheba, the physician who turned it civilian in 1953. Israelis call it Tel HaShomer, after the place: an 800-dunam campus in east Ramat Gan, not in Tel Aviv proper." }, "region": [ "west-asia" ], "facets": { "iso2": "IL", "ownership": "public", "founded": 1948, "specialty": [ "oncology", "cardiology", "rehabilitation", "paediatric haemato-oncology", "women's health" ], "draws": [ "car-t", "bone-marrow-transplant", "proton-therapy", "ivf" ], "status": "open", "languages": [ "Hebrew", "English", "Arabic", "Russian" ] }, "text": { "what": "Israel's largest hospital: about 1,580 beds on an 800-dunam campus at Tel HaShomer in east Ramat Gan, government-affiliated and attached to Tel Aviv University. It opened in 1948 as the army's hospital for casualties of that year's war and became civilian in 1953 under Chaim Sheba. Its Global Patient Services department treats patients from more than a hundred countries.", "story": "The hospital was founded as a military institution and the inheritance shows in what it is known for: rehabilitation, trauma, post-traumatic stress, and the research units built around them.\n\nIts published figures are unusually specific for this directory. About 1,580 beds across acute, rehabilitation and specialty hospitals; about 1,700 physicians and 12,000 other healthcare workers, with a further 1,700 staff and nearly a thousand volunteers and researchers; more than a million patient visits a year of which 200,000 are emergency visits; more than two million medical tests; a budget of 320 million dollars.\n\nThe patient figure counts VISITS. *Inference —* a million visits at a hospital with 1,580 beds is an outpatient system with an inpatient hospital inside it, and reading it as a million people would be reading it wrong by a wide margin.\n\nWhat brings foreign patients is the cell therapy: CAR-T and tumour-infiltrating lymphocyte immunotherapy are what Global Patient Services leads with, and they are treatments a patient travels for because they are not available at home rather than because they are cheaper. Newsweek placed the hospital eighth in the world in 2025.\n\nIsrael regulates this trade directly. The Knesset passed medical tourism legislation in 2018 setting conditions on how public hospitals may treat foreign patients, after years of argument about whether a public hospital's foreign work displaces its citizens.", "how": "Foreign patients reach the hospital through Global Patient Services, which is the department the 2018 law regulates. *Trade practice —* a cell therapy referral runs on pathology, prior treatment records and eligibility for a protocol, not on a package: the question answered first is whether the patient qualifies, and the price question comes after.\n\nNo price schedule is published. Israel's Ministry of Health publishes the framework; the hospital publishes the department.", "today": "As of 17 September 2026 the hospital states about 1,580 beds, about 1,700 physicians, 12,000 other healthcare workers, over a million patient visits a year including 200,000 emergency visits, and patients from over a hundred countries through Global Patient Services. Newsweek's 2025 list placed it eighth in the world." }, "geo": { "lat": 32.047184, "lon": 34.845201, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "Sderot Aharon Katzir, Tel HaShomer", "city": "Ramat Gan", "area": "Tel Aviv District", "country": "IL", "postcode": "5262657" }, "metrics": { "beds": 1580, "doctors": 1700, "staff": 12000, "annual_patients": 1000000, "annual_foreign_patients": null, "foreign_patient_countries": 100, "note": "annual_patients counts VISITS, not people: over 1,000,000 patient visits a year, of which 200,000 are emergency visits. A patient attending an outpatient clinic six times is six. Beds are about 1,580 across the acute, rehabilitation and specialty hospitals on one campus. Staff here is the 12,000 healthcare workers other than physicians; a further 1,700 staff and nearly a thousand volunteers and researchers are counted separately in the source. The foreign country figure is where patients come from — over 100 — and no count of foreign patients themselves is published.", "as_of": "2026", "source": "s:wp-sheba", "url": "https://en.wikipedia.org/wiki/Sheba_Medical_Center" }, "tags": [ { "tag": "public-hospital", "source": "s:wp-sheba", "tier": "cited", "note": "government-affiliated, founded 1948 as the army's hospital and civilian since 1953" }, { "tag": "university-hospital", "source": "s:wp-sheba", "tier": "cited", "note": "affiliated with Tel Aviv University" }, { "tag": "international-office", "source": "s:wp-sheba", "tier": "cited", "note": "Global Patient Services, treating patients from over a hundred countries" }, { "tag": "interpreter", "source": "s:wp-sheba", "tier": "cited", "note": "multilingual support stated as part of Global Patient Services" }, { "tag": "transplant-programme", "source": "s:wp-sheba", "tier": "cited", "note": "cell therapy — CAR-T and tumour-infiltrating lymphocyte immunotherapy — named as what international patients come for" }, { "tag": "no-price-published", "source": "s:israel-moh-medical-tourism", "tier": "cited", "note": "no schedule is published by the hospital; the ministry publishes the regulatory framework instead" } ], "recognitions": [ { "by": "newsweek-statista", "what": "Ranked eighth in the world in the 2025 Newsweek list, its highest placing among Asian and Israeli hospitals", "year": 2025, "valid_until": null, "source": "s:wp-sheba", "url": "https://en.wikipedia.org/wiki/Sheba_Medical_Center", "note": "a ranking by survey and published indicators, counted and not weighted by this project" } ], "kin": [ { "to": "tel-aviv", "as": "The hospital the Tel Aviv cluster is built on, though its campus is in Ramat Gan rather than the city.", "rel": "place" }, { "to": "israel", "as": "The country's largest hospital, and the one the 2018 medical tourism law was written around.", "rel": "destination" }, { "to": "car-t", "as": "Among the cell therapies its international department leads with — a treatment travelled for because it is unavailable at home, not because it is cheap.", "rel": "performs" }, { "to": "hadassah", "as": "Jerusalem's teaching hospital, funded by an American women's organisation, against a government hospital founded by an army.", "rel": "contrast" }, { "to": "king-hussein-cancer-center", "as": "The other regional cancer centre in this batch, an hour's drive and a closed border away.", "rel": "contrast" }, { "to": "deciding-whether", "as": "A patient who travels for a therapy unavailable at home is answering a different question from one travelling for a price.", "rel": "step" }, { "to": "counting-patients", "as": "A million a year, and the word in the source is visits.", "rel": "story" }, { "to": "unproven-stem-cell", "as": "A regulated cell-therapy programme in a public hospital is the thing an unproven clinic imitates the vocabulary of.", "rel": "contrast" } ], "links": [ { "label": "Sheba Medical Center", "url": "https://eng.sheba.co.il/" }, { "label": "Medical Tourism in Israel — Ministry of Health", "url": "https://www.gov.il/en/pages/medical-tourism-israel" } ], "sources": [ "s:wp-sheba", "s:israel-moh-medical-tourism", "s:loc-israel-medical-tourism-law", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "text.how": { "tier": "tradition", "note": "the shape of a cell therapy referral; marked in the prose" }, "metrics": { "tier": "cited", "source": "s:wp-sheba" } } }, "x_commons_files": [ "File:Sheba Medical Center.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "Israel's largest hospital: about 1,580 beds on an 800-dunam campus at Tel HaShomer in east Ramat Gan, government-affiliated and attached to Tel Aviv University.", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "tel-aviv", "type": "hub", "name": "Tel Aviv", "as": "The hospital the Tel Aviv cluster is built on, though its campus is in Ramat Gan rather than the city.", "rel": "place" }, { "to": "israel", "type": "destination", "name": "Israel", "as": "The country's largest hospital, and the one the 2018 medical tourism law was written around.", "rel": "destination" }, { "to": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "Among the cell therapies its international department leads with — a treatment travelled for because it is unavailable at home, not because it is cheap.", "rel": "performs" }, { "to": "hadassah", "type": "facility", "name": "Hadassah Medical Center", "as": "Jerusalem's teaching hospital, funded by an American women's organisation, against a government hospital founded by an army.", "rel": "contrast" }, { "to": "king-hussein-cancer-center", "type": "facility", "name": "King Hussein Cancer Center", "as": "The other regional cancer centre in this batch, an hour's drive and a closed border away.", "rel": "contrast" }, { "to": "deciding-whether", "type": "pathway", "name": "Deciding whether to go", "as": "A patient who travels for a therapy unavailable at home is answering a different question from one travelling for a price.", "rel": "step" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "A million a year, and the word in the source is visits.", "rel": "story" }, { "to": "unproven-stem-cell", "type": "risk", "name": "Unproven stem cell treatment", "as": "A regulated cell-therapy programme in a public hospital is the thing an unproven clinic imitates the vocabulary of.", "rel": "contrast" } ], "source_list": [ { "id": "s:wp-sheba", "kind": "wikipedia", "title": "Sheba Medical Center", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Sheba_Medical_Center", "license": "CC BY-SA 4.0", "accessed": "2026-09-17", "note": "founded 1948 as Israel's first military hospital, civilian from 1953 under Chaim Sheba, government-affiliated, Tel HaShomer in Ramat Gan on an 800-dunam campus; about 1,580 beds, about 1,700 physicians and 12,000 other healthcare workers; over 1,000,000 patient visits a year including 200,000 emergency visits; Global Patient Services treats patients from over 100 countries; Newsweek ranked it 8th in the world in 2025" }, { "id": "s:israel-moh-medical-tourism", "kind": "gov", "title": "Medical Tourism in Israel", "publisher": "Israel Ministry of Health", "url": "https://www.gov.il/en/pages/medical-tourism-israel", "accessed": "2026-09-16", "note": "published 15 November 2021, updated 20 March 2023; carries the Ministry of Tourism's arrivals estimate and the ministry's account of the 2018 law" }, { "id": "s:loc-israel-medical-tourism-law", "kind": "law", "title": "Israel: Knesset Passes Medical Tourism Legislation", "publisher": "Library of Congress, Global Legal Monitor", "url": "https://www.loc.gov/item/global-legal-monitor/2018-09-25/israel-knesset-passes-medical-tourism-legislation/", "accessed": "2026-09-16", "note": "names the instrument as the Medical Tourism Law, 5778-2018, passed 18 July 2018. The page would not open for this project on the access date — a bot check stood in front of it — so the provisions here were taken from the Israeli Ministry of Health's own summary and flagged for verification against the statute." }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "the shape of a cell therapy referral; marked in the prose" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:wp-sheba" } }, "primary_image": null, "tag_facts": [ { "key": "public-hospital", "label": "Public hospital", "icon": "🏛", "group": "ownership", "evidence": "a ministry register, a national health service list, or the hospital's own statement", "source": "s:wp-sheba", "note": "government-affiliated, founded 1948 as the army's hospital and civilian since 1953", "tier": "cited", "url": "" }, { "key": "university-hospital", "label": "University hospital", "icon": "🎓", "group": "ownership", "evidence": "the affiliated university's own page or the hospital's charter", "source": "s:wp-sheba", "note": "affiliated with Tel Aviv University", "tier": "cited", "url": "" }, { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:wp-sheba", "note": "Global Patient Services, treating patients from over a hundred countries", "tier": "cited", "url": "" }, { "key": "interpreter", "label": "Interpreters on staff", "icon": "🗣", "group": "service", "evidence": "the facility's own page naming the languages, or a published inspection or accreditation report", "source": "s:wp-sheba", "note": "multilingual support stated as part of Global Patient Services", "tier": "cited", "url": "" }, { "key": "transplant-programme", "label": "Transplant programme", "icon": "🫀", "group": "clinical", "evidence": "a national transplant registry, a ministry licence list, or the facility's own programme page", "source": "s:wp-sheba", "note": "cell therapy — CAR-T and tumour-infiltrating lymphocyte immunotherapy — named as what international patients come for", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:israel-moh-medical-tourism", "note": "no schedule is published by the hospital; the ministry publishes the regulatory framework instead", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "newsweek-statista", "label": "Newsweek / Statista World's Best Hospitals", "what": "Ranked eighth in the world in the 2025 Newsweek list, its highest placing among Asian and Israeli hospitals", "url": "https://en.wikipedia.org/wiki/Sheba_Medical_Center", "kind": "listing", "year": 2025, "valid_until": null, "source": "s:wp-sheba" } ], "acclaim": 1, "kin_in": [ { "from": "israel", "type": "destination", "name": "Israel", "as": "One of the public hospitals the trade runs through.", "rel": "part" }, { "from": "tel-aviv", "type": "hub", "name": "Tel Aviv", "as": "The larger hospital campus at Tel HaShomer, inside this record's harvest radius.", "rel": "part" }, { "from": "hadassah", "type": "facility", "name": "Hadassah Medical Center", "as": "The larger Israeli hospital, government-founded by an army, against a hospital founded and part-funded by a women's organisation abroad.", "rel": "contrast" }, { "from": "king-hussein-cancer-center", "type": "facility", "name": "King Hussein Cancer Center", "as": "The other regional cancer centre in this batch, an hour's drive and a closed border away.", "rel": "contrast" } ] }, { "schema": 1, "id": "wooridul", "type": "facility", "names": { "name": "Wooridul Spine Hospital", "aliases": [ "우리들병원", "Cheongdam Wooridul Spine Hospital", "Wooridul Hospital" ], "said": "WOO-ri-deul — uri-deul, ours, the plural of we. One thing only: backs." }, "region": [ "east-asia" ], "facets": { "iso2": "KR", "ownership": "private", "founded": 1982, "specialty": [ "spine surgery", "neurosurgery", "orthopaedics", "rehabilitation medicine" ], "draws": [ "spinal-fusion", "disc-replacement" ], "status": "open", "languages": [ "Korean", "English", "Russian", "Arabic" ] }, "text": { "what": "A single-specialty spine hospital in Cheongdam, Gangnam-gu, Seoul, founded in 1982 by the neurosurgeon Sang-Ho Lee and built entirely around the spine: neurosurgery, orthopaedics and rehabilitation medicine, and nothing else. The state's promotion body lists it at 240 beds and 30 doctors. It opened a department for foreign patients in 2006, three years before the state's own count of foreign patients starts, and was designated an international training centre for two spine-surgery societies in 2001.", "story": "The hospital's own milestone list reads as a single specialty widening without ever changing subject. Sangho Lee Neurosurgery Clinic in 1982; Dongrae Wooridul Hospital in 1984; Yeoksam Wooridul in 1992; the Cheongdam headquarters in 1999. The Korean Ministry of Health and Welfare selected it as a specialty hospital in spine diseases in 2005 and again under the formal scheme in 2011.\n\nThe foreign practice came from the teaching, not from a marketing department. In 2001 the hospital was designated an international training centre by ISMISS and IMLAS — the minimally invasive spine surgery societies — and in 2002 an international training centre and Korean branch of the Royal College of Physicians and Surgeons. The Wooridul International Patient Center opened in 2006. Korea's own count of foreign patients begins in 2009, and the Act that governs registration now dates from 2015. *Inference —* the sequence puts Wooridul among the first Korean hospitals to build a foreign-patient practice, and it built it by training the surgeons who would refer, which is a slower route than an accreditation and a harder one to buy.\n\nThen the hospital went the other way. Shanghai in 2009, Jakarta in 2010, Istanbul and Dubai in 2011, Singapore in 2012. The current site lists two of them — Dubai, inside King's College Hospital London Dubai, and Abu Dhabi — alongside the five Korean sites, and says nothing about the rest; this record notes the difference between the two lists and makes no finding about what happened to the others.\n\nWhat the Abu Dhabi centre is worth reading closely. Healthpoint describes the Wooridul Spine Center as a partnership between Mubadala Health and the Seoul hospital, wholly owned by Mubadala, staffed by Korean spine surgeons, with its physiotherapists trained in Seoul, and it names the aim: to reduce the need for patients to travel abroad. *Inference —* that is a branch in the branding sense and an export in the commercial one. The hospital is not exporting a building. It is exporting the surgeon and the training, to a state that would rather buy the operation at home than send the patient and the fee to Korea.\n\nThe hospital's own greeting page calls it a \"world-class spine hospital\". This directory quotes that rather than asserting it, and carries no outcome figure, no complication rate and no volume count for the unit, because none was published on any page read here.", "how": "Foreign patients reach it through the International Patient Center opened in 2006. The state's Medical Korea listing names English, Russian and Arabic, western, Korean and halal catering, and direct billing with named international insurers — which is the part that matters to a Gulf patient whose treatment is paid for by somebody else. *Trade practice —* the Korean shape holds: registration with the ministry, an in-hospital international office, an estimate given on request, and no figure on the public pages.\n\nNothing is priced on any page read for this record.", "today": "As of 17 September 2026 the Korea Health Industry Development Institute's Medical Korea listing carries 240 beds, 30 doctors, KOIHA accreditation and three patient languages for the Hakdong-ro hospital. The hospital's own history page ends its overseas openings in 2012 and its current location list names Dubai and Abu Dhabi. No bed count, no founding figure and no foreign-patient number comes from the hospital itself; the counts here are the state body's." }, "geo": { "lat": 37.51906, "lon": 127.04971, "precision": "street", "source": "s:osm-nominatim" }, "address": { "street": "445 Hakdong-ro, Gangnam-gu", "city": "Seoul", "country": "KR", "postcode": "06068" }, "metrics": { "beds": 240, "doctors": 30, "annual_patients": null, "annual_foreign_patients": null, "note": "Beds and doctors are the Korea Health Industry Development Institute's listing for the Hakdong-ro hospital, not a figure the hospital publishes about itself, and they cover that site rather than the five-site Korean group. No patient count of any kind is published on the pages read: not total, not foreign, not by operation. A single-specialty hospital's case volume would be the number worth having here, and it is the number nobody prints.", "as_of": "2026", "source": "s:medicalkorea-wooridul", "url": "https://www.medicalkorea.or.kr/en/mostvisitedmedicalinstitutions/view?medicalProviderNo=102" }, "tags": [ { "tag": "international-office", "source": "s:wooridul-history", "tier": "cited", "note": "the Wooridul International Patient Center opened in 2006, three years before the state's own count of foreign patients starts", "url": "https://www.wooridul.com/introduce/history" }, { "tag": "interpreter", "source": "s:medicalkorea-wooridul", "tier": "cited", "note": "English, Russian and Arabic named on the state body's listing, with western, Korean and halal catering" }, { "tag": "insurer-direct", "source": "s:medicalkorea-wooridul", "tier": "cited", "note": "direct billing with named international insurers, listed by KHIDI" }, { "tag": "teaching", "source": "s:wooridul-history", "tier": "cited", "note": "designated an international training centre by ISMISS and IMLAS in 2001 and by the Royal College of Physicians and Surgeons in 2002; the founder's page names an International Training Center for doctors from abroad" }, { "tag": "chain", "source": "s:wooridul-greetings", "tier": "cited", "note": "five Korean sites — Cheongdam, Gimpo Airport, Busan, Daegu, Gwangju — plus centres listed at Dubai and Abu Dhabi" }, { "tag": "no-price-published", "source": "s:medicalkorea-wooridul", "tier": "cited", "note": "no figure on the state listing and none on the hospital's own pages read for this record" } ], "recognitions": [ { "by": "kohta", "what": "KOIHA accreditation, listed by the Korea Health Industry Development Institute", "year": null, "valid_until": null, "source": "s:medicalkorea-wooridul", "url": "https://www.medicalkorea.or.kr/en/mostvisitedmedicalinstitutions/view?medicalProviderNo=102", "note": "the state listing names the accreditation and gives no year; separate from the compulsory ministry registration every Korean facility treating foreign patients must hold" }, { "by": "other", "what": "Specialty hospital in spine diseases, designated by the Korean Ministry of Health and Welfare", "year": 2011, "valid_until": null, "source": "s:wooridul-history", "url": "https://www.wooridul.com/introduce/history", "note": "the hospital's history page records a first selection in 2005 and the designation under the formal scheme in 2011" } ], "kin": [ { "to": "seoul", "as": "Sits in Cheongdam, in the Gangnam blocks the city's clinic trade is named for, and does none of the work that trade is known for.", "rel": "place" }, { "to": "south-korea", "as": "Among the earliest Korean hospitals to build a foreign-patient practice, by training foreign surgeons before the state built a register.", "rel": "destination" }, { "to": "spinal-fusion", "as": "One of the two operations this hospital exists to do, listed on the state's own page for it.", "rel": "performs" }, { "to": "disc-replacement", "as": "The motion-preserving alternative to fusion; the Gulf centre staffed from this hospital lists it, and the Seoul pages read for this record do not.", "rel": "performs" }, { "to": "korea-foreign-patient-registration", "as": "Operates under the registration every Korean facility treating foreign patients must hold — a regime whose counts start in 2009, three years after this hospital opened its foreign-patient centre.", "rel": "governed-by" }, { "to": "severance", "as": "The other early Korean entrant, a 2,437-bed university hospital where this one is a single specialty.", "rel": "contrast" }, { "to": "khidi", "as": "The state body whose listing supplies every number on this record.", "rel": "measured-by" }, { "to": "getting-a-quote", "as": "An estimate on request and no published figure, which is the Korean pattern rather than this hospital's choice.", "rel": "step" } ], "links": [ { "label": "Wooridul Spine Hospital", "url": "https://www.wooridul.com/" }, { "label": "Wooridul Spine Hospital — history", "url": "https://www.wooridul.com/introduce/history" }, { "label": "Medical Korea listing (KHIDI)", "url": "https://www.medicalkorea.or.kr/en/mostvisitedmedicalinstitutions/view?medicalProviderNo=102" } ], "sources": [ "s:wooridul-history", "s:wooridul-greetings", "s:wooridul-location", "s:medicalkorea-wooridul", "s:healthpoint-wooridul-spine-centre", "s:khidi-medicalkorea", "s:osm-nominatim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:wooridul-history", "note": "the milestone dates are the hospital's own history page, read 17 September 2026; the Abu Dhabi description is Healthpoint's own; the two stretches marked *Inference —* are this project's reading" }, "text.how": { "tier": "tradition", "note": "the Korean route's shape; the languages, catering and direct billing are cited to the state listing" }, "metrics": { "tier": "cited", "source": "s:medicalkorea-wooridul" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim", "note": "geocoded from the address on the hospital's own location page" } } }, "x_commons_files": [ "File:Wooridul Spine Hospital.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "A single-specialty spine hospital in Cheongdam, Gangnam-gu, Seoul, founded in 1982 by the neurosurgeon Sang-Ho Lee and built entirely around the spine: neurosurgery, orthopaedics and rehabilitation medicine, and nothing…", "region_terms": [ { "key": "east-asia", "name": "East Asia", "note": "South Korea, Japan, Taiwan, China" } ], "kin_out": [ { "to": "seoul", "type": "hub", "name": "Seoul", "as": "Sits in Cheongdam, in the Gangnam blocks the city's clinic trade is named for, and does none of the work that trade is known for.", "rel": "place" }, { "to": "south-korea", "type": "destination", "name": "South Korea", "as": "Among the earliest Korean hospitals to build a foreign-patient practice, by training foreign surgeons before the state built a register.", "rel": "destination" }, { "to": "spinal-fusion", "type": "procedure", "name": "Spinal fusion", "as": "One of the two operations this hospital exists to do, listed on the state's own page for it.", "rel": "performs" }, { "to": "disc-replacement", "type": "procedure", "name": "Artificial disc replacement", "as": "The motion-preserving alternative to fusion; the Gulf centre staffed from this hospital lists it, and the Seoul pages read for this record do not.", "rel": "performs" }, { "to": "korea-foreign-patient-registration", "type": "rule", "name": "Korea's foreign patient attraction registration", "as": "Operates under the registration every Korean facility treating foreign patients must hold — a regime whose counts start in 2009, three years after this hospital opened its foreign-patient centre.", "rel": "governed-by" }, { "to": "severance", "type": "facility", "name": "Severance Hospital", "as": "The other early Korean entrant, a 2,437-bed university hospital where this one is a single specialty.", "rel": "contrast" }, { "to": "khidi", "type": "org", "name": "Korea Health Industry Development Institute", "as": "The state body whose listing supplies every number on this record.", "rel": "measured-by" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "An estimate on request and no published figure, which is the Korean pattern rather than this hospital's choice.", "rel": "step" } ], "source_list": [ { "id": "s:wooridul-history", "kind": "web", "title": "History — Wooridul Spine Hospital", "publisher": "Wooridul Spine Hospital", "url": "https://www.wooridul.com/introduce/history", "accessed": "2026-09-17", "note": "the hospital's own dated milestone list: 1982 Sangho Lee Neurosurgery Clinic founded; 1984 Dongrae Wooridul Hospital; 1992 Yeoksam Wooridul Hospital; 1999 Cheongdam Wooridul Spine Hospital as headquarters; 2001 international training centre for ISMISS and IMLAS; 2002 international training centre and Korea branch of the Royal College of Physicians and Surgeons; 2005 and 2011 spine specialty hospital designations by the Korean Ministry of Health and Welfare; 2006 Wooridul International Patient Center; 2009 Shanghai; 2010 Jakarta; 2011 Istanbul and Dubai; 2012 Singapore; 2012 first medical institution certificate from the Ministry" }, { "id": "s:wooridul-greetings", "kind": "web", "title": "Greetings — Wooridul Spine Hospital", "publisher": "Wooridul Spine Hospital", "url": "https://www.wooridul.com/introduce/greetings", "accessed": "2026-09-17", "note": "founder Dr Sang-Ho Lee's own page: a spine doctor since 1975, minimally invasive spine treatment, an International Training Center for doctors at home and abroad, and the hospital describing itself as a \"world-class spine hospital\". Current locations listed: Cheongdam, Gimpo Airport, Busan, Daegu, Gwangju, Dubai and Abu Dhabi" }, { "id": "s:wooridul-location", "kind": "web", "title": "Location — Wooridul Spine Hospital", "publisher": "Wooridul Spine Hospital", "url": "https://wooridul.com/introduce/location", "accessed": "2026-09-17", "note": "headquarters address given as 445 Hakdong-ro, Gangnam-gu, Seoul 06068" }, { "id": "s:medicalkorea-wooridul", "kind": "gov", "title": "Wooridul Spine Hospital — Medical Korea institution listing", "publisher": "Korea Health Industry Development Institute (KHIDI), Ministry of Health and Welfare", "url": "https://www.medicalkorea.or.kr/en/mostvisitedmedicalinstitutions/view?medicalProviderNo=102", "accessed": "2026-09-17", "note": "the state promotion body's own listing: 240 beds, 30 doctors, neurosurgery, orthopaedics and rehabilitation medicine, English, Russian and Arabic, western, Korean and halal meals, direct billing with named international insurers, KOIHA accreditation. No foreign patient count and no price" }, { "id": "s:healthpoint-wooridul-spine-centre", "kind": "web", "title": "Wooridul Spine Center — Healthpoint, Abu Dhabi", "publisher": "Healthpoint / Mubadala Health", "url": "https://healthpoint.ae/services/wooridul-spine-center/", "accessed": "2026-09-17", "note": "describes the centre as a partnership between Mubadala Health and Wooridul Spine Hospital, wholly owned by Mubadala, staffed by South Korean spine surgeons, with physiotherapists trained at the Seoul hospital; the stated aim is to reduce the need for patients to travel abroad. No opening date on the page" }, { "id": "s:khidi-medicalkorea", "kind": "org", "title": "About KHIDI — Medical Korea", "publisher": "Korea Health Industry Development Institute", "url": "http://www.medicalkorea.or.kr/en/aboutkhidi", "accessed": "2026-09-16", "note": "government-affiliated institution under the Ministry of Health and Welfare; the registration system, registered hospitals and registered facilitators" }, { "id": "s:osm-nominatim", "kind": "dataset", "title": "Nominatim search over OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://nominatim.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "queried by hand for the street and the point of each anchor hospital in this batch. A Nominatim answer is whatever a mapper typed and whatever the geocoder matched it to; the addr: tags are read here as the street, not as a postal address the hospital itself published." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:wooridul-history", "note": "the milestone dates are the hospital's own history page, read 17 September 2026; the Abu Dhabi description is Healthpoint's own; the two stretches marked *Inference —* are this project's reading" }, "text.how": { "tier": "tradition", "note": "the Korean route's shape; the languages, catering and direct billing are cited to the state listing" }, "text.today": { "tier": "cited" }, "geo": { "tier": "harvested", "source": "s:osm-nominatim", "note": "geocoded from the address on the hospital's own location page" }, "address": { "tier": "cited" }, "metrics": { "tier": "cited", "source": "s:medicalkorea-wooridul" } }, "primary_image": null, "tag_facts": [ { "key": "international-office", "label": "International patient office", "icon": "✈", "group": "service", "evidence": "the hospital's own international-patient page, or a directory entry naming the department", "source": "s:wooridul-history", "note": "the Wooridul International Patient Center opened in 2006, three years before the state's own count of foreign patients starts", "tier": "cited", "url": "https://www.wooridul.com/introduce/history" }, { "key": "interpreter", "label": "Interpreters on staff", "icon": "🗣", "group": "service", "evidence": "the facility's own page naming the languages, or a published inspection or accreditation report", "source": "s:medicalkorea-wooridul", "note": "English, Russian and Arabic named on the state body's listing, with western, Korean and halal catering", "tier": "cited", "url": "" }, { "key": "insurer-direct", "label": "Bills foreign insurers", "icon": "📄", "group": "money", "evidence": "the facility names the insurers or schemes it bills directly", "source": "s:medicalkorea-wooridul", "note": "direct billing with named international insurers, listed by KHIDI", "tier": "cited", "url": "" }, { "key": "teaching", "label": "Teaching hospital", "icon": "📚", "group": "clinical", "evidence": "a recognised training post list or the hospital's own statement", "source": "s:wooridul-history", "note": "designated an international training centre by ISMISS and IMLAS in 2001 and by the Royal College of Physicians and Surgeons in 2002; the founder's page names an International Training Center for doctors from abroad", "tier": "cited", "url": "" }, { "key": "chain", "label": "Part of a hospital group", "icon": "🔗", "group": "ownership", "evidence": "the group's own list of hospitals, or a filing naming the parent", "source": "s:wooridul-greetings", "note": "five Korean sites — Cheongdam, Gimpo Airport, Busan, Daegu, Gwangju — plus centres listed at Dubai and Abu Dhabi", "tier": "cited", "url": "" }, { "key": "no-price-published", "label": "No published price", "icon": "—", "group": "money", "evidence": "the facility's own site carries no price for the procedures it advertises, checked on a dated visit", "source": "s:medicalkorea-wooridul", "note": "no figure on the state listing and none on the hospital's own pages read for this record", "tier": "cited", "url": "" } ], "recognition_facts": [ { "key": "kohta", "label": "KOIHA / KAHF (South Korea)", "what": "KOIHA accreditation, listed by the Korea Health Industry Development Institute", "url": "https://www.medicalkorea.or.kr/en/mostvisitedmedicalinstitutions/view?medicalProviderNo=102", "kind": "national", "year": null, "valid_until": null, "source": "s:medicalkorea-wooridul" }, { "key": "other", "label": "Somebody else", "what": "Specialty hospital in spine diseases, designated by the Korean Ministry of Health and Welfare", "url": "https://www.wooridul.com/introduce/history", "kind": "other", "year": 2011, "valid_until": null, "source": "s:wooridul-history" } ], "acclaim": 2, "kin_in": [ { "from": "south-korea", "type": "destination", "name": "South Korea", "as": "The spine specialist that made Korea a named address for back surgery.", "rel": "part" }, { "from": "seoul", "type": "hub", "name": "Seoul", "as": "The spine hospital that made Korean spinal surgery a destination in its own right.", "rel": "part" } ] }, { "id": "aftercare-at-home", "names": { "name": "Aftercare at home", "aliases": [ "follow-up", "the six-week check", "post-operative care at home" ], "said": "The package called it follow-up and meant the week in the hotel. At home it means whoever takes the stitches out." }, "facets": { "stage": "aftercare" }, "x_order": 15, "text": { "what": "Wound checks, stitch removal, physiotherapy, drug management and the first sight of a complication happen in the patient's own country, performed by clinicians who were not party to the consent, did not select the implant, hold no record of the operation beyond what the patient carries, and were not paid for any of it.", "story": "The asymmetry is stated plainly by the NHS for its own readers: \"If you have complications after an operation in the UK, it's the surgeon's responsibility to provide follow-up treatment\", while \"Overseas clinics may not provide follow-up treatment, or they may not provide it to the same standard as in the UK.\"\n\nWhere the load lands has been counted, in the one specialty where the cases are visible. A cost analysis at Gold Coast University Hospital in Queensland totalled 12 patients presenting in the 2012–13 financial year with complications of cosmetic surgery performed in Thailand: AUD$151,172.52 to that hospital in one year, averaging AUD$12,597.71 a patient and ranging from AUD$1,190.28 to AUD$33,060.02. In the United Kingdom a 2025 review carries the BAAPS national audit figures — UK residents needing NHS hospital treatment after surgery abroad up \"by 94% in 3 years\", \"75% citing Turkey as the origin of their surgery\", and an average NHS cost of \"£15,000 per person, depending on the treatment required\" — alongside an NHS Scotland series of 81 patients over five years costing \"£755,559.68, an average of over £9,327.90 per patient\".\n\nThose counts are narrow and worth saying so: they count patients who reached a public hospital with a complication of cosmetic surgery, in three health systems, over fixed periods. They are not a complication rate, they have no denominator, and they say nothing about dental, orthopaedic or fertility work.\n\n*Inference —* the structural fact underneath is that the fee and the aftercare are paid to different systems. The revenue went to the provider abroad; the cost of what follows sits with a public system or a home insurer that never priced it, and with a general practitioner holding a summary they did not write.", "how": "*Trade practice —* packages that name follow-up usually mean visits inside the destination stay. Where a complication policy exists it runs for a defined window and pays for treatment by the original provider, which implies flying back.\n\nWhat a reader would have to ask before the trip, since the answer cannot be got afterwards: who removes the sutures and where, whether the home system will accept the case, whether the operating surgeon will answer a question from a home clinician, what the implant is, and what the provider undertakes to do if the wound fails at week three.", "today": "As of 16 September 2026 the published counts of what returning patients cost their home systems all come from plastic surgery and from a handful of countries. No national system this project could find routinely records, in its own data, that an episode of care was caused by treatment obtained abroad." }, "kin": [ { "to": "follow-up-gap", "as": "The risk record for the hole this step falls into.", "rel": "risk" }, { "to": "revision-at-home", "as": "What happens when the operation has to be done again, by someone else.", "rel": "risk" }, { "to": "the-discharge-summary", "as": "The only document the home clinician has to work from.", "rel": "step" }, { "to": "the-flight-home", "as": "The step before, and the one that sets how much healing happened in transit.", "rel": "step" }, { "to": "when-it-goes-wrong", "as": "Where this step goes when the wound fails.", "rel": "step" }, { "to": "the-follow-up-nobody-books", "as": "The longer piece on this gap.", "rel": "story" }, { "to": "surgical-site-infection", "as": "The commonest reason a returning patient presents at home.", "rel": "risk" } ], "sources": [ "s:nhs-cosmetic-surgery-abroad", "s:eplasty-cosmetic-tourism-cost", "s:wounds-uk-cosmetic-tourism" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "tradition" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "pathway", "region": [ "global" ], "updated": "2026-09-16", "blurb": "Wound checks, stitch removal, physiotherapy, drug management and the first sight of a complication happen in the patient's own country, performed by clinicians who were not party to the consent, did not select the…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The risk record for the hole this step falls into.", "rel": "risk" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "What happens when the operation has to be done again, by someone else.", "rel": "risk" }, { "to": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "The only document the home clinician has to work from.", "rel": "step" }, { "to": "the-flight-home", "type": "pathway", "name": "The flight home", "as": "The step before, and the one that sets how much healing happened in transit.", "rel": "step" }, { "to": "when-it-goes-wrong", "type": "pathway", "name": "When it goes wrong", "as": "Where this step goes when the wound fails.", "rel": "step" }, { "to": "the-follow-up-nobody-books", "type": "story", "name": "The follow-up nobody books", "as": "The longer piece on this gap.", "rel": "story" }, { "to": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The commonest reason a returning patient presents at home.", "rel": "risk" } ], "source_list": [ { "id": "s:nhs-cosmetic-surgery-abroad", "kind": "org", "title": "Cosmetic surgery abroad", "publisher": "NHS (England)", "url": "https://www.nhs.uk/tests-and-treatments/cosmetic-procedures/advice/cosmetic-surgery-abroad/", "accessed": "2026-09-16", "note": "read for aftercare responsibility, flying intervals and the statement on travel insurance" }, { "id": "s:eplasty-cosmetic-tourism-cost", "kind": "paper", "title": "The real cost of cosmetic tourism: cost analysis study of cosmetic tourism complications presenting to a public hospital", "publisher": "Livingston R, Berlund P, Eccles-Smith J, Sawhney R. Eplasty 2015;15:e34", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC4522144/", "accessed": "2026-09-16", "note": "Gold Coast University Hospital, Queensland, financial year 2012–13, 12 patients" }, { "id": "s:wounds-uk-cosmetic-tourism", "kind": "paper", "title": "Cosmetic tourism: the cost of going 'under the knife' abroad for cosmetic surgery", "publisher": "Hatch J. Wounds UK 2025;21(4):44–49", "url": "https://wounds-uk.com/journal-articles/cosmetic-tourism-the-cost-of-going-under-the-knife-abroad-for-cosmetic-surgery/", "accessed": "2026-09-16", "note": "carries the BAAPS national audit figures and the NHS Scotland series" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "chiang-mai", "type": "hub", "name": "Chiang Mai", "as": "The long stay exists partly to move the recovery here rather than home.", "rel": "step" }, { "from": "vilnius", "type": "hub", "name": "Vilnius", "as": "Where the physiotherapy after a joint replacement actually happens.", "rel": "step" }, { "from": "acl-reconstruction", "type": "procedure", "name": "Anterior cruciate ligament reconstruction", "as": "The step this operation lives or dies by, and which most price pages leave out.", "rel": "step" }, { "from": "addiction-rehab", "type": "procedure", "name": "Residential addiction treatment", "as": "Where the promise of lifetime aftercare groups has to be kept, by video.", "rel": "step" }, { "from": "cochlear-implant", "type": "procedure", "name": "Cochlear implant", "as": "Where the map, the spare parts and the audiologist have to be, for the rest of the patient's life.", "rel": "step" }, { "from": "facelift", "type": "procedure", "name": "Facelift", "as": "Sutures out in stages, and the last of them often after the flight.", "rel": "step" }, { "from": "hospital-cima-san-jose", "type": "facility", "name": "Hospital CIMA San José", "as": "Four hours from Miami, close enough that the follow-up is a flight and not a relocation.", "rel": "step" }, { "from": "the-companion", "type": "pathway", "name": "The companion", "as": "Where the nursing the companion started gets handed to nobody in particular.", "rel": "step" }, { "from": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "Where this document becomes the whole of the clinical history.", "rel": "step" }, { "from": "the-flight-home", "type": "pathway", "name": "The flight home", "as": "What lands on the other side.", "rel": "step" }, { "from": "when-it-goes-wrong", "type": "pathway", "name": "When it goes wrong", "as": "The step this one interrupts.", "rel": "step" }, { "from": "alone-after-discharge", "type": "risk", "name": "Discharged alone", "as": "The step that begins after a flight, where a household would have begun the same evening.", "rel": "step" }, { "from": "antimicrobial-resistance", "type": "risk", "name": "Antimicrobial resistance acquired abroad", "as": "The step at which the screening swab is taken.", "rel": "step" }, { "from": "bloodborne-virus", "type": "risk", "name": "Bloodborne virus from treatment abroad", "as": "The step at which nobody takes the travel history that would find this.", "rel": "step" }, { "from": "candida-auris", "type": "risk", "name": "Candida auris", "as": "The step at which a screening swab would be taken, if anyone ordered one.", "rel": "step" }, { "from": "counterfeit-medicines", "type": "risk", "name": "Substandard and falsified medicines", "as": "The step at which the course runs out and is refilled somewhere.", "rel": "step" }, { "from": "dvt-pe", "type": "risk", "name": "Deep vein thrombosis and pulmonary embolism", "as": "Where the anticoagulant course runs out, in a system with no record of when it started.", "rel": "step" }, { "from": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The step this risk is the absence of.", "rel": "step" }, { "from": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The step it interrupts.", "rel": "step" }, { "from": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The step at which this is usually found.", "rel": "step" }, { "from": "cross-border-prescriptions", "type": "rule", "name": "A prescription that crosses a border", "as": "The step where the prescription is presented.", "rel": "step" }, { "from": "patient-data-transfer", "type": "rule", "name": "Moving a medical record across a border", "as": "Where the absence of a record is discovered.", "rel": "step" }, { "from": "gha", "type": "org", "name": "Global Healthcare Accreditation", "as": "The end of the pathway this scheme claims to cover, and the part no clinical accreditation reaches.", "rel": "step" }, { "from": "the-follow-up-nobody-books", "type": "story", "name": "The follow-up nobody books", "as": "The step in the journey that this is the failure of.", "rel": "step" } ] }, { "id": "arrival-and-consent", "names": { "name": "Arrival and consent", "aliases": [ "the pre-operative consultation", "signing the consent form" ], "said": "The first meeting with the surgeon and the signing of the form usually happen on the same day, sometimes in the same hour." }, "facets": { "stage": "on-arrival" }, "x_order": 11, "text": { "what": "The patient lands, is examined for the first time by the person who will operate, and signs a consent form. In a domestic pathway these events are separated by weeks. Here they are compressed into a day or two, at the far end of a flight, after the money has gone.", "story": "Consent across a language barrier is measured, and the measurements are not reassuring even in the easy case. Schenker and colleagues matched 74 pairs of patients at a US public teaching hospital with on-site professional interpreters, for lumbar puncture, thoracentesis and paracentesis, between January 2004 and January 2006. Full documentation of informed consent was present for 53% of English-speaking patients and 28% of patients with limited English proficiency — an adjusted odds ratio of 3.10 (95% CI 1.49–6.47, p=0.003). Only 41% of the limited-English charts contained a consent form in the patient's own language or signed by an interpreter. The conclusion: \"Despite the availability of on-site professional interpreter services, hospitalized patients who do not speak English are less likely to have documentation of informed consent for common invasive procedures.\"\n\n*Inference —* that is the well-resourced version of the problem. The patient in this step is the linguistic minority in the building, the interpreter may be the coordinator who sold the package, and the form is in the hospital's working language and under the hospital's law.\n\nThe consent form is also a legal document doing work the clinical conversation does not mention. It names the procedure, and sometimes the surgeon; it may name the implant; it may contain the only written statement of which country's courts hear a dispute. Directive 2011/24/EU obliges providers in an EU state of treatment to give \"relevant information ... on treatment options ... quality and safety\" (Article 4(2)(b)); outside the EU, what must be disclosed is whatever that jurisdiction's own law requires.", "how": "*Trade practice —* the sequence on arrival is consultation, blood tests and imaging, an anaesthetic review, a revised price, and the form. The revision at this point is where the package meets the body: an unexpected finding, a second procedure suggested, a higher grade of implant offered.\n\nWhat a reader would have to ask: who interprets and who employs them, whether the form exists in a language the patient reads, whether the named surgeon on the form is the surgeon who operates, whether any part of the form waives a right or fixes a forum, and what the price is now.", "today": "As of 16 September 2026 no cross-border standard this project could find requires a consent form for a foreign patient to be given in that patient's own language, or requires an independent interpreter. Where accreditation standards touch it, they bind the hospital that chose to be accredited." }, "kin": [ { "to": "language-consent", "as": "The risk this step runs on, with the published measurement of it.", "rel": "risk" }, { "to": "informed-consent", "as": "The doctrine, and what it assumes about a shared language.", "rel": "term" }, { "to": "in-hospital", "as": "What the signature starts.", "rel": "step" }, { "to": "anaesthetic-risk-unscreened", "as": "The assessment this compressed day is supposed to contain.", "rel": "risk" }, { "to": "malpractice-recourse", "as": "Decided, often, by wording inside the form signed here.", "rel": "risk" }, { "to": "eu-directive-2011-24", "as": "What a provider in an EU state of treatment must disclose.", "rel": "governed-by" } ], "sources": [ "s:schenker-consent-language", "s:dir-2011-24-chapter-ii" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "tradition" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "pathway", "region": [ "global" ], "updated": "2026-09-16", "blurb": "The patient lands, is examined for the first time by the person who will operate, and signs a consent form. In a domestic pathway these events are separated by weeks.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "The risk this step runs on, with the published measurement of it.", "rel": "risk" }, { "to": "informed-consent", "type": "term", "name": "Informed consent", "as": "The doctrine, and what it assumes about a shared language.", "rel": "term" }, { "to": "in-hospital", "type": "pathway", "name": "In hospital", "as": "What the signature starts.", "rel": "step" }, { "to": "anaesthetic-risk-unscreened", "type": "risk", "name": "Fitness for anaesthesia, assessed on arrival", "as": "The assessment this compressed day is supposed to contain.", "rel": "risk" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "Decided, often, by wording inside the form signed here.", "rel": "risk" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "What a provider in an EU state of treatment must disclose.", "rel": "governed-by" } ], "source_list": [ { "id": "s:schenker-consent-language", "kind": "paper", "title": "The impact of language barriers on documentation of informed consent at a hospital with on-site interpreter services", "publisher": "Schenker Y, Wang F, Selig SJ, Ng R, Fernandez A. Journal of General Internal Medicine 2007;22(Suppl 2):294–9", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2078548/", "accessed": "2026-09-16", "note": "74 matched pairs, lumbar puncture, thoracentesis and paracentesis, one US public teaching hospital, January 2004 to January 2006" }, { "id": "s:dir-2011-24-chapter-ii", "kind": "law", "title": "Directive 2011/24/EU, Chapter II — responsibilities of the Member State of treatment and of affiliation, Articles 4 to 6", "publisher": "legislation.gov.uk, retained text of Directive 2011/24/EU", "url": "https://www.legislation.gov.uk/cy/eudr/2011/24/chapter/II/data.htm?view=plain", "accessed": "2026-09-16", "note": "read for Art 4(2)(b) invoices and prices, 4(2)(c) complaints and redress, 4(2)(d) professional liability insurance, 4(2)(f) copy of the medical record, 5(d) access to records, and Art 6 national contact points" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "complaint-and-claim", "type": "pathway", "name": "Complaint and claim", "as": "Where the forum and the governing law were probably fixed, in a form signed on arrival.", "rel": "step" }, { "from": "in-hospital", "type": "pathway", "name": "In hospital", "as": "The signature that opened this step.", "rel": "step" }, { "from": "the-companion", "type": "pathway", "name": "The companion", "as": "The conversation the companion is the second listener in.", "rel": "step" }, { "from": "anaesthetic-risk-unscreened", "type": "risk", "name": "Fitness for anaesthesia, assessed on arrival", "as": "The step the anaesthetic review sits in, on the same day as the signature.", "rel": "step" }, { "from": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "The step this risk sits inside: the examination and the signature, usually on the same day.", "rel": "step" }, { "from": "asa-grade", "type": "term", "name": "ASA grade", "as": "The step where the grade is actually assigned.", "rel": "step" }, { "from": "informed-consent", "type": "term", "name": "Informed consent", "as": "The step where the form is signed, usually the day before surgery.", "rel": "step" } ] }, { "id": "booking-the-flight", "names": { "name": "Booking the flight", "aliases": [ "the outbound and the return", "ticketing" ], "said": "The outbound date is a clinic's date. The return date is a guess made before the operation exists." }, "facets": { "stage": "before-you-fly" }, "x_order": 9, "text": { "what": "Two dates are bought at once, weeks before any operation happens. The outbound follows the clinic's calendar. The return is fixed against an expected recovery that nobody has yet examined, and it is the date that collides with clinical reality later.", "story": "Published guidance on how long to wait before flying is written by aviation medicine, not by the clinics that sell packages, and it is specific by procedure. The UK Civil Aviation Authority states that \"travel should be avoided for 10 days following abdominal surgery\", that \"it is advisable to avoid flying for approximately 24 hours after laparoscopic intervention, due to the residual CO2 gas\", and that after neurosurgery it is \"advisable to avoid air travel for approximately 7 days following this type of procedure\". For intra-ocular procedures it gives \"1 week should elapse before flying\", extending to \"approximately 2 weeks if sulphur hexafluoride is used and 6 weeks with the use of perfluoropropane\" where gas is injected. For plaster casts it notes that \"the majority of airlines restrict flying for 24 hours on flights of less than 2 hours or 48 hours for longer flights\".\n\nThe CDC Yellow Book carries a blunter version: travellers \"should not fly for 10 days after chest or abdominal surgery\", and it puts 7 to 10 days on laser and cosmetic procedures to the face, eyelids or nose. The NHS gives 5 to 7 days after breast surgery and liposuction and 7 to 10 days after facial procedures or an abdominoplasty, and names the reason: \"Air travel and major surgery increase your risk of a blood clot, which can be life threatening.\"\n\n*Inference —* those intervals are longer than the ward stays most packages name, which is how a return ticket bought at booking ends up landing inside the window the guidance describes.", "how": "*Trade practice —* a cheap fare is the one with the change fee, and the fare rules that make a ticket cheap are the rules that make a slipped discharge expensive. Airlines may also require medical clearance for a passenger travelling soon after surgery, and the clearance decision belongs to the airline's medical department rather than to the treating surgeon.\n\nWhat a reader would have to ask: what a date change costs on the fare bought, whether the airline requires a fitness-to-fly form and who signs it, whether the seat can be changed if a cast or a drain makes the booked one impossible, and who pays for the extra hotel nights if the return moves.", "today": "As of 16 September 2026 the aviation guidance and the package length of stay are published by different parties with no obligation to agree, and no provider this project read prices the gap between them." }, "metrics": { "days_before_flying": 10, "note": "Ten days is the CDC Yellow Book interval after chest or abdominal surgery and the UK Civil Aviation Authority interval after abdominal surgery. It is not a universal figure: the CAA gives about 24 hours after laparoscopic surgery, about 7 days after neurosurgery, 1 to 6 weeks after intra-ocular procedures depending on the gas used, and airlines set their own restrictions on top.", "as_of": "2026-09-16", "source": "s:caa-surgical-conditions", "url": "https://www.caa.co.uk/passengers-and-public/passenger-guidance/health-guidance/guidance-for-health-professionals/surgical-conditions/" }, "kin": [ { "to": "the-flight-home", "as": "The leg this step buys blind.", "rel": "step" }, { "to": "flying-after-surgery", "as": "The clinical risk the booked return date runs into.", "rel": "risk" }, { "to": "dvt-pe", "as": "The specific hazard the flying intervals exist to reduce.", "rel": "risk" }, { "to": "the-visa", "as": "The permission whose dates the tickets have to sit inside.", "rel": "step" }, { "to": "the-companion", "as": "The second ticket, bought at the same time and rarely in the quoted price.", "rel": "step" } ], "sources": [ "s:caa-surgical-conditions", "s:cdc-yellowbook-medical-tourism", "s:nhs-cosmetic-surgery-abroad" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "tradition", "note": "fare rules and airline clearance practice; marked inline" }, "text.today": { "tier": "inference" }, "metrics": { "tier": "cited", "source": "s:caa-surgical-conditions" } } }, "confidence": "high", "schema": 1, "type": "pathway", "region": [ "global" ], "updated": "2026-09-16", "blurb": "Two dates are bought at once, weeks before any operation happens. The outbound follows the clinic's calendar.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "the-flight-home", "type": "pathway", "name": "The flight home", "as": "The leg this step buys blind.", "rel": "step" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The clinical risk the booked return date runs into.", "rel": "risk" }, { "to": "dvt-pe", "type": "risk", "name": "Deep vein thrombosis and pulmonary embolism", "as": "The specific hazard the flying intervals exist to reduce.", "rel": "risk" }, { "to": "the-visa", "type": "pathway", "name": "The visa", "as": "The permission whose dates the tickets have to sit inside.", "rel": "step" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "The second ticket, bought at the same time and rarely in the quoted price.", "rel": "step" } ], "source_list": [ { "id": "s:caa-surgical-conditions", "kind": "org", "title": "Surgical conditions — health guidance for health professionals", "publisher": "UK Civil Aviation Authority", "url": "https://www.caa.co.uk/passengers-and-public/passenger-guidance/health-guidance/guidance-for-health-professionals/surgical-conditions/", "accessed": "2026-09-16", "note": "intervals before flying after abdominal, laparoscopic, orthopaedic, ocular and neurosurgical procedures" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:nhs-cosmetic-surgery-abroad", "kind": "org", "title": "Cosmetic surgery abroad", "publisher": "NHS (England)", "url": "https://www.nhs.uk/tests-and-treatments/cosmetic-procedures/advice/cosmetic-surgery-abroad/", "accessed": "2026-09-16", "note": "read for aftercare responsibility, flying intervals and the statement on travel insurance" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "fare rules and airline clearance practice; marked inline" }, "text.today": { "tier": "inference" }, "metrics": { "tier": "cited", "source": "s:caa-surgical-conditions" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "dialysis-holiday", "type": "procedure", "name": "Dialysis away from home", "as": "Sessions are booked before the flight here, not after it.", "rel": "step" }, { "from": "the-flight-home", "type": "pathway", "name": "The flight home", "as": "Where this date was chosen, weeks before the body existed to fly it.", "rel": "step" }, { "from": "the-visa", "type": "pathway", "name": "The visa", "as": "The next step, and the one whose dates the visa constrains.", "rel": "step" }, { "from": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The step at which the return date is fixed, usually before anyone has seen the wound.", "rel": "step" }, { "from": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "The step at which the second ticket is bought, on dates the surgery may move.", "rel": "step" } ] }, { "id": "choosing-a-facilitator", "names": { "name": "Choosing a facilitator", "aliases": [ "broker", "medical travel agency", "patient coordinator", "medical concierge" ], "said": "The industry says facilitator. The research literature says broker. The contract, where there is one, often says agent." }, "facets": { "stage": "booking" }, "x_order": 5, "text": { "what": "An intermediary stands between the patient and the hospital: it collects records, produces a quote, books the surgeon, sometimes books the flight and the hotel, and meets the patient at the airport. It is a commercial party, it is usually paid by the hospital rather than by the patient, and in most countries no licence is required to be one.", "story": "The most-cited empirical work counted what these firms tell the people who read them. Penney and colleagues examined 17 English-language Canadian broker websites in the summer of 2010: 47% made no mention of risks, only two of the seventeen displayed certified accreditation, 35.3% displayed a membership logo instead, 52.9% promised follow-up care, and one site stated it had \"no ongoing involvement in the doctor-patient relationship\". The authors concluded that brokers \"currently lack a common standard of care and accreditation\".\n\n*Trade practice —* the commercial arrangement is the part that is rarely written down where a patient can see it: the facilitator is typically remunerated by the hospital on a commission or referral basis, which means the party choosing the surgeon is paid by the surgeon's employer. Facilitator sites this project read do not state the arrangement.\n\n*Inference —* the accreditation logos that appear in place of a licence are not equivalent. A hospital accreditation says something about the hospital; a trade-body membership says the firm paid a subscription. Neither is a licence and neither creates a body that can strike a facilitator off.\n\nWhen something goes wrong, the question is what the intermediary agreed to be. An agent who arranged a service and a provider who supplied one carry different obligations, and that distinction turns on contract wording rather than on the job title used on the website.", "how": "No national licensing regime for medical travel facilitators turned up anywhere this project could read. Some destinations license the hospital, and some license a health-tourism intermediary as a condition of operating in that country — those regimes are described on their own rule records — but the firm a patient contracts with is frequently registered in the patient's own country as an ordinary company, selling a service performed eight time zones away.\n\nWhat a reader would have to ask to find out: which legal entity is named on the contract and where it is registered, whether that entity is paid by the hospital and how much, which country's law and which forum the contract names, what the firm undertakes to do if a complication occurs, and whether it carries any insurance of its own.", "today": "As of 16 September 2026 the only systematic evidence about this trade that this project could find is content analysis of what facilitators publish — the Canadian sample above and studies like it — not audit of what they do. Nothing counts how many patients travel through a facilitator, and nothing counts what happens to those who do." }, "kin": [ { "to": "getting-a-quote", "as": "The document this party usually issues.", "rel": "step" }, { "to": "the-deposit", "as": "Where the money often lands first — in the intermediary's account, not the hospital's.", "rel": "step" }, { "to": "facilitator", "as": "The word, and the argument about what the job is.", "rel": "term" }, { "to": "malpractice-recourse", "as": "What the intermediary's contract wording decides in advance.", "rel": "risk" }, { "to": "medical-tourism-association", "as": "A trade body whose logo appears where a licence does not exist.", "rel": "org" }, { "to": "the-accreditation-question", "as": "What an accreditation mark on a broker's page does and does not say.", "rel": "story" }, { "to": "reading-the-exclusions", "as": "The paper the facilitator's promises have to survive.", "rel": "step" }, { "to": "defiant", "as": "A named facilitator, listed here because its fee basis and its posted prices are the two things this step says are worth reading; this directory and it share an owner.", "rel": "org" } ], "sources": [ "s:penney-broker-websites" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "Penney 2011 is cited; the commission paragraph is marked trade practice and the accreditation paragraph inference, inline" }, "text.how": { "tier": "inference", "note": "this project's search for a licensing regime; absence here means not found, not proven absent" }, "text.today": { "tier": "inference" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "pathway", "region": [ "global" ], "updated": "2026-09-16", "blurb": "An intermediary stands between the patient and the hospital: it collects records, produces a quote, books the surgeon, sometimes books the flight and the hotel, and meets the patient at the airport.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The document this party usually issues.", "rel": "step" }, { "to": "the-deposit", "type": "pathway", "name": "The deposit", "as": "Where the money often lands first — in the intermediary's account, not the hospital's.", "rel": "step" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The word, and the argument about what the job is.", "rel": "term" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "What the intermediary's contract wording decides in advance.", "rel": "risk" }, { "to": "medical-tourism-association", "type": "org", "name": "Medical Tourism Association", "as": "A trade body whose logo appears where a licence does not exist.", "rel": "org" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "What an accreditation mark on a broker's page does and does not say.", "rel": "story" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The paper the facilitator's promises have to survive.", "rel": "step" }, { "to": "defiant", "type": "org", "name": "Defiant", "as": "A named facilitator, listed here because its fee basis and its posted prices are the two things this step says are worth reading; this directory and it share an owner.", "rel": "org" } ], "source_list": [ { "id": "s:penney-broker-websites", "kind": "paper", "title": "Risk communication and informed consent in the medical tourism industry: a thematic content analysis of Canadian broker websites", "publisher": "Penney K, Snyder J, Crooks VA, Johnston R. BMC Medical Ethics 2011;12:17", "url": "https://bmcmedethics.biomedcentral.com/articles/10.1186/1472-6939-12-17", "accessed": "2026-09-16", "note": "17 English-language Canadian broker sites, summer 2010" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "Penney 2011 is cited; the commission paragraph is marked trade practice and the accreditation paragraph inference, inline" }, "text.how": { "tier": "inference", "note": "this project's search for a licensing regime; absence here means not found, not proven absent" }, "text.today": { "tier": "inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "san-jose-cr", "type": "hub", "name": "San José, Costa Rica", "as": "The step that matters most here, because a facilitator stands between patient and surgeon in much of this market.", "rel": "step" }, { "from": "clinica-las-americas", "type": "facility", "name": "Clínica Las Américas", "as": "An in-house international office is the alternative to a broker, and it is the clinic's own staff.", "rel": "step" }, { "from": "fortis-gurgaon", "type": "facility", "name": "Fortis Memorial Research Institute, Gurugram", "as": "Much of the Delhi NCR inbound trade reaches hospitals like this one through brokers rather than directly.", "rel": "step" }, { "from": "complaint-and-claim", "type": "pathway", "name": "Complaint and claim", "as": "The party whose contract wording often decides where this step can be brought.", "rel": "step" }, { "from": "deciding-whether", "type": "pathway", "name": "Deciding whether to go", "as": "The party who wrote most of what gets read at this stage, and who is paid when the answer is yes.", "rel": "step" }, { "from": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "Who usually issues the quote, and who is paid on it.", "rel": "step" }, { "from": "the-deposit", "type": "pathway", "name": "The deposit", "as": "Often the party that actually receives the money.", "rel": "step" }, { "from": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "Decides who the deposit is actually paid to, and who is liable if the clinic cancels.", "rel": "step" }, { "from": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "The step at which the seller becomes the interpreter.", "rel": "step" }, { "from": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "The step at which a third party enters the contract, and the liability question splits in two.", "rel": "step" }, { "from": "korea-foreign-patient-registration", "type": "rule", "name": "Korea's foreign patient attraction registration", "as": "The step at which the register and the guaranty insurance matter.", "rel": "step" }, { "from": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The step at which the register can be checked.", "rel": "step" }, { "from": "uae-clinic-licensing", "type": "rule", "name": "Licensing a clinic in the United Arab Emirates", "as": "The step at which a register can be searched, if you know which one.", "rel": "step" }, { "from": "defiant", "type": "org", "name": "Defiant", "as": "One named example of the link in the chain that step is about.", "rel": "step" }, { "from": "promed", "type": "org", "name": "PROMED", "as": "The step where a membership seal is often read as an inspection.", "rel": "step" }, { "from": "temos", "type": "org", "name": "Temos International Healthcare Accreditation", "as": "The step of the journey where a broker's accreditation is the only external mark on offer.", "rel": "step" }, { "from": "josef-woodman", "type": "person", "name": "Josef Woodman", "as": "The step of the journey his guide was written for.", "rel": "pathway" }, { "from": "facilitator", "type": "term", "name": "Facilitator", "as": "The step where this word is chosen from, and what a reader can check about it.", "rel": "step" } ] }, { "id": "complaint-and-claim", "names": { "name": "Complaint and claim", "aliases": [ "redress", "malpractice claim", "regulatory complaint" ], "said": "Two different things with one name: a complaint to a regulator, which can sanction a doctor, and a claim in court, which can pay money." }, "facets": { "stage": "when-it-goes-wrong" }, "x_order": 17, "text": { "what": "The attempt to hold somebody answerable after harm. It divides into a regulatory complaint against a licensed clinician, heard by the body that licensed them, and a civil claim for compensation, heard by a court. For a patient treated abroad both routes sit in the destination's jurisdiction, in the destination's language, under the destination's limitation period.", "story": "Inside the European Union the position is written down, and it is the exception rather than the pattern. Directive 2011/24/EU requires the Member State of treatment to ensure \"transparent complaints procedures and mechanisms in place for patients, in order for them to seek remedies ... if they suffer harm arising from the healthcare\" (Article 4(2)(c)), and to ensure that \"systems of professional liability insurance, or a guarantee or similar arrangement that is equivalent or essentially comparable\" are in place (Article 4(2)(d)). Article 6 obliges every Member State to run a national contact point that tells patients about providers, rights, complaints procedures and dispute resolution. The Member State of affiliation must in turn provide information on \"procedures for accessing ... appeal and redress if patients consider that their rights have not been respected\" (Article 5(b)). The governing law is the destination's: cross-border healthcare is provided in accordance with the legislation of the Member State of treatment.\n\n*Inference —* outside that bloc no comparable instrument turned up in this project's reading. The claim, if there is one, is brought where the treatment happened, and the practical obstacles are ordinary rather than exotic: a limitation period that runs from the operation, court fees and local counsel, a contract that may name a forum, evidence in another language, and a defendant whose insurer — if the hospital carries insurance at all — has no obligation to a foreign claimant beyond what that country's law imposes.\n\nThe regulatory route has a matching gap. A home regulator registers home licensees; a complaint about a surgeon in another country is a complaint to that country's register, if it maintains one that accepts complaints from non-residents. An intermediary who arranged the trip is usually not registered by anybody at all, which is the subject of the facilitator step.", "how": "What a reader would have to ask, and the answers are documentary rather than clinical: which body registers the operating surgeon and whether it publishes its register, whether that body accepts a complaint from a non-resident and in which language, what the limitation period is for a claim in that jurisdiction and when it starts, whether the signed contract or consent form names a governing law or a forum, whether the hospital carries professional liability insurance and whether the policy responds to a foreign claimant, and whether any judgment obtained at home could be enforced against assets in the destination.", "today": "As of 16 September 2026 the EU national contact points are the only cross-border complaint infrastructure this project could find that is built into an instrument. Elsewhere the route is the destination's own, and no body this project could find publishes how many claims foreign patients bring, or what becomes of them." }, "kin": [ { "to": "malpractice-recourse", "as": "The risk record this step is the procedure for.", "rel": "risk" }, { "to": "eu-directive-2011-24", "as": "The one instrument that names complaints, redress and liability insurance across borders.", "rel": "governed-by" }, { "to": "eu-national-contact-points", "as": "The bodies Article 6 obliges each Member State to run.", "rel": "org" }, { "to": "when-it-goes-wrong", "as": "The clinical event that precedes this step.", "rel": "step" }, { "to": "choosing-a-facilitator", "as": "The party whose contract wording often decides where this step can be brought.", "rel": "step" }, { "to": "arrival-and-consent", "as": "Where the forum and the governing law were probably fixed, in a form signed on arrival.", "rel": "step" }, { "to": "circumvention", "as": "Why some patients cannot complain at home without disclosing what they travelled for.", "rel": "story" } ], "sources": [ "s:dir-2011-24-chapter-ii", "s:eu-directive-2011-24" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "pathway", "region": [ "global" ], "updated": "2026-09-16", "blurb": "The attempt to hold somebody answerable after harm. It divides into a regulatory complaint against a licensed clinician, heard by the body that licensed them, and a civil claim for compensation, heard by a court.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "The risk record this step is the procedure for.", "rel": "risk" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The one instrument that names complaints, redress and liability insurance across borders.", "rel": "governed-by" }, { "to": "eu-national-contact-points", "type": "org", "name": "EU National Contact Points for cross-border healthcare", "as": "The bodies Article 6 obliges each Member State to run.", "rel": "org" }, { "to": "when-it-goes-wrong", "type": "pathway", "name": "When it goes wrong", "as": "The clinical event that precedes this step.", "rel": "step" }, { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "The party whose contract wording often decides where this step can be brought.", "rel": "step" }, { "to": "arrival-and-consent", "type": "pathway", "name": "Arrival and consent", "as": "Where the forum and the governing law were probably fixed, in a form signed on arrival.", "rel": "step" }, { "to": "circumvention", "type": "story", "name": "Circumvention", "as": "Why some patients cannot complain at home without disclosing what they travelled for.", "rel": "story" } ], "source_list": [ { "id": "s:dir-2011-24-chapter-ii", "kind": "law", "title": "Directive 2011/24/EU, Chapter II — responsibilities of the Member State of treatment and of affiliation, Articles 4 to 6", "publisher": "legislation.gov.uk, retained text of Directive 2011/24/EU", "url": "https://www.legislation.gov.uk/cy/eudr/2011/24/chapter/II/data.htm?view=plain", "accessed": "2026-09-16", "note": "read for Art 4(2)(b) invoices and prices, 4(2)(c) complaints and redress, 4(2)(d) professional liability insurance, 4(2)(f) copy of the medical record, 5(d) access to records, and Art 6 national contact points" }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "when-it-goes-wrong", "type": "pathway", "name": "When it goes wrong", "as": "What this step becomes once the clinical emergency is over.", "rel": "step" }, { "from": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "The step this risk decides the outcome of.", "rel": "step" } ] }, { "id": "deciding-whether", "names": { "name": "Deciding whether to go", "aliases": [ "the decision to travel for treatment" ], "said": "Brokers call it the enquiry. Clinicians, where they hear about it at all, hear about it after the flight is booked." }, "facets": { "stage": "deciding" }, "x_order": 1, "text": { "what": "The step before any money moves: a person weighs a price, a queue or a refusal at home against a procedure in another country. Nobody is a patient yet and no contract exists, so the exposure here is informational — what is written down, who wrote it, and who is paid when it is believed.", "story": "The published reasons people give divide three ways: a bill at home they cannot meet, a wait at home measured in months, and a treatment at home that is unlawful, unfunded or unavailable to them. The three carry different pressure. A person in a queue can wait longer; a person refused cannot.\n\nWhat gets read at this stage is mostly commercial. Penney and colleagues took 17 English-language Canadian broker websites in the summer of 2010 and counted what they told a reader: 47% made no mention of risks at all, only two of the seventeen raised risks specific to travelling for care, 17.6% addressed possible negative outcomes, 70.6% carried patient testimonials, and 29.4% named a price. Their conclusion was that Canadian brokers \"currently lack a common standard of care and accreditation, and are widely lacking in providing adequate risk communication\".\n\nThe medical side of the decision has its own timetable, and it sits later than most people expect. The CDC Yellow Book puts the pre-travel consultation \"4–6 weeks before travel\", which is usually after the destination has been chosen and often after a deposit has been paid. *Inference —* by the time a clinician who knows about travel medicine is in the conversation, most of the decisions this site describes have already been made.", "how": "No register anywhere this project could read records who decides to travel, or why. The counts that circulate — patients per year, percentage cheaper — come from market summaries that resell each other and generally count foreign nationals treated at a hospital, which includes every resident expatriate with a chest infection. A hospital's own count of its own international patients, a national statistics office, or a peer-reviewed study is a narrower number and says what it counts.\n\nThe questions that have documentary answers at this stage are dull and specific: which named surgeon will operate, what the price covers and excludes in the provider's own words, who provides follow-up and where, and which country's law governs the contract being signed. Each of those has a paper answer or it does not exist.", "today": "As of 16 September 2026 the evidence a person meets while deciding is written almost entirely by parties paid when the answer is yes. The counterweight published by states — the CDC Yellow Book chapter, the NHS page on cosmetic surgery abroad — describes hazards rather than providers, and names no hospital." }, "kin": [ { "to": "second-opinion", "as": "The next step for a diagnosis that has only been made once.", "rel": "step" }, { "to": "getting-a-quote", "as": "Where the price being weighed here turns into a document with exclusions.", "rel": "step" }, { "to": "choosing-a-facilitator", "as": "The party who wrote most of what gets read at this stage, and who is paid when the answer is yes.", "rel": "step" }, { "to": "oecd-waiting-times", "as": "The published series behind the queue at home that is half of this decision.", "rel": "measured-by" }, { "to": "is-it-cheaper", "as": "The comparison this step is built on, taken apart.", "rel": "story" }, { "to": "counting-patients", "as": "Why the headline number of people who travel is not a count of people.", "rel": "story" }, { "to": "follow-up-gap", "as": "The cost that is rarely in the comparison being made here.", "rel": "risk" }, { "to": "medical-travel", "as": "The name this site uses for what is being decided.", "rel": "term" } ], "sources": [ "s:penney-broker-websites", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "inference", "note": "this project's reading of what is and is not documented at this stage" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "pathway", "region": [ "global" ], "updated": "2026-09-16", "blurb": "The step before any money moves: a person weighs a price, a queue or a refusal at home against a procedure in another country.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "second-opinion", "type": "pathway", "name": "The second opinion", "as": "The next step for a diagnosis that has only been made once.", "rel": "step" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "Where the price being weighed here turns into a document with exclusions.", "rel": "step" }, { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "The party who wrote most of what gets read at this stage, and who is paid when the answer is yes.", "rel": "step" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The published series behind the queue at home that is half of this decision.", "rel": "measured-by" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The comparison this step is built on, taken apart.", "rel": "story" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why the headline number of people who travel is not a count of people.", "rel": "story" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The cost that is rarely in the comparison being made here.", "rel": "risk" }, { "to": "medical-travel", "type": "term", "name": "Medical travel", "as": "The name this site uses for what is being decided.", "rel": "term" } ], "source_list": [ { "id": "s:penney-broker-websites", "kind": "paper", "title": "Risk communication and informed consent in the medical tourism industry: a thematic content analysis of Canadian broker websites", "publisher": "Penney K, Snyder J, Crooks VA, Johnston R. BMC Medical Ethics 2011;12:17", "url": "https://bmcmedethics.biomedcentral.com/articles/10.1186/1472-6939-12-17", "accessed": "2026-09-16", "note": "17 English-language Canadian broker sites, summer 2010" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference", "note": "this project's reading of what is and is not documented at this stage" }, "text.today": { "tier": "inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "assisted-dying", "type": "procedure", "name": "Assisted dying", "as": "The step this record is entirely composed of.", "rel": "step" }, { "from": "stem-cell-unproven", "type": "procedure", "name": "Unapproved stem cell treatment", "as": "The step where a poor prognosis meets a confident page.", "rel": "step" }, { "from": "sheba", "type": "facility", "name": "Sheba Medical Center", "as": "A patient who travels for a therapy unavailable at home is answering a different question from one travelling for a price.", "rel": "step" }, { "from": "second-opinion", "type": "pathway", "name": "The second opinion", "as": "The step this one tests.", "rel": "step" }, { "from": "unproven-stem-cell", "type": "risk", "name": "Unproven stem cell treatment", "as": "The step at which a poor prognosis meets a confident marketing page.", "rel": "step" }, { "from": "medical-travel", "type": "term", "name": "Medical travel", "as": "The step where a reader first meets the thing this word names.", "rel": "step" }, { "from": "prior-authorisation", "type": "term", "name": "Prior authorisation", "as": "The step a refusal usually starts.", "rel": "step" }, { "from": "waiting-lists", "type": "story", "name": "The queue is the product", "as": "The step where the calendar, rather than the price, is usually what decides it.", "rel": "step" } ] }, { "id": "getting-a-quote", "names": { "name": "Getting a quote", "aliases": [ "estimate", "cost estimate", "package quotation" ], "said": "Hospitals say estimate. Brokers say quote. Neither word is a contract price unless the paper says so." }, "facets": { "stage": "booking" }, "x_order": 4, "text": { "what": "A provider or an intermediary puts a number on paper. The number is usually a package: a bundle of theatre time, a named number of nights and a set of professional fees, with a list of what falls outside it. What the number excludes is the part that moves.", "story": "Published price transparency is rare enough that its absence is the finding. Of 17 Canadian broker websites examined by Penney and colleagues in 2010, 29.4% included specific pricing at all; the other seven in ten invited an enquiry instead.\n\nWhere a duty to quote clearly exists, it is territorial. Directive 2011/24/EU requires that healthcare providers in the Member State of treatment provide \"clear invoices and clear information on prices\" (Article 4(2)(b)). That obligation binds a clinic in Kraków and says nothing about a clinic in Bangkok or Tijuana.\n\n*Inference —* the exclusion list is where a package and a bill diverge, and the divergence is structural rather than deceptive. A fixed price can only be fixed for the predictable part. The implant, the unplanned night, the intensive care bed, the second bag of blood and the histology are the unpredictable part, and they are commonly listed as excluded in the provider's own words. A package that names three nights has priced three nights.", "how": "A quote is normally produced from a description of the problem rather than from an examination — records emailed, photographs uploaded, a form filled. It is commonly revised on arrival, after the consultation and the pre-operative tests, and that revision is the first point at which the traveller is already in the country.\n\nThe documentary questions are: whether the paper is an estimate or an offer, what currency and what exchange date, what happens to the price if the operation takes longer or the stay runs over, who is the counter-party named on it, and whether a second procedure found during surgery is billed separately.", "today": "As of 16 September 2026 no cross-border standard this project could find requires a quote for treatment abroad to state inclusions, exclusions and the conditions on which it changes. The exclusion lists that do exist are published voluntarily, and the clearest of them sit on hospital package pages rather than on intermediaries' sites." }, "kin": [ { "to": "reading-the-exclusions", "as": "The half of the quote that decides what the bill becomes.", "rel": "step" }, { "to": "choosing-a-facilitator", "as": "Who usually issues the quote, and who is paid on it.", "rel": "step" }, { "to": "the-deposit", "as": "The step that turns the number into money already sent.", "rel": "step" }, { "to": "package-price", "as": "The pricing form this step almost always takes.", "rel": "term" }, { "to": "implant-excluded", "as": "The single line most often outside the quoted number.", "rel": "risk" }, { "to": "the-price-that-isnt", "as": "What happens between a quoted package and a discharge bill.", "rel": "story" }, { "to": "eu-directive-2011-24", "as": "The one instrument that obliges a provider to invoice and price clearly, and only inside the EU.", "rel": "governed-by" } ], "sources": [ "s:penney-broker-websites", "s:dir-2011-24-chapter-ii" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "tradition", "note": "how quotes are produced and revised, as the trade does it" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "pathway", "region": [ "global" ], "updated": "2026-09-16", "blurb": "A provider or an intermediary puts a number on paper. The number is usually a package: a bundle of theatre time, a named number of nights and a set of professional fees, with a list of what falls outside it.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The half of the quote that decides what the bill becomes.", "rel": "step" }, { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "Who usually issues the quote, and who is paid on it.", "rel": "step" }, { "to": "the-deposit", "type": "pathway", "name": "The deposit", "as": "The step that turns the number into money already sent.", "rel": "step" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The pricing form this step almost always takes.", "rel": "term" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The single line most often outside the quoted number.", "rel": "risk" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "What happens between a quoted package and a discharge bill.", "rel": "story" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The one instrument that obliges a provider to invoice and price clearly, and only inside the EU.", "rel": "governed-by" } ], "source_list": [ { "id": "s:penney-broker-websites", "kind": "paper", "title": "Risk communication and informed consent in the medical tourism industry: a thematic content analysis of Canadian broker websites", "publisher": "Penney K, Snyder J, Crooks VA, Johnston R. BMC Medical Ethics 2011;12:17", "url": "https://bmcmedethics.biomedcentral.com/articles/10.1186/1472-6939-12-17", "accessed": "2026-09-16", "note": "17 English-language Canadian broker sites, summer 2010" }, { "id": "s:dir-2011-24-chapter-ii", "kind": "law", "title": "Directive 2011/24/EU, Chapter II — responsibilities of the Member State of treatment and of affiliation, Articles 4 to 6", "publisher": "legislation.gov.uk, retained text of Directive 2011/24/EU", "url": "https://www.legislation.gov.uk/cy/eudr/2011/24/chapter/II/data.htm?view=plain", "accessed": "2026-09-16", "note": "read for Art 4(2)(b) invoices and prices, 4(2)(c) complaints and redress, 4(2)(d) professional liability insurance, 4(2)(f) copy of the medical record, 5(d) access to records, and Art 6 national contact points" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "how quotes are produced and revised, as the trade does it" }, "text.today": { "tier": "inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "panama-city", "type": "hub", "name": "Panama City", "as": "Quoted in US dollars here, which removes the currency argument and leaves the inclusion list.", "rel": "step" }, { "from": "san-jose-cr", "type": "hub", "name": "San José, Costa Rica", "as": "In this city that is a form and a telephone call, not a page.", "rel": "step" }, { "from": "abortion-care", "type": "procedure", "name": "Abortion", "as": "The step at which a resident's price of zero becomes a non-resident's telephone call.", "rel": "step" }, { "from": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "The step where a crown quote turns out to exclude the laboratory fee.", "rel": "step" }, { "from": "dhi-hair-transplant", "type": "procedure", "name": "Direct hair implantation (DHI)", "as": "The step at which a technique name becomes a price tier.", "rel": "step" }, { "from": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The step where a photograph produces a graft number, and the number produces the price.", "rel": "step" }, { "from": "lasik", "type": "procedure", "name": "LASIK", "as": "The step at which a per-eye price turns into a per-patient one.", "rel": "step" }, { "from": "phalloplasty", "type": "procedure", "name": "Phalloplasty", "as": "The step where a staged operation has to be added up, because no page adds it up.", "rel": "step" }, { "from": "root-canal", "type": "procedure", "name": "Root canal treatment", "as": "The step at which by-the-tooth and by-the-hour turn out not to compare.", "rel": "step" }, { "from": "shoulder-replacement", "type": "procedure", "name": "Total shoulder replacement", "as": "The step a shoulder patient cannot skip, because the package price does not exist.", "rel": "step" }, { "from": "veneers", "type": "procedure", "name": "Dental veneers", "as": "The step where one tooth becomes ten and the quote multiplies.", "rel": "step" }, { "from": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "Where the Fiyat Sor button leads, and the step at which a price first exists.", "rel": "step" }, { "from": "apollo-chennai", "type": "facility", "name": "Apollo Hospitals, Greams Road, Chennai", "as": "Publishes no price; a foreign patient here gets an emailed estimate instead.", "rel": "step" }, { "from": "clinica-biblica", "type": "facility", "name": "Hospital Clínica Bíblica", "as": "The Presupuestos form is where the price starts existing, and the only place it does.", "rel": "step" }, { "from": "fundacion-santa-fe", "type": "facility", "name": "Fundación Santa Fe de Bogotá", "as": "With no price published, the estimate after the records are read is the only figure.", "rel": "step" }, { "from": "heidelberg-university-hospital", "type": "facility", "name": "Heidelberg University Hospital", "as": "No estimate exists until its specialists have read the records, and the hospital says the estimate may move.", "rel": "step" }, { "from": "liv-hospital", "type": "facility", "name": "Liv Hospital", "as": "A published starting price is where a quotation begins, not where it ends.", "rel": "step" }, { "from": "max-saket", "type": "facility", "name": "Max Super Speciality Hospital, Saket", "as": "Publishes no price; the quote is an email against a named surgeon and a named stay.", "rel": "step" }, { "from": "medicana", "type": "facility", "name": "Medicana Health Group", "as": "With nothing published, the quotation is the only price that exists here.", "rel": "step" }, { "from": "mount-elizabeth", "type": "facility", "name": "Mount Elizabeth Hospital", "as": "The surgeon has rooms in the medical centre and bills separately from the hospital, which is two quotations and not one.", "rel": "step" }, { "from": "severance", "type": "facility", "name": "Severance Hospital", "as": "Its international centre states it can give an estimated cost before medical consent, which is where the price starts existing.", "rel": "step" }, { "from": "wooridul", "type": "facility", "name": "Wooridul Spine Hospital", "as": "An estimate on request and no published figure, which is the Korean pattern rather than this hospital's choice.", "rel": "step" }, { "from": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "The document this party usually issues.", "rel": "step" }, { "from": "deciding-whether", "type": "pathway", "name": "Deciding whether to go", "as": "Where the price being weighed here turns into a document with exclusions.", "rel": "step" }, { "from": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The number these lists qualify.", "rel": "step" }, { "from": "second-opinion", "type": "pathway", "name": "The second opinion", "as": "What a hospital's remote opinion usually arrives as.", "rel": "step" }, { "from": "the-deposit", "type": "pathway", "name": "The deposit", "as": "The number this payment attaches to.", "rel": "step" }, { "from": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "The step at which the number is given and the conditions are not.", "rel": "step" }, { "from": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The step at which the headline number is supplied and the device price is not.", "rel": "step" }, { "from": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "The step where the claim meets a number.", "rel": "step" }, { "from": "s2-route", "type": "rule", "name": "The S2 route", "as": "The step this route removes, by paying at the destination's own tariff.", "rel": "step" }, { "from": "defiant", "type": "org", "name": "Defiant", "as": "The step where a facilitator like this one enters the story.", "rel": "step" }, { "from": "case-rate", "type": "term", "name": "Case rate", "as": "The step where a flat figure is handed over without its severity clause.", "rel": "step" }, { "from": "cycle", "type": "term", "name": "Cycle", "as": "The step where a per-cycle figure is first quoted, usually without its denominator.", "rel": "step" }, { "from": "package-price", "type": "term", "name": "Package price", "as": "Where a package number is first put in front of a patient.", "rel": "step" }, { "from": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The step where a headline number arrives and the device price does not.", "rel": "step" }, { "from": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "Where the headline number arrives and the excluded lines do not.", "rel": "step" } ] }, { "id": "getting-your-records", "names": { "name": "Getting your records out", "aliases": [ "medical records request", "records portability", "subject access request" ], "said": "Data-protection lawyers say subject access. Hospitals say records release. Both mean the same envelope." }, "facets": { "stage": "deciding" }, "x_order": 3, "text": { "what": "The patient asks the home health system for a copy of their own file — imaging, operation notes, pathology, drug list — so that a clinician in another country can read it. Two different bodies of law govern the request, and neither of them was written with a foreign surgeon in mind.", "story": "In the European Union the right is squarely written. GDPR Article 15(3) states that \"The controller shall provide a copy of the personal data undergoing processing\", with a reasonable administrative fee permitted only for further copies. Article 20 adds portability — a structured, commonly used, machine-readable format, and direct transmission from one controller to another \"where technically feasible\" — but only where the processing rests on consent or on a contract and is carried out by automated means, which is not the footing most public hospital records sit on.\n\nDirective 2011/24/EU adds a health-specific right in both directions: the Member State of treatment must ensure patients are \"entitled to a written or electronic medical record\" of the treatment and \"access to at least a copy of this record\" (Article 4(2)(f)), and the Member State of affiliation must ensure patients have \"remote access to or have at least a copy of their medical records\" (Article 5(d)).\n\nIn the United States the instrument is 45 CFR § 164.524. A covered entity must act within 30 days, may take one 30-day extension on written notice, must provide the record \"in the form and format requested by the individual, if it readily producible in such form and format\", and may charge only \"a reasonable, cost-based fee\".\n\n*Inference —* none of those instruments reaches the second half of the journey. A patient travelling from a country with no equivalent statute has whatever the hospital's own policy gives, and a patient asking a hospital abroad for the record of what it did to them is asking under that country's law, not their own.", "how": "What actually fails is mechanical. Imaging arrives as a disc in a viewer nobody abroad can open, or as a report without the images. Pathology sits as a block in a laboratory that releases it only to another laboratory. A thirty-day clock, lawful at home, lands after the flight. The file comes in a language the receiving surgeon does not read, and no one in the transaction owns the translation.\n\nThe CDC Yellow Book pushes the same request in the other direction, telling travellers to \"request copies of their overseas medical records in English\" and to hand them to whoever provides follow-up, and citing the American College of Surgeons on obtaining \"a complete set of medical records before returning home\".", "today": "As of 16 September 2026 the legal right to a copy is strong in the EU and the United States and undocumented in much of the rest of the world as far as this project could read. What no instrument anywhere supplies is a format both ends can open and a translation somebody is responsible for." }, "kin": [ { "to": "second-opinion", "as": "The step these records are usually collected for.", "rel": "step" }, { "to": "the-discharge-summary", "as": "The same request made in the other direction, at the far end.", "rel": "step" }, { "to": "patient-data-transfer", "as": "The rule that governs moving a file across a border.", "rel": "governed-by" }, { "to": "eu-directive-2011-24", "as": "Names the record right on both sides of an EU cross-border episode.", "rel": "governed-by" }, { "to": "follow-up-gap", "as": "What a record that never arrives becomes at home.", "rel": "risk" }, { "to": "informed-consent", "as": "What the receiving surgeon is consenting the patient to without the file.", "rel": "term" } ], "sources": [ "s:gdpr-art-15", "s:gdpr-art-20", "s:hipaa-access-164-524", "s:dir-2011-24-chapter-ii", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "tradition", "note": "the failure modes are trade knowledge; the CDC paragraph is cited" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "pathway", "region": [ "global" ], "updated": "2026-09-16", "blurb": "The patient asks the home health system for a copy of their own file — imaging, operation notes, pathology, drug list — so that a clinician in another country can read it.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "second-opinion", "type": "pathway", "name": "The second opinion", "as": "The step these records are usually collected for.", "rel": "step" }, { "to": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "The same request made in the other direction, at the far end.", "rel": "step" }, { "to": "patient-data-transfer", "type": "rule", "name": "Moving a medical record across a border", "as": "The rule that governs moving a file across a border.", "rel": "governed-by" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "Names the record right on both sides of an EU cross-border episode.", "rel": "governed-by" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "What a record that never arrives becomes at home.", "rel": "risk" }, { "to": "informed-consent", "type": "term", "name": "Informed consent", "as": "What the receiving surgeon is consenting the patient to without the file.", "rel": "term" } ], "source_list": [ { "id": "s:gdpr-art-15", "kind": "law", "title": "Article 15 — Right of access by the data subject, Regulation (EU) 2016/679 (GDPR)", "publisher": "gdpr-info.eu, consolidated text of Regulation (EU) 2016/679", "url": "https://gdpr-info.eu/art-15-gdpr/", "accessed": "2026-09-16", "note": "read for the right to obtain a copy of personal data undergoing processing, and the fee permitted for further copies" }, { "id": "s:gdpr-art-20", "kind": "law", "title": "Article 20 — Right to data portability, Regulation (EU) 2016/679 (GDPR)", "publisher": "gdpr-info.eu, consolidated text of Regulation (EU) 2016/679", "url": "https://gdpr-info.eu/art-20-gdpr/", "accessed": "2026-09-16", "note": "applicable when processing rests on consent or on a contract and is carried out by automated means; direct controller-to-controller transmission only where technically feasible" }, { "id": "s:hipaa-access-164-524", "kind": "law", "title": "45 CFR § 164.524 — Access of individuals to protected health information", "publisher": "Legal Information Institute, Cornell Law School", "url": "https://www.law.cornell.edu/cfr/text/45/164.524", "accessed": "2026-09-16", "note": "30 days to act, one 30-day extension on written notice, form and format as requested where readily producible, reasonable cost-based fee" }, { "id": "s:dir-2011-24-chapter-ii", "kind": "law", "title": "Directive 2011/24/EU, Chapter II — responsibilities of the Member State of treatment and of affiliation, Articles 4 to 6", "publisher": "legislation.gov.uk, retained text of Directive 2011/24/EU", "url": "https://www.legislation.gov.uk/cy/eudr/2011/24/chapter/II/data.htm?view=plain", "accessed": "2026-09-16", "note": "read for Art 4(2)(b) invoices and prices, 4(2)(c) complaints and redress, 4(2)(d) professional liability insurance, 4(2)(f) copy of the medical record, 5(d) access to records, and Art 6 national contact points" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition", "note": "the failure modes are trade knowledge; the CDC paragraph is cited" }, "text.today": { "tier": "inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "assisted-dying", "type": "procedure", "name": "Assisted dying", "as": "The medical file assembled at home is what the Swiss doctor decides on.", "rel": "step" }, { "from": "dialysis-holiday", "type": "procedure", "name": "Dialysis away from home", "as": "The prescription and the serology are what the receiving unit books on.", "rel": "step" }, { "from": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The report travels as a PDF; the images usually need asking for before departure.", "rel": "step" }, { "from": "gamma-knife", "type": "procedure", "name": "Gamma knife radiosurgery", "as": "The imaging a distant unit needs before it will accept a referral.", "rel": "step" }, { "from": "anadolu-medical-center", "type": "facility", "name": "Anadolu Medical Center", "as": "An oncology referral here starts with slides and imaging rather than with a form.", "rel": "step" }, { "from": "charite-international", "type": "facility", "name": "Charité International Patients", "as": "The German route starts with reports and imaging, and nothing else happens until a specialist has read them.", "rel": "step" }, { "from": "second-opinion", "type": "pathway", "name": "The second opinion", "as": "The material without which a second opinion is an opinion on a summary.", "rel": "step" }, { "from": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "The same request, made in the other direction before departure.", "rel": "step" }, { "from": "anaesthetic-risk-unscreened", "type": "risk", "name": "Fitness for anaesthesia, assessed on arrival", "as": "The step that decides what the assessing team has to grade from.", "rel": "step" }, { "from": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The step that decides whether anyone at home can tell what was done.", "rel": "step" }, { "from": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "The other translation nobody in the transaction owns.", "rel": "step" }, { "from": "patient-data-transfer", "type": "rule", "name": "Moving a medical record across a border", "as": "The step this rule governs, at the front of the journey.", "rel": "step" }, { "from": "informed-consent", "type": "term", "name": "Informed consent", "as": "The file without which a receiving surgeon is consenting a patient blind.", "rel": "step" } ] }, { "id": "in-hospital", "names": { "name": "In hospital", "aliases": [ "the admission", "the inpatient stay" ], "said": "The package names the nights. The bill counts them." }, "facets": { "stage": "in-hospital" }, "x_order": 12, "text": { "what": "Admission, operation, ward, discharge. For the length of the stay the patient is inside an institution whose rules, staffing and law are the destination's, with no home clinician involved, and with a bill accruing against a package that fixed a number of nights in advance.", "story": "The commercial mechanics of the stay are visible in the package documents. The Bangkok knee package this site reads covers three nights in the surgical ward and states that nights beyond three, any intensive care, blood transfusion, laboratory and imaging before or after surgery, and take-home medication fall outside the price. *Inference —* that is the structure of the financial risk in this step: the predictable part was prepaid, and every clinical deviation converts directly into an unquoted charge, payable before discharge.\n\nThe clinical exposure is harder to see from outside. The ward is where surgical site infection is acquired or is not, where a resistant organism is present or is not, and where the blood, if it is needed, comes from a supply whose screening regime is the destination's. Those are the subjects of this site's risk records rather than of any provider's page.\n\nNothing this project could find publishes what an international patient is charged against what a local patient is charged in the same institution for the same operation, or compares the ward a package buys with the one a local patient occupies. *Trade practice —* the international wing of a large private hospital is commonly a distinct service with its own rooms and its own price list, which is how it is described by the hospitals that run one.", "how": "What a reader would have to ask: who is on the ward overnight and at what ratio, which named surgeon performed the operation and whether the operation note says so, what each extra night costs, what triggers a transfer to intensive care and what that costs, whether the hospital will release the operation note and the implant details before discharge, and who settles the balance and in which currency.", "today": "As of 16 September 2026 the length of a stay is the most-published number in this trade, because it is the number a package has to fix. What happens during it is among the least published: no outcome registry this project could find collects results for foreign patients by hospital." }, "kin": [ { "to": "arrival-and-consent", "as": "The signature that opened this step.", "rel": "step" }, { "to": "the-discharge-summary", "as": "The only document most of this step leaves behind.", "rel": "step" }, { "to": "surgical-site-infection", "as": "The commonest thing that goes wrong here, and the hardest to attribute afterwards.", "rel": "risk" }, { "to": "antimicrobial-resistance", "as": "What the ward may hand over along with the operation.", "rel": "risk" }, { "to": "blood-supply-safety", "as": "Where the transfusion excluded from the package comes from.", "rel": "risk" }, { "to": "length-of-stay", "as": "The number the package fixed and the bill counts.", "rel": "term" }, { "to": "bumrungrad", "as": "Publishes the package whose ward nights and exclusions this step reads.", "rel": "place" } ], "sources": [ "s:bumrungrad-joint04" ], "provenance": { "default": { "tier": "cited", "source": "s:bumrungrad-joint04" }, "fields": { "text.story": { "tier": "cited", "note": "package terms cited; the paragraphs about clinical exposure and about pricing comparisons are marked inline" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "pathway", "region": [ "global" ], "updated": "2026-09-16", "blurb": "Admission, operation, ward, discharge. For the length of the stay the patient is inside an institution whose rules, staffing and law are the destination's, with no home clinician involved, and with a bill accruing…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "arrival-and-consent", "type": "pathway", "name": "Arrival and consent", "as": "The signature that opened this step.", "rel": "step" }, { "to": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "The only document most of this step leaves behind.", "rel": "step" }, { "to": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The commonest thing that goes wrong here, and the hardest to attribute afterwards.", "rel": "risk" }, { "to": "antimicrobial-resistance", "type": "risk", "name": "Antimicrobial resistance acquired abroad", "as": "What the ward may hand over along with the operation.", "rel": "risk" }, { "to": "blood-supply-safety", "type": "risk", "name": "Blood supply safety", "as": "Where the transfusion excluded from the package comes from.", "rel": "risk" }, { "to": "length-of-stay", "type": "term", "name": "Length of stay", "as": "The number the package fixed and the bill counts.", "rel": "term" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Publishes the package whose ward nights and exclusions this step reads.", "rel": "place" } ], "source_list": [ { "id": "s:bumrungrad-joint04", "kind": "web", "title": "Total Knee Replacement Surgery (Exclude implant) — package JOINT04", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery", "accessed": "2026-09-16", "note": "read off the hospital's own package page; price stated valid until 31 December 2026" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:bumrungrad-joint04" }, "text.story": { "tier": "cited", "note": "package terms cited; the paragraphs about clinical exposure and about pricing comparisons are marked inline" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "asan-medical-center", "type": "facility", "name": "Asan Medical Center", "as": "An outpatient department seeing eleven thousand people a day is the setting a foreign patient's international centre exists to bypass.", "rel": "step" }, { "from": "arrival-and-consent", "type": "pathway", "name": "Arrival and consent", "as": "What the signature starts.", "rel": "step" }, { "from": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "The stay this document is the record of.", "rel": "step" }, { "from": "length-of-stay", "type": "term", "name": "Length of stay", "as": "The step this number is the length of.", "rel": "step" } ] }, { "id": "reading-the-exclusions", "names": { "name": "Reading the exclusions", "aliases": [ "the small print", "what the package leaves out", "policy exclusions" ], "said": "Two documents carry exclusion lists, and they are usually read as one: the package page and the insurance policy." }, "facets": { "stage": "booking" }, "x_order": 6, "text": { "what": "Two separate exclusion lists govern a trip for treatment. The provider's package names what its price does not cover. The insurer's policy names what it will not pay for. They are written by different parties for different purposes, and the gap between them is where an unplanned bill falls.", "story": "On the provider side the list is often longer than the inclusions. The knee package this site reads at one Bangkok hospital covers three hours of theatre, three nights on the ward, surgeon, assistant and anaesthesiologist — and excludes the implant, the first consultation and the follow-up visits, nights beyond three, any intensive care, blood transfusion, laboratory and imaging before or after surgery, take-home medication, and complex or emergency cases. A joint package that excludes the implant is quoting the operation, not the joint.\n\nOn the insurance side the NHS states the general position for its own readers plainly: travel insurance \"does not normally cover if things go wrong in surgery\". The UK government's travel insurance guidance is written around emergencies and lists repatriation, emergency transport and getting home after treatment when the original ticket cannot be used; it also warns that EHIC and GHIC \"are not alternatives to travel insurance as they do not cover any private medical healthcare costs, repatriation or additional costs\".\n\nThe CDC Yellow Book puts the same duty on the traveller in its own terms: check what the domestic plan covers outside the country, and consider supplemental cover \"including medical evacuation insurance\".\n\n*Inference —* the structural trap is that a planned operation is not an emergency, and most travel policies are emergency instruments. A complication of a procedure the traveller flew out to have can be a genuine emergency in the ward and an excluded event on the policy at the same time.", "how": "Specialist products exist that cover complications of treatment abroad for a defined window after surgery, sold separately from both the package and the travel policy. This project has not read a policy wording of that kind end to end and states no terms for them.\n\nWhat a reader would have to ask: whether the package's stated price is per night or per stay, what triggers the excluded items, whether the provider's complication cover is a contractual term with a duration or a customer-service statement, whether the travel policy excludes treatment the trip was taken for and also excludes its complications, and who pays for a changed flight if discharge slips.", "today": "As of 16 September 2026 no regulator this project could find publishes a comparison of what travel policies exclude for planned treatment abroad. The exclusion wording lives in individual policy documents, which is the only place the answer exists." }, "kin": [ { "to": "getting-a-quote", "as": "The number these lists qualify.", "rel": "step" }, { "to": "implant-excluded", "as": "The commonest exclusion on an orthopaedic or dental package.", "rel": "risk" }, { "to": "insurance-exclusions", "as": "The rule side of the policy half of this step.", "rel": "governed-by" }, { "to": "repatriation-cost", "as": "The bill an excluded policy leaves with the family.", "rel": "risk" }, { "to": "package-price", "as": "The form of price whose exclusions this step reads.", "rel": "term" }, { "to": "the-deposit", "as": "The next step, usually taken before these two documents have been read together.", "rel": "step" }, { "to": "bumrungrad", "as": "Publishes an exclusion list this step quotes.", "rel": "place" } ], "sources": [ "s:bumrungrad-joint04", "s:nhs-cosmetic-surgery-abroad", "s:gov-uk-foreign-travel-insurance", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "inference", "note": "the questions are this project's; the statement about specialist complication policies is deliberately unsourced because no wording was read" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "pathway", "region": [ "global" ], "updated": "2026-09-16", "blurb": "Two separate exclusion lists govern a trip for treatment. The provider's package names what its price does not cover. The insurer's policy names what it will not pay for.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The number these lists qualify.", "rel": "step" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The commonest exclusion on an orthopaedic or dental package.", "rel": "risk" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "The rule side of the policy half of this step.", "rel": "governed-by" }, { "to": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "The bill an excluded policy leaves with the family.", "rel": "risk" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The form of price whose exclusions this step reads.", "rel": "term" }, { "to": "the-deposit", "type": "pathway", "name": "The deposit", "as": "The next step, usually taken before these two documents have been read together.", "rel": "step" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Publishes an exclusion list this step quotes.", "rel": "place" } ], "source_list": [ { "id": "s:bumrungrad-joint04", "kind": "web", "title": "Total Knee Replacement Surgery (Exclude implant) — package JOINT04", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery", "accessed": "2026-09-16", "note": "read off the hospital's own package page; price stated valid until 31 December 2026" }, { "id": "s:nhs-cosmetic-surgery-abroad", "kind": "org", "title": "Cosmetic surgery abroad", "publisher": "NHS (England)", "url": "https://www.nhs.uk/tests-and-treatments/cosmetic-procedures/advice/cosmetic-surgery-abroad/", "accessed": "2026-09-16", "note": "read for aftercare responsibility, flying intervals and the statement on travel insurance" }, { "id": "s:gov-uk-foreign-travel-insurance", "kind": "org", "title": "Foreign travel insurance", "publisher": "UK Foreign, Commonwealth and Development Office, gov.uk", "url": "https://www.gov.uk/guidance/foreign-travel-insurance", "accessed": "2026-09-16", "note": "read for repatriation, emergency transport, declaration of existing conditions and the limits of EHIC/GHIC" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference", "note": "the questions are this project's; the statement about specialist complication policies is deliberately unsourced because no wording was read" }, "text.today": { "tier": "inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "antalya", "type": "hub", "name": "Antalya", "as": "The step that matters most where a hotel, a transfer and an operation share one invoice.", "rel": "step" }, { "from": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "The step at which a weight limit or a missing ward night turns up.", "rel": "step" }, { "from": "abortion-care", "type": "procedure", "name": "Abortion", "as": "The consultation is a separate line on every list read here, and it is a third of the smallest total.", "rel": "step" }, { "from": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "The step at which per-arch turns into per-mouth and the bill doubles.", "rel": "step" }, { "from": "angioplasty-stent", "type": "procedure", "name": "Coronary angioplasty and stent", "as": "The step at which a stent turns out not to be in the stent package.", "rel": "step" }, { "from": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "The step where the brand, the volume and the ward night are separated from the headline.", "rel": "step" }, { "from": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "The step at which Set 1 turns out to mean one kind of lens.", "rel": "step" }, { "from": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The step that decides whether a quoted implant is a screw or a tooth.", "rel": "step" }, { "from": "disc-replacement", "type": "procedure", "name": "Artificial disc replacement", "as": "The step on which this package's headline figure turns.", "rel": "step" }, { "from": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The step where a donor-egg package that excludes the donor eggs is found.", "rel": "step" }, { "from": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "The step at which per-arch becomes per-mouth.", "rel": "step" }, { "from": "gallbladder-removal", "type": "procedure", "name": "Gallbladder removal", "as": "The step at which a converted operation stops being covered by the fixed price.", "rel": "step" }, { "from": "gastric-balloon", "type": "procedure", "name": "Gastric balloon", "as": "Where early removal for intolerance is found outside the price that included removal.", "rel": "step" }, { "from": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "The step where lifetime multivitamins are found on the exclusion list of an all-inclusive price.", "rel": "step" }, { "from": "heart-valve-replacement", "type": "procedure", "name": "Heart valve replacement", "as": "The step at which special device turns out to mean the valve.", "rel": "step" }, { "from": "hernia-repair", "type": "procedure", "name": "Hernia repair", "as": "The step at which one night turns out to mean one night exactly.", "rel": "step" }, { "from": "hysterectomy", "type": "procedure", "name": "Hysterectomy", "as": "The step at which special equipment turns out to mean the instrument the operation uses.", "rel": "step" }, { "from": "icl", "type": "procedure", "name": "Implantable collamer lens", "as": "The step at which same-day surgery turns out to price an overnight stay separately.", "rel": "step" }, { "from": "icsi", "type": "procedure", "name": "Intracytoplasmic sperm injection", "as": "The step of the journey where a bundled ICSI and an itemised one turn out to differ.", "rel": "step" }, { "from": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "Where a bundled PGT and a per-embryo PGT turn out to be different purchases.", "rel": "step" }, { "from": "phalloplasty", "type": "procedure", "name": "Phalloplasty", "as": "Where the words Other Places, and what they cost, would be found.", "rel": "step" }, { "from": "prostatectomy", "type": "procedure", "name": "Prostatectomy", "as": "The step at which the daily ward round turns out to be billed separately.", "rel": "step" }, { "from": "spinal-fusion", "type": "procedure", "name": "Spinal fusion", "as": "The step that decides what a one-level fusion price actually covers.", "rel": "step" }, { "from": "top-surgery", "type": "procedure", "name": "Top surgery", "as": "A surgeon's fee, a facility fee and a pathology charge are three different numbers and two of them are usually missing.", "rel": "step" }, { "from": "vaginoplasty", "type": "procedure", "name": "Vaginoplasty", "as": "The step at which a price with a nights column and no inclusion list has to be read.", "rel": "step" }, { "from": "american-hospital-dubai", "type": "facility", "name": "American Hospital Dubai", "as": "Its maternity package prices every exclusion and none of the inclusions, which is the whole lesson of that page in one document.", "rel": "step" }, { "from": "heidelberg-university-hospital", "type": "facility", "name": "Heidelberg University Hospital", "as": "The exclusion here is open-ended: a complication is charged beyond the estimate, and the page says so.", "rel": "step" }, { "from": "island-hospital-penang", "type": "facility", "name": "Island Hospital", "as": "Its screening package excludes everything the screening finds, in one sentence.", "rel": "step" }, { "from": "prince-court", "type": "facility", "name": "Prince Court Medical Centre", "as": "Its cosmetic package excludes complications, which is the line that decides what happens if the operation does not go as planned.", "rel": "step" }, { "from": "raffles-hospital", "type": "facility", "name": "Raffles Hospital", "as": "Not for women under forty, not for women with a pre-existing condition — a screening price is a price for the well.", "rel": "step" }, { "from": "samitivej", "type": "facility", "name": "Samitivej Sukhumvit Hospital", "as": "Its spinal package prints two nights and nine exclusions, screws among them.", "rel": "step" }, { "from": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "The paper the facilitator's promises have to survive.", "rel": "step" }, { "from": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The half of the quote that decides what the bill becomes.", "rel": "step" }, { "from": "anaesthetic-risk-unscreened", "type": "risk", "name": "Fitness for anaesthesia, assessed on arrival", "as": "The eligibility bar is on the same page as the exclusion list, and is read the same way.", "rel": "step" }, { "from": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "The same document, read for what the price does not cover.", "rel": "step" }, { "from": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The step at which this is caught, when it is caught.", "rel": "step" }, { "from": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "The step where this is discovered, or is not.", "rel": "step" }, { "from": "s2-route", "type": "rule", "name": "The S2 route", "as": "Travel, accommodation and the experimental part of a treatment are outside the certificate.", "rel": "step" }, { "from": "eu-national-contact-points", "type": "org", "name": "EU National Contact Points for cross-border healthcare", "as": "The step where a patient discovers what their own state will and will not refund.", "rel": "step" }, { "from": "co-payment", "type": "term", "name": "Co-payment", "as": "The step where the difference between a fixed sum and a percentage is discovered.", "rel": "step" }, { "from": "package-price", "type": "term", "name": "Package price", "as": "The step in the journey where this form of price is actually read.", "rel": "step" }, { "from": "repatriation", "type": "term", "name": "Repatriation", "as": "Where the cover for this is either found or not found.", "rel": "step" }, { "from": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The step in the journey where the nine excluded lines are found, when they are found.", "rel": "step" }, { "from": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "The step where this is caught, against a second exclusion list written by an insurer.", "rel": "step" } ] }, { "id": "second-opinion", "names": { "name": "The second opinion", "aliases": [ "second consultation", "remote opinion" ], "said": "Hospitals abroad sell it as a remote or online opinion; at home it is a referral." }, "facets": { "stage": "deciding" }, "x_order": 2, "text": { "what": "A second clinician reviews the diagnosis and the proposed operation. It can be sought at home before travelling, or bought from the destination hospital, and the two are different things: one is independent of the provider who would operate, the other is the provider who would operate.", "story": "The case for a second reading is documented inside single health systems rather than across borders. Mayo Clinic reported 286 patients referred into one general internal medicine division between 2009 and 2010: in 21% of cases the diagnosis was completely changed, in 66% it was refined or redefined, and in 12% it was confirmed as given. That study says nothing about travel; it says what happens when one diagnosis is looked at twice.\n\n*Inference —* the transaction changes when the second opinion is sold by the hospital that would perform the operation. The reviewer is then paid by the party whose theatre list the answer fills. Nothing this project could find measures how often a destination hospital's remote opinion disagrees with the referral it was sent.\n\nA remote opinion also runs on whatever the patient managed to send. Imaging that never left the home hospital, a pathology block that was never requested, a drug list written from memory — each is a hole the reviewer cannot see and usually does not flag.", "how": "A remote opinion is normally bought as a fixed fee, paid before review, with records uploaded by the patient. What comes back is commonly a letter naming a proposed procedure and a price. Where the same hospital then operates, the fee is sometimes credited against the package. *Trade practice —* that credit is described on provider pages rather than in any published standard.\n\nThe documentary questions here are: who the reviewing clinician is and where they are registered, what records the review was based on, and whether the opinion is written as a clinical letter or as a quotation.", "today": "As of 16 September 2026 no register this project could read collects the qualifications of clinicians giving remote opinions to patients in other countries, and no published series compares those opinions against the diagnoses they were sent." }, "kin": [ { "to": "deciding-whether", "as": "The step this one tests.", "rel": "step" }, { "to": "getting-your-records", "as": "The material without which a second opinion is an opinion on a summary.", "rel": "step" }, { "to": "informed-consent", "as": "What a diagnosis reviewed once cannot fully support.", "rel": "term" }, { "to": "getting-a-quote", "as": "What a hospital's remote opinion usually arrives as.", "rel": "step" }, { "to": "language-consent", "as": "The same problem one step earlier: an opinion given in a language the patient does not read.", "rel": "risk" } ], "sources": [ "s:van-such-second-opinions" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "the Mayo figures are cited; the paragraph about who pays the reviewer is marked inference inline" }, "text.how": { "tier": "tradition", "note": "the shape of a paid remote-opinion service, as providers describe it" }, "text.today": { "tier": "inference" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "pathway", "region": [ "global" ], "updated": "2026-09-16", "blurb": "A second clinician reviews the diagnosis and the proposed operation.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "deciding-whether", "type": "pathway", "name": "Deciding whether to go", "as": "The step this one tests.", "rel": "step" }, { "to": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "The material without which a second opinion is an opinion on a summary.", "rel": "step" }, { "to": "informed-consent", "type": "term", "name": "Informed consent", "as": "What a diagnosis reviewed once cannot fully support.", "rel": "term" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "What a hospital's remote opinion usually arrives as.", "rel": "step" }, { "to": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "The same problem one step earlier: an opinion given in a language the patient does not read.", "rel": "risk" } ], "source_list": [ { "id": "s:van-such-second-opinions", "kind": "paper", "title": "Extent of diagnostic agreement among medical referrals (J Eval Clin Pract 2017, doi:10.1111/jep.12747), as reported in the Mayo Clinic research release", "publisher": "Van Such M, Lohr R, Beckman T, Naessens JM; release reported by ScienceDaily", "url": "https://www.sciencedaily.com/releases/2017/04/170404084442.htm", "accessed": "2026-09-16", "note": "figures read off the release, not off the paper: 286 patients referred to one general internal medicine division, 2009–2010" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "the Mayo figures are cited; the paragraph about who pays the reviewer is marked inference inline" }, "text.how": { "tier": "tradition", "note": "the shape of a paid remote-opinion service, as providers describe it" }, "text.today": { "tier": "inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "penang", "type": "hub", "name": "Penang", "as": "Much of what arrives here is a second reading of a scan done at home.", "rel": "step" }, { "from": "gamma-knife", "type": "procedure", "name": "Gamma knife radiosurgery", "as": "The step where a patient learns that the machine exists at all, and in which country.", "rel": "step" }, { "from": "stem-cell-unproven", "type": "procedure", "name": "Unapproved stem cell treatment", "as": "The step at which an unapproved indication is most often identified as one.", "rel": "step" }, { "from": "charite-international", "type": "facility", "name": "Charité International Patients", "as": "Much of what reaches a European university hospital from abroad arrives as a request for a second reading.", "rel": "step" }, { "from": "hadassah", "type": "facility", "name": "Hadassah Medical Center", "as": "A hospital reached through a diaspora organisation's networks is often reached for a second reading first.", "rel": "step" }, { "from": "deciding-whether", "type": "pathway", "name": "Deciding whether to go", "as": "The next step for a diagnosis that has only been made once.", "rel": "step" }, { "from": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "The step these records are usually collected for.", "rel": "step" }, { "from": "unproven-stem-cell", "type": "risk", "name": "Unproven stem cell treatment", "as": "The step this risk is most often avoided at.", "rel": "step" }, { "from": "informed-consent", "type": "term", "name": "Informed consent", "as": "What the alternatives half of the doctrine actually requires.", "rel": "step" } ] }, { "id": "the-companion", "names": { "name": "The companion", "aliases": [ "escort", "medical attendant", "carer", "the person who comes along" ], "said": "India's visa system calls them a medical attendant. Hospitals say relative. Nobody bills for them and nobody counts them." }, "facets": { "stage": "before-you-fly" }, "x_order": 10, "text": { "what": "Somebody travels with the patient: a spouse, an adult child, a friend. They are not a patient, not staff and not a party to the contract, and they end up doing the work nobody costed — sitting through the consent conversation, moving a post-operative body through an airport, watching a wound at 3am in a hotel room.", "story": "One state has put a number on it. India's e-Visa scheme grants the e-Medical Attendant Visa alongside the patient's visa and caps it: \"Only two e-Medical Attendant Visas will be granted against one e-Medical Visa (patient)\". That is an immigration rule rather than a clinical finding, but it is the clearest published statement this project found of how many people a treatment trip is expected to involve.\n\n*Inference —* the companion is the part of the cost that never appears in a comparison. A second airfare, a hotel room for the length of the stay, unpaid leave, and in a hair or dental trip the entire nursing function after discharge. The package price sits on one side of the ledger; none of this is on the other.\n\nThe companion is also the person who absorbs the failures of every earlier step. Where the consent conversation runs through an interpreter, they are the second listener. Where the discharge summary is thin, they are the one who remembers what was said. Where the patient cannot fly on the booked date, they are the one who rebooks.\n\nNothing this project could find measures any of it: not how many patients travel with someone, not what the companion spends, not what happens to patients who travel alone.", "how": "What a reader would have to ask: whether the destination admits a companion in its own right or only as an ordinary visitor, whether the hospital permits a relative to stay overnight on the ward and at what charge, whether the package includes a second bed or a hotel room, what happens to the companion's own visa if the patient's stay extends, and who provides care in the recovery hotel — staff, or the person who came along.", "today": "As of 16 September 2026 the only hard number this project can attach to this step is a visa quota: two attendants per patient, in one country's immigration rules. The clinical and financial load on that person is undocumented." }, "kin": [ { "to": "the-escort-burden", "as": "The risk record for what this person carries.", "rel": "risk" }, { "to": "alone-after-discharge", "as": "What the same step looks like when nobody comes.", "rel": "risk" }, { "to": "the-visa", "as": "Where the companion becomes a legal category, and a quota.", "rel": "step" }, { "to": "arrival-and-consent", "as": "The conversation the companion is the second listener in.", "rel": "step" }, { "to": "aftercare-at-home", "as": "Where the nursing the companion started gets handed to nobody in particular.", "rel": "step" } ], "sources": [ "s:india-emedical-visa" ], "provenance": { "default": { "tier": "inference", "note": "the visa quota is cited; everything about the burden is marked inference because nothing published measures it" }, "fields": { "text.story": { "tier": "cited", "source": "s:india-emedical-visa", "note": "first paragraph cited, the rest marked inline" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "pathway", "region": [ "global" ], "updated": "2026-09-16", "blurb": "Somebody travels with the patient: a spouse, an adult child, a friend.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "The risk record for what this person carries.", "rel": "risk" }, { "to": "alone-after-discharge", "type": "risk", "name": "Discharged alone", "as": "What the same step looks like when nobody comes.", "rel": "risk" }, { "to": "the-visa", "type": "pathway", "name": "The visa", "as": "Where the companion becomes a legal category, and a quota.", "rel": "step" }, { "to": "arrival-and-consent", "type": "pathway", "name": "Arrival and consent", "as": "The conversation the companion is the second listener in.", "rel": "step" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "Where the nursing the companion started gets handed to nobody in particular.", "rel": "step" } ], "source_list": [ { "id": "s:india-emedical-visa", "kind": "web", "title": "e-Visa — e-Medical Visa and e-Medical Attendant Visa", "publisher": "Bureau of Immigration, Ministry of Home Affairs, Government of India", "url": "https://indianvisaonline.gov.in/evisa/tvoa.html", "accessed": "2026-09-16", "note": "one year from arrival, multiple entries, hospital letter on letterhead, two attendant visas per patient" } ], "tiers": { "text.what": { "tier": "inference", "note": "the visa quota is cited; everything about the burden is marked inference because nothing published measures it" }, "text.story": { "tier": "cited", "source": "s:india-emedical-visa", "note": "first paragraph cited, the rest marked inline" }, "text.how": { "tier": "inference", "note": "the visa quota is cited; everything about the burden is marked inference because nothing published measures it" }, "text.today": { "tier": "inference", "note": "the visa quota is cited; everything about the burden is marked inference because nothing published measures it" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "bengaluru", "type": "hub", "name": "Bengaluru", "as": "Twenty kilometres from the city means the relative needs housing, not a chair.", "rel": "step" }, { "from": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "The relative who comes too, and who has to be housed for the length of the stay.", "rel": "step" }, { "from": "medellin", "type": "hub", "name": "Medellín", "as": "Named in the visa rule here: a companion falls under the same requirement as the patient.", "rel": "step" }, { "from": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "Somebody has to be there for the drains and the first week bent forward.", "rel": "step" }, { "from": "addiction-rehab", "type": "procedure", "name": "Residential addiction treatment", "as": "Family involvement across time zones is part of the treatment and none of the price.", "rel": "step" }, { "from": "assisted-dying", "type": "procedure", "name": "Assisted dying", "as": "Nobody makes this journey alone, and the escort is a published line on the bill.", "rel": "step" }, { "from": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "The label assumes someone is watching the patient daily; somebody has to be that person, in another country.", "rel": "step" }, { "from": "facelift", "type": "procedure", "name": "Facelift", "as": "Two weeks of visible bruising, and somebody has to be in the room.", "rel": "step" }, { "from": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "The carer the NHS funded a seat for, on a nine-week absence.", "rel": "step" }, { "from": "vaginoplasty", "type": "procedure", "name": "Vaginoplasty", "as": "Nine nights in hospital and weeks in the city afterwards are an escort's calendar too.", "rel": "step" }, { "from": "hospital-cima-san-jose", "type": "facility", "name": "Hospital CIMA San José", "as": "A hundred-bed hospital discharges early, and the recovery hotel is where the escort's week actually goes.", "rel": "step" }, { "from": "king-hussein-cancer-center", "type": "facility", "name": "King Hussein Cancer Center", "as": "A course of cancer treatment measured in months moves a family, not an escort.", "rel": "step" }, { "from": "booking-the-flight", "type": "pathway", "name": "Booking the flight", "as": "The second ticket, bought at the same time and rarely in the quoted price.", "rel": "step" }, { "from": "the-visa", "type": "pathway", "name": "The visa", "as": "Who the attendant visa is for, and how many of them a state will admit.", "rel": "step" }, { "from": "alone-after-discharge", "type": "risk", "name": "Discharged alone", "as": "The step this risk is the absence of.", "rel": "step" }, { "from": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "The step this risk is the price of.", "rel": "step" }, { "from": "assisted-dying-law", "type": "rule", "name": "Assisted dying, and who may cross a border for it", "as": "The person who travels too, and whose position at home is a separate question.", "rel": "pathway" }, { "from": "gcc-sponsored-treatment-abroad", "type": "rule", "name": "Gulf state-sponsored treatment abroad", "as": "The escort the bylaw counts, and pays.", "rel": "step" }, { "from": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The person this class counts, and caps at two.", "rel": "step" }, { "from": "schengen-medical-visa", "type": "rule", "name": "The Schengen visa, for treatment", "as": "Who has to apply separately, and prove someone else's purpose.", "rel": "step" }, { "from": "thai-medical-visa", "type": "rule", "name": "Thailand's medical treatment visa", "as": "The person these pages do not mention.", "rel": "step" }, { "from": "day-case", "type": "term", "name": "Day case", "as": "The person a day case requires and a foreign trip may not have.", "rel": "step" }, { "from": "medical-visa", "type": "term", "name": "Medical visa", "as": "The person a medical class does or does not admit — India grants two.", "rel": "step" } ] }, { "id": "the-deposit", "names": { "name": "The deposit", "aliases": [ "booking fee", "advance payment", "prepayment" ], "said": "Clinics say deposit or booking fee; the bank statement says international transfer." }, "facets": { "stage": "booking" }, "x_order": 7, "text": { "what": "Money crosses the border before the patient does. A deposit — or in dental and hair work often the whole price — is paid to secure a date, usually by card or bank transfer, to an entity in another country that the payer has not met and may not be able to identify from the invoice.", "story": "*Inference —* this is the first irreversible step in the journey and the least documented. Nothing this project could find measures how often deposits are taken, how large they are, what share is refunded when a patient cancels or is found unfit, or what happens when a clinic closes between the payment and the date.\n\nWhat can be said from the paper: a deposit paid to a facilitator is money held by a party that is not the provider, and a deposit paid by international bank transfer has no chargeback route, while a card payment may have one against the merchant that appears on the statement rather than against the party that failed. Whether that merchant is the hospital, the intermediary, or a payment processor in a third country is visible only on the invoice and the statement.\n\nThe deposit also changes the shape of every later decision. A pre-operative test that comes back wrong, a surgeon who turns out not to be the one named, a revised price on arrival — each is met by a patient who has already sent money and bought a ticket. *Trade practice —* clinics commonly credit a deposit against a rescheduled date rather than refund it; that is a policy, published at the clinic's discretion, not a rule.", "how": "What a reader would have to ask, because no published source answers it: which legal entity receives the money and in which country, whether the sum is a deposit or a prepayment of the whole price, what is refundable and by when, what happens if the operation is cancelled by the provider rather than the patient, whether the payment route leaves any dispute mechanism at all, and whether a consumer-protection regime in the payer's own country reaches a service supplied abroad.", "today": "As of 16 September 2026 deposit and refund practice in this trade is unmeasured as far as this project could read: no regulator collects it, no study counts it, and the terms exist only in individual provider and intermediary contracts." }, "kin": [ { "to": "getting-a-quote", "as": "The number this payment attaches to.", "rel": "step" }, { "to": "choosing-a-facilitator", "as": "Often the party that actually receives the money.", "rel": "step" }, { "to": "deposit-and-refund", "as": "The risk this step creates, and who carries it.", "rel": "risk" }, { "to": "the-visa", "as": "The next step, and one that can fail after the money has gone.", "rel": "step" }, { "to": "out-of-pocket", "as": "What almost every payment in this journey is.", "rel": "term" } ], "sources": [ "s:penney-broker-websites" ], "provenance": { "default": { "tier": "inference", "note": "no published measurement of deposit practice was found; the record says so and says what would have to be asked" }, "fields": { "text.story": { "tier": "inference" }, "text.how": { "tier": "inference" } } }, "confidence": "low", "needs_verification": true, "schema": 1, "type": "pathway", "region": [ "global" ], "updated": "2026-09-16", "blurb": "Money crosses the border before the patient does. A deposit — or in dental and hair work often the whole price — is paid to secure a date, usually by card or bank transfer, to an entity in another country that the payer…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The number this payment attaches to.", "rel": "step" }, { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "Often the party that actually receives the money.", "rel": "step" }, { "to": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "The risk this step creates, and who carries it.", "rel": "risk" }, { "to": "the-visa", "type": "pathway", "name": "The visa", "as": "The next step, and one that can fail after the money has gone.", "rel": "step" }, { "to": "out-of-pocket", "type": "term", "name": "Out-of-pocket", "as": "What almost every payment in this journey is.", "rel": "term" } ], "source_list": [ { "id": "s:penney-broker-websites", "kind": "paper", "title": "Risk communication and informed consent in the medical tourism industry: a thematic content analysis of Canadian broker websites", "publisher": "Penney K, Snyder J, Crooks VA, Johnston R. BMC Medical Ethics 2011;12:17", "url": "https://bmcmedethics.biomedcentral.com/articles/10.1186/1472-6939-12-17", "accessed": "2026-09-16", "note": "17 English-language Canadian broker sites, summer 2010" } ], "tiers": { "text.what": { "tier": "inference", "note": "no published measurement of deposit practice was found; the record says so and says what would have to be asked" }, "text.story": { "tier": "inference" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference", "note": "no published measurement of deposit practice was found; the record says so and says what would have to be asked" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "assisted-dying", "type": "procedure", "name": "Assisted dying", "as": "The first 4,000 francs buys an assessment, and the page says so.", "rel": "step" }, { "from": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "Where a job this size meets a clinic's staged deposit terms.", "rel": "step" }, { "from": "american-hospital-dubai", "type": "facility", "name": "American Hospital Dubai", "as": "The self-pay patient pays the entire package price in advance at sign-up, in the hospital's own words.", "rel": "step" }, { "from": "heidelberg-university-hospital", "type": "facility", "name": "Heidelberg University Hospital", "as": "The whole estimated sum before the appointment is confirmed, refunded to source if the final bill is lower.", "rel": "step" }, { "from": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "Where the money often lands first — in the intermediary's account, not the hospital's.", "rel": "step" }, { "from": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step that turns the number into money already sent.", "rel": "step" }, { "from": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The next step, usually taken before these two documents have been read together.", "rel": "step" }, { "from": "anaesthetic-risk-unscreened", "type": "risk", "name": "Fitness for anaesthesia, assessed on arrival", "as": "Paid before the grading, and the thing at stake when the grade comes back high.", "rel": "step" }, { "from": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "The step this risk is about.", "rel": "step" }, { "from": "out-of-pocket", "type": "term", "name": "Out-of-pocket", "as": "The first out-of-pocket payment in almost every trip for treatment.", "rel": "step" } ] }, { "id": "the-discharge-summary", "names": { "name": "The discharge summary", "aliases": [ "discharge letter", "epicrisis", "operation report" ], "said": "Hospitals in continental Europe say epicrisis. In English it is the discharge letter, and it is the only clinical document most patients carry home." }, "facets": { "stage": "going-home" }, "x_order": 13, "text": { "what": "A document handed over at discharge that states what was done. It is the only clinical record of the episode that travels with the patient, and the doctor who reads it next was not party to the consent, did not choose the implant, and cannot telephone the theatre.", "story": "Even inside one national system the handover is imperfect. A 2025 review of discharge communication to primary care reports that general practitioners criticise summaries for missing relevant content, and cites work finding that GPs and hospital doctors disagreed about whether the summary had done its job in 44% of cases. That is with a shared language, a shared record system and a shared regulator.\n\nThe cross-border version removes all three. The CDC Yellow Book's instruction is to \"request copies of their overseas medical records in English\" and to give them to whoever provides follow-up, and it cites the American College of Surgeons on obtaining \"a complete set of medical records before returning home\". Inside the EU the entitlement is statutory: the Member State of treatment must ensure patients are \"entitled to a written or electronic medical record\" of the treatment and \"access to at least a copy of this record\" (Directive 2011/24/EU, Article 4(2)(f)).\n\n*Inference —* what makes a summary usable later is specific and frequently absent: the make, model and serial number of any implant, which decides whether a revision at home can be planned; the operation note rather than a discharge narrative; the anaesthetic record; drugs given and drugs sent home, in generic names rather than local brands; any culture taken and its result; results still pending when the patient boarded; and a named contact who will answer a question in six weeks. A summary with the brand names of one country's formulary is a summary that has to be decoded before it can be acted on.", "how": "The document is issued by the treating hospital in its own language and its own format. Translation is nobody's contractual duty unless the package says so. *Trade practice —* larger international departments issue an English summary as a matter of course, and smaller clinics issue whatever their system prints.\n\nWhat a reader would have to ask: whether the summary will be in a language the home clinician reads, whether the operation note and the implant identifiers are included, whether pending results will be sent and to whom, and who at the hospital answers a clinical question after the patient has left the country.", "today": "As of 16 September 2026 no cross-border standard this project could find specifies what a discharge summary given to a foreign patient must contain. The EU entitlement is to a copy of the record, not to a record that meets a content standard." }, "kin": [ { "to": "in-hospital", "as": "The stay this document is the record of.", "rel": "step" }, { "to": "aftercare-at-home", "as": "Where this document becomes the whole of the clinical history.", "rel": "step" }, { "to": "getting-your-records", "as": "The same request, made in the other direction before departure.", "rel": "step" }, { "to": "follow-up-gap", "as": "What a thin summary turns into at the first appointment at home.", "rel": "risk" }, { "to": "revision-at-home", "as": "Why the implant's make and serial number matter years later.", "rel": "risk" }, { "to": "eu-directive-2011-24", "as": "The instrument that entitles an EU patient to at least a copy.", "rel": "governed-by" }, { "to": "cross-border-prescriptions", "as": "What the take-home drug list has to survive at a pharmacy in another country.", "rel": "governed-by" } ], "sources": [ "s:boddy-discharge-communication", "s:cdc-yellowbook-medical-tourism", "s:dir-2011-24-chapter-ii" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "tradition" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "pathway", "region": [ "global" ], "updated": "2026-09-16", "blurb": "A document handed over at discharge that states what was done.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "in-hospital", "type": "pathway", "name": "In hospital", "as": "The stay this document is the record of.", "rel": "step" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "Where this document becomes the whole of the clinical history.", "rel": "step" }, { "to": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "The same request, made in the other direction before departure.", "rel": "step" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "What a thin summary turns into at the first appointment at home.", "rel": "risk" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Why the implant's make and serial number matter years later.", "rel": "risk" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The instrument that entitles an EU patient to at least a copy.", "rel": "governed-by" }, { "to": "cross-border-prescriptions", "type": "rule", "name": "A prescription that crosses a border", "as": "What the take-home drug list has to survive at a pharmacy in another country.", "rel": "governed-by" } ], "source_list": [ { "id": "s:boddy-discharge-communication", "kind": "paper", "title": "One template does not fit all: where next to improve hospital discharge communication to primary care?", "publisher": "Boddy N, Reeve J, Spencer RA, Avery AJ. Primary Health Care Research and Development 2025;26:e78", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12555088/", "accessed": "2026-09-16", "note": "cites Weetman et al. 2021 on disagreement between GPs and hospital doctors in 44% of cases" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:dir-2011-24-chapter-ii", "kind": "law", "title": "Directive 2011/24/EU, Chapter II — responsibilities of the Member State of treatment and of affiliation, Articles 4 to 6", "publisher": "legislation.gov.uk, retained text of Directive 2011/24/EU", "url": "https://www.legislation.gov.uk/cy/eudr/2011/24/chapter/II/data.htm?view=plain", "accessed": "2026-09-16", "note": "read for Art 4(2)(b) invoices and prices, 4(2)(c) complaints and redress, 4(2)(d) professional liability insurance, 4(2)(f) copy of the medical record, 5(d) access to records, and Art 6 national contact points" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "cochlear-implant", "type": "procedure", "name": "Cochlear implant", "as": "The paper a patient carries home, which for this device has to include the implant model and the map.", "rel": "step" }, { "from": "prostatectomy", "type": "procedure", "name": "Prostatectomy", "as": "The document this package charges for separately and a home urologist cannot work without.", "rel": "step" }, { "from": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The only document the home clinician has to work from.", "rel": "step" }, { "from": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "The same request made in the other direction, at the far end.", "rel": "step" }, { "from": "in-hospital", "type": "pathway", "name": "In hospital", "as": "The only document most of this step leaves behind.", "rel": "step" }, { "from": "the-flight-home", "type": "pathway", "name": "The flight home", "as": "The document that should carry the surgeon's fitness-to-fly interval, and often does not.", "rel": "step" }, { "from": "alone-after-discharge", "type": "risk", "name": "Discharged alone", "as": "The document that leaves with the patient, and the only thing a hotel room contains that a clinician could read.", "rel": "step" }, { "from": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The document that would close this gap, when it exists and when it is in a language the next clinician reads.", "rel": "step" }, { "from": "cross-border-prescriptions", "type": "rule", "name": "A prescription that crosses a border", "as": "The document the common-name rule is really about.", "rel": "step" }, { "from": "patient-data-transfer", "type": "rule", "name": "Moving a medical record across a border", "as": "The document that matters most, and the one most often a letter instead.", "rel": "step" }, { "from": "the-follow-up-nobody-books", "type": "story", "name": "The follow-up nobody books", "as": "The document that would close the gap, when it exists and is in a language the next clinician reads.", "rel": "step" } ] }, { "id": "the-flight-home", "names": { "name": "The flight home", "aliases": [ "the return leg", "repatriation by scheduled flight" ], "said": "The ticket was bought before the operation. The body it now has to carry is a different one." }, "facets": { "stage": "going-home" }, "x_order": 14, "text": { "what": "A post-operative body in a pressurised cabin, hours from any theatre, on a date chosen before the operation. It is the point where the booking made at step nine meets the guidance written by aviation medicine, and where a clot, a wound or a cast turns a ticket into a problem.", "story": "The intervals are published and they are procedure-specific. The UK Civil Aviation Authority: \"travel should be avoided for 10 days following abdominal surgery\"; about 24 hours after laparoscopic surgery because of residual CO2; about 7 days after neurosurgery; a week after intra-ocular surgery, and \"approximately 2 weeks if sulphur hexafluoride is used and 6 weeks with the use of perfluoropropane\" where gas is injected into the eye. The CDC Yellow Book states travellers \"should not fly for 10 days after chest or abdominal surgery\" and gives 7 to 10 days for laser and cosmetic work on the face, eyelids or nose. The NHS gives 5 to 7 days after breast surgery and liposuction, 7 to 10 days after facial procedures and abdominoplasty, and names the mechanism: \"Air travel and major surgery increase your risk of a blood clot, which can be life threatening.\"\n\n*Inference —* the collision is arithmetical. A package that names three ward nights and a return booked for day five sits inside the ten-day interval the same guidance applies to the operation. The person who resolves that conflict is the patient at a check-in desk, with a non-refundable fare and a hotel bill running.\n\nIf the patient cannot fly, the next options are commercial and expensive: a changed fare, extra nights, a seat the airline will clear, a medical escort, or an air ambulance. What each costs is not published by anyone this project could read, and travel policies commonly exclude the very event that caused the delay.", "how": "*Trade practice —* airlines may require medical clearance for recent surgery, assessed by the carrier's own medical department against a form completed by a doctor, and the carrier can refuse carriage. Oxygen, a stretcher and a lie-flat seat are booked as services with their own charges and lead times.\n\nWhat a reader would have to ask: what interval the operating surgeon gives in writing for this operation, whether that is in the discharge summary, what the airline requires, what a change costs on the fare bought, and what the policy pays if the return is delayed on medical advice.", "today": "As of 16 September 2026 the flying intervals in this record come from aviation-medicine and public-health guidance. No provider page this project read prices the possibility that the patient will not be fit to fly on the booked date." }, "metrics": { "days_before_flying": 10, "note": "The ten-day figure is for chest or abdominal surgery, from both the CDC Yellow Book and the UK Civil Aviation Authority. Other procedures carry different intervals — about 24 hours after laparoscopic surgery, about 7 days after neurosurgery, up to 6 weeks after retinal surgery with perfluoropropane gas — and airlines set their own rules on top.", "as_of": "2026-09-16", "source": "s:caa-surgical-conditions", "url": "https://www.caa.co.uk/passengers-and-public/passenger-guidance/health-guidance/guidance-for-health-professionals/surgical-conditions/" }, "kin": [ { "to": "flying-after-surgery", "as": "The risk record for this leg, with the guidance in full.", "rel": "risk" }, { "to": "dvt-pe", "as": "The clot that the intervals exist to avoid, and the commonest fatal event on this leg.", "rel": "risk" }, { "to": "booking-the-flight", "as": "Where this date was chosen, weeks before the body existed to fly it.", "rel": "step" }, { "to": "repatriation-cost", "as": "What this step becomes when a scheduled seat is no longer possible.", "rel": "risk" }, { "to": "the-discharge-summary", "as": "The document that should carry the surgeon's fitness-to-fly interval, and often does not.", "rel": "step" }, { "to": "aftercare-at-home", "as": "What lands on the other side.", "rel": "step" } ], "sources": [ "s:caa-surgical-conditions", "s:cdc-yellowbook-medical-tourism", "s:nhs-cosmetic-surgery-abroad" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "tradition" }, "text.today": { "tier": "inference" }, "metrics": { "tier": "cited", "source": "s:caa-surgical-conditions" } } }, "confidence": "high", "schema": 1, "type": "pathway", "region": [ "global" ], "updated": "2026-09-16", "blurb": "A post-operative body in a pressurised cabin, hours from any theatre, on a date chosen before the operation.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The risk record for this leg, with the guidance in full.", "rel": "risk" }, { "to": "dvt-pe", "type": "risk", "name": "Deep vein thrombosis and pulmonary embolism", "as": "The clot that the intervals exist to avoid, and the commonest fatal event on this leg.", "rel": "risk" }, { "to": "booking-the-flight", "type": "pathway", "name": "Booking the flight", "as": "Where this date was chosen, weeks before the body existed to fly it.", "rel": "step" }, { "to": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "What this step becomes when a scheduled seat is no longer possible.", "rel": "risk" }, { "to": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "The document that should carry the surgeon's fitness-to-fly interval, and often does not.", "rel": "step" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "What lands on the other side.", "rel": "step" } ], "source_list": [ { "id": "s:caa-surgical-conditions", "kind": "org", "title": "Surgical conditions — health guidance for health professionals", "publisher": "UK Civil Aviation Authority", "url": "https://www.caa.co.uk/passengers-and-public/passenger-guidance/health-guidance/guidance-for-health-professionals/surgical-conditions/", "accessed": "2026-09-16", "note": "intervals before flying after abdominal, laparoscopic, orthopaedic, ocular and neurosurgical procedures" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:nhs-cosmetic-surgery-abroad", "kind": "org", "title": "Cosmetic surgery abroad", "publisher": "NHS (England)", "url": "https://www.nhs.uk/tests-and-treatments/cosmetic-procedures/advice/cosmetic-surgery-abroad/", "accessed": "2026-09-16", "note": "read for aftercare responsibility, flying intervals and the statement on travel insurance" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "tradition" }, "text.today": { "tier": "inference" }, "metrics": { "tier": "cited", "source": "s:caa-surgical-conditions" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "abortion-care", "type": "procedure", "name": "Abortion", "as": "Where a day case stops being a day case: the bleeding and the distance from a clinician.", "rel": "step" }, { "from": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The step before, and the one that sets how much healing happened in transit.", "rel": "step" }, { "from": "booking-the-flight", "type": "pathway", "name": "Booking the flight", "as": "The leg this step buys blind.", "rel": "step" }, { "from": "alone-after-discharge", "type": "risk", "name": "Discharged alone", "as": "The next thing asked of a body nobody is watching.", "rel": "step" }, { "from": "dvt-pe", "type": "risk", "name": "Deep vein thrombosis and pulmonary embolism", "as": "The step where the seated hours are spent.", "rel": "step" }, { "from": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The step this guidance is about.", "rel": "step" }, { "from": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "The ordinary version of the same journey, at the price of a seat.", "rel": "contrast" }, { "from": "repatriation", "type": "term", "name": "Repatriation", "as": "The step this word replaces when the patient cannot board.", "rel": "step" } ] }, { "id": "the-visa", "names": { "name": "The visa", "aliases": [ "medical visa", "treatment visa", "medical attendant visa" ], "said": "Several states run a named medical category; others admit the same patient as a visitor and never count them." }, "facets": { "stage": "before-you-fly" }, "x_order": 8, "text": { "what": "Entry permission for treatment. Some states issue a dedicated class that names the hospital and admits a companion; others treat a patient arriving for surgery as an ordinary visitor. Which applies decides how long the patient may stay, whether a companion may come, and whether the trip appears in any official count.", "story": "India's e-Visa scheme is one of the explicit ones, and it is worth reading because it states what a state thinks a treatment trip needs. The e-Medical Visa runs \"One year (365 days) from the date of arrival into India\" with multiple entries, and requires a \"Copy of Letter from the Hospital concerned in India on its letterhead which including the date / tentative date which admission have been suggested\". Alongside it sits the e-Medical Attendant Visa, and the rule is numerical: \"Only two e-Medical Attendant Visas will be granted against one e-Medical Visa (patient)\". Two — a state's own arithmetic of how many people one patient needs.\n\n*Inference —* the named category cuts both ways. It ties the stay to a hospital letter, so a change of provider on arrival is a paperwork problem as well as a clinical one; and it makes the purpose of travel a matter of record, which matters where a treatment is lawful at the destination and not at home.\n\nWhere no medical class exists, the patient enters as a visitor. Nothing about that is unlawful in itself, but the trip then leaves no trace in migration statistics, which is one reason the counts of who travels for care are as poor as they are.", "how": "A medical class typically wants the hospital's letter, evidence of funds and a return ticket, and it typically runs from a date fixed weeks in advance. Treatment dates move; visa validity does not move with them.\n\nWhat a reader would have to ask: whether the destination issues a medical class at all and whether their nationality is eligible for it, whether the hospital issues the letter before or after the deposit, how many companions the class admits, whether the stay can be extended if recovery runs long, and whether entering as a visitor while intending treatment breaches the terms of that visitor permission.", "today": "As of 16 September 2026 the visa classes that name treatment are held on individual rule records on this site, each naming its own instrument and date. The e-Medical and e-Medical Attendant classes described here are read off the Government of India's own e-Visa page." }, "kin": [ { "to": "india-e-medical-visa", "as": "The rule this step reads in full.", "rel": "governed-by" }, { "to": "thai-medical-visa", "as": "The same instrument in another jurisdiction.", "rel": "governed-by" }, { "to": "schengen-medical-visa", "as": "The European version, and the one with no dedicated treatment class.", "rel": "governed-by" }, { "to": "the-companion", "as": "Who the attendant visa is for, and how many of them a state will admit.", "rel": "step" }, { "to": "booking-the-flight", "as": "The next step, and the one whose dates the visa constrains.", "rel": "step" }, { "to": "circumvention", "as": "Why the stated purpose of a trip is sometimes the sensitive part.", "rel": "story" }, { "to": "counting-patients", "as": "Why a patient admitted as a visitor is a patient nobody counted.", "rel": "story" } ], "sources": [ "s:india-emedical-visa" ], "provenance": { "default": { "tier": "cited", "source": "s:india-emedical-visa" }, "fields": { "text.how": { "tier": "tradition", "note": "the general shape of a medical visa application; the India specifics are cited" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "pathway", "region": [ "global" ], "updated": "2026-09-16", "blurb": "Entry permission for treatment. Some states issue a dedicated class that names the hospital and admits a companion; others treat a patient arriving for surgery as an ordinary visitor.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The rule this step reads in full.", "rel": "governed-by" }, { "to": "thai-medical-visa", "type": "rule", "name": "Thailand's medical treatment visa", "as": "The same instrument in another jurisdiction.", "rel": "governed-by" }, { "to": "schengen-medical-visa", "type": "rule", "name": "The Schengen visa, for treatment", "as": "The European version, and the one with no dedicated treatment class.", "rel": "governed-by" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "Who the attendant visa is for, and how many of them a state will admit.", "rel": "step" }, { "to": "booking-the-flight", "type": "pathway", "name": "Booking the flight", "as": "The next step, and the one whose dates the visa constrains.", "rel": "step" }, { "to": "circumvention", "type": "story", "name": "Circumvention", "as": "Why the stated purpose of a trip is sometimes the sensitive part.", "rel": "story" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a patient admitted as a visitor is a patient nobody counted.", "rel": "story" } ], "source_list": [ { "id": "s:india-emedical-visa", "kind": "web", "title": "e-Visa — e-Medical Visa and e-Medical Attendant Visa", "publisher": "Bureau of Immigration, Ministry of Home Affairs, Government of India", "url": "https://indianvisaonline.gov.in/evisa/tvoa.html", "accessed": "2026-09-16", "note": "one year from arrival, multiple entries, hospital letter on letterhead, two attendant visas per patient" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:india-emedical-visa" }, "text.story": { "tier": "cited", "source": "s:india-emedical-visa" }, "text.how": { "tier": "tradition", "note": "the general shape of a medical visa application; the India specifics are cited" }, "text.today": { "tier": "inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "amman", "type": "hub", "name": "Amman", "as": "The invitation letter the hospital issues is the step that makes the journey possible.", "rel": "step" }, { "from": "bogota", "type": "hub", "name": "Bogotá", "as": "Colombia asks for a health visa where the stay runs past ninety days.", "rel": "step" }, { "from": "medellin", "type": "hub", "name": "Medellín", "as": "Colombia's health visa, needed past ninety days, with the hospital itself explaining it.", "rel": "step" }, { "from": "clinica-las-americas", "type": "facility", "name": "Clínica Las Américas", "as": "Publishes a step-by-step page on Colombia's medical visa, which is the step its office exists for.", "rel": "step" }, { "from": "booking-the-flight", "type": "pathway", "name": "Booking the flight", "as": "The permission whose dates the tickets have to sit inside.", "rel": "step" }, { "from": "the-companion", "type": "pathway", "name": "The companion", "as": "Where the companion becomes a legal category, and a quota.", "rel": "step" }, { "from": "the-deposit", "type": "pathway", "name": "The deposit", "as": "The next step, and one that can fail after the money has gone.", "rel": "step" }, { "from": "abortion-travel-law", "type": "rule", "name": "Travelling for a termination", "as": "Why a named purpose of travel matters here.", "rel": "pathway" }, { "from": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The step this rule sits inside, and the one the pathway record quotes.", "rel": "pathway" }, { "from": "schengen-medical-visa", "type": "rule", "name": "The Schengen visa, for treatment", "as": "The step this rule sits inside.", "rel": "pathway" }, { "from": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "Why the stated purpose of a journey matters here more than anywhere else.", "rel": "pathway" }, { "from": "thai-medical-visa", "type": "rule", "name": "Thailand's medical treatment visa", "as": "The step this rule sits inside.", "rel": "pathway" }, { "from": "medical-visa", "type": "term", "name": "Medical visa", "as": "The step in the journey where this class is applied for.", "rel": "step" }, { "from": "who-travels", "type": "story", "name": "Who travels", "as": "The step that decides most of this, and the one no price page prices.", "rel": "step" } ] }, { "id": "when-it-goes-wrong", "names": { "name": "When it goes wrong", "aliases": [ "the complication", "the emergency abroad", "the failed result" ], "said": "Abroad it is an emergency. At home, weeks later, it is a presentation with no history." }, "facets": { "stage": "when-it-goes-wrong" }, "x_order": 16, "text": { "what": "A complication arrives, either in the destination while the patient is still there or at home after the flight. Who treats it, who pays for it and who holds the record differ in the two cases, and both differ from the domestic pathway where one institution owns the whole episode.", "story": "The events that get published are the outbreaks, because an outbreak is what makes a scatter of individual complications countable. The CDC names fungal meningitis in patients who received epidural anaesthesia in Mexico, carbapenem-resistant Enterobacterales infections after invasive procedures in Mexico, and surgical site infections caused by nontuberculous mycobacteria in the Dominican Republic. Each was found because the cases clustered.\n\n*Inference —* the corollary is the shape of the evidence in this field. A complication that does not cluster is absorbed at home as an ordinary presentation, attributed to nothing in particular, and counted by nobody. The outbreak reports are the visible fraction, and the denominator is unknown.\n\nWhat the patient meets financially is the second exclusion list. The NHS states that travel insurance \"does not normally cover if things go wrong in surgery\". The CDC directs travellers to check what a domestic plan covers abroad and to consider supplemental cover \"including medical evacuation insurance\". The UK government's travel insurance guidance is built around emergencies and unplanned costs — repatriation, emergency transport, \"getting home after medical treatment if you cannot use your original ticket\" — and notes that EHIC and GHIC \"are not alternatives to travel insurance as they do not cover any private medical healthcare costs, repatriation or additional costs\".\n\nAbroad, the immediate questions are practical: whether the treating hospital will readmit and at what charge, whether the package's complication terms cover a return to theatre, whether the patient is well enough to be moved, and who pays for an air ambulance if not.", "how": "What a reader would have to ask, and ask before travelling because the answers cannot be obtained during a crisis: what the provider's written complication terms cover and for how long, whether the insurer's cover survives a planned procedure, what the destination's consular service for the patient's nationality will and will not do, which hospital in the destination takes emergencies if the clinic cannot, and who holds the operation note if the patient is unconscious.", "today": "As of 16 September 2026 the published record of failures in this trade consists of outbreak investigations, single-hospital cost analyses of returning patients, and case reports. No system counts complications of treatment abroad against the number of people who travelled." }, "kin": [ { "to": "complaint-and-claim", "as": "What this step becomes once the clinical emergency is over.", "rel": "step" }, { "to": "repatriation-cost", "as": "The bill when a scheduled seat is no longer an option.", "rel": "risk" }, { "to": "malpractice-recourse", "as": "Whether anything can be recovered, and where.", "rel": "risk" }, { "to": "surgical-site-infection", "as": "The commonest failure, and the one that presents after the flight.", "rel": "risk" }, { "to": "mexico-fungal-meningitis-2023", "as": "An outbreak that made a scatter of cases countable.", "rel": "event" }, { "to": "dominican-republic-ntm-outbreak", "as": "The same, in another destination and another organism.", "rel": "event" }, { "to": "aftercare-at-home", "as": "The step this one interrupts.", "rel": "step" }, { "to": "what-the-data-cannot-see", "as": "Why the denominator under all of this is missing.", "rel": "story" } ], "sources": [ "s:cdc-yellowbook-medical-tourism", "s:nhs-cosmetic-surgery-abroad", "s:gov-uk-foreign-travel-insurance" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "pathway", "region": [ "global" ], "updated": "2026-09-16", "blurb": "A complication arrives, either in the destination while the patient is still there or at home after the flight.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "complaint-and-claim", "type": "pathway", "name": "Complaint and claim", "as": "What this step becomes once the clinical emergency is over.", "rel": "step" }, { "to": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "The bill when a scheduled seat is no longer an option.", "rel": "risk" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "Whether anything can be recovered, and where.", "rel": "risk" }, { "to": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The commonest failure, and the one that presents after the flight.", "rel": "risk" }, { "to": "mexico-fungal-meningitis-2023", "type": "event", "name": "The Matamoros fungal meningitis outbreak, 2023", "as": "An outbreak that made a scatter of cases countable.", "rel": "event" }, { "to": "dominican-republic-ntm-outbreak", "type": "event", "name": "The Dominican mycobacterial outbreaks, 2013–14 and 2017", "as": "The same, in another destination and another organism.", "rel": "event" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The step this one interrupts.", "rel": "step" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "Why the denominator under all of this is missing.", "rel": "story" } ], "source_list": [ { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:nhs-cosmetic-surgery-abroad", "kind": "org", "title": "Cosmetic surgery abroad", "publisher": "NHS (England)", "url": "https://www.nhs.uk/tests-and-treatments/cosmetic-procedures/advice/cosmetic-surgery-abroad/", "accessed": "2026-09-16", "note": "read for aftercare responsibility, flying intervals and the statement on travel insurance" }, { "id": "s:gov-uk-foreign-travel-insurance", "kind": "org", "title": "Foreign travel insurance", "publisher": "UK Foreign, Commonwealth and Development Office, gov.uk", "url": "https://www.gov.uk/guidance/foreign-travel-insurance", "accessed": "2026-09-16", "note": "read for repatriation, emergency transport, declaration of existing conditions and the limits of EHIC/GHIC" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "Where this step goes when the wound fails.", "rel": "step" }, { "from": "complaint-and-claim", "type": "pathway", "name": "Complaint and claim", "as": "The clinical event that precedes this step.", "rel": "step" }, { "from": "fungal-meningitis", "type": "risk", "name": "Fungal meningitis after epidural anaesthesia", "as": "The step at which a headache two weeks after a flight becomes an emergency.", "rel": "step" }, { "from": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "The step at which the question first gets asked.", "rel": "step" }, { "from": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "The step at which the aircraft is chartered.", "rel": "step" }, { "from": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The step this is the bill for.", "rel": "step" }, { "from": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The step this risk turns into.", "rel": "step" }, { "from": "revision", "type": "term", "name": "Revision", "as": "The step in the journey this word belongs to.", "rel": "step" }, { "from": "the-follow-up-nobody-books", "type": "story", "name": "The follow-up nobody books", "as": "Where the patient goes at week three, and who is on take.", "rel": "step" } ] }, { "id": "alone-after-discharge", "names": { "name": "Discharged alone", "aliases": [ "no responsible adult", "discharged to a hotel", "nobody at the other end" ], "said": "Day-surgery guidance calls the missing person a responsible adult. The booking calls it a hotel transfer." }, "region": [ "global" ], "facets": { "kind": "clinical" }, "text": { "what": "Discharge from a hospital abroad into a hotel room rather than a household. Two instruments this project has read require an adult at the other end of a general anaesthetic, and both were drafted for a patient going home. Nobody counts how many people who travel for treatment are discharged without one.", "story": "The requirement is written down in plain terms. The Royal College of Anaesthetists, in Chapter 6 of its Guidelines for the Provision of Anaesthesia Services, published 31 March 2021, recommends at 5.25 that \"Following procedures performed under general or regional anaesthesia, a responsible adult should escort the patient home and provide support for the first 24 hours after surgery\", qualified by the observation that \"A carer at home may not be essential if there has been good recovery after brief or non-invasive procedures and where any postoperative haemorrhage is likely to be obvious and controllable with simple pressure.\" The recommendation is graded C and strong. Two lines later, at 5.26: \"Transport home should be by private car or taxi; public transport is not normally appropriate.\" At 5.24, a 24-hour telephone number \"should ideally be to an acute surgical area and should not be an answer phone\".\n\nThe United States puts it in a condition of coverage rather than a guideline. 42 CFR 416.52(c)(3) requires an ambulatory surgical center to \"Ensure all patients are discharged in the company of a responsible adult, except those patients exempted by the attending physician\" - a rule in force since 18 November 2008 and amended on 30 September 2019, binding on facilities billing Medicare.\n\n*Inference -* read together, the two describe a household. A car at the door, a person in the building overnight, a telephone answered by someone who can send an ambulance. A patient recovering in a hotel three time zones from home has a taxi rank, a front desk and a clinic's daytime line, and the hotel is not a party to the discharge.\n\nThe gap between the two is unmeasured. No ministry, accreditor or registry publishes how many patients treated abroad travel with a companion, how many are discharged to a hotel, or what happens to those who arrive alone. This site's pathway record for the companion reaches the same wall from the other side: the only hard number attached to that step anywhere is an immigration quota.\n\nWhat is published instead is the shape of the package. The Bangkok knee package this site reads names three nights in the surgical ward and then stops; nights beyond the third are billed at the hospital's rates, and nothing after discharge is inside the price at all.", "how": "The lifting is the part that does not appear in any document. Somebody gets a post-operative body from a wheelchair at the hospital door into a taxi, and out of it at the other end. Somebody watches the dressing overnight, times the analgesia, decides at 3am whether a temperature is the operation or a complication, and finds the hospital number. Where no such person travelled, the roles fall to hotel staff with no clinical duty, to a facilitator's coordinator working office hours, or to nobody.\n\n*Trade practice -* the hotel room, the recovery apartment and the escorted transfer are sold as convenience rather than as care, and the packages this project has read do not describe who provides nursing in them or on what hours. Where a hospital offers a nurse or a serviced recovery suite, that is a separate purchase with its own price.", "today": "As of 17 September 2026 the named guidance and the named regulation stand, and no published count exists of medical travellers discharged without a responsible adult. What can be stated is narrower: two health systems require a person at the other end after an anaesthetic, and the accommodation sold with a treatment package is not required by either of them to supply one." }, "metrics": { "note": "No figure is carried because none is published. Nobody counts medical travellers discharged without a responsible adult - not a health ministry, not an accreditor, not a hospital register this project could find. The two measurable things are instruments rather than rates: recommendation 5.25 of the Royal College of Anaesthetists' day surgery chapter of 31 March 2021, which asks for an escort home and support for 24 hours after a general or regional anaesthetic, and 42 CFR 416.52(c)(3), which requires a US ambulatory surgical center to discharge patients in the company of a responsible adult unless the attending physician exempts them. Both were written for domestic day surgery.", "as_of": "2026-09-17", "source": "s:rcoa-gpas-day-surgery-2021", "url": "https://rcoa.ac.uk/gpas/chapter-6" }, "kin": [ { "to": "the-companion", "as": "The step this risk is the absence of.", "rel": "step" }, { "to": "the-escort-burden", "as": "The same person, costed: what it takes to have anyone there at all.", "rel": "kin" }, { "to": "day-case", "as": "The category built on somebody being at the other end by evening.", "rel": "term" }, { "to": "the-discharge-summary", "as": "The document that leaves with the patient, and the only thing a hotel room contains that a clinician could read.", "rel": "step" }, { "to": "aftercare-at-home", "as": "The step that begins after a flight, where a household would have begun the same evening.", "rel": "step" }, { "to": "the-flight-home", "as": "The next thing asked of a body nobody is watching.", "rel": "step" }, { "to": "dvt-pe", "as": "The complication that presents while sitting still in a room, and the one an absent observer does not see.", "rel": "kin" }, { "to": "flying-after-surgery", "as": "The wait that puts the patient in the hotel in the first place.", "rel": "kin" }, { "to": "follow-up-gap", "as": "The same absence, further along: nobody responsible, at a greater distance.", "rel": "kin" } ], "links": [ { "label": "RCoA - Guidelines for the Provision of Anaesthesia Services for Day Surgery 2021", "url": "https://rcoa.ac.uk/gpas/chapter-6" }, { "label": "42 CFR 416.52 - patient admission, assessment and discharge", "url": "https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-416/subpart-D/section-416.52" } ], "sources": [ "s:rcoa-gpas-day-surgery-2021", "s:ecfr-42-416-52", "s:bumrungrad-joint04", "s:india-emedical-visa" ], "provenance": { "default": { "tier": "cited", "source": "s:rcoa-gpas-day-surgery-2021" }, "fields": { "text.story": { "tier": "cited", "source": "s:ecfr-42-416-52", "note": "the guidance and the regulation are quoted; the stretch marked *Inference -* is this project reading the two together" }, "text.how": { "tier": "tradition", "note": "the shape of recovery accommodation in this trade; this project holds no contract for any of it and no hotel's own description of what it provides" }, "metrics": { "tier": "cited", "source": "s:rcoa-gpas-day-surgery-2021" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-17", "blurb": "Discharge from a hospital abroad into a hotel room rather than a household.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "The step this risk is the absence of.", "rel": "step" }, { "to": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "The same person, costed: what it takes to have anyone there at all.", "rel": "kin" }, { "to": "day-case", "type": "term", "name": "Day case", "as": "The category built on somebody being at the other end by evening.", "rel": "term" }, { "to": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "The document that leaves with the patient, and the only thing a hotel room contains that a clinician could read.", "rel": "step" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The step that begins after a flight, where a household would have begun the same evening.", "rel": "step" }, { "to": "the-flight-home", "type": "pathway", "name": "The flight home", "as": "The next thing asked of a body nobody is watching.", "rel": "step" }, { "to": "dvt-pe", "type": "risk", "name": "Deep vein thrombosis and pulmonary embolism", "as": "The complication that presents while sitting still in a room, and the one an absent observer does not see.", "rel": "kin" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The wait that puts the patient in the hotel in the first place.", "rel": "kin" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The same absence, further along: nobody responsible, at a greater distance.", "rel": "kin" } ], "source_list": [ { "id": "s:rcoa-gpas-day-surgery-2021", "kind": "org", "title": "Chapter 6: Guidelines for the Provision of Anaesthesia Services for Day Surgery 2021, published 31 March 2021", "publisher": "The Royal College of Anaesthetists (United Kingdom)", "url": "https://rcoa.ac.uk/gpas/chapter-6", "accessed": "2026-09-17", "note": "read in a browser because the page is refused to a plain fetch. Recommendation 5.25 (grade C, strong) on a responsible adult escorting the patient home and supporting them for 24 hours; 5.26 on private car or taxi; 5.24 on a 24-hour telephone number that is not an answerphone; 5.7 on preoperative assessment as early as possible in the pathway; 5.29 on the patient's copy of the discharge summary" }, { "id": "s:ecfr-42-416-52", "kind": "law", "title": "42 CFR 416.52 — Conditions for coverage: patient admission, assessment and discharge (ambulatory surgical centers)", "publisher": "Electronic Code of Federal Regulations, US Office of the Federal Register", "url": "https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-416/subpart-D/section-416.52", "accessed": "2026-09-17", "note": "paragraph (c)(3) on discharge in the company of a responsible adult. Source note at the section: 73 FR 68813, 18 November 2008, as amended at 84 FR 51814, 30 September 2019. eCFR states Title 42 current as of 15 September 2026" }, { "id": "s:bumrungrad-joint04", "kind": "web", "title": "Total Knee Replacement Surgery (Exclude implant) — package JOINT04", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery", "accessed": "2026-09-16", "note": "read off the hospital's own package page; price stated valid until 31 December 2026" }, { "id": "s:india-emedical-visa", "kind": "web", "title": "e-Visa — e-Medical Visa and e-Medical Attendant Visa", "publisher": "Bureau of Immigration, Ministry of Home Affairs, Government of India", "url": "https://indianvisaonline.gov.in/evisa/tvoa.html", "accessed": "2026-09-16", "note": "one year from arrival, multiple entries, hospital letter on letterhead, two attendant visas per patient" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:rcoa-gpas-day-surgery-2021" }, "text.story": { "tier": "cited", "source": "s:ecfr-42-416-52", "note": "the guidance and the regulation are quoted; the stretch marked *Inference -* is this project reading the two together" }, "text.how": { "tier": "tradition", "note": "the shape of recovery accommodation in this trade; this project holds no contract for any of it and no hotel's own description of what it provides" }, "text.today": { "tier": "cited", "source": "s:rcoa-gpas-day-surgery-2021" }, "metrics": { "tier": "cited", "source": "s:rcoa-gpas-day-surgery-2021" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "medellin", "type": "hub", "name": "Medellín", "as": "What a body-contouring patient faces in a rented flat rather than a ward.", "rel": "risk" }, { "from": "santo-domingo", "type": "hub", "name": "Santo Domingo", "as": "A recovery house is not a ward, and the difference shows up in who notices a wound going wrong.", "rel": "risk" }, { "from": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "Two weeks near the centre with a carer, which is the part no price list carries.", "rel": "risk" }, { "from": "the-companion", "type": "pathway", "name": "The companion", "as": "What the same step looks like when nobody comes.", "rel": "risk" }, { "from": "dvt-pe", "type": "risk", "name": "Deep vein thrombosis and pulmonary embolism", "as": "Who notices a swollen calf in a hotel room.", "rel": "kin" }, { "from": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "What happens where no companion travelled.", "rel": "kin" } ] }, { "id": "anaesthetic-risk-unscreened", "names": { "name": "Fitness for anaesthesia, assessed on arrival", "aliases": [ "unscreened for anaesthesia", "pre-operative assessment on arrival", "ASA grading at the far end of a flight" ], "said": "The grade is assigned by an anaesthetist who met the patient this week, from a history given in a second language." }, "region": [ "global" ], "facets": { "kind": "clinical" }, "text": { "what": "Pre-operative assessment compressed into the days between landing and the operation, carried out by a team holding whatever records the patient brought. The standard grading is the American Society of Anesthesiologists physical status classification - the ASA grade - a single ordinal score for how much systemic disease a patient carries, assigned before an anaesthetic and recorded on the chart.", "story": "The ASA classification was introduced in 1941 and runs from ASA I, a healthy patient, to ASA VI, a declared brain-dead patient whose organs are being procured, with the letter E appended for an emergency. The current definitions were approved by the ASA House of Delegates on 15 October 2014 and last amended on 13 December 2020. ASA II is mild systemic disease and ASA III is severe systemic disease; there is no class for moderate, which is one reason two anaesthetists grade the same patient differently. Meta-analyses put its sensitivity for predicting postoperative mortality at about 0.74 (95% CI 0.73 to 0.74) and its specificity at about 0.67, with an area under the curve around 0.736 (95% CI 0.725 to 0.747). The classification \"cannot be used alone to determine anesthesia or surgical risks because other factors (such as procedure invasiveness and patient frailty) also contribute to perioperative risk for poor outcomes\", and age does not appear in it at all.\n\nThe grade is also a commercial boundary, and this site has one worked case of it. Bumrungrad International Hospital's knee package JOINT04, read on 17 September 2026, states that \"The eligible patient who can apply this package is patient without complication and attending physician considered appropriate to this package\", and lists five conditions under which a patient \"will be considered as 'high risk' and will not qualify for the package\": organ failure; \"A patient with severe systemic disease. Examples include (but not limited to) poorly controlled DM or HTN or COPD, implanted pacemaker etc. (ASA classification III and above)\"; an acute myocardial infarction within four weeks; HIV infection; and previous knee surgery unless the attending physician decides otherwise.\n\nThat list is the package model's own statement of what it prices. A fixed price holds because the case is predictable, and the hospital has said in its own words which patients it does not treat as predictable. *Inference -* the eligibility bar and the exclusion list do the same work from opposite ends: one removes the patient from the price, the other removes items from it.\n\nWhere the bar bites is on arrival. The Royal College of Anaesthetists asks that \"Effective preoperative assessment and patient preparation, performed as early as possible in the planned patient pathway, is essential to the safety and success of day surgery\" - as early as possible, because a problem found early is a problem that can be optimised or the list rearranged around. A patient graded for the first time three days before an operation they have flown to and paid a deposit on is being assessed at the latest possible point, by a team that has not seen a decade of home records, from a history taken through an interpreter.\n\nNobody has measured the consequence. No hospital, ministry, accreditor or research group publishes how many arriving patients are regraded on assessment, how many packages are repriced or refused at that point, or what happens to the deposit when they are.", "how": "The sequence on arrival is consultation, blood tests and imaging, an anaesthetic review and a revised price. The ASA grade is assigned at the anaesthetic review by a clinician meeting the patient for the first time, from a history the patient recounts rather than a record a system holds. Medication lists, previous anaesthetic charts, echocardiograms and the reason a drug was stopped are the things that change a grade, and they are exactly what tends not to travel.\n\nA grade above the package's bar has three commercial outcomes rather than one: the operation proceeds off-package at itemised rates, the operation proceeds after optimisation on a later date with the extra nights billed, or the hospital declines. Which of the three applies, and what happens to money already paid, is set by the contract rather than by the grade.\n\n*Trade practice -* remote pre-screening by questionnaire and uploaded reports is common before a treatment trip. It is not the same act as a pre-operative assessment clinic, it does not include an examination, and the hospital's own page reserves the decision to the attending physician on the day.", "notes": "The Bumrungrad knee package's own eligibility bar — ASA III and above does not qualify — is carried on that package's price row, on the knee replacement record, rather than duplicated here." }, "metrics": { "note": "The published numbers here describe the grading instrument, not the travelling patient. Meta-analyses of the ASA physical status classification give a sensitivity of about 0.74 (95% CI 0.73 to 0.74), a specificity of about 0.67 (95% CI 0.67 to 0.67) and an area under the summary receiver operating curve of about 0.736 (95% CI 0.725 to 0.747) for predicting postoperative mortality - measured across surgical populations at home, in systems where the assessing team holds the patient's record. Nobody publishes how many patients assessed on arrival abroad are graded ASA III or above, how many are refused a package at that point, or how the grade assigned on arrival compares with one assigned at home.", "as_of": "2025", "source": "s:statpearls-asa-physical-status", "url": "https://www.ncbi.nlm.nih.gov/books/NBK441940/" }, "kin": [ { "to": "asa-grade", "as": "The word for the score this whole exposure turns on.", "rel": "term" }, { "to": "knee-replacement", "as": "The operation whose package bar this record was read off.", "rel": "procedure" }, { "to": "bumrungrad", "as": "Publishes the eligibility list that names ASA III and above.", "rel": "performed-at" }, { "to": "arrival-and-consent", "as": "The step the anaesthetic review sits in, on the same day as the signature.", "rel": "step" }, { "to": "getting-your-records", "as": "The step that decides what the assessing team has to grade from.", "rel": "step" }, { "to": "reading-the-exclusions", "as": "The eligibility bar is on the same page as the exclusion list, and is read the same way.", "rel": "step" }, { "to": "implant-excluded", "as": "The other half of what a fixed price leaves out: one removes items, this removes patients.", "rel": "kin" }, { "to": "package-price", "as": "The pricing form that needs a predictable case, and says so in its eligibility list.", "rel": "term" }, { "to": "the-deposit", "as": "Paid before the grading, and the thing at stake when the grade comes back high.", "rel": "step" } ], "links": [ { "label": "Bumrungrad package JOINT04 - eligibility and exclusions", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery" }, { "label": "ASA physical status classification - StatPearls", "url": "https://www.ncbi.nlm.nih.gov/books/NBK441940/" } ], "sources": [ "s:statpearls-asa-physical-status", "s:bumrungrad-joint04", "s:rcoa-gpas-day-surgery-2021" ], "provenance": { "default": { "tier": "cited", "source": "s:statpearls-asa-physical-status" }, "fields": { "text.story": { "tier": "cited", "source": "s:bumrungrad-joint04", "note": "the eligibility list is quoted from the hospital's own package page, read in a browser on 17 September 2026; the ASA history and figures are from the StatPearls chapter, used because the ASA's own statement page redirects to a host that refuses automated access. The stretch marked *Inference -* is this project's reading" }, "text.how": { "tier": "tradition", "note": "the arrival sequence and the three commercial outcomes are the general shape of the trade; this project holds no hospital's protocol and no patient's contract" }, "metrics": { "tier": "cited", "source": "s:statpearls-asa-physical-status" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-17", "blurb": "Pre-operative assessment compressed into the days between landing and the operation, carried out by a team holding whatever records the patient brought.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "asa-grade", "type": "term", "name": "ASA grade", "as": "The word for the score this whole exposure turns on.", "rel": "term" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The operation whose package bar this record was read off.", "rel": "procedure" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Publishes the eligibility list that names ASA III and above.", "rel": "performed-at" }, { "to": "arrival-and-consent", "type": "pathway", "name": "Arrival and consent", "as": "The step the anaesthetic review sits in, on the same day as the signature.", "rel": "step" }, { "to": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "The step that decides what the assessing team has to grade from.", "rel": "step" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The eligibility bar is on the same page as the exclusion list, and is read the same way.", "rel": "step" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The other half of what a fixed price leaves out: one removes items, this removes patients.", "rel": "kin" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The pricing form that needs a predictable case, and says so in its eligibility list.", "rel": "term" }, { "to": "the-deposit", "type": "pathway", "name": "The deposit", "as": "Paid before the grading, and the thing at stake when the grade comes back high.", "rel": "step" } ], "source_list": [ { "id": "s:statpearls-asa-physical-status", "kind": "reference", "title": "American Society of Anesthesiologists Physical Status Classification System — StatPearls, last updated 11 February 2025", "publisher": "Hendrix JM, Garmon EH. StatPearls Publishing, NCBI Bookshelf NBK441940", "url": "https://www.ncbi.nlm.nih.gov/books/NBK441940/", "accessed": "2026-09-17", "note": "used because the ASA's own statement page now redirects to a journal host that refuses automated access. Carries the 1941 introduction, the House of Delegates approval of 15 October 2014 and the amendment of 13 December 2020, the six ordinal classes plus the E designation, and the meta-analytic sensitivity, specificity and area under the curve for predicting postoperative mortality" }, { "id": "s:bumrungrad-joint04", "kind": "web", "title": "Total Knee Replacement Surgery (Exclude implant) — package JOINT04", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery", "accessed": "2026-09-16", "note": "read off the hospital's own package page; price stated valid until 31 December 2026" }, { "id": "s:rcoa-gpas-day-surgery-2021", "kind": "org", "title": "Chapter 6: Guidelines for the Provision of Anaesthesia Services for Day Surgery 2021, published 31 March 2021", "publisher": "The Royal College of Anaesthetists (United Kingdom)", "url": "https://rcoa.ac.uk/gpas/chapter-6", "accessed": "2026-09-17", "note": "read in a browser because the page is refused to a plain fetch. Recommendation 5.25 (grade C, strong) on a responsible adult escorting the patient home and supporting them for 24 hours; 5.26 on private car or taxi; 5.24 on a 24-hour telephone number that is not an answerphone; 5.7 on preoperative assessment as early as possible in the pathway; 5.29 on the patient's copy of the discharge summary" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:statpearls-asa-physical-status" }, "text.story": { "tier": "cited", "source": "s:bumrungrad-joint04", "note": "the eligibility list is quoted from the hospital's own package page, read in a browser on 17 September 2026; the ASA history and figures are from the StatPearls chapter, used because the ASA's own statement page redirects to a host that refuses automated access. The stretch marked *Inference -* is this project's reading" }, "text.how": { "tier": "tradition", "note": "the arrival sequence and the three commercial outcomes are the general shape of the trade; this project holds no hospital's protocol and no patient's contract" }, "metrics": { "tier": "cited", "source": "s:statpearls-asa-physical-status" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "liposuction", "type": "procedure", "name": "Liposuction", "as": "Large-volume aspiration is an anaesthetic problem as much as a surgical one.", "rel": "risk" }, { "from": "arrival-and-consent", "type": "pathway", "name": "Arrival and consent", "as": "The assessment this compressed day is supposed to contain.", "rel": "risk" }, { "from": "bbl-mortality", "type": "risk", "name": "Death from gluteal fat grafting", "as": "A long operation under general anaesthesia on a patient assessed the same morning.", "rel": "kin" }, { "from": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "The preoperative test on the day of admission is the commonest reason a booked operation is called off on arrival.", "rel": "kin" }, { "from": "fungal-meningitis", "type": "risk", "name": "Fungal meningitis after epidural anaesthesia", "as": "The anaesthetic, not the operation, was the route of infection here.", "rel": "kin" }, { "from": "mexico-fungal-meningitis-2023", "type": "event", "name": "The Matamoros fungal meningitis outbreak, 2023", "as": "The exposure here was the anaesthesia, not the operation.", "rel": "risk" }, { "from": "asa-grade", "type": "term", "name": "ASA grade", "as": "The risk this scale exists to measure, and what happens when nobody applies it before the flight.", "rel": "risk" } ] }, { "id": "antimicrobial-resistance", "names": { "name": "Antimicrobial resistance acquired abroad", "aliases": [ "AMR", "CRE", "carbapenem-resistant Enterobacterales", "multidrug-resistant organisms" ], "said": "Infection control says MDRO. The microbiology report names the enzyme." }, "region": [ "global" ], "facets": { "kind": "infection" }, "text": { "what": "An organism that survives the drugs meant to kill it, carried home in or on a patient who was treated in a hospital where such organisms are common. The CDC names carbapenem-resistant Enterobacterales and Candida auris as the two that \"appear to be more common in some countries where U.S. residents travel for medical tourism\", and asks US hospitals to screen anyone who spent a night in a healthcare facility abroad within the previous six months.", "story": "The link between hospital travel and resistance was established by a single paper. In 2010 Kumarasamy and colleagues reported a carbapenem resistance gene, blaNDM-1, in 44 isolates from Chennai, 26 from Haryana, 37 referred to the UK's national reference laboratory, and 73 from other sites in India and Pakistan. The gene sat mostly in Escherichia coli and Klebsiella pneumoniae, which were resistant to everything the authors tested except tigecycline and colistin, and it sat on plasmids that transferred readily between organisms. Case review found that most of the UK patients carrying it had travelled to India or Pakistan within the past year, or had links to those countries.\n\nThe paper was contested hard — the Lancet Infectious Diseases carried fourteen published comments in the three months after it appeared — and the naming of the enzyme after a city was part of what was contested. What was not in dispute was the mechanism: a plasmid moves between species, a patient moves between countries, and the two movements compound.\n\n*Inference —* the loss here is carried almost entirely by the receiving system. A colonised patient is not ill and presents no claim; the cost appears later as a side room, contact precautions, a screening programme, and an antibiotic course that may run to months. Nobody bills it to the operation that produced it.", "how": "Screening is a swab, and in the United States admission screening for carbapenem-resistant Enterobacterales is available free through the Antibiotic Resistance Laboratory Network. The CDC asks facilities to take an explicit travel history, including any medical care received abroad, and to report suspected or confirmed cases of unusual resistance to public health authorities so that clusters are recognised — returning patients present near home, which scatters an outbreak across jurisdictions before anyone sees its shape.", "today": "As of 16 September 2026 no destination country publishes a resistance rate for its international patients, and no source market publishes a count of resistant organisms imported by them. What exists is the screening rule, the outbreak investigations, and the reference laboratory referrals that started the subject." }, "metrics": { "note": "The 2010 Lancet Infectious Diseases study counted isolates, not patients or procedures: 44 NDM-1 isolates in Chennai, 26 in Haryana, 37 in the UK and 73 elsewhere in India and Pakistan, in Enterobacteriaceae resistant to all tested antibiotics except tigecycline and colistin. No rate per operation, per admission or per traveller has been published, here or since.", "as_of": "2010", "source": "s:kumarasamy-ndm1-2010", "url": "https://pubmed.ncbi.nlm.nih.gov/20705517/" }, "kin": [ { "to": "ndm-1-2010", "as": "The paper that put hospital travel and resistance in the same sentence, and the argument that followed it.", "rel": "event" }, { "to": "candida-auris", "as": "The fungal half of the pair the CDC names, and the one that colonises skin for months.", "rel": "kin" }, { "to": "surgical-site-infection", "as": "The wound this turns from a course of antibiotics into a year.", "rel": "kin" }, { "to": "nontuberculous-mycobacteria", "as": "Already resistant by nature, and the reason those wounds took three months of therapy.", "rel": "kin" }, { "to": "india", "as": "Where two of the four isolate collections in the founding study were taken.", "rel": "place" }, { "to": "follow-up-gap", "as": "Why the organism is usually found by a laboratory with no record of the operation.", "rel": "kin" }, { "to": "aftercare-at-home", "as": "The step at which the screening swab is taken.", "rel": "step" }, { "to": "who", "as": "Publishes the global surveillance this sits inside.", "rel": "org" } ], "links": [ { "label": "CDC Yellow Book 2026 — Medical Tourism", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" }, { "label": "Kumarasamy et al., Lancet Infect Dis 2010", "url": "https://pubmed.ncbi.nlm.nih.gov/20705517/" } ], "sources": [ "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism", "s:kumarasamy-ndm1-2010" ], "provenance": { "default": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "fields": { "metrics": { "tier": "cited", "source": "s:kumarasamy-ndm1-2010" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "An organism that survives the drugs meant to kill it, carried home in or on a patient who was treated in a hospital where such organisms are common.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "ndm-1-2010", "type": "event", "name": "NDM-1, 2010", "as": "The paper that put hospital travel and resistance in the same sentence, and the argument that followed it.", "rel": "event" }, { "to": "candida-auris", "type": "risk", "name": "Candida auris", "as": "The fungal half of the pair the CDC names, and the one that colonises skin for months.", "rel": "kin" }, { "to": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The wound this turns from a course of antibiotics into a year.", "rel": "kin" }, { "to": "nontuberculous-mycobacteria", "type": "risk", "name": "Nontuberculous mycobacteria", "as": "Already resistant by nature, and the reason those wounds took three months of therapy.", "rel": "kin" }, { "to": "india", "type": "destination", "name": "India", "as": "Where two of the four isolate collections in the founding study were taken.", "rel": "place" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Why the organism is usually found by a laboratory with no record of the operation.", "rel": "kin" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The step at which the screening swab is taken.", "rel": "step" }, { "to": "who", "type": "org", "name": "World Health Organization", "as": "Publishes the global surveillance this sits inside.", "rel": "org" } ], "source_list": [ { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:kumarasamy-ndm1-2010", "kind": "paper", "title": "Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study", "publisher": "The Lancet Infectious Diseases 2010;10(9):597-602 (Kumarasamy KK, Toleman MA, Walsh TR, et al.)", "url": "https://pubmed.ncbi.nlm.nih.gov/20705517/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "text.story": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "text.how": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "text.today": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "metrics": { "tier": "cited", "source": "s:kumarasamy-ndm1-2010" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "mexico", "type": "destination", "name": "Mexico", "as": "The CDC names CRE infections after invasive procedures in this country.", "rel": "risk" }, { "from": "tijuana", "type": "hub", "name": "Tijuana", "as": "What the CDC actually found: an organism resistant to the first-line drugs, carried home in 19 states.", "rel": "risk" }, { "from": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "What an infection means in a patient with no immune system, and what a patient can carry home.", "rel": "risk" }, { "from": "hospital-angeles-tijuana", "type": "facility", "name": "Hospital Angeles Tijuana", "as": "American bariatric patients operated on in this city carried extensively drug-resistant Pseudomonas home, which the CDC investigated and published.", "rel": "risk" }, { "from": "in-hospital", "type": "pathway", "name": "In hospital", "as": "What the ward may hand over along with the operation.", "rel": "risk" }, { "from": "candida-auris", "type": "risk", "name": "Candida auris", "as": "The bacterial half of the pair the CDC names, with the same six-month travel window behind it.", "rel": "kin" }, { "from": "nontuberculous-mycobacteria", "type": "risk", "name": "Nontuberculous mycobacteria", "as": "Resistant by nature rather than by acquisition, which is why the courses run months.", "rel": "kin" }, { "from": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "What decides whether this infection is a week of antibiotics or six months of them.", "rel": "kin" }, { "from": "ndm-1-2010", "type": "event", "name": "NDM-1, 2010", "as": "The risk this paper put at the centre of the subject.", "rel": "risk" } ] }, { "id": "bbl-mortality", "names": { "name": "Death from gluteal fat grafting", "aliases": [ "BBL death", "pulmonary fat embolism", "macroscopic fat embolism" ], "said": "The surgeons' own task force called it the highest mortality of any aesthetic procedure, and set up to reduce it." }, "region": [ "global" ], "facets": { "kind": "clinical" }, "text": { "what": "Fat injected into the buttock enters a torn gluteal vein and travels to the lung. Death can follow within minutes and often on the operating table. The mechanism is specific to injection below the muscle fascia, and the procedure it belongs to is gluteal fat grafting, marketed as the \"Brazilian butt lift\" and named by the CDC among the cosmetic procedures US residents travel for.", "story": "The figure came from the surgeons who perform it. In 2017 a task force convened by the Aesthetic Surgery Education and Research Foundation surveyed 4,843 plastic surgeons worldwide. Six hundred and ninety-two replied, a response rate of 14.3%, of whom 612 performed the procedure, and between them they reported 198,857 cases. Over their careers those respondents reported 32 deaths from pulmonary fat emboli and 103 non-fatal ones. Three per cent of respondents had lost a patient; seven per cent had had at least one pulmonary fat embolism.\n\nThe task force converted that into three mortality estimates by three different methods: 1 in 6,214 from career case volume, 1 in 3,448 from an annual rate, and 1 in 2,351 from accredited facility data. It concluded the true rate was likely higher than the 1 in 4,000 previously estimated, and it identified the technical causes — injection into deep muscle, cannulae narrower than 4 mm, and pointing the cannula downwards.\n\nThe survey has the weaknesses of every voluntary survey of adverse events by the people who caused them: a 14.3% response rate, recall over a career, and self-selection in both directions.\n\nBy 2022 the Multi-Society Task Force's advisory had moved on to two new levers, both of them about the conditions of work rather than the anatomy. It recommended ultrasound-guided documentation of cannula placement before and during injection, and a limit of three of these cases per surgeon per day — the second because, as the advisory records, in Florida the majority of deaths from the procedure occur at the end of the week, a distribution its authors read as fatigue and distraction.\n\n*Inference —* that last finding is the one that travels. A daily case limit is an operational constraint, and the economics of a high-volume clinic selling a fixed-price package to patients who have flown in for a fixed week push directly against it. Nothing in an accreditation logo discloses how many of these a surgeon did the day a given patient was on the table.\n\nWhat happens to those who survive is visible in the UK readmission series. In a Royal London review of 20 patients treated for complications of cosmetic surgery abroad, all four major complications were gluteal augmentations; in a Royal Free series of 24, gluteal enhancement was the commonest procedure at 38%.", "how": "Safety guidance across the advisories converges on keeping the fat in the subcutaneous layer and out of the muscle: a cannula of 4 mm or more, angled upward rather than down, moving continuously, with the patient's position and the cannula's plane confirmed — since 2022, by ultrasound. Onset of a fatal embolism is intraoperative or immediately postoperative, which means it happens where the surgery happens and is survivable only if the theatre is equipped for it.", "today": "As of 16 September 2026 the published mortality estimates for this procedure remain the three from the 2017 task force survey, between 1 in 2,351 and 1 in 6,214. No country publishes a death rate for it, and no destination publishes one for the operations it sells to foreign patients." }, "metrics": { "mortality_per_1000": 0.43, "note": "0.43 deaths per 1,000 cases is 1 in 2,351, the highest of the three estimates published by the ASERF task force in 2017; the other two were 1 in 3,448 and 1 in 6,214, and the task force judged the true figure likely higher than the 1 in 4,000 previously estimated. The population is patients of the 612 surveyed plastic surgeons who performed gluteal fat grafting, reporting 198,857 cases and 32 fatal pulmonary fat emboli over their careers, at a 14.3% survey response rate. It is not a rate for any country, clinic or surgeon, and not specific to patients who travelled.", "as_of": "2017", "source": "s:mofid-gluteal-2017", "url": "https://academic.oup.com/asj/article/37/7/796/3075249" }, "kin": [ { "to": "bbl", "as": "The procedure this is the mortality of.", "rel": "procedure" }, { "to": "liposuction", "as": "Where the fat comes from, and its own share of the risk.", "rel": "procedure" }, { "to": "dvt-pe", "as": "A different embolism — clot rather than fat — over days rather than minutes.", "rel": "contrast" }, { "to": "revision-at-home", "as": "Gluteal augmentation accounts for most of the major complications in the published UK readmission series.", "rel": "kin" }, { "to": "nontuberculous-mycobacteria", "as": "What the survivors of the Dominican clusters had come for.", "rel": "kin" }, { "to": "repatriation-cost", "as": "What moving a patient in this condition costs, when they can be moved at all.", "rel": "kin" }, { "to": "dominican-republic", "as": "One of the destinations the published case series name.", "rel": "place" }, { "to": "turkiye", "as": "Named as the country of surgery in most of the UK readmission series.", "rel": "place" }, { "to": "isaps", "as": "One of the societies whose members made up the surveyed population.", "rel": "org" }, { "to": "anaesthetic-risk-unscreened", "as": "A long operation under general anaesthesia on a patient assessed the same morning.", "rel": "kin" } ], "links": [ { "label": "Mofid et al., Aesthetic Surgery Journal 2017", "url": "https://academic.oup.com/asj/article/37/7/796/3075249" }, { "label": "Del Vecchio and Kenkel, Practice Advisory on Gluteal Fat Grafting, 2022", "url": "https://pubmed.ncbi.nlm.nih.gov/35404456/" } ], "sources": [ "s:mofid-gluteal-2017", "s:delvecchio-gluteal-advisory-2022", "s:farid-cosmetic-abroad-2019", "s:thacoor-nhs-cost-2019", "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited", "source": "s:mofid-gluteal-2017" }, "fields": { "text.story": { "tier": "cited", "note": "the paragraph on daily case limits and package economics is marked inline as this project's reasoning" }, "text.how": { "tier": "cited", "source": "s:delvecchio-gluteal-advisory-2022" }, "metrics": { "tier": "cited", "source": "s:mofid-gluteal-2017" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "Fat injected into the buttock enters a torn gluteal vein and travels to the lung. Death can follow within minutes and often on the operating table.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "The procedure this is the mortality of.", "rel": "procedure" }, { "to": "liposuction", "type": "procedure", "name": "Liposuction", "as": "Where the fat comes from, and its own share of the risk.", "rel": "procedure" }, { "to": "dvt-pe", "type": "risk", "name": "Deep vein thrombosis and pulmonary embolism", "as": "A different embolism — clot rather than fat — over days rather than minutes.", "rel": "contrast" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Gluteal augmentation accounts for most of the major complications in the published UK readmission series.", "rel": "kin" }, { "to": "nontuberculous-mycobacteria", "type": "risk", "name": "Nontuberculous mycobacteria", "as": "What the survivors of the Dominican clusters had come for.", "rel": "kin" }, { "to": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "What moving a patient in this condition costs, when they can be moved at all.", "rel": "kin" }, { "to": "dominican-republic", "type": "destination", "name": "Dominican Republic", "as": "One of the destinations the published case series name.", "rel": "place" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "Named as the country of surgery in most of the UK readmission series.", "rel": "place" }, { "to": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "One of the societies whose members made up the surveyed population.", "rel": "org" }, { "to": "anaesthetic-risk-unscreened", "type": "risk", "name": "Fitness for anaesthesia, assessed on arrival", "as": "A long operation under general anaesthesia on a patient assessed the same morning.", "rel": "kin" } ], "source_list": [ { "id": "s:mofid-gluteal-2017", "kind": "paper", "title": "Report on Mortality from Gluteal Fat Grafting: Recommendations from the ASERF Task Force", "publisher": "Aesthetic Surgery Journal 2017;37(7):796 (Mofid M, Teitelbaum S, Suissa D, et al.), Aesthetic Surgery Education and Research Foundation", "url": "https://academic.oup.com/asj/article/37/7/796/3075249", "accessed": "2026-09-16" }, { "id": "s:delvecchio-gluteal-advisory-2022", "kind": "paper", "title": "Practice Advisory on Gluteal Fat Grafting", "publisher": "Aesthetic Surgery Journal 2022;42(9):1019-1029 (Del Vecchio D, Kenkel JM), for the Multi-Society Task Force for Safety in Gluteal Fat Grafting", "url": "https://pubmed.ncbi.nlm.nih.gov/35404456/", "accessed": "2026-09-16" }, { "id": "s:farid-cosmetic-abroad-2019", "kind": "paper", "title": "Complications of Cosmetic Surgery Abroad — Cost Analysis and Patient Perception", "publisher": "Plastic and Reconstructive Surgery Global Open 2019;7(6):e2281 (Farid M, Nikkhah D, Little M, Edwards D, Needham W, Shibu M), Royal London Hospital", "url": "https://pubmed.ncbi.nlm.nih.gov/31624684/", "accessed": "2026-09-16" }, { "id": "s:thacoor-nhs-cost-2019", "kind": "paper", "title": "Surgical Management of Cosmetic Surgery Tourism-Related Complications: Current Trends and Cost Analysis Study of the Financial Impact on the UK National Health Service", "publisher": "Aesthetic Surgery Journal 2019;39(7):786-791 (Thacoor A, van den Bosch P, Akhavani MA), Royal Free Hospital, London", "url": "https://pubmed.ncbi.nlm.nih.gov/30590431/", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:mofid-gluteal-2017" }, "text.story": { "tier": "cited", "note": "the paragraph on daily case limits and package economics is marked inline as this project's reasoning" }, "text.how": { "tier": "cited", "source": "s:delvecchio-gluteal-advisory-2022" }, "text.today": { "tier": "cited", "source": "s:mofid-gluteal-2017" }, "metrics": { "tier": "cited", "source": "s:mofid-gluteal-2017" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "colombia", "type": "destination", "name": "Colombia", "as": "The risk attached to the operation this country is best known for.", "rel": "risk" }, { "from": "medellin", "type": "hub", "name": "Medellín", "as": "The reason the operation this city is known for is the one with a named death rate attached.", "rel": "risk" }, { "from": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "The risk this operation carries, with the task-force figure and the argument over what it counts.", "rel": "risk" }, { "from": "dvt-pe", "type": "risk", "name": "Deep vein thrombosis and pulmonary embolism", "as": "A different embolism — fat, not clot — and a far faster one.", "rel": "contrast" }, { "from": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "The complication most likely to make a patient unfit to board a scheduled flight.", "rel": "kin" }, { "from": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The other thing that goes wrong after gluteal fat grafting, and the faster one.", "rel": "contrast" }, { "from": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "A risk measured the same way the counts are: by asking the society's own members.", "rel": "risk" } ] }, { "id": "blood-supply-safety", "names": { "name": "Blood supply safety", "aliases": [ "transfusion-transmissible infection", "TTI", "blood screening" ], "said": "The package page says blood transfusion is excluded, and means the charge, not the risk." }, "region": [ "global" ], "facets": { "kind": "infection" }, "text": { "what": "Whether the blood a patient may be given during an operation was screened, and screened under a quality system. WHO recommends that screening for HIV, hepatitis B, hepatitis C and syphilis be mandatory for all donations. Of the countries reporting to WHO for 2023, 10 were not able to screen all donated blood for one or more of those four.", "story": "The WHO Global Database on Blood Safety collected data from 153 countries for 2023, with responses from 168 covering 97% of the world's population. Of 120.4 million donations collected globally, 36% came from high-income countries holding 15% of the world's people. Donation rates ran from 28.9 per 1,000 people in high-income countries to 4.5 per 1,000 in low-income ones.\n\nTwo figures in that release bear directly on an operation abroad. First, external quality assessment: 63% of blood screening laboratories worldwide took part in such schemes, and by income group the figures were 92%, 66%, 48% and 68% for high-, upper-middle-, lower-middle- and low-income countries. A laboratory that screens without external assessment is screening; whether it is screening correctly is unverified. Second, WHO states plainly that the prevalence of transfusion-transmissible infections in donations is considerably lower in high-income countries than in low- and middle-income ones.\n\nThe donor base matters for the same reason. In 59 countries more than half the supply still comes from family, replacement and paid donors, and WHO's position is that regular voluntary unpaid donors are the safest group because the prevalence of bloodborne infection is lowest among them.\n\n*Inference —* the exposure is concentrated in a small set of procedures and almost absent from the rest. A dental implant and a hair transplant do not reach the blood bank. Cardiac surgery, liver transplantation and a revision joint do.", "how": "A hospital's own transfusion service is not the same thing as its country's national blood system, and a large private hospital may run to a standard well above the national figure. Neither position is published at hospital level anywhere this project has looked. What is published is the country figure, and the exclusion line on the package: the Bumrungrad knee package read for this site excludes blood transfusion from its fixed price, which prices the bag without describing where it came from.", "today": "As of 16 September 2026 the only figures available are national and come from one annual WHO collection. No accreditor publishes a facility-level transfusion-safety measure, and no destination publishes one for the hospitals that treat foreign patients." }, "metrics": { "note": "From WHO's 2023 reporting year, published 12 June 2026: 120.4 million donations globally; 10 reporting countries unable to screen all donated blood for one or more of HIV, hepatitis B, hepatitis C and syphilis; 63% of screening laboratories in external quality assessment schemes, being 92%, 66%, 48% and 68% by income group from high to low; 59 countries drawing more than half their supply from family, replacement and paid donors. Country-level figures, not hospital-level ones.", "as_of": "2026-06-12", "source": "s:who-blood-safety", "url": "https://www.who.int/news-room/fact-sheets/detail/blood-safety-and-availability" }, "kin": [ { "to": "bloodborne-virus", "as": "What an unscreened unit carries, and the reason the screening figures matter.", "rel": "kin" }, { "to": "cabg", "as": "The operation on this site most likely to need blood.", "rel": "procedure" }, { "to": "heart-valve-replacement", "as": "Open-chest surgery, with the same transfusion exposure.", "rel": "procedure" }, { "to": "liver-transplant", "as": "The largest transfusion requirement of any elective operation here.", "rel": "procedure" }, { "to": "knee-replacement", "as": "The package whose exclusion list names blood transfusion as a charge.", "rel": "procedure" }, { "to": "implant-excluded", "as": "The same exclusion list, read for what else is missing from it.", "rel": "kin" }, { "to": "who", "as": "Runs the Global Database on Blood Safety, which is the only source for any of this.", "rel": "measured-by" }, { "to": "transplant-harm", "as": "Where donor screening and blood screening are the same failure.", "rel": "kin" } ], "links": [ { "label": "WHO — Blood safety and availability", "url": "https://www.who.int/news-room/fact-sheets/detail/blood-safety-and-availability" } ], "sources": [ "s:who-blood-safety", "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism", "s:bumrungrad-joint04" ], "provenance": { "default": { "tier": "cited", "source": "s:who-blood-safety" }, "fields": { "text.how": { "tier": "inference", "note": "the point about hospital-level versus national figures is this project's, from the absence of any facility-level publication" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "Whether the blood a patient may be given during an operation was screened, and screened under a quality system.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "bloodborne-virus", "type": "risk", "name": "Bloodborne virus from treatment abroad", "as": "What an unscreened unit carries, and the reason the screening figures matter.", "rel": "kin" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The operation on this site most likely to need blood.", "rel": "procedure" }, { "to": "heart-valve-replacement", "type": "procedure", "name": "Heart valve replacement", "as": "Open-chest surgery, with the same transfusion exposure.", "rel": "procedure" }, { "to": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "The largest transfusion requirement of any elective operation here.", "rel": "procedure" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The package whose exclusion list names blood transfusion as a charge.", "rel": "procedure" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The same exclusion list, read for what else is missing from it.", "rel": "kin" }, { "to": "who", "type": "org", "name": "World Health Organization", "as": "Runs the Global Database on Blood Safety, which is the only source for any of this.", "rel": "measured-by" }, { "to": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "Where donor screening and blood screening are the same failure.", "rel": "kin" } ], "source_list": [ { "id": "s:who-blood-safety", "kind": "org", "title": "Blood safety and availability — fact sheet dated 12 June 2026, from the WHO Global Database on Blood Safety, 2023 reporting year", "publisher": "World Health Organization", "url": "https://www.who.int/news-room/fact-sheets/detail/blood-safety-and-availability", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:bumrungrad-joint04", "kind": "web", "title": "Total Knee Replacement Surgery (Exclude implant) — package JOINT04", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery", "accessed": "2026-09-16", "note": "read off the hospital's own package page; price stated valid until 31 December 2026" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:who-blood-safety" }, "text.story": { "tier": "cited", "source": "s:who-blood-safety" }, "text.how": { "tier": "inference", "note": "the point about hospital-level versus national figures is this project's, from the absence of any facility-level publication" }, "text.today": { "tier": "cited", "source": "s:who-blood-safety" }, "metrics": { "tier": "cited", "source": "s:who-blood-safety" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "The transfusions that carry a patient through the weeks without marrow.", "rel": "risk" }, { "from": "in-hospital", "type": "pathway", "name": "In hospital", "as": "Where the transfusion excluded from the package comes from.", "rel": "risk" }, { "from": "bloodborne-virus", "type": "risk", "name": "Bloodborne virus from treatment abroad", "as": "The upstream half of the same risk, and the only part of it with numbers.", "rel": "kin" }, { "from": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "Also on that exclusion list, and a risk rather than a charge.", "rel": "kin" }, { "from": "transplant-prohibition", "type": "rule", "name": "Buying an organ, and being transplanted abroad", "as": "The neighbouring supply question, with the same payment argument attached.", "rel": "risk" } ] }, { "id": "bloodborne-virus", "names": { "name": "Bloodborne virus from treatment abroad", "aliases": [ "hepatitis B", "hepatitis C", "HIV", "blood-borne infection" ], "said": "The chapter lists three viruses in one clause and moves on. They have the longest tail of anything on it." }, "region": [ "global" ], "facets": { "kind": "infection" }, "text": { "what": "Hepatitis B, hepatitis C or HIV transmitted by a reused needle, an inadequately reprocessed instrument, a contaminated injectable or an unscreened transfusion. The CDC names all three together: inadequate infection prevention and control practices place people at risk for \"blood-borne infections, including hepatitis B, hepatitis C, and HIV; bloodstream infections; donor-derived infections; and surgical site infections\". It asks that medical travellers be up to date on routine vaccinations, \"especially hepatitis B virus immunization\".", "story": "Of everything that can go wrong on a trip for treatment, this is the item with the longest delay between the exposure and the diagnosis, and the delay is what erases the link. A wound infection declares itself in days and is traced to the operation by the patient. A hepatitis C infection acquired in a clinic may be found years later on a routine liver panel, by a clinician who takes no travel history because the travel was a decade ago.\n\nThe CDC's own instruction to US facilities is the tell: obtain an explicit travel history including any medical care received abroad, and screen anyone with an overnight stay in a foreign healthcare facility in the past six months. Six months captures a resistant organism. It does not capture a virus with a long incubation.\n\n*Inference —* the consequence is that this risk has no numerator anywhere. A country's hepatitis C surveillance counts cases, not the procedures that caused them, and no country attributes any share of its viral hepatitis burden to treatment its residents had abroad.", "how": "Transmission routes are the ordinary ones — injection equipment, endoscopes and dental instruments that were not reprocessed to standard, and transfused blood. Hepatitis B is preventable by vaccination before travel, and the CDC singles it out for that reason; hepatitis C is not. Post-exposure testing is only performed where somebody suspects an exposure, which requires the patient to know one happened.", "today": "As of 16 September 2026 no published figure attributes bloodborne virus infections to cross-border treatment as a class. The named quantity in this area is the blood screening one: 10 countries reporting to WHO for 2023 could not screen all donated blood for one or more of HIV, hepatitis B, hepatitis C and syphilis." }, "metrics": { "note": "Nobody has measured this. No surveillance system attributes hepatitis B, hepatitis C or HIV infections to healthcare received in another country, and the CDC's six-month travel-history window is set for resistant organisms rather than for viruses with long incubation periods. The nearest published figure is upstream, in the blood supply: 10 countries reporting to WHO for 2023 could not screen all donated blood for one or more of the four mandatory markers.", "as_of": "2026-06-12", "source": "s:who-blood-safety", "url": "https://www.who.int/news-room/fact-sheets/detail/blood-safety-and-availability" }, "kin": [ { "to": "blood-supply-safety", "as": "The upstream half of the same risk, and the only part of it with numbers.", "rel": "kin" }, { "to": "surgical-site-infection", "as": "The same lapse in infection control, declaring itself in days rather than years.", "rel": "contrast" }, { "to": "dental-implant", "as": "Dental care is the commonest reason US residents travel, and instrument reprocessing is the whole of the exposure.", "rel": "procedure" }, { "to": "dialysis-holiday", "as": "Repeated vascular access in an unfamiliar unit, week after week.", "rel": "procedure" }, { "to": "kidney-transplant", "as": "Where donor-derived infection enters the same list.", "rel": "procedure" }, { "to": "transplant-harm", "as": "Where the CDC's phrase donor-derived infections points.", "rel": "kin" }, { "to": "aftercare-at-home", "as": "The step at which nobody takes the travel history that would find this.", "rel": "step" } ], "links": [ { "label": "CDC Yellow Book 2026 — Medical Tourism", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" } ], "sources": [ "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism", "s:who-blood-safety" ], "provenance": { "default": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "fields": { "text.story": { "tier": "cited", "note": "the closing paragraph is this project's reading of why no numerator exists, marked inline" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "Hepatitis B, hepatitis C or HIV transmitted by a reused needle, an inadequately reprocessed instrument, a contaminated injectable or an unscreened transfusion.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "blood-supply-safety", "type": "risk", "name": "Blood supply safety", "as": "The upstream half of the same risk, and the only part of it with numbers.", "rel": "kin" }, { "to": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The same lapse in infection control, declaring itself in days rather than years.", "rel": "contrast" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "Dental care is the commonest reason US residents travel, and instrument reprocessing is the whole of the exposure.", "rel": "procedure" }, { "to": "dialysis-holiday", "type": "procedure", "name": "Dialysis away from home", "as": "Repeated vascular access in an unfamiliar unit, week after week.", "rel": "procedure" }, { "to": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "Where donor-derived infection enters the same list.", "rel": "procedure" }, { "to": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "Where the CDC's phrase donor-derived infections points.", "rel": "kin" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The step at which nobody takes the travel history that would find this.", "rel": "step" } ], "source_list": [ { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:who-blood-safety", "kind": "org", "title": "Blood safety and availability — fact sheet dated 12 June 2026, from the WHO Global Database on Blood Safety, 2023 reporting year", "publisher": "World Health Organization", "url": "https://www.who.int/news-room/fact-sheets/detail/blood-safety-and-availability", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "text.story": { "tier": "cited", "note": "the closing paragraph is this project's reading of why no numerator exists, marked inline" }, "text.how": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "text.today": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "metrics": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "dialysis-holiday", "type": "procedure", "name": "Dialysis away from home", "as": "Hepatitis status decides whether a unit has a machine for the patient at all.", "rel": "risk" }, { "from": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "What an unscreened donor can transmit with the graft.", "rel": "risk" }, { "from": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "Acquired hepatitis B ran at 5.4% against 0% in the series this page carries.", "rel": "risk" }, { "from": "blood-supply-safety", "type": "risk", "name": "Blood supply safety", "as": "What an unscreened unit carries, and the reason the screening figures matter.", "rel": "kin" }, { "from": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The same failure of infection control, with a longer incubation and a quieter arrival.", "rel": "kin" }, { "from": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "Donor-derived infection is the named screening failure.", "rel": "kin" } ] }, { "id": "candida-auris", "names": { "name": "Candida auris", "aliases": [ "C. auris", "Candidozyma auris" ], "said": "Infection control says see auris. It spells the rest of the ward's year." }, "region": [ "global" ], "facets": { "kind": "infection" }, "text": { "what": "A yeast that colonises skin, survives on surfaces for long periods, spreads between patients in healthcare facilities, and resists antifungal drugs. The CDC names it with carbapenem-resistant Enterobacterales as a pathogen that \"appear[s] to be more common in some countries where U.S. residents travel for medical tourism\".", "story": "What makes this organism a cross-border problem is that a carrier is not a patient. The CDC's own account is that people can have C. auris on their skin and elsewhere without symptoms, that they may not know, that colonisation persists on the body for a long time whether or not symptoms ever appear, and that a colonised person spreads it to surfaces and to other patients throughout. Screening is a skin swab, and it is performed only when somebody thinks to order it.\n\nThe drug position is narrow. Most strains resist at least one class of antifungal; echinocandins are the preferred treatment for most infections; some strains resist all three main classes, and for those the CDC notes limited data and the use of combinations or newer agents.\n\nThe CDC asks US facilities to report suspected or confirmed C. auris to public health authorities so that testing and infection control can be put in place before onward transmission.\n\n*Inference —* the cost of this one falls almost entirely on the next hospital rather than on the patient who carried it. A colonised person who is otherwise well generates a side room, contact precautions, environmental decontamination and a screening round of everyone they shared a bay with. None of that appears on any bill connected to the operation abroad.", "how": "Risk concentrates in patients with severe underlying conditions and invasive devices — breathing tubes, feeding tubes, venous and urinary catheters — which is to say in intensive care and in long admissions rather than in a day-case dental chair. The CDC states that people without those risk factors generally neither carry it nor become ill from it, and that screening healthcare workers or family members is usually unnecessary. Attribution of death is explicitly uncertain: \"When patients with C. auris die, it is hard to know how much C. auris contributed to their death compared to other pre-existing illnesses.\"", "today": "As of 16 September 2026 no destination publishes a colonisation rate for its hospitals, and no source market publishes a count of cases traceable to care received abroad. The CDC's travel-linked instruction is the six-month screening rule for carbapenem-resistant Enterobacterales; C. auris is reported when found, not screened for by travel history." }, "metrics": { "note": "No rate is carried because none has been published for travel-associated acquisition. The CDC states that most strains resist at least one class of antifungal and that some resist all three main classes, and declines to attribute mortality: when a patient with C. auris dies it is hard to separate the organism's contribution from the underlying illness.", "as_of": "2026-02-26", "source": "s:cdc-candida-auris", "url": "https://www.cdc.gov/candida-auris/about/index.html" }, "kin": [ { "to": "antimicrobial-resistance", "as": "The bacterial half of the pair the CDC names, with the same six-month travel window behind it.", "rel": "kin" }, { "to": "surgical-site-infection", "as": "One of the sites this organism turns up in, alongside blood and ears.", "rel": "kin" }, { "to": "follow-up-gap", "as": "Colonisation is silent, so nothing in the patient's own account will raise it.", "rel": "kin" }, { "to": "transplant-harm", "as": "Immunosuppression is what turns colonisation into an infection.", "rel": "kin" }, { "to": "aftercare-at-home", "as": "The step at which a screening swab would be taken, if anyone ordered one.", "rel": "step" }, { "to": "who", "as": "Lists this organism among its fungal priority pathogens.", "rel": "org" } ], "links": [ { "label": "CDC — About C. auris", "url": "https://www.cdc.gov/candida-auris/about/index.html" }, { "label": "CDC Yellow Book 2026 — Medical Tourism", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" } ], "sources": [ "s:cdc-candida-auris", "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited", "source": "s:cdc-candida-auris" }, "fields": { "text.story": { "tier": "cited", "note": "the closing paragraph is marked inline as this project's reading of where the cost falls" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "A yeast that colonises skin, survives on surfaces for long periods, spreads between patients in healthcare facilities, and resists antifungal drugs.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "antimicrobial-resistance", "type": "risk", "name": "Antimicrobial resistance acquired abroad", "as": "The bacterial half of the pair the CDC names, with the same six-month travel window behind it.", "rel": "kin" }, { "to": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "One of the sites this organism turns up in, alongside blood and ears.", "rel": "kin" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Colonisation is silent, so nothing in the patient's own account will raise it.", "rel": "kin" }, { "to": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "Immunosuppression is what turns colonisation into an infection.", "rel": "kin" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The step at which a screening swab would be taken, if anyone ordered one.", "rel": "step" }, { "to": "who", "type": "org", "name": "World Health Organization", "as": "Lists this organism among its fungal priority pathogens.", "rel": "org" } ], "source_list": [ { "id": "s:cdc-candida-auris", "kind": "org", "title": "About C. auris, page dated 26 February 2026", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/candida-auris/about/index.html", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:cdc-candida-auris" }, "text.story": { "tier": "cited", "note": "the closing paragraph is marked inline as this project's reading of where the cost falls" }, "text.how": { "tier": "cited", "source": "s:cdc-candida-auris" }, "text.today": { "tier": "cited", "source": "s:cdc-candida-auris" }, "metrics": { "tier": "cited", "source": "s:cdc-candida-auris" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "antimicrobial-resistance", "type": "risk", "name": "Antimicrobial resistance acquired abroad", "as": "The fungal half of the pair the CDC names, and the one that colonises skin for months.", "rel": "kin" }, { "from": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "What immunosuppression turns from colonisation into disease.", "rel": "kin" } ] }, { "id": "counterfeit-medicines", "names": { "name": "Substandard and falsified medicines", "aliases": [ "counterfeit medicines", "falsified medical products", "SF medical products" ], "said": "WHO stopped saying counterfeit, because the word turned every quality failure into a trademark dispute." }, "region": [ "global" ], "facets": { "kind": "clinical" }, "text": { "what": "A medicine that is not what its label says: falsified in its identity, composition or source, or substandard because it failed a quality specification, expired, was contaminated, or was stored wrongly. The CDC notes that pharmaceuticals, laboratory services and medical devices used in other countries \"might not be subject to the same regulatory scrutiny and oversight\", and that \"some drugs could be counterfeit or otherwise ineffective because of expiration, contamination, or improper storage\".", "story": "The headline number comes from a 2017 WHO study and has stood since: at least 1 in 10 medicines in low- and middle-income countries are substandard or falsified, a figure derived from products that failed quality control testing. WHO puts the money at an estimated USD 30.5 billion a year spent on them, and notes they are often sold online or through informal markets.\n\n*Inference —* that figure is a national market measure, and it is not the same thing as the risk inside an accredited hospital pharmacy, which buys through a tendered supply chain and is typically the last place in a country where a falsified product would surface. Carrying the 1 in 10 figure across to the ward would be reading the wrong denominator.\n\nWhere it does bear on a trip for treatment is at the edges: a drug bought over a counter for pain during the recovery week, a course of antibiotics dispensed to take home, a prescription refilled in the destination because it was easier than bringing enough, and anything bought online afterwards because the home prescription ran out and the operating clinic is not reachable.\n\nThe naming matters and is itself part of the record. WHO's current term is \"substandard and falsified medical products\"; the older word counterfeit collapsed a public health problem into an intellectual property one, and is kept on this page as an alias rather than as the heading.", "how": "Neither a patient nor a pharmacist can identify a falsified product by looking at it in most cases; detection is by laboratory testing, by supply chain verification, or by a cluster of treatment failures. The relevant exposure on a trip for treatment is therefore procedural rather than perceptual: whether the product came from the hospital's own pharmacy against a prescription, and whether the patient left with enough of it to finish the course at home.", "today": "As of 16 September 2026 no study has measured the quality of medicines dispensed specifically to foreign patients, in any destination. The WHO figure is the only quantity available and it describes a country's medicine supply, not a hospital's." }, "metrics": { "note": "At least 1 in 10 medicines in low- and middle-income countries are substandard or falsified, from WHO's 2017 study of products failing quality control testing, restated in the fact sheet dated 3 December 2024; countries spend an estimated USD 30.5 billion a year on them. This is a measure of national medicine markets. It is not a measure of what an accredited hospital pharmacy dispenses, and no study has measured that for foreign patients anywhere.", "as_of": "2024-12-03", "source": "s:who-substandard-falsified", "url": "https://www.who.int/news-room/fact-sheets/detail/substandard-and-falsified-medical-products" }, "kin": [ { "to": "cross-border-prescriptions", "as": "The rule that decides whether a prescription written abroad can be filled at home.", "rel": "governed-by" }, { "to": "aftercare-at-home", "as": "The step at which the course runs out and is refilled somewhere.", "rel": "step" }, { "to": "addiction-rehab", "as": "Where the substance itself is the treatment, and its identity is the whole of the question.", "rel": "procedure" }, { "to": "unproven-stem-cell", "as": "A different failure of the same regulatory gap: the product is what it says, and no trial has shown it does anything.", "rel": "contrast" }, { "to": "who", "as": "Publishes the only figure this record carries.", "rel": "measured-by" }, { "to": "follow-up-gap", "as": "Why a treatment failure at home is rarely traced back to what was dispensed abroad.", "rel": "kin" } ], "links": [ { "label": "WHO — Substandard and falsified medical products", "url": "https://www.who.int/news-room/fact-sheets/detail/substandard-and-falsified-medical-products" }, { "label": "CDC Yellow Book 2026 — Medical Tourism", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" } ], "sources": [ "s:who-substandard-falsified", "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited", "source": "s:who-substandard-falsified" }, "fields": { "text.story": { "tier": "cited", "note": "the second paragraph is marked inline as this project's reasoning about the denominator" }, "text.how": { "tier": "tradition", "note": "the detection account is general knowledge of the field" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "A medicine that is not what its label says: falsified in its identity, composition or source, or substandard because it failed a quality specification, expired, was contaminated, or was stored wrongly.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "cross-border-prescriptions", "type": "rule", "name": "A prescription that crosses a border", "as": "The rule that decides whether a prescription written abroad can be filled at home.", "rel": "governed-by" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The step at which the course runs out and is refilled somewhere.", "rel": "step" }, { "to": "addiction-rehab", "type": "procedure", "name": "Residential addiction treatment", "as": "Where the substance itself is the treatment, and its identity is the whole of the question.", "rel": "procedure" }, { "to": "unproven-stem-cell", "type": "risk", "name": "Unproven stem cell treatment", "as": "A different failure of the same regulatory gap: the product is what it says, and no trial has shown it does anything.", "rel": "contrast" }, { "to": "who", "type": "org", "name": "World Health Organization", "as": "Publishes the only figure this record carries.", "rel": "measured-by" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Why a treatment failure at home is rarely traced back to what was dispensed abroad.", "rel": "kin" } ], "source_list": [ { "id": "s:who-substandard-falsified", "kind": "org", "title": "Substandard and falsified medical products — fact sheet dated 3 December 2024", "publisher": "World Health Organization", "url": "https://www.who.int/news-room/fact-sheets/detail/substandard-and-falsified-medical-products", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:who-substandard-falsified" }, "text.story": { "tier": "cited", "note": "the second paragraph is marked inline as this project's reasoning about the denominator" }, "text.how": { "tier": "tradition", "note": "the detection account is general knowledge of the field" }, "text.today": { "tier": "cited", "source": "s:who-substandard-falsified" }, "metrics": { "tier": "cited", "source": "s:who-substandard-falsified" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "nuevo-progreso", "type": "hub", "name": "Nuevo Progreso", "as": "The risk that attaches to the pharmacy half of the trade rather than the dental half.", "rel": "risk" }, { "from": "angioplasty-stent", "type": "procedure", "name": "Coronary angioplasty and stent", "as": "The neighbouring worry about what is in the box, here about devices rather than drugs.", "rel": "risk" }, { "from": "panchakarma", "type": "procedure", "name": "Panchakarma", "as": "Herbal preparations dispensed abroad and carried home raise a separate question about what is in them.", "rel": "risk" }, { "from": "stem-cell-unproven", "type": "procedure", "name": "Unapproved stem cell treatment", "as": "The mirror case: a product that is not what it says, against a product that is exactly what it says and has not been shown to do anything.", "rel": "contrast" }, { "from": "unproven-stem-cell", "type": "risk", "name": "Unproven stem cell treatment", "as": "The mirror case: a product that is not what it says, rather than a product that is exactly what it says and does nothing.", "rel": "contrast" }, { "from": "cross-border-prescriptions", "type": "rule", "name": "A prescription that crosses a border", "as": "What fills the gap when the prescription will not travel.", "rel": "risk" } ] }, { "id": "deposit-and-refund", "names": { "name": "The deposit, and whether it comes back", "aliases": [ "prepayment", "booking fee", "cancellation terms" ], "said": "The clinic calls it securing the date. The bank calls it an international transfer with no chargeback." }, "region": [ "global" ], "facets": { "kind": "financial" }, "text": { "what": "Money paid before travel to hold a surgical date, and what happens to it when the operation does not take place — because the patient withdrew, because the clinic cancelled, because a visa was refused, or because a preoperative test on the day of admission found something that made the operation unsafe. The CDC notes that costs for these procedures are usually out of pocket, and that travellers should expect to pay up front and claim later where they can claim at all.", "story": "This is the item on which this site has the least to say, and the silence is the finding.\n\nNobody has published what share of deposits are refunded, on what terms, or how often an operation is cancelled on arrival. There is no regulator collecting it, no trade body reporting it, and no study counting it. The terms are private contracts between a patient and a clinic or a facilitator, and this project holds none of them.\n\nWhat is documented is the information environment the deposit is paid into. A 2011 content analysis of 17 Canadian broker websites found price among the most commonly included business dimensions, alongside the speed of surgery and the broker's role in follow-up care — while discussion of surgical risk was absent from 47% of the same sites. Price is what these pages are built to carry; the conditions attached to it are not.\n\nThe United Kingdom's General Medical Council, in guidance in force since 1 June 2016, requires a doctor on its register to \"explain your charges clearly, so patients know the financial implications of any decision to proceed to the next stage or to withdraw\", and separately not to \"use promotional tactics in ways that could encourage people to make an ill-considered decision\". Both obligations attach to the doctor. A time-limited price offered by a clinic in another country, taken by a patient who transfers a deposit that week, sits outside the reach of that register entirely.\n\n*Inference —* the structural asymmetry is in the payment instrument rather than the contract. A deposit sent by international bank transfer to a company in another jurisdiction carries no chargeback right, and recovering it means the same four obstacles that stand in front of any other claim against a provider abroad — forum, applicable law, limitation, and enforcement against assets held somewhere else.", "how": "Where terms exist they usually distinguish a non-refundable booking or administration fee from a treatment deposit, set a sliding scale by how close the cancellation falls to the date, and treat a cancellation by the clinic differently from one by the patient. A separate question is what happens when the clinic cancels on arrival after a preoperative assessment, since the patient has by then also bought flights and a hotel. This project has read no set of such terms and describes the shape rather than any instance.", "today": "As of 16 September 2026 no published figure exists for deposit forfeiture, refusal on arrival, or refund in this trade, anywhere. That is a gap in the record, not a finding that the problem is small." }, "metrics": { "note": "Nobody has measured this. No regulator, trade body or study reports what share of deposits paid for treatment abroad is refunded when the operation does not happen, or how often an operation is cancelled after the patient arrives. The nearest published measurement is of what broker sites carry: in 17 Canadian broker websites analysed in 2011, price was among the most commonly included business dimensions and discussion of surgical risk was absent from 47%.", "as_of": "2011", "source": "s:penney-broker-consent-2011", "url": "https://pubmed.ncbi.nlm.nih.gov/21943392/" }, "kin": [ { "to": "the-deposit", "as": "The step this risk is about.", "rel": "step" }, { "to": "getting-a-quote", "as": "The step at which the number is given and the conditions are not.", "rel": "step" }, { "to": "reading-the-exclusions", "as": "The same document, read for what the price does not cover.", "rel": "step" }, { "to": "choosing-a-facilitator", "as": "Decides who the deposit is actually paid to, and who is liable if the clinic cancels.", "rel": "step" }, { "to": "facilitator", "as": "The party that often holds the money without performing the treatment.", "rel": "term" }, { "to": "malpractice-recourse", "as": "The same four obstacles, in front of a smaller sum.", "rel": "kin" }, { "to": "implant-excluded", "as": "The other way a headline price and a final bill diverge.", "rel": "kin" }, { "to": "package-price", "as": "The form the money is quoted in.", "rel": "term" }, { "to": "anaesthetic-risk-unscreened", "as": "The preoperative test on the day of admission is the commonest reason a booked operation is called off on arrival.", "rel": "kin" } ], "links": [ { "label": "GMC — Guidance for doctors who offer cosmetic interventions", "url": "https://www.gmc-uk.org/professional-standards/the-professional-standards/cosmetic-interventions" }, { "label": "CDC Yellow Book 2026 — Medical Tourism", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" } ], "sources": [ "s:gmc-cosmetic-interventions", "s:penney-broker-consent-2011", "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited", "source": "s:gmc-cosmetic-interventions" }, "fields": { "text.story": { "tier": "cited", "note": "the closing paragraph is marked inline as this project's reasoning; the GMC wording and the 2011 content analysis are quoted" }, "text.how": { "tier": "tradition", "note": "the shape of such terms as the trade writes them; this project holds no instance" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "Money paid before travel to hold a surgical date, and what happens to it when the operation does not take place — because the patient withdrew, because the clinic cancelled, because a visa was refused, or because a…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "the-deposit", "type": "pathway", "name": "The deposit", "as": "The step this risk is about.", "rel": "step" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step at which the number is given and the conditions are not.", "rel": "step" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The same document, read for what the price does not cover.", "rel": "step" }, { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "Decides who the deposit is actually paid to, and who is liable if the clinic cancels.", "rel": "step" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The party that often holds the money without performing the treatment.", "rel": "term" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "The same four obstacles, in front of a smaller sum.", "rel": "kin" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The other way a headline price and a final bill diverge.", "rel": "kin" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The form the money is quoted in.", "rel": "term" }, { "to": "anaesthetic-risk-unscreened", "type": "risk", "name": "Fitness for anaesthesia, assessed on arrival", "as": "The preoperative test on the day of admission is the commonest reason a booked operation is called off on arrival.", "rel": "kin" } ], "source_list": [ { "id": "s:gmc-cosmetic-interventions", "kind": "org", "title": "Guidance for doctors who offer cosmetic interventions — in effect 1 June 2016, updated 13 December 2024", "publisher": "General Medical Council (United Kingdom)", "url": "https://www.gmc-uk.org/professional-standards/the-professional-standards/cosmetic-interventions", "accessed": "2026-09-16", "note": "paragraph numbers cited on this site are from the sections Communication, partnership and teamwork (paras 14-45) and Maintaining trust (paras 46-56)" }, { "id": "s:penney-broker-consent-2011", "kind": "paper", "title": "Risk communication and informed consent in the medical tourism industry: a thematic content analysis of Canadian broker websites", "publisher": "BMC Medical Ethics 2011;12:17 (Penney K, Snyder J, Crooks VA, Johnston R)", "url": "https://pubmed.ncbi.nlm.nih.gov/21943392/", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:gmc-cosmetic-interventions" }, "text.story": { "tier": "cited", "note": "the closing paragraph is marked inline as this project's reasoning; the GMC wording and the 2011 content analysis are quoted" }, "text.how": { "tier": "tradition", "note": "the shape of such terms as the trade writes them; this project holds no instance" }, "text.today": { "tier": "cited", "source": "s:gmc-cosmetic-interventions" }, "metrics": { "tier": "cited", "source": "s:gmc-cosmetic-interventions" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "iran", "type": "destination", "name": "Iran", "as": "What happens to money paid in cash to an agency when the operation does not happen.", "rel": "risk" }, { "from": "assisted-dying", "type": "procedure", "name": "Assisted dying", "as": "One association publishes what is returned when an application is refused and what is kept when it is withdrawn.", "rel": "risk" }, { "from": "egg-freezing", "type": "procedure", "name": "Egg freezing", "as": "The yearly storage invoice, and what happens to a store when it stops being paid.", "rel": "risk" }, { "from": "gastric-balloon", "type": "procedure", "name": "Gastric balloon", "as": "What is owed when a device comes out early and the months it was bought for did not happen.", "rel": "risk" }, { "from": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "The staged payments, and what is returned when a journey ends between them.", "rel": "risk" }, { "from": "heidelberg-university-hospital", "type": "facility", "name": "Heidelberg University Hospital", "as": "Publishes the refund rule as well as the deposit rule, which is the half most deposit pages leave out.", "rel": "risk" }, { "from": "the-deposit", "type": "pathway", "name": "The deposit", "as": "The risk this step creates, and who carries it.", "rel": "risk" }, { "from": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "The same contract, read at the other end of the trip.", "rel": "kin" }, { "from": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "The other contract nobody reads before signing.", "rel": "risk" }, { "from": "facilitator", "type": "term", "name": "Facilitator", "as": "The risk that follows from an unlicensed party holding the money.", "rel": "risk" } ] }, { "id": "dvt-pe", "names": { "name": "Deep vein thrombosis and pulmonary embolism", "aliases": [ "DVT", "PE", "venous thromboembolism", "VTE" ], "said": "Wards say VTE. Newspapers say economy class syndrome, which names the seat and not the surgery." }, "region": [ "global" ], "facets": { "kind": "clinical" }, "text": { "what": "A clot forms in a deep vein, usually in the leg, and part of it travels to the lung. Surgery raises the risk and long-haul flight raises it, and a patient who has both in the same fortnight carries both. The CDC states that air travel and surgery independently increase the risk, and that travel after surgery increases it further because it requires sitting still for long periods in a hypercoagulable state.", "story": "The travel half of the risk has been measured, and it is smaller than the coverage of it suggests. A 2022 systematic review found 18 studies addressing the question and concluded that the association between venous thromboembolism and length of travel is real but mild to moderate, with odds ratios between 1.1 and 4. It identified a dose-response relationship — a 26% higher risk for every two hours of air travel after the first four — and rated the quality of evidence for both travel length and for thromboprophylaxis as low. Graduated compression stockings were the one measure shown to work.\n\nThe surgical half is larger and is procedure-specific; it is carried on the records for the operations themselves.\n\n*Inference —* the combination is what has no published figure. Nobody has measured the rate of venous thromboembolism in patients who had major surgery and then flew home inside two weeks, because no registry follows a patient across that border. The 2026 Birmingham series of UK patients readmitted after cosmetic surgery abroad records venous thromboembolism among the complications seen, without a denominator to put it over.", "how": "Prophylaxis after major surgery is compression, early mobilisation and, for higher-risk operations, an anticoagulant for a defined period after discharge. That last one is where a cross-border episode strains: the drug is prescribed in one country, dispensed for a fixed number of days, and the patient goes home to a system that has no record of when the course started. Presentation is a swollen painful calf, or sudden breathlessness and chest pain, and it is usually to an emergency department with no note of the operation.", "today": "As of 16 September 2026 the measured figure this site carries is the 26% increase in risk per two hours of flying beyond four, from the 2022 review, with its own authors' rating of low evidence quality. The combined surgical-plus-flight figure is not measured." }, "metrics": { "note": "No rate is stated here because none has been published for the combination this record is about. The 2022 systematic review of 18 studies found odds ratios between 1.1 and 4 for travel-associated venous thromboembolism and a 26% higher risk per additional two hours of air travel beyond four hours, in general travellers rather than in post-surgical ones, and rated the evidence low quality.", "as_of": "2022", "source": "s:johnson-travel-vte-2022", "url": "https://pubmed.ncbi.nlm.nih.gov/35370084/" }, "kin": [ { "to": "flying-after-surgery", "as": "The interval guidance written partly for this.", "rel": "kin" }, { "to": "the-flight-home", "as": "The step where the seated hours are spent.", "rel": "step" }, { "to": "knee-replacement", "as": "Major lower-limb surgery, where regional anaesthesia is preferred partly to lower this risk.", "rel": "procedure" }, { "to": "hip-replacement", "as": "The other joint, with the same prophylaxis question and the same flight home.", "rel": "procedure" }, { "to": "abdominoplasty", "as": "A long operation on a patient kept still, and one of the commonest reasons for travel.", "rel": "procedure" }, { "to": "gastric-sleeve", "as": "Bariatric surgery, where the underlying weight is itself a risk factor for clots.", "rel": "procedure" }, { "to": "bbl-mortality", "as": "A different embolism — fat, not clot — and a far faster one.", "rel": "contrast" }, { "to": "aftercare-at-home", "as": "Where the anticoagulant course runs out, in a system with no record of when it started.", "rel": "step" }, { "to": "alone-after-discharge", "as": "Who notices a swollen calf in a hotel room.", "rel": "kin" } ], "links": [ { "label": "CDC Yellow Book 2026 — Medical Tourism", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" } ], "sources": [ "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism", "s:johnson-travel-vte-2022", "s:mafi-cosmetic-tourism-cost-2026" ], "provenance": { "default": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "fields": { "text.how": { "tier": "tradition", "note": "standard perioperative account; the cross-border strain on a fixed anticoagulant course is this project's reading" }, "metrics": { "tier": "cited", "source": "s:johnson-travel-vte-2022" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "A clot forms in a deep vein, usually in the leg, and part of it travels to the lung. Surgery raises the risk and long-haul flight raises it, and a patient who has both in the same fortnight carries both.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The interval guidance written partly for this.", "rel": "kin" }, { "to": "the-flight-home", "type": "pathway", "name": "The flight home", "as": "The step where the seated hours are spent.", "rel": "step" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "Major lower-limb surgery, where regional anaesthesia is preferred partly to lower this risk.", "rel": "procedure" }, { "to": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "The other joint, with the same prophylaxis question and the same flight home.", "rel": "procedure" }, { "to": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "A long operation on a patient kept still, and one of the commonest reasons for travel.", "rel": "procedure" }, { "to": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "Bariatric surgery, where the underlying weight is itself a risk factor for clots.", "rel": "procedure" }, { "to": "bbl-mortality", "type": "risk", "name": "Death from gluteal fat grafting", "as": "A different embolism — fat, not clot — and a far faster one.", "rel": "contrast" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "Where the anticoagulant course runs out, in a system with no record of when it started.", "rel": "step" }, { "to": "alone-after-discharge", "type": "risk", "name": "Discharged alone", "as": "Who notices a swollen calf in a hotel room.", "rel": "kin" } ], "source_list": [ { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:johnson-travel-vte-2022", "kind": "paper", "title": "Travel-Associated Venous Thromboembolism", "publisher": "Wilderness and Environmental Medicine 2022;33(2):169-178 (McKerrow Johnson I, Shatzel J, Olson S, Kohl T, Hamilton A, DeLoughery TG)", "url": "https://pubmed.ncbi.nlm.nih.gov/35370084/", "accessed": "2026-09-16" }, { "id": "s:mafi-cosmetic-tourism-cost-2026", "kind": "paper", "title": "Recurrent Clinical Burden and Cost of Cosmetic Surgery Tourism Complications: A Five-Year Retrospective Study From a UK Tertiary Centre", "publisher": "Cureus 2026;18(5):e109006 (Mafi P, Patel K, Hoque-Uddin S, Warner R), Queen Elizabeth Hospital Birmingham", "url": "https://pubmed.ncbi.nlm.nih.gov/42311717/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "text.story": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "text.how": { "tier": "tradition", "note": "standard perioperative account; the cross-border strain on a fixed anticoagulant course is this project's reading" }, "text.today": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "metrics": { "tier": "cited", "source": "s:johnson-travel-vte-2022" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "The clot this operation and the flight home both raise.", "rel": "risk" }, { "from": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "A different embolism from the fat one, and the one the flight home adds.", "rel": "risk" }, { "from": "booking-the-flight", "type": "pathway", "name": "Booking the flight", "as": "The specific hazard the flying intervals exist to reduce.", "rel": "risk" }, { "from": "the-flight-home", "type": "pathway", "name": "The flight home", "as": "The clot that the intervals exist to avoid, and the commonest fatal event on this leg.", "rel": "risk" }, { "from": "alone-after-discharge", "type": "risk", "name": "Discharged alone", "as": "The complication that presents while sitting still in a room, and the one an absent observer does not see.", "rel": "kin" }, { "from": "bbl-mortality", "type": "risk", "name": "Death from gluteal fat grafting", "as": "A different embolism — clot rather than fat — over days rather than minutes.", "rel": "contrast" }, { "from": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The clot risk that the seated hours add to the surgical one.", "rel": "kin" } ] }, { "id": "flying-after-surgery", "names": { "name": "Flying after surgery", "aliases": [ "fitness to fly", "the ten-day rule" ], "said": "The clinic calls it the fit-to-fly letter. The airline calls it medical clearance." }, "region": [ "global" ], "facets": { "kind": "travel" }, "text": { "what": "A cabin at cruising altitude is pressurised to roughly the outside air pressure at 6,000 to 8,000 feet. Gas trapped in a body cavity expands at that pressure, and a passenger sits still for hours in a state that clots more readily than usual. The CDC states that medical travellers should not fly for 10 days after chest or abdominal surgery, and cites the American Society of Plastic Surgeons recommendation that patients who have had laser treatments or cosmetic procedures to the face, eyelids or nose wait 7 to 10 days before flying.", "story": "The ten-day figure is the one number in this subject that almost every package quietly contradicts. A fixed-price bundle that names three ward nights and a hotel week is selling a trip shorter than the interval the CDC names for chest or abdominal surgery, and the difference is made up by the patient booking the return flight before the surgeon has seen the wound at a week.\n\n*Trade practice —* the fit-to-fly letter is the instrument that resolves this in practice: a signed note from the operating team saying the patient may board. It is issued by the party whose ward night ends when the patient leaves, which is the structural problem with it, and no register of such letters exists anywhere.\n\nThe Aerospace Medical Association's medical guidelines for air travel are the standing reference the CDC points to for travel with particular conditions.", "how": "Airlines apply their own medical clearance rules and may require a form completed by a physician; the thresholds differ by carrier and are not published as a single standard. The clinical concerns split into three: gas expansion in a chest, abdomen, eye or middle ear; reduced cabin oxygen against a patient who has just lost blood; and immobility against a fresh surgical wound. The last of those is the clot risk, and it is carried on its own record.", "today": "As of 16 September 2026 the published guidance this site carries is the CDC's 10 days after chest or abdominal surgery and the American Society of Plastic Surgeons' 7 to 10 days after facial, eyelid and nasal procedures. Neither is a rule an airline enforces, and neither is priced into a package." }, "metrics": { "days_before_flying": 10, "note": "Ten days is the CDC's guidance not to fly after chest or abdominal surgery. The American Society of Plastic Surgeons figure the same chapter cites is 7 to 10 days after laser treatments or cosmetic procedures to the face, eyelids or nose. Both are guidance to clinicians, not airline rules, and neither is a measured rate of anything.", "as_of": "2026-09-16", "source": "s:cdc-yellowbook-2026-medical-tourism", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" }, "kin": [ { "to": "dvt-pe", "as": "The clot risk that the seated hours add to the surgical one.", "rel": "kin" }, { "to": "the-flight-home", "as": "The step this guidance is about.", "rel": "step" }, { "to": "booking-the-flight", "as": "The step at which the return date is fixed, usually before anyone has seen the wound.", "rel": "step" }, { "to": "knee-replacement", "as": "Major lower-limb surgery, where orthopaedic teams commonly apply the same ten-day interval for the clot risk.", "rel": "procedure" }, { "to": "rhinoplasty", "as": "A nasal procedure, and the one the plastic surgeons' 7-to-10-day figure was written for.", "rel": "procedure" }, { "to": "abdominoplasty", "as": "Abdominal surgery, which is what the ten-day figure names.", "rel": "procedure" }, { "to": "gastric-sleeve", "as": "Abdominal surgery sold in packages shorter than the interval the guidance names.", "rel": "procedure" }, { "to": "package-price", "as": "The pricing form whose stated length of stay sits against this interval.", "rel": "term" }, { "to": "repatriation-cost", "as": "What it costs when the patient cannot board at all.", "rel": "kin" } ], "links": [ { "label": "CDC Yellow Book 2026 — Medical Tourism", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" } ], "sources": [ "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism", "s:asps-flying" ], "provenance": { "default": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "fields": { "text.story": { "tier": "tradition", "note": "the fit-to-fly letter paragraph is the trade's practice, marked inline; the ten-day and seven-to-ten-day figures are cited" }, "text.how": { "tier": "tradition", "note": "standard aviation-medicine account; the cabin pressure figure is cited" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "A cabin at cruising altitude is pressurised to roughly the outside air pressure at 6,000 to 8,000 feet.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "dvt-pe", "type": "risk", "name": "Deep vein thrombosis and pulmonary embolism", "as": "The clot risk that the seated hours add to the surgical one.", "rel": "kin" }, { "to": "the-flight-home", "type": "pathway", "name": "The flight home", "as": "The step this guidance is about.", "rel": "step" }, { "to": "booking-the-flight", "type": "pathway", "name": "Booking the flight", "as": "The step at which the return date is fixed, usually before anyone has seen the wound.", "rel": "step" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "Major lower-limb surgery, where orthopaedic teams commonly apply the same ten-day interval for the clot risk.", "rel": "procedure" }, { "to": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "A nasal procedure, and the one the plastic surgeons' 7-to-10-day figure was written for.", "rel": "procedure" }, { "to": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "Abdominal surgery, which is what the ten-day figure names.", "rel": "procedure" }, { "to": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "Abdominal surgery sold in packages shorter than the interval the guidance names.", "rel": "procedure" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The pricing form whose stated length of stay sits against this interval.", "rel": "term" }, { "to": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "What it costs when the patient cannot board at all.", "rel": "kin" } ], "source_list": [ { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:asps-flying", "kind": "org", "title": "American Society of Plastic Surgeons guidance on flying after a procedure, as cited in the CDC Yellow Book", "publisher": "American Society of Plastic Surgeons", "url": "https://www.plasticsurgery.org/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "text.story": { "tier": "tradition", "note": "the fit-to-fly letter paragraph is the trade's practice, marked inline; the ten-day and seven-to-ten-day figures are cited" }, "text.how": { "tier": "tradition", "note": "standard aviation-medicine account; the cabin pressure figure is cited" }, "text.today": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "metrics": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "lithuania", "type": "destination", "name": "Lithuania", "as": "What sets the number of nights between a cosmetic operation and the flight home.", "rel": "risk" }, { "from": "antalya", "type": "hub", "name": "Antalya", "as": "The clot risk that decides whether the return flight on the package is the return flight taken.", "rel": "risk" }, { "from": "cancun", "type": "hub", "name": "Cancún", "as": "The constraint that decides which operations can be sold on a one-week resort schedule.", "rel": "risk" }, { "from": "medellin", "type": "hub", "name": "Medellín", "as": "The constraint that sets the length of a body-contouring stay, not the operating time.", "rel": "risk" }, { "from": "phuket", "type": "hub", "name": "Phuket", "as": "The wait before boarding, which matters more on an island whose patients arrive by air.", "rel": "risk" }, { "from": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "The wound, the drains and the clot risk that set the earliest flight home.", "rel": "risk" }, { "from": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "Sitting restrictions and the clot risk of the flight collide in this operation more than any other cosmetic one.", "rel": "risk" }, { "from": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The rule that keeps a chest-surgery patient on the ground for ten days.", "rel": "risk" }, { "from": "gallbladder-removal", "type": "procedure", "name": "Gallbladder removal", "as": "The clot risk that sets how long after abdominal surgery a patient can board.", "rel": "risk" }, { "from": "gastric-bypass", "type": "procedure", "name": "Gastric bypass", "as": "The clot risk that sets how long after this abdominal operation a patient can board.", "rel": "risk" }, { "from": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "The clot risk that sets how long after this abdominal operation a patient can board.", "rel": "risk" }, { "from": "heart-valve-replacement", "type": "procedure", "name": "Heart valve replacement", "as": "The rule that keeps a chest-surgery patient on the ground.", "rel": "risk" }, { "from": "hernia-repair", "type": "procedure", "name": "Hernia repair", "as": "The clot risk that sets how long after abdominal surgery a patient can board.", "rel": "risk" }, { "from": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "The clot risk that sets how long after this operation a patient can board.", "rel": "risk" }, { "from": "hysterectomy", "type": "procedure", "name": "Hysterectomy", "as": "The clot risk that sets how long after abdominal surgery a patient can board.", "rel": "risk" }, { "from": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The clot risk that sets how long after this operation a patient can board.", "rel": "risk" }, { "from": "prostatectomy", "type": "procedure", "name": "Prostatectomy", "as": "The clot risk that sets how long after pelvic surgery a patient can board.", "rel": "risk" }, { "from": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "The splint comes off before the flight, and the clot risk of the flight itself is argued separately.", "rel": "risk" }, { "from": "spinal-fusion", "type": "procedure", "name": "Spinal fusion", "as": "The clot risk that sets the wait before the flight home.", "rel": "risk" }, { "from": "top-surgery", "type": "procedure", "name": "Top surgery", "as": "What sets the earliest sensible flight after a general anaesthetic and a chest wound.", "rel": "risk" }, { "from": "booking-the-flight", "type": "pathway", "name": "Booking the flight", "as": "The clinical risk the booked return date runs into.", "rel": "risk" }, { "from": "the-flight-home", "type": "pathway", "name": "The flight home", "as": "The risk record for this leg, with the guidance in full.", "rel": "risk" }, { "from": "alone-after-discharge", "type": "risk", "name": "Discharged alone", "as": "The wait that puts the patient in the hotel in the first place.", "rel": "kin" }, { "from": "dvt-pe", "type": "risk", "name": "Deep vein thrombosis and pulmonary embolism", "as": "The interval guidance written partly for this.", "rel": "kin" }, { "from": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "The guidance that, followed, keeps a patient off this aircraft.", "rel": "kin" }, { "from": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "The clause about fitness to fly, and the clinical reason behind it.", "rel": "risk" }, { "from": "length-of-stay", "type": "term", "name": "Length of stay", "as": "The second, longer stay: days in the country before a seat is allowed.", "rel": "risk" }, { "from": "repatriation", "type": "term", "name": "Repatriation", "as": "The clinical reason a commercial seat is refused in the first place.", "rel": "risk" } ] }, { "id": "follow-up-gap", "names": { "name": "The follow-up gap", "aliases": [ "loss to follow-up", "no aftercare" ], "said": "The clinic calls it discharge. The system at home calls it a first presentation." }, "region": [ "global" ], "facets": { "kind": "clinical" }, "text": { "what": "The interval between an operation abroad and the first clinician at home who sees the wound, during which nobody is responsible for the result. The American Medical Association's guiding principles, reproduced in the CDC's chapter, ask that \"local follow-up care should be coordinated\" before travel and that coverage include the cost of follow-up on return. The CDC also notes that \"some overseas facilities and healthcare professionals charge substantial fees for follow-up care in addition to the base cost\".", "story": "The gap is measurable from one side only, and what it looks like from that side is a paperwork failure. A Manchester breast unit reviewing twelve months of cosmetic surgery complications in 2022 and 2023 found 25 patients, 20 of whom had been operated on abroad. The precise date of surgery was recorded for 48% of them. The name of the clinic was recorded for 8%. The name of the surgeon was recorded for 0%. Seventy-two per cent presented within eight weeks of the operation.\n\nThat is not a study of infection or of technique. It is a study of what arrives: a patient, a complication, and no identifiable counterparty.\n\nThe General Medical Council's guidance for doctors offering cosmetic interventions, in force since 1 June 2016, sets out what the record is supposed to contain — a named contact for complications outside working hours, written information detailed enough \"to enable another medical professional to take over the patient's care\", and records organised so patients treated with a particular device can be identified if a safety concern arises. Those obligations bind a doctor on the UK register. The clinic that performed the operation is not on it.\n\n*Inference —* the exposure transfers cleanly. The operating clinic's liability, such as it is, ends at the airport; the home system's begins at the emergency department door, without a contract, a referral or a fee.", "how": "The CDC asks clinicians to remind travellers to request copies of overseas records in English, and the American College of Surgeons goes further, asking that a complete set be obtained before returning home. Neither is enforceable at a distance. Where follow-up is offered by the operating facility it is usually by message or video, which cannot take a swab, remove a suture or drain a collection.", "today": "As of 16 September 2026 there is no published measure of how many people who travel for surgery attend any follow-up at all. The figures that exist are the recording rates in single-centre series of the patients who came back with a problem — a sample selected for having one." }, "metrics": { "note": "From 25 patients seen by one NHS breast surgery unit over twelve months in 2022 and 2023, 20 of them operated on abroad: the precise date of surgery was recorded for 48%, the clinic name for 8%, the surgeon's name for 0%, and 72% presented within eight weeks. These are recording rates in the patients who presented with a complication, not rates in everyone who travelled.", "as_of": "2024", "source": "s:ahari-breast-unit-2024", "url": "https://pubmed.ncbi.nlm.nih.gov/39476527/" }, "kin": [ { "to": "the-discharge-summary", "as": "The document that would close this gap, when it exists and when it is in a language the next clinician reads.", "rel": "step" }, { "to": "aftercare-at-home", "as": "The step this risk is the absence of.", "rel": "step" }, { "to": "getting-your-records", "as": "The step that decides whether anyone at home can tell what was done.", "rel": "step" }, { "to": "revision-at-home", "as": "What the gap costs, once somebody has to operate again.", "rel": "kin" }, { "to": "malpractice-recourse", "as": "Without the surgeon's name, there is no defendant.", "rel": "kin" }, { "to": "surgical-site-infection", "as": "The commonest thing found in the gap.", "rel": "kin" }, { "to": "the-follow-up-nobody-books", "as": "The longer piece on this.", "rel": "story" }, { "to": "hair-transplant-fue", "as": "A procedure sold as a two-day trip, with the result judged at twelve months.", "rel": "procedure" }, { "to": "knee-replacement", "as": "Six-week and twelve-week reviews, and the physiotherapy between them, sit outside every package this site has read.", "rel": "procedure" } ], "links": [ { "label": "CDC Yellow Book 2026 — Medical Tourism", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" }, { "label": "GMC — Guidance for doctors who offer cosmetic interventions", "url": "https://www.gmc-uk.org/professional-standards/the-professional-standards/cosmetic-interventions" } ], "sources": [ "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism", "s:ahari-breast-unit-2024", "s:gmc-cosmetic-interventions" ], "provenance": { "default": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "fields": { "metrics": { "tier": "cited", "source": "s:ahari-breast-unit-2024" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "The interval between an operation abroad and the first clinician at home who sees the wound, during which nobody is responsible for the result.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "The document that would close this gap, when it exists and when it is in a language the next clinician reads.", "rel": "step" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The step this risk is the absence of.", "rel": "step" }, { "to": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "The step that decides whether anyone at home can tell what was done.", "rel": "step" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "What the gap costs, once somebody has to operate again.", "rel": "kin" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "Without the surgeon's name, there is no defendant.", "rel": "kin" }, { "to": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The commonest thing found in the gap.", "rel": "kin" }, { "to": "the-follow-up-nobody-books", "type": "story", "name": "The follow-up nobody books", "as": "The longer piece on this.", "rel": "story" }, { "to": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "A procedure sold as a two-day trip, with the result judged at twelve months.", "rel": "procedure" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "Six-week and twelve-week reviews, and the physiotherapy between them, sit outside every package this site has read.", "rel": "procedure" } ], "source_list": [ { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:ahari-breast-unit-2024", "kind": "paper", "title": "The impact of cosmetic tourism across one year on an NHS breast surgery unit", "publisher": "Journal of Plastic, Reconstructive and Aesthetic Surgery 2024;99:462-467 (Ahari D, Zaccariah ZR, Preston M, Highton L), Wythenshawe Hospital", "url": "https://pubmed.ncbi.nlm.nih.gov/39476527/", "accessed": "2026-09-16" }, { "id": "s:gmc-cosmetic-interventions", "kind": "org", "title": "Guidance for doctors who offer cosmetic interventions — in effect 1 June 2016, updated 13 December 2024", "publisher": "General Medical Council (United Kingdom)", "url": "https://www.gmc-uk.org/professional-standards/the-professional-standards/cosmetic-interventions", "accessed": "2026-09-16", "note": "paragraph numbers cited on this site are from the sections Communication, partnership and teamwork (paras 14-45) and Maintaining trust (paras 46-56)" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "text.story": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "text.how": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "text.today": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "metrics": { "tier": "cited", "source": "s:ahari-breast-unit-2024" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "australia", "type": "destination", "name": "Australia", "as": "A median of 3.8 weeks from surgery to presentation is the gap, measured.", "rel": "risk" }, { "from": "canada", "type": "destination", "name": "Canada", "as": "Who sees the wound at six weeks when the operation happened in another country.", "rel": "risk" }, { "from": "dominican-republic", "type": "destination", "name": "Dominican Republic", "as": "Both outbreaks were found by doctors at home, weeks after discharge abroad.", "rel": "risk" }, { "from": "indonesia", "type": "destination", "name": "Indonesia", "as": "The Indonesian doctor reading a discharge summary from an operation they did not order.", "rel": "risk" }, { "from": "nepal", "type": "destination", "name": "Nepal", "as": "The Kathmandu review after an operation done across the border.", "rel": "risk" }, { "from": "tunisia", "type": "destination", "name": "Tunisia", "as": "The structural weakness of a package sold across the Mediterranean.", "rel": "risk" }, { "from": "vietnam", "type": "destination", "name": "Vietnam", "as": "Who checks an implant placed on a fortnight's holiday.", "rel": "risk" }, { "from": "istanbul", "type": "hub", "name": "Istanbul", "as": "What a one-week package leaves behind: the wash, the shedding and the twelve-month result all happen at home.", "rel": "risk" }, { "from": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "Short here — the patient can come back across in an afternoon, which is not true of anywhere else in this directory.", "rel": "risk" }, { "from": "nuevo-progreso", "type": "hub", "name": "Nuevo Progreso", "as": "Nearly closed here, because the patient is parked twenty minutes away until April.", "rel": "risk" }, { "from": "phuket", "type": "hub", "name": "Phuket", "as": "Recovery in a hotel means the six-week check is somebody else's, somewhere else.", "rel": "risk" }, { "from": "santo-domingo", "type": "hub", "name": "Santo Domingo", "as": "An infection that presents at week six, in a country the surgeon does not practise in.", "rel": "risk" }, { "from": "acl-reconstruction", "type": "procedure", "name": "Anterior cruciate ligament reconstruction", "as": "Who supervises nine months of rehabilitation after a two-night admission abroad.", "rel": "risk" }, { "from": "angioplasty-stent", "type": "procedure", "name": "Coronary angioplasty and stent", "as": "Who prescribes and monitors the antiplatelet drugs after the flight home.", "rel": "risk" }, { "from": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "Graft-versus-host disease declares itself months later, in another country.", "rel": "risk" }, { "from": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "Who holds the implant card, and who scans the breast in five years.", "rel": "risk" }, { "from": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "Who reads the echocardiogram at three months, and where.", "rel": "risk" }, { "from": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "Who checks the eye the day after, and who sees it at six weeks.", "rel": "risk" }, { "from": "cochlear-implant", "type": "procedure", "name": "Cochlear implant", "as": "The exact shape of this device's problem: an operation that crosses a border easily and a programming appointment that does not.", "rel": "risk" }, { "from": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "Who sees the implant at the six-month check, and who fixes a failed one.", "rel": "risk" }, { "from": "dialysis-holiday", "type": "procedure", "name": "Dialysis away from home", "as": "The reverse case: the home unit keeps the patient and lends them out for a fortnight.", "rel": "contrast" }, { "from": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "What happens to an abnormal result eight time zones from the doctor who will act on it.", "rel": "risk" }, { "from": "full-mouth-restoration", "type": "procedure", "name": "Full mouth restoration", "as": "Who checks a rebuilt bite at six months, and where.", "rel": "risk" }, { "from": "gallbladder-removal", "type": "procedure", "name": "Gallbladder removal", "as": "Who sees the wounds at two weeks, and who investigates the pain that did not go away.", "rel": "risk" }, { "from": "gamma-knife", "type": "procedure", "name": "Gamma knife radiosurgery", "as": "The scan at six months, back home, that nobody booked.", "rel": "risk" }, { "from": "gastric-balloon", "type": "procedure", "name": "Gastric balloon", "as": "Who takes the balloon out, months later, in the country the patient went home to.", "rel": "risk" }, { "from": "gastric-bypass", "type": "procedure", "name": "Gastric bypass", "as": "Who orders the annual bloods this operation makes compulsory, once the coordinator's calls stop.", "rel": "risk" }, { "from": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "Who checks the bloods at year three, when the package's six months of video calls have run out.", "rel": "risk" }, { "from": "heart-valve-replacement", "type": "procedure", "name": "Heart valve replacement", "as": "Who monitors the anticoagulation a mechanical valve requires, weekly, at home.", "rel": "risk" }, { "from": "hernia-repair", "type": "procedure", "name": "Hernia repair", "as": "Who looks at the wound at two weeks once the patient has flown.", "rel": "risk" }, { "from": "hysterectomy", "type": "procedure", "name": "Hysterectomy", "as": "Who checks the wound and the vault at six weeks, and where.", "rel": "risk" }, { "from": "icl", "type": "procedure", "name": "Implantable collamer lens", "as": "Who checks the eye pressure in the weeks after, and who takes the lens out in thirty years.", "rel": "risk" }, { "from": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "A graft that arrives home without an operative note, and a clinic that must take it on anyway.", "rel": "risk" }, { "from": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "Who takes the stitches out, and who sees the knee at six weeks.", "rel": "risk" }, { "from": "lasik", "type": "procedure", "name": "LASIK", "as": "Who sees the eye the next day, and who does the enhancement a year later.", "rel": "risk" }, { "from": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "Loss to follow-up is named in the published review as one of the three mechanisms of harm.", "rel": "risk" }, { "from": "phalloplasty", "type": "procedure", "name": "Phalloplasty", "as": "Four stages across years, and the record of the first three sitting in another country.", "rel": "risk" }, { "from": "prostatectomy", "type": "procedure", "name": "Prostatectomy", "as": "Who removes the catheter, and who measures the PSA at three months.", "rel": "risk" }, { "from": "shoulder-replacement", "type": "procedure", "name": "Total shoulder replacement", "as": "Who runs the sling protocol and the six weeks of physiotherapy after the flight home.", "rel": "risk" }, { "from": "spinal-fusion", "type": "procedure", "name": "Spinal fusion", "as": "Who orders the imaging that shows whether the bone knitted.", "rel": "risk" }, { "from": "top-surgery", "type": "procedure", "name": "Top surgery", "as": "Who takes the drains out, and who looks at the scars at six weeks.", "rel": "risk" }, { "from": "vaginoplasty", "type": "procedure", "name": "Vaginoplasty", "as": "Dilation is a two-year daily instruction, and nobody abroad supervises it.", "rel": "risk" }, { "from": "hospital-angeles-tijuana", "type": "facility", "name": "Hospital Angeles Tijuana", "as": "A border crossing between the operating surgeon and every subsequent appointment.", "rel": "risk" }, { "from": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The risk record for the hole this step falls into.", "rel": "risk" }, { "from": "deciding-whether", "type": "pathway", "name": "Deciding whether to go", "as": "The cost that is rarely in the comparison being made here.", "rel": "risk" }, { "from": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "What a record that never arrives becomes at home.", "rel": "risk" }, { "from": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "What a thin summary turns into at the first appointment at home.", "rel": "risk" }, { "from": "alone-after-discharge", "type": "risk", "name": "Discharged alone", "as": "The same absence, further along: nobody responsible, at a greater distance.", "rel": "kin" }, { "from": "antimicrobial-resistance", "type": "risk", "name": "Antimicrobial resistance acquired abroad", "as": "Why the organism is usually found by a laboratory with no record of the operation.", "rel": "kin" }, { "from": "candida-auris", "type": "risk", "name": "Candida auris", "as": "Colonisation is silent, so nothing in the patient's own account will raise it.", "rel": "kin" }, { "from": "counterfeit-medicines", "type": "risk", "name": "Substandard and falsified medicines", "as": "Why a treatment failure at home is rarely traced back to what was dispensed abroad.", "rel": "kin" }, { "from": "fungal-meningitis", "type": "risk", "name": "Fungal meningitis after epidural anaesthesia", "as": "Why case-finding had to be run as a public appeal to people who had been to a named address.", "rel": "kin" }, { "from": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "Where an unclear consent surfaces: a clinician at home reading a form nobody can translate.", "rel": "kin" }, { "from": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "The reason there is often no name to sue.", "rel": "kin" }, { "from": "nontuberculous-mycobacteria", "type": "risk", "name": "Nontuberculous mycobacteria", "as": "Weeks-long incubation means the first clinician to see it is always at home.", "rel": "kin" }, { "from": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Why the second surgeon operates without an operative note.", "rel": "kin" }, { "from": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "Why the infection is usually diagnosed by someone who did not make the wound.", "rel": "kin" }, { "from": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "Immunosuppression makes the gap immediately dangerous rather than eventually.", "rel": "kin" }, { "from": "cross-border-prescriptions", "type": "rule", "name": "A prescription that crosses a border", "as": "The interval this instrument was written to shorten.", "rel": "risk" }, { "from": "dominican-republic-ntm-outbreak", "type": "event", "name": "The Dominican mycobacterial outbreaks, 2013–14 and 2017", "as": "Both outbreaks were found by doctors at home, weeks after discharge abroad.", "rel": "risk" }, { "from": "mexico-fungal-meningitis-2023", "type": "event", "name": "The Matamoros fungal meningitis outbreak, 2023", "as": "Patients were traced by telephone from a list, weeks after they had flown home.", "rel": "risk" }, { "from": "bundled-payment", "type": "term", "name": "Bundled payment", "as": "What a 90-day episode covers at home and nobody covers abroad.", "rel": "risk" }, { "from": "revision", "type": "term", "name": "Revision", "as": "The space a revision falls into when nobody at home agreed to see the patient.", "rel": "risk" }, { "from": "the-follow-up-nobody-books", "type": "story", "name": "The follow-up nobody books", "as": "The risk record for the interval this piece is about, and the recording rates inside it.", "rel": "risk" } ] }, { "id": "fungal-meningitis", "names": { "name": "Fungal meningitis after epidural anaesthesia", "aliases": [ "Fusarium solani meningitis", "the Matamoros outbreak" ], "said": "The investigation called it a point source. The patients had gone for liposuction." }, "region": [ "global", "mexico" ], "facets": { "kind": "infection" }, "text": { "what": "Infection of the lining of the brain and spinal cord by a mould introduced at the moment an epidural is placed. The CDC's medical travel chapter names it among the documented outbreaks in travelling patients: \"fungal meningitis in patients who received epidural anesthesia in Mexico\".", "story": "The investigation ran from 8 May 2023, when it was announced, to 13 May, when the two clinics at the centre of it closed. Both were in Matamoros, Tamaulipas: River Side Surgical Center and Clinica K-3. The exposure window was 1 January to 13 May 2023.\n\nAs reported in Clinical Infectious Diseases in 2024, 185 residents of 22 US states and jurisdictions were identified as potentially exposed. Ten cases were confirmed, 10 probable and 11 suspected. Eight people died — seven confirmed cases and one probable. The organism was the Fusarium solani species complex, its antifungal susceptibility profile poor enough to require triple-drug therapy, and the deaths were driven by severe vascular complications rather than by the meningitis alone.\n\nMetagenomic sequencing published by the CDC in 2025 examined isolates from five patients and found the strains clustered together, consistent with a single point source. The finding supported the epidemiological conclusion that a contaminated drug or device used for the epidural was the cause.\n\n*Inference —* two features of this outbreak make it structural rather than local. The infection came from the anaesthetic, not the operation, so no amount of scrutiny of the surgeon would have found it. And the patients dispersed to 22 jurisdictions before anyone was ill, which is why the case-finding had to be run as a public appeal to people who had been to a named address on a named date.", "how": "Presentation was delayed and non-specific — headache, fever, neck stiffness, nausea — in people who had been discharged well and flown home. Diagnosis required lumbar puncture and, in most cases, molecular testing rather than culture. Case definitions in the CDC investigation were tiered as suspected, probable and confirmed by whether fungal signal was detected in cerebrospinal fluid, which is why the published counts come in three numbers rather than one.", "today": "As of 16 September 2026 the outbreak is closed and the published totals stand at 31 US cases across the three case definitions with 8 deaths, from 185 people identified as potentially exposed. A separate Fusarium solani meningitis outbreak associated with neuraxial blockade was reported in Durango, Mexico, over 2022 and 2023; this record covers the Matamoros one." }, "metrics": { "note": "185 US residents in 22 states and jurisdictions identified as potentially exposed; 10 confirmed, 10 probable and 11 suspected cases; 8 deaths, of which 7 were confirmed cases and 1 probable. Exposure window 1 January to 13 May 2023 at two clinics in Matamoros, Tamaulipas. Counts of an investigated outbreak, not a rate for epidural anaesthesia anywhere.", "as_of": "2024", "source": "s:smith-fungal-meningitis-2024", "url": "https://academic.oup.com/cid/article/78/6/1554/7280488" }, "kin": [ { "to": "mexico-fungal-meningitis-2023", "as": "The outbreak itself, with its dates and its two addresses.", "rel": "event" }, { "to": "mexico", "as": "Where both clinics were, and one of the two countries named in the CDC's outbreak list.", "rel": "place" }, { "to": "anaesthetic-risk-unscreened", "as": "The anaesthetic, not the operation, was the route of infection here.", "rel": "kin" }, { "to": "liposuction", "as": "Among the cosmetic procedures the exposed patients had travelled for.", "rel": "procedure" }, { "to": "surgical-site-infection", "as": "The commoner infection after the same trips, and a far less lethal one.", "rel": "contrast" }, { "to": "follow-up-gap", "as": "Why case-finding had to be run as a public appeal to people who had been to a named address.", "rel": "kin" }, { "to": "repatriation-cost", "as": "What it costs to move a patient in this condition.", "rel": "kin" }, { "to": "when-it-goes-wrong", "as": "The step at which a headache two weeks after a flight becomes an emergency.", "rel": "step" } ], "links": [ { "label": "Smith et al., Clinical Infectious Diseases 2024", "url": "https://academic.oup.com/cid/article/78/6/1554/7280488" }, { "label": "CDC, Emerging Infectious Diseases 2025 — metagenomic identification", "url": "https://wwwnc.cdc.gov/eid/article/31/5/24-1657_article" } ], "sources": [ "s:smith-fungal-meningitis-2024", "s:eid-fusarium-metagenomics-2025", "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited", "source": "s:smith-fungal-meningitis-2024" }, "fields": { "text.story": { "tier": "cited", "note": "the closing paragraph is marked inline as this project's reading" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "Infection of the lining of the brain and spinal cord by a mould introduced at the moment an epidural is placed.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "mexico", "name": "Mexico", "note": "its own entry because the border towns are a category of their own" } ], "kin_out": [ { "to": "mexico-fungal-meningitis-2023", "type": "event", "name": "The Matamoros fungal meningitis outbreak, 2023", "as": "The outbreak itself, with its dates and its two addresses.", "rel": "event" }, { "to": "mexico", "type": "destination", "name": "Mexico", "as": "Where both clinics were, and one of the two countries named in the CDC's outbreak list.", "rel": "place" }, { "to": "anaesthetic-risk-unscreened", "type": "risk", "name": "Fitness for anaesthesia, assessed on arrival", "as": "The anaesthetic, not the operation, was the route of infection here.", "rel": "kin" }, { "to": "liposuction", "type": "procedure", "name": "Liposuction", "as": "Among the cosmetic procedures the exposed patients had travelled for.", "rel": "procedure" }, { "to": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The commoner infection after the same trips, and a far less lethal one.", "rel": "contrast" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Why case-finding had to be run as a public appeal to people who had been to a named address.", "rel": "kin" }, { "to": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "What it costs to move a patient in this condition.", "rel": "kin" }, { "to": "when-it-goes-wrong", "type": "pathway", "name": "When it goes wrong", "as": "The step at which a headache two weeks after a flight becomes an emergency.", "rel": "step" } ], "source_list": [ { "id": "s:smith-fungal-meningitis-2024", "kind": "paper", "title": "Update on Outbreak of Fungal Meningitis Among US Residents Who Received Epidural Anesthesia at Two Clinics in Matamoros, Mexico", "publisher": "Clinical Infectious Diseases 2024;78(6):1554-1558 (Smith DJ, Gold JAW, Chiller T, et al.)", "url": "https://academic.oup.com/cid/article/78/6/1554/7280488", "accessed": "2026-09-16" }, { "id": "s:eid-fusarium-metagenomics-2025", "kind": "paper", "title": "Metagenomic Identification of Fusarium solani Strain as Cause of US Fungal Meningitis Outbreak Associated with Surgical Procedures in Mexico, 2023", "publisher": "Emerging Infectious Diseases 2025;31(5), US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/eid/article/31/5/24-1657_article", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:smith-fungal-meningitis-2024" }, "text.story": { "tier": "cited", "note": "the closing paragraph is marked inline as this project's reading" }, "text.how": { "tier": "cited", "source": "s:smith-fungal-meningitis-2024" }, "text.today": { "tier": "cited", "source": "s:smith-fungal-meningitis-2024" }, "metrics": { "tier": "cited", "source": "s:smith-fungal-meningitis-2024" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "mexico", "type": "destination", "name": "Mexico", "as": "What the two Matamoros clinics sent home with their patients.", "rel": "risk" }, { "from": "mexico-fungal-meningitis-2023", "type": "event", "name": "The Matamoros fungal meningitis outbreak, 2023", "as": "The risk record: what it is, how it is found, and who treats it.", "rel": "risk" } ] }, { "id": "implant-excluded", "names": { "name": "The implant is excluded", "aliases": [ "excluding implant", "device billed separately", "prosthesis not included" ], "said": "The package title says it out loud, in brackets, after the name of the operation." }, "region": [ "global" ], "facets": { "kind": "financial" }, "text": { "what": "A fixed package price for an operation that installs a manufactured device, quoted without the device. The headline number covers theatre time, the surgical team, the anaesthetist and a stated number of ward nights; the component that will be screwed, cemented or seated into the patient is billed separately at a price the page does not give.", "story": "The worked case sits on this site's knee record. Bumrungrad International Hospital in Bangkok publishes package JOINT04 for a unilateral total knee replacement at 356,500 baht, and titles the page \"Total Knee Replacement Surgery (Exclude implant)\". The inclusion list runs to eight lines: three hours of operating theatre, the nursing and surgical team fees inside those three hours, three nights on the surgical ward, equipment and supplies, medications related to the procedure, surgeon, assistant surgeon if needed, anaesthesiologist. The exclusion list runs to ten, and the implant is the first of them. Also excluded: the first consultation and the follow-up visits, specialist consultations, any night past the third and any ICU, blood transfusion, laboratory and imaging before or after surgery, take-home medication, outpatient charges before admission, and complex or emergency cases. The price is stated valid until 31 December 2026.\n\nNothing about that page is concealed. The exclusion is in the title. The point is what it does to a comparison: a knee package that excludes the implant and a knee price at home that includes it are two different objects, and the difference between them is not a discount.\n\nThe pattern is not confined to joints. A dental implant package quoted per fixture may exclude the abutment and the crown; a cardiac package may exclude the valve or the stent; a cochlear package may exclude the processor.\n\n*Trade practice —* the reason is procurement rather than marketing. Implant prices move with the manufacturer, the model, the size and the contract, and a hospital that fixed a package price including the device would be quoting a component cost it does not control. The effect on a price page is the same either way.\n\nThe United Kingdom's General Medical Council requires a doctor on its register to \"be clear about what is included in quoted prices and what other charges might be payable, including possible charges for revision or routine follow up\", and to tell patients if an implanted device may need to be removed or replaced and after how long. A clinic abroad is not on that register.", "how": "The exclusion is read off the page: the title, the line that names the device, and the validity date. Where a package names a device it usually names a tier — a standard implant against a premium one, a manual technique against a robot-assisted one — and the tier changes the number. Every price row on this site carries its own inclusion and exclusion list in the provider's words for this reason, and the exclusion list is the half worth reading.", "today": "As of 16 September 2026 the package this record is built on lists 356,500 baht for one knee, implant excluded, valid until 31 December 2026. This project has not found a published figure for what that implant costs at that hospital, and has not found any destination that requires an implant price to be published alongside a package.", "notes": "The Bumrungrad knee package that this record works from is carried once, on the knee replacement record, so the price table counts it once." }, "metrics": { "note": "Nobody publishes the size of the gap. A package price excluding the implant is public; the implant price is quoted to the patient, not posted, and no register, ministry or accreditor requires otherwise. The measurable part is the count of exclusions: ten on the knee package read for this record, against eight inclusions.", "as_of": "2026-09-16", "source": "s:bumrungrad-joint04", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery" }, "kin": [ { "to": "knee-replacement", "as": "The operation this exclusion was read off, and the one where the device is often the largest line.", "rel": "procedure" }, { "to": "hip-replacement", "as": "The same trade, the same exclusion, usually a higher package.", "rel": "procedure" }, { "to": "dental-implant", "as": "Priced per fixture, with the abutment and crown on their own lines.", "rel": "procedure" }, { "to": "cochlear-implant", "as": "Where the external processor is a separate purchase from the operation.", "rel": "procedure" }, { "to": "bumrungrad", "as": "Publishes the package this record is built on, exclusion stated in the title.", "rel": "performed-at" }, { "to": "package-price", "as": "The pricing form this risk lives inside.", "rel": "term" }, { "to": "reading-the-exclusions", "as": "The step at which this is caught, when it is caught.", "rel": "step" }, { "to": "getting-a-quote", "as": "The step at which the headline number is supplied and the device price is not.", "rel": "step" }, { "to": "the-price-that-isnt", "as": "The longer piece on what a published price covers.", "rel": "story" }, { "to": "revision-at-home", "as": "When the device fails, the second one is bought in a different country.", "rel": "kin" }, { "to": "blood-supply-safety", "as": "Also on that exclusion list, and a risk rather than a charge.", "rel": "kin" } ], "links": [ { "label": "Bumrungrad package JOINT04", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery" }, { "label": "GMC — Guidance for doctors who offer cosmetic interventions", "url": "https://www.gmc-uk.org/professional-standards/the-professional-standards/cosmetic-interventions" } ], "sources": [ "s:bumrungrad-joint04", "s:bumrungrad-packages", "s:gmc-cosmetic-interventions", "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited", "source": "s:bumrungrad-joint04" }, "fields": { "text.story": { "tier": "cited", "note": "the procurement paragraph is marked as trade practice; everything else is read off the package page or the GMC guidance" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "A fixed package price for an operation that installs a manufactured device, quoted without the device.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The operation this exclusion was read off, and the one where the device is often the largest line.", "rel": "procedure" }, { "to": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "The same trade, the same exclusion, usually a higher package.", "rel": "procedure" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "Priced per fixture, with the abutment and crown on their own lines.", "rel": "procedure" }, { "to": "cochlear-implant", "type": "procedure", "name": "Cochlear implant", "as": "Where the external processor is a separate purchase from the operation.", "rel": "procedure" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Publishes the package this record is built on, exclusion stated in the title.", "rel": "performed-at" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The pricing form this risk lives inside.", "rel": "term" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step at which this is caught, when it is caught.", "rel": "step" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step at which the headline number is supplied and the device price is not.", "rel": "step" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "The longer piece on what a published price covers.", "rel": "story" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "When the device fails, the second one is bought in a different country.", "rel": "kin" }, { "to": "blood-supply-safety", "type": "risk", "name": "Blood supply safety", "as": "Also on that exclusion list, and a risk rather than a charge.", "rel": "kin" } ], "source_list": [ { "id": "s:bumrungrad-joint04", "kind": "web", "title": "Total Knee Replacement Surgery (Exclude implant) — package JOINT04", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery", "accessed": "2026-09-16", "note": "read off the hospital's own package page; price stated valid until 31 December 2026" }, { "id": "s:bumrungrad-packages", "kind": "web", "title": "Packages & Programs — joint replacement and spine", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages", "accessed": "2026-09-16" }, { "id": "s:gmc-cosmetic-interventions", "kind": "org", "title": "Guidance for doctors who offer cosmetic interventions — in effect 1 June 2016, updated 13 December 2024", "publisher": "General Medical Council (United Kingdom)", "url": "https://www.gmc-uk.org/professional-standards/the-professional-standards/cosmetic-interventions", "accessed": "2026-09-16", "note": "paragraph numbers cited on this site are from the sections Communication, partnership and teamwork (paras 14-45) and Maintaining trust (paras 46-56)" }, { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:bumrungrad-joint04" }, "text.story": { "tier": "cited", "note": "the procurement paragraph is marked as trade practice; everything else is read off the package page or the GMC guidance" }, "text.how": { "tier": "cited", "source": "s:bumrungrad-joint04" }, "text.today": { "tier": "cited", "source": "s:bumrungrad-joint04" }, "metrics": { "tier": "cited", "source": "s:bumrungrad-joint04" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "vilnius", "type": "hub", "name": "Vilnius", "as": "The line an orthopaedic quote from here usually carries separately.", "rel": "risk" }, { "from": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "The same trap as the joint implant: a headline price that is a subtotal.", "rel": "risk" }, { "from": "angioplasty-stent", "type": "procedure", "name": "Coronary angioplasty and stent", "as": "The trap by its own name: the stent is the special device the package leaves out.", "rel": "risk" }, { "from": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "The line item that decides whether a published price is half a bill; here the device is usually inside it, which is the exception.", "rel": "risk" }, { "from": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "The trap this operation mostly avoids by naming the lens — and reopens by naming only some lenses.", "rel": "risk" }, { "from": "cochlear-implant", "type": "procedure", "name": "Cochlear implant", "as": "The same trick in another trade: a price for the operation that is not a price for the hardware.", "rel": "risk" }, { "from": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The same trap as the joint implant, written smaller and more often.", "rel": "risk" }, { "from": "disc-replacement", "type": "procedure", "name": "Artificial disc replacement", "as": "The exclusion that removes the device the operation is named after.", "rel": "risk" }, { "from": "heart-valve-replacement", "type": "procedure", "name": "Heart valve replacement", "as": "The line item this operation's headline price leaves out.", "rel": "risk" }, { "from": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "The line the Bangkok packages put in writing and the English price list does not mention.", "rel": "risk" }, { "from": "hysterectomy", "type": "procedure", "name": "Hysterectomy", "as": "The same shape of exclusion, here a sealing device rather than a joint.", "rel": "risk" }, { "from": "icl", "type": "procedure", "name": "Implantable collamer lens", "as": "The trap this package avoids by naming the lens, and narrows by naming only some types.", "rel": "risk" }, { "from": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The line item this operation's headline price usually leaves out.", "rel": "risk" }, { "from": "phalloplasty", "type": "procedure", "name": "Phalloplasty", "as": "The prosthesis is excluded from the prosthesis row, in the same way an artificial joint is excluded from a joint package.", "rel": "risk" }, { "from": "shoulder-replacement", "type": "procedure", "name": "Total shoulder replacement", "as": "The cost the Australian schedule fee leaves entirely outside itself.", "rel": "risk" }, { "from": "spinal-fusion", "type": "procedure", "name": "Spinal fusion", "as": "The cage, the screws and the graft — the first line on the Bangkok exclusion list.", "rel": "risk" }, { "from": "bangkok-hospital", "type": "facility", "name": "Bangkok Hospital", "as": "Its arthroscopy package says so in the title; the largest line on a joint bill is not in the number.", "rel": "risk" }, { "from": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Its joint packages are priced without the implant, which the page states.", "rel": "risk" }, { "from": "medanta", "type": "facility", "name": "Medanta — The Medicity, Gurugram", "as": "The counter-example: here the implant price is published against a regulator's ceiling instead of left out of the quote.", "rel": "risk" }, { "from": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The single line most often outside the quoted number.", "rel": "risk" }, { "from": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The commonest exclusion on an orthopaedic or dental package.", "rel": "risk" }, { "from": "anaesthetic-risk-unscreened", "type": "risk", "name": "Fitness for anaesthesia, assessed on arrival", "as": "The other half of what a fixed price leaves out: one removes items, this removes patients.", "rel": "kin" }, { "from": "blood-supply-safety", "type": "risk", "name": "Blood supply safety", "as": "The same exclusion list, read for what else is missing from it.", "rel": "kin" }, { "from": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "The other way a headline price and a final bill diverge.", "rel": "kin" }, { "from": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The second device is bought again, in a second country.", "rel": "kin" }, { "from": "patient-data-transfer", "type": "rule", "name": "Moving a medical record across a border", "as": "Why the implant's lot number is worth asking for by name.", "rel": "risk" }, { "from": "package-price", "type": "term", "name": "Package price", "as": "The commonest missing line, and the reason two package prices are not comparable.", "rel": "risk" }, { "from": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The unpriced line the whole comparison turns on.", "rel": "risk" }, { "from": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "The risk record for the single commonest missing line, worked on the knee package.", "rel": "risk" } ] }, { "id": "language-consent", "names": { "name": "Consent taken across a language barrier", "aliases": [ "interpreted consent", "language barrier consent", "the form in the wrong language" ], "said": "The form is in the hospital's working language. The conversation is in whatever language the person interpreting happens to share." }, "region": [ "global" ], "facets": { "kind": "legal" }, "text": { "what": "A consent signed after a conversation conducted through a third person. Consent is two things at once: a clinical exchange about what the operation does, what it can do instead and what it cannot be undone from, and a signed instrument fixing what was disclosed and by whom. Both run through the interpreter. What that person was trained in, who pays them, and whether they sign anything are set by the hospital, the facilitator or nobody, and no cross-border rule fixes any of it.", "story": "The published evidence is real, and all of it was gathered inside single national health systems.\n\nSchenker and colleagues matched 74 pairs of patients at a United States public teaching hospital that had on-site professional interpreters, for lumbar puncture, thoracentesis and paracentesis, between January 2004 and January 2006. Full documentation of informed consent was present for 53% of the English-speaking patients and for 28% of the patients with limited English proficiency, an adjusted odds ratio of 3.10 (95% CI 1.49-6.47, p=0.003). Only 41% of the limited-English charts held a consent form in the patient's own language or signed by an interpreter. The authors concluded that \"Despite the availability of on-site professional interpreter services, hospitalized patients who do not speak English are less likely to have documentation of informed consent for common invasive procedures.\"\n\nWho interprets moves the error rate. Flores and colleagues audiotaped 57 emergency department encounters with Spanish-speaking patients of limited English proficiency over 30 months in the two largest paediatric emergency departments in Massachusetts: 20 with professional interpreters, 27 with ad hoc interpreters, 10 with none. They counted 1,884 interpreter errors, 18% of them carrying potential clinical consequences. Split by arrangement, that was 12% for professional interpreters, 22% for ad hoc interpreters and 20% where nobody interpreted. Among the professionals, hours of training rather than years of experience tracked the count: a median of 12 errors for those with 100 hours of training or more, against 33 for those with fewer.\n\nBoth studies were run in institutions that employed interpreters and kept charts an auditor could pull. That is the point of quoting them here. The cross-border case is the one with no measurement: a patient who lands in a country whose working language they do not read, meets the operating surgeon and signs the form in the same week. No regulator, accreditor or research group publishes documentation rates, interpreter error rates, or a count of consent forms issued in the patient's own language, for patients treated abroad.\n\nOne state writes the interpreter into its licensing rules, and where it files them is the tell. Turkiye's Uluslararasi Saglik Turizmi ve Turistin Sagligi Hakkinda Yonetmelik, published in the Resmi Gazete on 13 July 2017, No. 30123, requires an authorised facility to run a unit coordinating \"kabul, kayit, teshis, tedavi, faturalandirma, taburculuk, tercumanlik\" - admission, registration, diagnosis, treatment, billing, discharge and interpreting - as one function (Article 6(1)). The unit employs at least two foreign-language speakers including its head, one of the languages being English (Article 6(3)), qualified at level B2 of the European language framework, at 65 out of 100 on the national language examination, or by a degree in translation and interpreting (Article 6(4)). Article 11(1)(b)(1) then requires the licensed intermediary to supply, free on request, an itemised breakdown of its charges for accommodation, transport and transfer, interpreting and consultancy. In the same instrument, interpreting is a coordinated function of the billing office and a billed line on a travel agency's invoice.", "how": "Four arrangements sit behind the one word, and they are not the same thing.\n\nA salaried hospital interpreter is an employee of the facility, trained to its standard, rostered by it and answerable to it. An agency interpreter is a contractor booked by the hour, whose competence is the agency's representation and whose duty runs through a commercial contract the patient never sees. A facilitator's staff member is employed by the company that sold the package and paid on its arrangements, which puts the risk conversation inside the seller: Penney and colleagues, reviewing 17 Canadian broker websites in 2011, found discussion of surgical risk absent from 47% of them and limited on the rest. A relative is none of the above - no employer, no training standard, no record of what was said, and the ad hoc category Flores measured at 22% of errors carrying potential clinical consequences.\n\n*Inference -* liability follows the employment, and the patient does not pick the employer. Where the interpreter is the hospital's employee, a dispute about what was said is a dispute with the hospital, under the law of the country of treatment. Where the interpreter is an agency's or a facilitator's, the hospital's answer is that it engaged a competent third party, and the claimant is left looking for a contract between two companies, which is private. Where the interpreter is a relative, no third party was engaged at all, and the question becomes whether the clinician was entitled to rely on the translation. Turkiye's regulation puts the services a patient needs from admission to discharge on the facility whether or not it contracts them out (Article 5(4)); whether that reaches the content of an interpreted conversation is not a question this project has found decided anywhere.\n\nAccreditation settles none of it. An accreditor certifies that a hospital operates a process. It is not a party to a consent and not a forum for an argument about one.", "today": "As of 17 September 2026 every published measurement of interpreted consent this project has found was taken inside a single national health system, the most-cited of them from a study that ended in 2006. For patients treated abroad, nobody publishes how often a consent form exists in the patient's own language, how often an interpreter signs it, or who employed the interpreter." }, "metrics": { "note": "From 74 matched pairs at one United States public teaching hospital with on-site professional interpreters, January 2004 to January 2006: full documentation of informed consent in 28% of patients with limited English proficiency against 53% of English-speaking patients, adjusted odds ratio 3.10 (95% CI 1.49-6.47); 41% of the limited-English charts held a form in the patient's own language or signed by an interpreter. Measured in one health system, in one city, for three bedside procedures. No equivalent figure exists for any patient treated across a border.", "as_of": "2007", "source": "s:schenker-consent-language", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2078548/" }, "kin": [ { "to": "arrival-and-consent", "as": "The step this risk sits inside: the examination and the signature, usually on the same day.", "rel": "step" }, { "to": "informed-consent", "as": "The word, and the doctrine behind the form being signed.", "rel": "term" }, { "to": "malpractice-recourse", "as": "What was consented to, in which language, is the first thing a claim turns on.", "rel": "kin" }, { "to": "choosing-a-facilitator", "as": "The step at which the seller becomes the interpreter.", "rel": "step" }, { "to": "facilitator", "as": "The company whose staff member often does the interpreting, and whose invoice it appears on.", "rel": "term" }, { "to": "turkiye-health-tourism-authorisation", "as": "The one regime this project has read that names interpreting and sets a language qualification for it.", "rel": "governed-by" }, { "to": "getting-your-records", "as": "The other translation nobody in the transaction owns.", "rel": "step" }, { "to": "follow-up-gap", "as": "Where an unclear consent surfaces: a clinician at home reading a form nobody can translate.", "rel": "kin" }, { "to": "jci", "as": "Certifies that a hospital runs a process; it is not a party to a consent.", "rel": "contrast" } ], "links": [ { "label": "Schenker et al., J Gen Intern Med 2007;22(Suppl 2):294-9", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2078548/" }, { "label": "Resmi Gazete, 13 July 2017, No. 30123 - the Turkish regulation", "url": "https://www.resmigazete.gov.tr/eskiler/2017/07/20170713-3.htm" } ], "sources": [ "s:schenker-consent-language", "s:flores-interpreter-errors-2012", "s:penney-broker-consent-2011", "s:rg-saglik-turizmi-2017" ], "provenance": { "default": { "tier": "cited", "source": "s:schenker-consent-language" }, "fields": { "text.story": { "tier": "cited", "source": "s:rg-saglik-turizmi-2017", "note": "the Turkish articles were read in Turkish off the Resmi Gazete page as published on 13 July 2017; amendments since that publication have not been checked" }, "text.how": { "tier": "inference", "note": "the four arrangements and where liability lands are this project reasoning from the cited studies and the one named regulation, marked inline. It is a description of a structure, not a reading of any court and not legal advice" }, "metrics": { "tier": "cited", "source": "s:schenker-consent-language" } } }, "confidence": "high", "needs_verification": true, "schema": 1, "type": "risk", "updated": "2026-09-17", "blurb": "A consent signed after a conversation conducted through a third person.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "arrival-and-consent", "type": "pathway", "name": "Arrival and consent", "as": "The step this risk sits inside: the examination and the signature, usually on the same day.", "rel": "step" }, { "to": "informed-consent", "type": "term", "name": "Informed consent", "as": "The word, and the doctrine behind the form being signed.", "rel": "term" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "What was consented to, in which language, is the first thing a claim turns on.", "rel": "kin" }, { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "The step at which the seller becomes the interpreter.", "rel": "step" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The company whose staff member often does the interpreting, and whose invoice it appears on.", "rel": "term" }, { "to": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The one regime this project has read that names interpreting and sets a language qualification for it.", "rel": "governed-by" }, { "to": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "The other translation nobody in the transaction owns.", "rel": "step" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Where an unclear consent surfaces: a clinician at home reading a form nobody can translate.", "rel": "kin" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "Certifies that a hospital runs a process; it is not a party to a consent.", "rel": "contrast" } ], "source_list": [ { "id": "s:schenker-consent-language", "kind": "paper", "title": "The impact of language barriers on documentation of informed consent at a hospital with on-site interpreter services", "publisher": "Schenker Y, Wang F, Selig SJ, Ng R, Fernandez A. Journal of General Internal Medicine 2007;22(Suppl 2):294–9", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2078548/", "accessed": "2026-09-16", "note": "74 matched pairs, lumbar puncture, thoracentesis and paracentesis, one US public teaching hospital, January 2004 to January 2006" }, { "id": "s:flores-interpreter-errors-2012", "kind": "paper", "title": "Errors of medical interpretation and their potential clinical consequences: a comparison of professional versus ad hoc versus no interpreters", "publisher": "Flores G, Abreu M, Barone CP, Bachur R, Lin H. Annals of Emergency Medicine 2012;60(5):545-53", "url": "https://pubmed.ncbi.nlm.nih.gov/22424655/", "accessed": "2026-09-17", "note": "57 audiotaped encounters over 30 months in the two largest paediatric emergency departments in Massachusetts, Spanish-speaking patients of limited English proficiency; 1,884 interpreter errors counted" }, { "id": "s:penney-broker-consent-2011", "kind": "paper", "title": "Risk communication and informed consent in the medical tourism industry: a thematic content analysis of Canadian broker websites", "publisher": "BMC Medical Ethics 2011;12:17 (Penney K, Snyder J, Crooks VA, Johnston R)", "url": "https://pubmed.ncbi.nlm.nih.gov/21943392/", "accessed": "2026-09-16" }, { "id": "s:rg-saglik-turizmi-2017", "kind": "web", "title": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik", "publisher": "Resmî Gazete, Republic of Türkiye (Ministry of Health)", "url": "https://www.resmigazete.gov.tr/eskiler/2017/07/20170713-3.htm", "accessed": "2026-09-16", "note": "Resmî Gazete 13 July 2017, No. 30123. Read in Turkish off the Resmî Gazete page. Article 5(1) makes an international health tourism authorisation certificate (yetki belgesi) compulsory for both the health facility and the intermediary; the Ministry halts the activity of anyone without one. Transitional Article 1 gave those already trading one year to comply. Article 16: in force on publication. REPEALED: MADDE 17 of the regulation of 26 April 2025 (Resmî Gazete 32882) revokes this one. Cite it for what the regime was, not for what it is." } ], "tiers": { "text.what": { "tier": "cited", "source": "s:schenker-consent-language" }, "text.story": { "tier": "cited", "source": "s:rg-saglik-turizmi-2017", "note": "the Turkish articles were read in Turkish off the Resmi Gazete page as published on 13 July 2017; amendments since that publication have not been checked" }, "text.how": { "tier": "inference", "note": "the four arrangements and where liability lands are this project reasoning from the cited studies and the one named regulation, marked inline. It is a description of a structure, not a reading of any court and not legal advice" }, "text.today": { "tier": "cited", "source": "s:schenker-consent-language" }, "metrics": { "tier": "cited", "source": "s:schenker-consent-language" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "japan", "type": "destination", "name": "Japan", "as": "The constraint that decides which Japanese hospitals can take a foreign patient at all.", "rel": "risk" }, { "from": "monterrey", "type": "hub", "name": "Monterrey", "as": "Answered here by policy — consent documents in English, interpreters on request — which is not the norm.", "rel": "risk" }, { "from": "arrival-and-consent", "type": "pathway", "name": "Arrival and consent", "as": "The risk this step runs on, with the published measurement of it.", "rel": "risk" }, { "from": "second-opinion", "type": "pathway", "name": "The second opinion", "as": "The same problem one step earlier: an opinion given in a language the patient does not read.", "rel": "risk" }, { "from": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "What was consented to, in which language, is the first thing any such claim turns on.", "rel": "kin" }, { "from": "gender-affirming-care-access", "type": "rule", "name": "Access to gender-affirming care", "as": "What a consent form gates when the statute does not.", "rel": "risk" }, { "from": "patient-data-transfer", "type": "rule", "name": "Moving a medical record across a border", "as": "The consent form, in whichever language it was actually signed.", "rel": "risk" }, { "from": "defiant", "type": "org", "name": "Defiant", "as": "Its stated answer to the language barrier is an interpreter at every appointment.", "rel": "risk" }, { "from": "informed-consent", "type": "term", "name": "Informed consent", "as": "The risk this doctrine runs into across a language barrier.", "rel": "risk" } ] }, { "id": "malpractice-recourse", "names": { "name": "Malpractice recourse across a border", "aliases": [ "legal recourse", "cross-border liability", "suing abroad" ], "said": "The brochure says \"fully accredited\". Neither word is a forum." }, "region": [ "global" ], "facets": { "kind": "legal" }, "text": { "what": "The question of which court will hear a claim against a clinician abroad, which country's law it will apply, how long the claimant has to bring it, and whether any judgment can be collected. The CDC puts the position in one sentence: patients \"might not have the same legal recourse as they would if they received their care in the United States\". The American Medical Association's guiding principles ask that patients be informed of their rights and legal recourse before agreeing to travel.", "story": "The subject has a founding legal text. Nathan Cortez's *Patients Without Borders*, at 83 Indiana Law Journal 71 (2008), set out the problem as one of health law rather than tort: a body of consumer protection, licensing, insurance regulation and malpractice liability that was built nationally and does not follow a patient across a frontier. I. Glenn Cohen's *Patients with Passports* (Oxford University Press, 2014) is the book-length treatment.\n\nWhat little empirical work exists looks at the destination rather than the source. Crooks, Cohen and colleagues convened nine lawyers in Barbados in February 2014 and found liability the first of five themes they raised unprompted; the ability of arriving patients to recover damages for an adverse event was one of the two concerns the authors identified as predominant both in the room and in the literature.\n\n*Inference —* the structural position is four separate obstacles, each of which is enough on its own. A suit brought at home must first establish that the home court has jurisdiction over a defendant who never traded there, and may be met with an argument that the proper forum is the country where the treatment happened. A suit brought there is governed by that country's law, including its limitation period and any statutory cap on damages, and is litigated in its language through local counsel. Damages awarded in either place reflect the cost of care where the award is made, not where the claimant will be treated. And a judgment is a piece of paper until a court where the defendant holds assets agrees to enforce it, which is a matter of bilateral arrangements that mostly do not exist between source markets and destinations.\n\nNone of that is specific to a bad clinic. It applies equally to a university hospital.", "how": "Contracts in this trade commonly name a governing law and a forum, and where a facilitator is involved its terms usually distinguish its own obligations — introducing, booking, arranging — from the clinical obligations of the treating facility. This project has read no such contract and holds none; the terms are private documents between a patient and a company.", "today": "As of 16 September 2026 no register, regulator or research group publishes a count of malpractice claims brought by cross-border patients, how many were heard, how many succeeded, or how many judgments were paid. The absence is not a gap in this site's research. Nobody has counted." }, "metrics": { "note": "No figure is carried on this record because none exists. There is no published count of cross-border malpractice claims brought, settled, tried or enforced, in any jurisdiction, by any body. The empirical work in the field is qualitative: the 2015 Barbados study interviewed nine lawyers in one focus group.", "as_of": "2026-09-16", "source": "s:crooks-barbados-lawyers-2015", "url": "https://pubmed.ncbi.nlm.nih.gov/26215979/" }, "kin": [ { "to": "complaint-and-claim", "as": "The step this risk decides the outcome of.", "rel": "step" }, { "to": "when-it-goes-wrong", "as": "The step at which the question first gets asked.", "rel": "step" }, { "to": "follow-up-gap", "as": "The reason there is often no name to sue.", "rel": "kin" }, { "to": "deposit-and-refund", "as": "The same contract, read at the other end of the trip.", "rel": "kin" }, { "to": "revision-at-home", "as": "The bill that lands while the claim is still theoretical.", "rel": "kin" }, { "to": "eu-directive-2011-24", "as": "The one instrument that gives a defined class of cross-border patients a stated route, inside one bloc.", "rel": "governed-by" }, { "to": "choosing-a-facilitator", "as": "The step at which a third party enters the contract, and the liability question splits in two.", "rel": "step" }, { "to": "jci", "as": "Accreditation is not a forum, and the accreditor is not a party.", "rel": "contrast" }, { "to": "language-consent", "as": "What was consented to, in which language, is the first thing any such claim turns on.", "rel": "kin" } ], "links": [ { "label": "Cortez, Patients Without Borders, 83 Ind. L.J. 71 (2008)", "url": "https://www.repository.law.indiana.edu/ilj/vol83/iss1/3/" }, { "label": "CDC Yellow Book 2026 — Medical Tourism", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" } ], "sources": [ "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism", "s:cortez-patients-without-borders-2008", "s:cohen-patients-with-passports-2014", "s:crooks-barbados-lawyers-2015" ], "provenance": { "default": { "tier": "cited", "source": "s:cortez-patients-without-borders-2008" }, "fields": { "text.story": { "tier": "inference", "note": "the four-obstacle paragraph is this project reasoning from the cited legal literature, marked inline; it is not a reading of any named instrument and it is not legal advice" }, "text.how": { "tier": "tradition", "note": "the general shape of the contracts in this trade; this project holds none of them" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "The question of which court will hear a claim against a clinician abroad, which country's law it will apply, how long the claimant has to bring it, and whether any judgment can be collected.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "complaint-and-claim", "type": "pathway", "name": "Complaint and claim", "as": "The step this risk decides the outcome of.", "rel": "step" }, { "to": "when-it-goes-wrong", "type": "pathway", "name": "When it goes wrong", "as": "The step at which the question first gets asked.", "rel": "step" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The reason there is often no name to sue.", "rel": "kin" }, { "to": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "The same contract, read at the other end of the trip.", "rel": "kin" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The bill that lands while the claim is still theoretical.", "rel": "kin" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The one instrument that gives a defined class of cross-border patients a stated route, inside one bloc.", "rel": "governed-by" }, { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "The step at which a third party enters the contract, and the liability question splits in two.", "rel": "step" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "Accreditation is not a forum, and the accreditor is not a party.", "rel": "contrast" }, { "to": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "What was consented to, in which language, is the first thing any such claim turns on.", "rel": "kin" } ], "source_list": [ { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:cortez-patients-without-borders-2008", "kind": "paper", "title": "Patients Without Borders: The Emerging Global Market for Patients and the Evolution of Modern Health Care", "publisher": "Indiana Law Journal 2008;83(1):71 (Cortez N, Southern Methodist University)", "url": "https://www.repository.law.indiana.edu/ilj/vol83/iss1/3/", "accessed": "2026-09-16" }, { "id": "s:cohen-patients-with-passports-2014", "kind": "book", "title": "Patients with Passports: Medical Tourism, Law, and Ethics", "publisher": "Oxford University Press, 2014 (Cohen IG), ISBN 9780199975099", "url": "https://openlibrary.org/works/OL21085324W", "accessed": "2026-09-16" }, { "id": "s:crooks-barbados-lawyers-2015", "kind": "paper", "title": "Inbound medical tourism to Barbados: a qualitative examination of local lawyers' prospective legal and regulatory concerns", "publisher": "BMC Health Services Research 2015;15:291 (Crooks VA, Cohen IG, Adams K, Whitmore R, Morgan J)", "url": "https://pubmed.ncbi.nlm.nih.gov/26215979/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:cortez-patients-without-borders-2008" }, "text.story": { "tier": "inference", "note": "the four-obstacle paragraph is this project reasoning from the cited legal literature, marked inline; it is not a reading of any named instrument and it is not legal advice" }, "text.how": { "tier": "tradition", "note": "the general shape of the contracts in this trade; this project holds none of them" }, "text.today": { "tier": "cited", "source": "s:cortez-patients-without-borders-2008" }, "metrics": { "tier": "cited", "source": "s:cortez-patients-without-borders-2008" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "iran", "type": "destination", "name": "Iran", "as": "What a foreign patient can do afterwards, in a jurisdiction their own courts cannot reach.", "rel": "risk" }, { "from": "north-cyprus", "type": "destination", "name": "Northern Cyprus", "as": "What is left when no EU contact point and no home regulator can reach the clinic.", "rel": "risk" }, { "from": "nicosia", "type": "hub", "name": "Nicosia", "as": "Which court hears the complaint, and whether its judgment is recognised anywhere else.", "rel": "risk" }, { "from": "santo-domingo", "type": "hub", "name": "Santo Domingo", "as": "What a patient has after an infection acquired in a clinic that has since been closed.", "rel": "risk" }, { "from": "singapore-city", "type": "hub", "name": "Singapore", "as": "Part of what is being bought here: a regulator and a court that will hear a complaint.", "rel": "risk" }, { "from": "tijuana", "type": "hub", "name": "Tijuana", "as": "What a patient has, and does not have, when the surgeon is in another jurisdiction twenty minutes away.", "rel": "risk" }, { "from": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "What a family can do, and where, when the death happens abroad.", "rel": "risk" }, { "from": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "Who answers for an operation performed where the recipient cannot sue and the donor cannot be found.", "rel": "risk" }, { "from": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "Who answers for an operation performed where the recipient cannot sue and the donor cannot be traced.", "rel": "risk" }, { "from": "stem-cell-unproven", "type": "procedure", "name": "Unapproved stem cell treatment", "as": "A claim about a product no regulator approved, brought against a provider in another country.", "rel": "risk" }, { "from": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "Whose court hears it when an arrangement across two jurisdictions fails.", "rel": "risk" }, { "from": "vaginoplasty", "type": "procedure", "name": "Vaginoplasty", "as": "Where a claim goes when the operation was performed in another jurisdiction.", "rel": "risk" }, { "from": "arrival-and-consent", "type": "pathway", "name": "Arrival and consent", "as": "Decided, often, by wording inside the form signed here.", "rel": "risk" }, { "from": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "What the intermediary's contract wording decides in advance.", "rel": "risk" }, { "from": "complaint-and-claim", "type": "pathway", "name": "Complaint and claim", "as": "The risk record this step is the procedure for.", "rel": "risk" }, { "from": "when-it-goes-wrong", "type": "pathway", "name": "When it goes wrong", "as": "Whether anything can be recovered, and where.", "rel": "risk" }, { "from": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "The same four obstacles, in front of a smaller sum.", "rel": "kin" }, { "from": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Without the surgeon's name, there is no defendant.", "rel": "kin" }, { "from": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "What was consented to, in which language, is the first thing a claim turns on.", "rel": "kin" }, { "from": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "A claim arising from an unlawful transaction has nowhere to go.", "rel": "kin" }, { "from": "unproven-stem-cell", "type": "risk", "name": "Unproven stem cell treatment", "as": "A claim for a treatment that was never approved, against a provider in another country.", "rel": "kin" }, { "from": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "Article 4(2)(d) requires the cover; it does not supply the forum.", "rel": "risk" }, { "from": "korea-foreign-patient-registration", "type": "rule", "name": "Korea's foreign patient attraction registration", "as": "The exposure Article 6 insures against, inside one jurisdiction.", "rel": "risk" }, { "from": "patient-data-transfer", "type": "rule", "name": "Moving a medical record across a border", "as": "The record is the evidence, and the claim turns on it.", "rel": "risk" }, { "from": "stem-cell-regulation", "type": "rule", "name": "Regulating cell and tissue therapies", "as": "Where a claim goes when the treatment was lawful where it was given.", "rel": "risk" }, { "from": "uae-clinic-licensing", "type": "rule", "name": "Licensing a clinic in the United Arab Emirates", "as": "Where a complaint goes depends on which body holds the licence.", "rel": "risk" }, { "from": "defiant", "type": "org", "name": "Defiant", "as": "Publishes its own account of what recourse a foreign patient has under Thai law.", "rel": "risk" }, { "from": "informed-consent", "type": "term", "name": "Informed consent", "as": "What a defective consent is worth in a forum the patient cannot reach.", "rel": "risk" }, { "from": "the-follow-up-nobody-books", "type": "story", "name": "The follow-up nobody books", "as": "Without the surgeon's name, recorded for none of 25 patients in one series, there is no defendant.", "rel": "risk" } ] }, { "id": "nontuberculous-mycobacteria", "names": { "name": "Nontuberculous mycobacteria", "aliases": [ "NTM", "rapidly growing mycobacteria", "Mycobacterium abscessus" ], "said": "The first culture comes back negative, because the organism grows too slowly for a standard plate." }, "region": [ "global", "caribbean" ], "facets": { "kind": "infection" }, "text": { "what": "Environmental mycobacteria that live in water and soil, are not tuberculosis, resist most ordinary antibiotics, and infect surgical wounds where instruments, rinse water or injectables were contaminated. The CDC names the resulting outbreak in its medical travel chapter: \"surgical site infections caused by nontuberculous mycobacteria in patients who underwent cosmetic surgery in the Dominican Republic\".", "story": "The first cluster began with two Maryland residents in 2013 whose surgical sites would not respond to treatment after cosmetic procedures at one Dominican clinic. The multistate investigation that followed identified 21 case-patients in 6 states who had been operated on at one of 5 clinics, 13 of them — 62% — at the same one. Isolates from 12 of those patients, 92%, grew Mycobacterium abscessus complex.\n\nWhat the same investigation recorded about treatment is the part worth carrying. Of 9 case-patients from that clinic with data available, all required therapeutic surgical intervention, 8 were hospitalised, and 7 needed three months or more of antibacterial therapy. The report notes incomplete information on the financial burden, with some patients experiencing insurance claim denials and lost wages.\n\nIt happened again. In 2018 the CDC reported a second Dominican cluster: 52 patients reported, 38 meeting the confirmed case definition, with surgery between 4 January and 14 July 2017. Twenty-six of 32 confirmed cases with information available had been treated at one centre, Centro Internacional de Cirugía Plástica Avanzada; 14 surgeons at seven surgical centres were identified in total. Fourteen of 15 with treatment information required therapeutic surgical procedures after returning to the United States. One death was reported.\n\nA 2023 systematic review of 44 studies covering 589 patients who presented with complications after cosmetic surgery abroad found that 98% of the infectious organisms were bacterial and 81% of those were from the genus Mycobacterium.\n\n*Inference —* the organism is not exotic, and the pattern is not about a country. It is about water and instrument reprocessing in high-volume elective surgery, which is a procurement and engineering question rather than a surgical one, and which no accreditation logo on a website discloses.", "how": "These infections declare themselves late, over weeks rather than days, as painless or mildly painful nodules and non-healing wounds that do not respond to standard antibiotics. Diagnosis needs the laboratory to be told to look: standard cultures may be reported negative because the organism grows slowly. Treatment is multi-drug, months long, frequently intravenous, and usually requires the wound to be opened and debrided more than once.", "today": "As of 16 September 2026 the two Dominican investigations remain the best-documented clusters, at 21 and 38 confirmed cases respectively, and they are counts of people who presented in the United States rather than rates for any clinic or any country." }, "metrics": { "note": "From the 2013-2014 investigation: 21 case-patients in 6 US states operated on at 5 Dominican clinics, 13 of them at one clinic; Mycobacterium abscessus complex in 12 of 13 isolates tested; of 9 patients from that clinic with data, all required therapeutic surgery, 8 were hospitalised and 7 needed three months or more of antibacterial therapy. From the 2017 cluster: 52 patients reported, 38 confirmed, 1 death, 14 of 15 with data requiring surgery after returning. Case counts, not rates.", "as_of": "2016", "source": "s:eid-dr-mycobacteria-2016", "url": "https://wwwnc.cdc.gov/eid/article/22/8/15-1938_article" }, "kin": [ { "to": "dominican-republic-ntm-outbreak", "as": "The investigations themselves, with their clinics and dates.", "rel": "event" }, { "to": "dominican-republic", "as": "Where both clusters were traced to.", "rel": "place" }, { "to": "santo-domingo", "as": "The city the named clinics operated in.", "rel": "place" }, { "to": "surgical-site-infection", "as": "The general case this is the hardest version of.", "rel": "whole" }, { "to": "antimicrobial-resistance", "as": "Resistant by nature rather than by acquisition, which is why the courses run months.", "rel": "kin" }, { "to": "bbl", "as": "Among the cosmetic procedures the case-patients had travelled for.", "rel": "procedure" }, { "to": "liposuction", "as": "Among the procedures in both Dominican clusters.", "rel": "procedure" }, { "to": "abdominoplasty", "as": "Among the procedures in both Dominican clusters.", "rel": "procedure" }, { "to": "revision-at-home", "as": "All of the documented cases needed further surgery after returning.", "rel": "kin" }, { "to": "follow-up-gap", "as": "Weeks-long incubation means the first clinician to see it is always at home.", "rel": "kin" } ], "links": [ { "label": "Emerging Infectious Diseases 2016 — multistate outbreak, Dominican Republic 2013-2014", "url": "https://wwwnc.cdc.gov/eid/article/22/8/15-1938_article" }, { "label": "MMWR 2018 — Notes from the Field, Dominican Republic 2017", "url": "https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a5.htm" } ], "sources": [ "s:eid-dr-mycobacteria-2016", "s:mmwr-dr-mycobacteria-2018", "s:alkaelani-aesthetic-review-2023", "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited", "source": "s:eid-dr-mycobacteria-2016" }, "fields": { "text.story": { "tier": "cited", "note": "the closing paragraph is marked inline as this project's reading" }, "text.how": { "tier": "tradition", "note": "the clinical and laboratory account is general knowledge of the organism; the case numbers are cited" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "Environmental mycobacteria that live in water and soil, are not tuberculosis, resist most ordinary antibiotics, and infect surgical wounds where instruments, rinse water or injectables were contaminated.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "caribbean", "name": "The Caribbean", "note": "the Dominican Republic, Cuba, Barbados, the Caymans" } ], "kin_out": [ { "to": "dominican-republic-ntm-outbreak", "type": "event", "name": "The Dominican mycobacterial outbreaks, 2013–14 and 2017", "as": "The investigations themselves, with their clinics and dates.", "rel": "event" }, { "to": "dominican-republic", "type": "destination", "name": "Dominican Republic", "as": "Where both clusters were traced to.", "rel": "place" }, { "to": "santo-domingo", "type": "hub", "name": "Santo Domingo", "as": "The city the named clinics operated in.", "rel": "place" }, { "to": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The general case this is the hardest version of.", "rel": "whole" }, { "to": "antimicrobial-resistance", "type": "risk", "name": "Antimicrobial resistance acquired abroad", "as": "Resistant by nature rather than by acquisition, which is why the courses run months.", "rel": "kin" }, { "to": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "Among the cosmetic procedures the case-patients had travelled for.", "rel": "procedure" }, { "to": "liposuction", "type": "procedure", "name": "Liposuction", "as": "Among the procedures in both Dominican clusters.", "rel": "procedure" }, { "to": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "Among the procedures in both Dominican clusters.", "rel": "procedure" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "All of the documented cases needed further surgery after returning.", "rel": "kin" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Weeks-long incubation means the first clinician to see it is always at home.", "rel": "kin" } ], "source_list": [ { "id": "s:eid-dr-mycobacteria-2016", "kind": "paper", "title": "Multistate US Outbreak of Rapidly Growing Mycobacterial Infections Associated with Medical Tourism to the Dominican Republic, 2013-2014", "publisher": "Emerging Infectious Diseases 2016;22(8), US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/eid/article/22/8/15-1938_article", "accessed": "2026-09-16" }, { "id": "s:mmwr-dr-mycobacteria-2018", "kind": "org", "title": "Notes from the Field: Nontuberculous Mycobacteria Infections in U.S. Medical Tourists Associated with Plastic Surgery — Dominican Republic, 2017", "publisher": "Morbidity and Mortality Weekly Report 2018;67(12), US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a5.htm", "accessed": "2026-09-16" }, { "id": "s:alkaelani-aesthetic-review-2023", "kind": "paper", "title": "Complications of Medical Tourism in Aesthetic Surgery: A Systematic Review", "publisher": "Annals of Plastic Surgery 2023;91(6):668-673 (Alkaelani MT, Koussayer B, Blount T, et al.)", "url": "https://pubmed.ncbi.nlm.nih.gov/37962261/", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:eid-dr-mycobacteria-2016" }, "text.story": { "tier": "cited", "note": "the closing paragraph is marked inline as this project's reading" }, "text.how": { "tier": "tradition", "note": "the clinical and laboratory account is general knowledge of the organism; the case numbers are cited" }, "text.today": { "tier": "cited", "source": "s:eid-dr-mycobacteria-2016" }, "metrics": { "tier": "cited", "source": "s:eid-dr-mycobacteria-2016" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "dominican-republic", "type": "destination", "name": "Dominican Republic", "as": "The organism that made this country a case study.", "rel": "risk" }, { "from": "santo-domingo", "type": "hub", "name": "Santo Domingo", "as": "The organism that made this city a case study, twice, four years apart.", "rel": "risk" }, { "from": "antimicrobial-resistance", "type": "risk", "name": "Antimicrobial resistance acquired abroad", "as": "Already resistant by nature, and the reason those wounds took three months of therapy.", "rel": "kin" }, { "from": "bbl-mortality", "type": "risk", "name": "Death from gluteal fat grafting", "as": "What the survivors of the Dominican clusters had come for.", "rel": "kin" }, { "from": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The organism behind the best-documented cluster of these infections in cosmetic surgery patients returning from abroad.", "rel": "kin" }, { "from": "dominican-republic-ntm-outbreak", "type": "event", "name": "The Dominican mycobacterial outbreaks, 2013–14 and 2017", "as": "The organism, and why water and solutions are where it comes from.", "rel": "risk" } ] }, { "id": "repatriation-cost", "names": { "name": "Repatriation and medical evacuation cost", "aliases": [ "medevac", "air ambulance", "medical evacuation" ], "said": "The industry says medevac. An invoice says air ambulance, and it is five or six figures." }, "region": [ "global" ], "facets": { "kind": "financial" }, "text": { "what": "The cost of moving a patient who cannot fly commercially from where they were treated to a hospital that can finish the job. The CDC's travel insurance chapter states the range: \"The total cost of a medevac varies by location, ranging from USD 25,000 for transport within North America to over USD 250,000 for more distant and remote locations\", and adds that costs increase when the patient is critically ill or needs complex infection control measures.", "story": "Three features of that figure decide who carries it, and none of them is the number.\n\nThe first is that the decision is not the patient's. \"The decision to medically evacuate is at the discretion of the insurance company; it is not made at the request of the traveler\", the CDC states, and the usual threshold is hospitalisation with more days expected, or a treatment not available to comparable standard where the patient is.\n\nThe second is that domestic cover mostly does not reach. For US Medicare beneficiaries the position is stated flatly: except in limited circumstances the programme does not cover medical costs incurred outside the United States, nor medical evacuation. Medigap plans C, D, F, G, M and N cover some emergency care begun in the first 60 days abroad, at 80% of billed charges after a USD 250 deductible, with a USD 50,000 lifetime maximum. A single distant evacuation can exceed that lifetime cap five times over.\n\nThe third is that a policy bought is not a claim paid. The CDC cites a study of international travellers with travel health insurance claims in which insurers fully paid only two-thirds of them, the main reasons for refusal being pre-existing illness and poor documentation of expenses incurred.\n\n*Trade practice —* travel policies sold to leisure travellers commonly exclude treatment the traveller went abroad to obtain, and complications arising from it, on the ground that the trip was not a holiday during which something went wrong. This project has read no policy wording and states this as the trade's account rather than a fact; the wordings are private documents, and no regulator publishes a survey of them.\n\n*Inference —* the exposure therefore tends to land on the family, because the patient is unconscious or immobile and somebody has to guarantee the flight before it takes off.", "how": "An evacuation is an aircraft, a medical crew, ground transport at both ends and a receiving bed that has agreed to take the patient. Dedicated medical evacuation cover is bought separately or bundled; the CDC describes the standalone product as \"relatively inexpensive\" against the cost of the event. Features that decide whether it works are whether the insurer will guarantee payment direct to the hospital, whether there is a 24-hour physician-backed centre, and whether the policy repatriates to the home country or only to the nearest adequate facility.", "today": "As of 16 September 2026 the published range this site carries is USD 25,000 to over USD 250,000, from the CDC's 2026 edition. No figure exists for how often an evacuation follows an elective operation abroad, or for what share of those bills an insurer paid." }, "metrics": { "note": "USD 25,000 for transport within North America to over USD 250,000 for more distant and remote locations, as published by the CDC in the 2026 Yellow Book; higher for a critically ill patient or one needing complex infection control. The same chapter reports that in a study of international travellers with travel health insurance claims, insurers fully paid two-thirds of claims. Neither figure is specific to patients who travelled in order to be operated on; no such figure has been published.", "as_of": "2026-09-16", "source": "s:cdc-yellowbook-travel-insurance", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/travel-insurance.html" }, "kin": [ { "to": "insurance-exclusions", "as": "The rule that decides whether any of this is covered.", "rel": "governed-by" }, { "to": "us-medicare-abroad", "as": "The entitlement that does not extend to this, stated in the same chapter.", "rel": "governed-by" }, { "to": "when-it-goes-wrong", "as": "The step at which the aircraft is chartered.", "rel": "step" }, { "to": "the-flight-home", "as": "The ordinary version of the same journey, at the price of a seat.", "rel": "contrast" }, { "to": "flying-after-surgery", "as": "The guidance that, followed, keeps a patient off this aircraft.", "rel": "kin" }, { "to": "bbl-mortality", "as": "The complication most likely to make a patient unfit to board a scheduled flight.", "rel": "kin" }, { "to": "revision-at-home", "as": "What the bill becomes once the patient has landed.", "rel": "kin" }, { "to": "the-escort-burden", "as": "Who signs the guarantee when the patient cannot.", "rel": "kin" } ], "links": [ { "label": "CDC Yellow Book 2026 — Travel Insurance and Medical Evacuation Insurance", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/travel-insurance.html" } ], "sources": [ "s:cdc-yellowbook-travel-insurance", "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited", "source": "s:cdc-yellowbook-travel-insurance" }, "fields": { "text.story": { "tier": "cited", "note": "the fourth and fifth paragraphs are marked inline as trade practice and inference; this project has read no policy wording" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "The cost of moving a patient who cannot fly commercially from where they were treated to a hospital that can finish the job.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "The rule that decides whether any of this is covered.", "rel": "governed-by" }, { "to": "us-medicare-abroad", "type": "rule", "name": "Medicare outside the United States", "as": "The entitlement that does not extend to this, stated in the same chapter.", "rel": "governed-by" }, { "to": "when-it-goes-wrong", "type": "pathway", "name": "When it goes wrong", "as": "The step at which the aircraft is chartered.", "rel": "step" }, { "to": "the-flight-home", "type": "pathway", "name": "The flight home", "as": "The ordinary version of the same journey, at the price of a seat.", "rel": "contrast" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The guidance that, followed, keeps a patient off this aircraft.", "rel": "kin" }, { "to": "bbl-mortality", "type": "risk", "name": "Death from gluteal fat grafting", "as": "The complication most likely to make a patient unfit to board a scheduled flight.", "rel": "kin" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "What the bill becomes once the patient has landed.", "rel": "kin" }, { "to": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "Who signs the guarantee when the patient cannot.", "rel": "kin" } ], "source_list": [ { "id": "s:cdc-yellowbook-travel-insurance", "kind": "org", "title": "Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance — CDC Yellow Book 2026, chapter by Rhett J. Stoney", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/travel-insurance.html", "accessed": "2026-09-16", "note": "carries the USD 25,000 to over USD 250,000 medevac range, the Medicare and Medigap limits, and the finding that insurers fully paid two-thirds of travel health claims" }, { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:cdc-yellowbook-travel-insurance" }, "text.story": { "tier": "cited", "note": "the fourth and fifth paragraphs are marked inline as trade practice and inference; this project has read no policy wording" }, "text.how": { "tier": "cited", "source": "s:cdc-yellowbook-travel-insurance" }, "text.today": { "tier": "cited", "source": "s:cdc-yellowbook-travel-insurance" }, "metrics": { "tier": "cited", "source": "s:cdc-yellowbook-travel-insurance" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "johannesburg", "type": "hub", "name": "Johannesburg", "as": "Who pays for the flight home when a referral goes wrong, and on whose insurance.", "rel": "risk" }, { "from": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "What it costs to bring home a patient whose bypass went wrong abroad.", "rel": "risk" }, { "from": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "What a course of daily treatment abroad costs beyond the treatment.", "rel": "risk" }, { "from": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The bill an excluded policy leaves with the family.", "rel": "risk" }, { "from": "the-flight-home", "type": "pathway", "name": "The flight home", "as": "What this step becomes when a scheduled seat is no longer possible.", "rel": "risk" }, { "from": "when-it-goes-wrong", "type": "pathway", "name": "When it goes wrong", "as": "The bill when a scheduled seat is no longer an option.", "rel": "risk" }, { "from": "bbl-mortality", "type": "risk", "name": "Death from gluteal fat grafting", "as": "What moving a patient in this condition costs, when they can be moved at all.", "rel": "kin" }, { "from": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "What it costs when the patient cannot board at all.", "rel": "kin" }, { "from": "fungal-meningitis", "type": "risk", "name": "Fungal meningitis after epidural anaesthesia", "as": "What it costs to move a patient in this condition.", "rel": "kin" }, { "from": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "The other cost a state names in the same bylaw, and a private buyer meets alone.", "rel": "kin" }, { "from": "assisted-dying-law", "type": "rule", "name": "Assisted dying, and who may cross a border for it", "as": "The bill that follows, and that no row here carries.", "rel": "risk" }, { "from": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "The single largest number that falls in the gap.", "rel": "risk" }, { "from": "us-medicare-abroad", "type": "rule", "name": "Medicare outside the United States", "as": "The bill the exceptions do not reach.", "rel": "risk" }, { "from": "repatriation", "type": "term", "name": "Repatriation", "as": "The risk record behind this word, with the CDC range and who decides.", "rel": "risk" } ] }, { "id": "revision-at-home", "names": { "name": "Revision at home", "aliases": [ "putting it right", "corrective surgery", "the second operation" ], "said": "The clinic abroad calls it a touch-up. The unit at home codes it as an emergency admission." }, "region": [ "global" ], "facets": { "kind": "financial" }, "text": { "what": "The second operation, performed in the patient's own country by a surgeon who did not perform the first, on a wound whose details nobody recorded. It is the only part of this subject with a running set of published costs, because a publicly funded system that pays for it has a reason to count.", "story": "Five UK plastic surgery units have published their own ledgers, and they agree in shape.\n\nA London teaching hospital reviewed patients surgically managed between 2006 and 2018 for complications of cosmetic surgery abroad: 24 patients, 22 of them women, mean age 36. Gluteal enhancement was the commonest procedure at 38% and infection the commonest complication at 92%. Twenty-one were inpatients, mean stay 8 days with a range of 1 to 49. Total cost to the hospital USD 406,233, mean USD 16,296 per patient, range USD 817 to USD 41,778; abdominoplasty complications cost most per patient at USD 20,404. Most of the procedures had been done in Turkey.\n\nA major trauma centre reviewed January 2013 to August 2017 and found 20 patients. Costed against national tariffs and grouped by severity, the eight minor cases came to £3,448, the eight intermediate to £18,271, and the four major to £42,083.59. All four major complications were gluteal augmentations.\n\nA Manchester breast unit, twelve months across 2022 and 2023: 25 patients, 20 operated on abroad, 15 of those in Turkey, at least £37,000.\n\nA London hospital across 17 months to 2025: 96% of the surgical patients presenting with complications had been operated on abroad, 73% in Turkey, total estimated £110,690.\n\nA Birmingham tertiary centre, 2020 to 2025: 749 records screened, 29 patients, 58 hospital presentations, 82.8% of the procedures done in Turkey, mean inpatient stay 9.2 days, 27 theatre interventions. Nearly half the presentations — 48.3% — were repeat attendances after an earlier complication. Total £518,058.47, mean £17,864 per patient, individual presentations from about £46 to £57,691.\n\n*Inference —* these are counts of arrivals at five doors, not rates. No national system records how many of its residents had surgery abroad, so there is no denominator, and the totals are floors rather than estimates. What they do establish is the direction of the transfer: the fee was paid to a private provider in one country and the correction was paid for by a public system in another, which was never party to the transaction and cannot bill anyone for it.\n\nThe patient's own position is separate and worse documented. A publicly funded system will treat a complication; whether it will redo an unsatisfactory cosmetic result is a different question, usually answered no, and this project has found no published national policy stating the line.", "how": "The revision is harder than the original for a reason that has nothing to do with the first surgeon's skill. The operative note is usually missing, the implant or device model is unknown, the organism may be atypical and slow-growing, and the tissue has already been operated on once. Where an implant is involved the second device is bought again. The General Medical Council requires a doctor on its register to say at the outset what revision or routine follow-up might cost; that duty does not travel.", "today": "As of 16 September 2026 the five published UK series this record carries total roughly £1.1 million across 123 patients, over periods from one year to twelve, at five hospitals. No country publishes a national figure, and no destination publishes what its own clinics spend on revisions." }, "metrics": { "note": "Mean cost per patient of correcting complications of cosmetic surgery abroad, from five single-centre UK series: USD 16,296 (Royal Free London, 2006-2018, 24 patients); £3,448 minor, £18,271 intermediate and £42,083.59 major (Royal London, 2013-2017, 20 patients); at least £37,000 total (Wythenshawe breast unit, 2022-2023, 25 patients); £110,690 total (a London hospital, 17 months to 2025); and £17,864 mean per patient on £518,058.47 total (Queen Elizabeth Birmingham, 2020-2025, 29 patients over 58 presentations). Each is a count of who arrived at one hospital. There is no denominator, so no rate can be computed from any of them.", "as_of": "2026", "source": "s:mafi-cosmetic-tourism-cost-2026", "url": "https://pubmed.ncbi.nlm.nih.gov/42311717/" }, "kin": [ { "to": "when-it-goes-wrong", "as": "The step this is the bill for.", "rel": "step" }, { "to": "aftercare-at-home", "as": "The step it interrupts.", "rel": "step" }, { "to": "follow-up-gap", "as": "Why the second surgeon operates without an operative note.", "rel": "kin" }, { "to": "revision", "as": "The word, and what it covers when a package says it is included.", "rel": "term" }, { "to": "turkiye", "as": "Named as the country of the first operation in most of the UK series.", "rel": "place" }, { "to": "united-kingdom", "as": "The system that published its own ledgers, which is why this record has numbers at all.", "rel": "place" }, { "to": "bbl", "as": "Gluteal augmentation was the commonest procedure and the source of every major complication in two of the series.", "rel": "procedure" }, { "to": "abdominoplasty", "as": "The highest cost per patient in the Royal Free series.", "rel": "procedure" }, { "to": "breast-augmentation", "as": "The commonest procedure in the Manchester breast unit series.", "rel": "procedure" }, { "to": "uk-nhs-treatment-abroad", "as": "The entitlement that does not cover any of this.", "rel": "governed-by" }, { "to": "surgical-site-infection", "as": "The complication driving 92% of one series.", "rel": "kin" }, { "to": "implant-excluded", "as": "The second device is bought again, in a second country.", "rel": "kin" } ], "links": [ { "label": "Thacoor et al., Aesthetic Surgery Journal 2019", "url": "https://pubmed.ncbi.nlm.nih.gov/30590431/" }, { "label": "Mafi et al., Cureus 2026", "url": "https://pubmed.ncbi.nlm.nih.gov/42311717/" } ], "sources": [ "s:thacoor-nhs-cost-2019", "s:farid-cosmetic-abroad-2019", "s:ahari-breast-unit-2024", "s:whiteman-nhs-burden-2025", "s:mafi-cosmetic-tourism-cost-2026", "s:gmc-cosmetic-interventions", "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited", "source": "s:mafi-cosmetic-tourism-cost-2026" }, "fields": { "text.story": { "tier": "cited", "note": "the paragraph on denominators is marked inline as this project's reasoning" }, "text.how": { "tier": "tradition", "note": "the operative account is the trade's; the GMC duty is cited" }, "metrics": { "tier": "cited", "source": "s:mafi-cosmetic-tourism-cost-2026" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "The second operation, performed in the patient's own country by a surgeon who did not perform the first, on a wound whose details nobody recorded.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "when-it-goes-wrong", "type": "pathway", "name": "When it goes wrong", "as": "The step this is the bill for.", "rel": "step" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The step it interrupts.", "rel": "step" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Why the second surgeon operates without an operative note.", "rel": "kin" }, { "to": "revision", "type": "term", "name": "Revision", "as": "The word, and what it covers when a package says it is included.", "rel": "term" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "Named as the country of the first operation in most of the UK series.", "rel": "place" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The system that published its own ledgers, which is why this record has numbers at all.", "rel": "place" }, { "to": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "Gluteal augmentation was the commonest procedure and the source of every major complication in two of the series.", "rel": "procedure" }, { "to": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "The highest cost per patient in the Royal Free series.", "rel": "procedure" }, { "to": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "The commonest procedure in the Manchester breast unit series.", "rel": "procedure" }, { "to": "uk-nhs-treatment-abroad", "type": "rule", "name": "NHS funding for treatment abroad", "as": "The entitlement that does not cover any of this.", "rel": "governed-by" }, { "to": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The complication driving 92% of one series.", "rel": "kin" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The second device is bought again, in a second country.", "rel": "kin" } ], "source_list": [ { "id": "s:thacoor-nhs-cost-2019", "kind": "paper", "title": "Surgical Management of Cosmetic Surgery Tourism-Related Complications: Current Trends and Cost Analysis Study of the Financial Impact on the UK National Health Service", "publisher": "Aesthetic Surgery Journal 2019;39(7):786-791 (Thacoor A, van den Bosch P, Akhavani MA), Royal Free Hospital, London", "url": "https://pubmed.ncbi.nlm.nih.gov/30590431/", "accessed": "2026-09-16" }, { "id": "s:farid-cosmetic-abroad-2019", "kind": "paper", "title": "Complications of Cosmetic Surgery Abroad — Cost Analysis and Patient Perception", "publisher": "Plastic and Reconstructive Surgery Global Open 2019;7(6):e2281 (Farid M, Nikkhah D, Little M, Edwards D, Needham W, Shibu M), Royal London Hospital", "url": "https://pubmed.ncbi.nlm.nih.gov/31624684/", "accessed": "2026-09-16" }, { "id": "s:ahari-breast-unit-2024", "kind": "paper", "title": "The impact of cosmetic tourism across one year on an NHS breast surgery unit", "publisher": "Journal of Plastic, Reconstructive and Aesthetic Surgery 2024;99:462-467 (Ahari D, Zaccariah ZR, Preston M, Highton L), Wythenshawe Hospital", "url": "https://pubmed.ncbi.nlm.nih.gov/39476527/", "accessed": "2026-09-16" }, { "id": "s:whiteman-nhs-burden-2025", "kind": "paper", "title": "The rising NHS burden from cosmetic surgery procedures performed abroad and non-surgical procedures performed in the United Kingdom", "publisher": "Journal of Plastic, Reconstructive and Aesthetic Surgery 2025;102:39-41 (Whiteman E, Romain K, Welman T, et al.)", "url": "https://pubmed.ncbi.nlm.nih.gov/39892185/", "accessed": "2026-09-16" }, { "id": "s:mafi-cosmetic-tourism-cost-2026", "kind": "paper", "title": "Recurrent Clinical Burden and Cost of Cosmetic Surgery Tourism Complications: A Five-Year Retrospective Study From a UK Tertiary Centre", "publisher": "Cureus 2026;18(5):e109006 (Mafi P, Patel K, Hoque-Uddin S, Warner R), Queen Elizabeth Hospital Birmingham", "url": "https://pubmed.ncbi.nlm.nih.gov/42311717/", "accessed": "2026-09-16" }, { "id": "s:gmc-cosmetic-interventions", "kind": "org", "title": "Guidance for doctors who offer cosmetic interventions — in effect 1 June 2016, updated 13 December 2024", "publisher": "General Medical Council (United Kingdom)", "url": "https://www.gmc-uk.org/professional-standards/the-professional-standards/cosmetic-interventions", "accessed": "2026-09-16", "note": "paragraph numbers cited on this site are from the sections Communication, partnership and teamwork (paras 14-45) and Maintaining trust (paras 46-56)" }, { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:mafi-cosmetic-tourism-cost-2026" }, "text.story": { "tier": "cited", "note": "the paragraph on denominators is marked inline as this project's reasoning" }, "text.how": { "tier": "tradition", "note": "the operative account is the trade's; the GMC duty is cited" }, "text.today": { "tier": "cited", "source": "s:mafi-cosmetic-tourism-cost-2026" }, "metrics": { "tier": "cited", "source": "s:mafi-cosmetic-tourism-cost-2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "australia", "type": "destination", "name": "Australia", "as": "Who fixes it, and at whose cost, once the patient has landed.", "rel": "risk" }, { "from": "dominican-republic", "type": "destination", "name": "Dominican Republic", "as": "Fourteen of 19 in the first cluster were admitted in the United States for it.", "rel": "risk" }, { "from": "hungary", "type": "destination", "name": "Hungary", "as": "Who refits a crown that fails after the second flight home.", "rel": "risk" }, { "from": "mexico", "type": "destination", "name": "Mexico", "as": "Who fixes it, and what that bill looks like: $193,445.08 a patient in the San Diego series.", "rel": "risk" }, { "from": "turkiye", "type": "destination", "name": "Türkiye", "as": "The bill that lands on another health system when a graft or a sleeve needs doing again.", "rel": "risk" }, { "from": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The operation the NHS performs and did not price.", "rel": "risk" }, { "from": "united-states", "type": "destination", "name": "United States", "as": "This is the 'home' in that phrase for most of the traffic on this site.", "rel": "risk" }, { "from": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "Who refits the crown in Ohio when it fails, and at whose price.", "rel": "risk" }, { "from": "sopron", "type": "hub", "name": "Sopron", "as": "Who repairs the crown, ninety minutes back across the border.", "rel": "risk" }, { "from": "tunis", "type": "hub", "name": "Tunis", "as": "Who operates again, in Paris or Lyon, when a result needs correcting.", "rel": "risk" }, { "from": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "Who remakes the bridge when it fractures, and at whose price.", "rel": "risk" }, { "from": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "Who treats the complication after the flight, and who pays.", "rel": "risk" }, { "from": "cochlear-implant", "type": "procedure", "name": "Cochlear implant", "as": "Who reimplants a failed internal device, and on whose bill.", "rel": "risk" }, { "from": "dental-crown", "type": "procedure", "name": "Dental crown", "as": "Who recements a crown that comes off at home, and what they charge.", "rel": "risk" }, { "from": "gastric-bypass", "type": "procedure", "name": "Gastric bypass", "as": "Who operates when a join leaks or a pouch fails, in a country that did not do the first operation.", "rel": "risk" }, { "from": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "Who operates when a sleeve leaks, strictures or has to become a bypass.", "rel": "risk" }, { "from": "heart-valve-replacement", "type": "procedure", "name": "Heart valve replacement", "as": "Who replaces a tissue valve in fifteen years, and where.", "rel": "risk" }, { "from": "hernia-repair", "type": "procedure", "name": "Hernia repair", "as": "Who repairs a recurrence, and who deals with chronic groin pain after a mesh.", "rel": "risk" }, { "from": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "Who operates when the cup loosens, and who pays for it.", "rel": "risk" }, { "from": "lasik", "type": "procedure", "name": "LASIK", "as": "What an included enhancement is worth once the patient is on another continent.", "rel": "risk" }, { "from": "phalloplasty", "type": "procedure", "name": "Phalloplasty", "as": "Urethral fistula and stricture are the complications that arrive after the flight, and they need a surgeon.", "rel": "risk" }, { "from": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "Who fixes it, and at what price, once the patient has flown back.", "rel": "risk" }, { "from": "root-canal", "type": "procedure", "name": "Root canal treatment", "as": "Who retreats a root filling that fails after the flight home.", "rel": "risk" }, { "from": "top-surgery", "type": "procedure", "name": "Top surgery", "as": "Haematoma and graft loss declare themselves in the first fortnight, often after the flight.", "rel": "risk" }, { "from": "vaginoplasty", "type": "procedure", "name": "Vaginoplasty", "as": "Who repairs a fistula or a lost depth, and where the price for that is published.", "rel": "risk" }, { "from": "veneers", "type": "procedure", "name": "Dental veneers", "as": "Who rebonds a veneer that debonds after the flight, and at whose price.", "rel": "risk" }, { "from": "hospital-angeles-tijuana", "type": "facility", "name": "Hospital Angeles Tijuana", "as": "The revision happens on the American side, at American prices, with no record from the Mexican side.", "rel": "risk" }, { "from": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "What happens when the operation has to be done again, by someone else.", "rel": "risk" }, { "from": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "Why the implant's make and serial number matter years later.", "rel": "risk" }, { "from": "bbl-mortality", "type": "risk", "name": "Death from gluteal fat grafting", "as": "Gluteal augmentation accounts for most of the major complications in the published UK readmission series.", "rel": "kin" }, { "from": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "What the gap costs, once somebody has to operate again.", "rel": "kin" }, { "from": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "When the device fails, the second one is bought in a different country.", "rel": "kin" }, { "from": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "The bill that lands while the claim is still theoretical.", "rel": "kin" }, { "from": "nontuberculous-mycobacteria", "type": "risk", "name": "Nontuberculous mycobacteria", "as": "All of the documented cases needed further surgery after returning.", "rel": "kin" }, { "from": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "What the bill becomes once the patient has landed.", "rel": "kin" }, { "from": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "Who pays for the theatre time when the wound has to be reopened.", "rel": "kin" }, { "from": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "Who pays for the second operation.", "rel": "risk" }, { "from": "patient-data-transfer", "type": "rule", "name": "Moving a medical record across a border", "as": "The operation planned blind when the note did not travel.", "rel": "risk" }, { "from": "uk-nhs-treatment-abroad", "type": "rule", "name": "NHS funding for treatment abroad", "as": "The bill the NHS picks up when an operation bought abroad goes wrong.", "rel": "risk" }, { "from": "us-medicare-abroad", "type": "rule", "name": "Medicare outside the United States", "as": "The care that is covered, because it happens on the right side of the border.", "rel": "risk" }, { "from": "ishrs", "type": "org", "name": "International Society of Hair Restoration Surgery", "as": "The repair operation its census counts as a share of its members' caseload.", "rel": "risk" }, { "from": "dominican-republic-ntm-outbreak", "type": "event", "name": "The Dominican mycobacterial outbreaks, 2013–14 and 2017", "as": "Fourteen of 19 admitted in the United States in the first cluster; 14 of 15 needing further surgery in the second.", "rel": "risk" }, { "from": "mexico-fungal-meningitis-2023", "type": "event", "name": "The Matamoros fungal meningitis outbreak, 2023", "as": "Every counted case was managed by a hospital in the patient's own country.", "rel": "risk" }, { "from": "revision", "type": "term", "name": "Revision", "as": "The risk this word names, with the published ledgers behind it.", "rel": "risk" }, { "from": "the-follow-up-nobody-books", "type": "story", "name": "The follow-up nobody books", "as": "The five UK ledgers in full, with each series and its period.", "rel": "risk" } ] }, { "id": "surgical-site-infection", "names": { "name": "Surgical site infection", "aliases": [ "SSI", "wound infection" ], "said": "Surgeons say SSI. A discharge summary says wound infection. A package page says nothing at all." }, "region": [ "global" ], "facets": { "kind": "infection" }, "text": { "what": "An infection of the tissue an operation opened — skin, the layers beneath it, or the space around an implant. It is counted by surveillance systems within thirty days of surgery, or within ninety days where a device was left in. The CDC's medical travel chapter puts surgical site infection among the main infection concerns of treatment abroad, and names it alongside hepatitis B, hepatitis C, HIV, bloodstream infections and donor-derived infections.", "story": "Among people who travel for treatment, \"the most common complications are infection-related\", in the CDC's words, and inadequate infection prevention and control is the mechanism it names.\n\nThe background rate is not the same everywhere. A WHO-funded meta-analysis of 220 studies published between 1995 and 2008 put the pooled cumulative incidence of surgical site infection in developing countries at 5.6 per 100 surgical procedures, and called it the leading hospital infection in those settings — against a pooled health-care-associated infection prevalence of 15.5 per 100 patients in the high-quality studies, itself much higher than European and US figures. The authors note that many countries returned no data at all.\n\nA 2023 systematic review of 44 studies found 589 people who presented with complications after cosmetic surgery abroad; infection was the commonest complication, 98% of the organisms were bacterial, and 81% of those were from the genus Mycobacterium.\n\n*Inference —* the exposure here is not only clinical. A surgical site infection is normally counted by the hospital that made the wound, which also carries the cost of treating it. When the patient boards a plane, the numerator lands in one health system and the denominator stays in another. Neither figure is wrong; they are simply never added up, and no country publishes a surgical site infection rate for operations its residents had abroad.", "how": "Presentation is usually redness, discharge, fever or a wound that will not close, and it typically begins in the first weeks. Treatment runs from oral antibiotics to reopening the wound, removing an implant, and weeks or months of intravenous therapy where the organism is resistant. The CDC asks US facilities to take an explicit travel history at admission, and to screen anyone who had an overnight stay in a healthcare facility outside the United States within the previous six months for carbapenem-resistant Enterobacterales.", "today": "As of 16 September 2026 the narrow numbers this site can stand on are the 5.6 per 100 pooled incidence from the 2011 meta-analysis and the case counts in the named outbreak investigations. No published series gives a surgical site infection rate for cross-border surgery as a class, because no one holds both halves of the fraction." }, "metrics": { "complication_rate_pct": 5.6, "note": "Pooled cumulative incidence of surgical site infection, 5.6 per 100 surgical procedures, from a WHO-funded systematic review of 220 studies in developing countries published 1995-2008. It is not a rate for cross-border surgery and not a rate for any one hospital; it is the background against which a traveller's operation is performed. The same review put pooled health-care-associated infection prevalence at 15.5 per 100 patients in its high-quality studies.", "as_of": "2011", "source": "s:allegranzi-hai-2011", "url": "https://pubmed.ncbi.nlm.nih.gov/21146207/" }, "kin": [ { "to": "nontuberculous-mycobacteria", "as": "The organism behind the best-documented cluster of these infections in cosmetic surgery patients returning from abroad.", "rel": "kin" }, { "to": "antimicrobial-resistance", "as": "What decides whether this infection is a week of antibiotics or six months of them.", "rel": "kin" }, { "to": "follow-up-gap", "as": "Why the infection is usually diagnosed by someone who did not make the wound.", "rel": "kin" }, { "to": "revision-at-home", "as": "Who pays for the theatre time when the wound has to be reopened.", "rel": "kin" }, { "to": "bbl-mortality", "as": "The other thing that goes wrong after gluteal fat grafting, and the faster one.", "rel": "contrast" }, { "to": "bloodborne-virus", "as": "The same failure of infection control, with a longer incubation and a quieter arrival.", "rel": "kin" }, { "to": "knee-replacement", "as": "The operation where an infection means the implant comes out.", "rel": "procedure" }, { "to": "abdominoplasty", "as": "The procedure with the longest stay among UK patients readmitted after surgery abroad.", "rel": "procedure" }, { "to": "dominican-republic", "as": "Where the clearest documented cluster of these infections among travelling patients was traced to.", "rel": "place" }, { "to": "aftercare-at-home", "as": "The step at which this is usually found.", "rel": "step" }, { "to": "when-it-goes-wrong", "as": "The step this risk turns into.", "rel": "step" } ], "links": [ { "label": "CDC Yellow Book 2026 — Medical Tourism", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html" } ], "sources": [ "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism", "s:allegranzi-hai-2011", "s:alkaelani-aesthetic-review-2023" ], "provenance": { "default": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "fields": { "text.story": { "tier": "cited", "note": "the last paragraph is marked as this project's own reasoning about the denominator" }, "metrics": { "tier": "cited", "source": "s:allegranzi-hai-2011" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "An infection of the tissue an operation opened — skin, the layers beneath it, or the space around an implant.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "nontuberculous-mycobacteria", "type": "risk", "name": "Nontuberculous mycobacteria", "as": "The organism behind the best-documented cluster of these infections in cosmetic surgery patients returning from abroad.", "rel": "kin" }, { "to": "antimicrobial-resistance", "type": "risk", "name": "Antimicrobial resistance acquired abroad", "as": "What decides whether this infection is a week of antibiotics or six months of them.", "rel": "kin" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Why the infection is usually diagnosed by someone who did not make the wound.", "rel": "kin" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who pays for the theatre time when the wound has to be reopened.", "rel": "kin" }, { "to": "bbl-mortality", "type": "risk", "name": "Death from gluteal fat grafting", "as": "The other thing that goes wrong after gluteal fat grafting, and the faster one.", "rel": "contrast" }, { "to": "bloodborne-virus", "type": "risk", "name": "Bloodborne virus from treatment abroad", "as": "The same failure of infection control, with a longer incubation and a quieter arrival.", "rel": "kin" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The operation where an infection means the implant comes out.", "rel": "procedure" }, { "to": "abdominoplasty", "type": "procedure", "name": "Abdominoplasty", "as": "The procedure with the longest stay among UK patients readmitted after surgery abroad.", "rel": "procedure" }, { "to": "dominican-republic", "type": "destination", "name": "Dominican Republic", "as": "Where the clearest documented cluster of these infections among travelling patients was traced to.", "rel": "place" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The step at which this is usually found.", "rel": "step" }, { "to": "when-it-goes-wrong", "type": "pathway", "name": "When it goes wrong", "as": "The step this risk turns into.", "rel": "step" } ], "source_list": [ { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:allegranzi-hai-2011", "kind": "paper", "title": "Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis", "publisher": "The Lancet 2011;377(9761):228-41 (Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, Pittet D), funded by WHO", "url": "https://pubmed.ncbi.nlm.nih.gov/21146207/", "accessed": "2026-09-16" }, { "id": "s:alkaelani-aesthetic-review-2023", "kind": "paper", "title": "Complications of Medical Tourism in Aesthetic Surgery: A Systematic Review", "publisher": "Annals of Plastic Surgery 2023;91(6):668-673 (Alkaelani MT, Koussayer B, Blount T, et al.)", "url": "https://pubmed.ncbi.nlm.nih.gov/37962261/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "text.story": { "tier": "cited", "note": "the last paragraph is marked as this project's own reasoning about the denominator" }, "text.how": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "text.today": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "metrics": { "tier": "cited", "source": "s:allegranzi-hai-2011" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "australia", "type": "destination", "name": "Australia", "as": "Present in 41.7% of the Australian series.", "rel": "risk" }, { "from": "colombia", "type": "destination", "name": "Colombia", "as": "What a free-standing surgicentre manages differently from a hospital.", "rel": "risk" }, { "from": "dominican-republic", "type": "destination", "name": "Dominican Republic", "as": "What 38 confirmed patients flew home with in 2017.", "rel": "risk" }, { "from": "tijuana", "type": "hub", "name": "Tijuana", "as": "The route the resistant organism took — abdominal wounds after sleeve gastrectomy.", "rel": "risk" }, { "from": "samsung-medical-center", "type": "facility", "name": "Samsung Medical Center", "as": "The 2015 MERS outbreak centred here is the reminder that a hospital is also a place infections happen.", "rel": "risk" }, { "from": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The commonest reason a returning patient presents at home.", "rel": "risk" }, { "from": "in-hospital", "type": "pathway", "name": "In hospital", "as": "The commonest thing that goes wrong here, and the hardest to attribute afterwards.", "rel": "risk" }, { "from": "when-it-goes-wrong", "type": "pathway", "name": "When it goes wrong", "as": "The commonest failure, and the one that presents after the flight.", "rel": "risk" }, { "from": "antimicrobial-resistance", "type": "risk", "name": "Antimicrobial resistance acquired abroad", "as": "The wound this turns from a course of antibiotics into a year.", "rel": "kin" }, { "from": "bloodborne-virus", "type": "risk", "name": "Bloodborne virus from treatment abroad", "as": "The same lapse in infection control, declaring itself in days rather than years.", "rel": "contrast" }, { "from": "candida-auris", "type": "risk", "name": "Candida auris", "as": "One of the sites this organism turns up in, alongside blood and ears.", "rel": "kin" }, { "from": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The commonest thing found in the gap.", "rel": "kin" }, { "from": "fungal-meningitis", "type": "risk", "name": "Fungal meningitis after epidural anaesthesia", "as": "The commoner infection after the same trips, and a far less lethal one.", "rel": "contrast" }, { "from": "nontuberculous-mycobacteria", "type": "risk", "name": "Nontuberculous mycobacteria", "as": "The general case this is the hardest version of.", "rel": "whole" }, { "from": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The complication driving 92% of one series.", "rel": "kin" }, { "from": "dominican-republic-ntm-outbreak", "type": "event", "name": "The Dominican mycobacterial outbreaks, 2013–14 and 2017", "as": "What 38 confirmed patients flew home with in 2017.", "rel": "risk" }, { "from": "ndm-1-2010", "type": "event", "name": "NDM-1, 2010", "as": "The route most of these organisms take into a patient.", "rel": "risk" } ] }, { "id": "the-escort-burden", "names": { "name": "The escort burden", "aliases": [ "the companion's costs", "medical attendant", "refakatci", "accompanying person" ], "said": "India caps them at two. Dubai pays them by the day. Nobody bills for the work they do." }, "region": [ "global" ], "facets": { "kind": "financial" }, "text": { "what": "What the person travelling beside the patient carries: a second fare and a second bed, unpaid leave, and the nursing after discharge that no package quotes. Three states have written the escort into an instrument - one capping how many may come, one paying them a daily allowance, one putting their charges on an invoice. None of the three measures the labour.", "story": "The hard number is a visa quota. India's Bureau of Immigration grants the e-Medical Attendant Visa alongside the patient's own, and caps it: \"Only two e-Medical Attendant Visas will be granted against one e-Medical Visa (patient)\". That is an immigration rule, not a clinical finding, and it is still the clearest published statement of how many people a state expects a treatment trip to involve.\n\nThe Gulf prices them. Dubai's Administrative Resolution No. (14) of 2017, the bylaw for sending patients for overseas medical treatment, entitles a patient aged 18 or over to one escort and a patient under 18 to two, named as both parents; two again for a patient of 65 or over, or paralysed, comatose or disabled. The allowance schedule sets the daily rate by destination: EUR 150 for the patient and EUR 150 for the first escort in European countries outside the United Kingdom with EUR 50 for the second, GBP 120 and GBP 50 in the United Kingdom, USD 150 and USD 50 in the United States, USD 130 and USD 50 in Singapore and South Korea, AED 300 and AED 100 in India, Thailand and Arab countries. Article 6 of the same bylaw pays for interpreting, medical devices, air ambulance where needed, and repatriation of the body if the patient dies.\n\nTurkiye bills them. The 2017 regulation on international health travel defines the licensed intermediary as a group A travel agency authorised to supply accommodation, transport and transfer \"to the patient and the accompanying companion and other relatives\" (Article 4(1)(g)), and Article 11(1)(b)(1) requires that intermediary to hand over, free on request, an itemised breakdown of what it charged for accommodation, transport and transfer, interpreting and consultancy. The companion is a line item.\n\n*Inference -* a per-diem schedule is a floor, not a measure. It prices a bed and a meal for a person a state has decided to send. It says nothing about the wage that person is not earning, the leave they are spending, or the hours of care they provide after discharge - and those three, not the airfare, are the bulk of what the escort carries. Nobody has measured any of them in this population.", "how": "What the job is, in the words of the one guidance that describes it: the Royal College of Anaesthetists asks that after a general or regional anaesthetic \"a responsible adult should escort the patient home and provide support for the first 24 hours after surgery\", by private car or taxi rather than public transport. Abroad, that single sentence expands. The companion is the second listener at a consent conversation run through an interpreter, the memory of what was said when the discharge summary is thin, the person who rebooks the flight when the patient cannot fly on the booked date, and the one who lifts.\n\nThe cost sits in places a price comparison does not reach: a second ticket bought on the same dates, a hotel room for the length of the stay rather than the length of the admission, days of unpaid leave, and, where the patient is a child or is over 65, a second escort at a second set of rates.\n\n*Trade practice -* packages that name a companion usually name a bed, not a service - a second bed in the room, or a hotel night for the nights the package covers. Whether a relative may stay overnight on the ward, and at what charge, is set hospital by hospital.", "today": "As of 17 September 2026 the published figures attached to the companion are a cap and a set of per diems: two attendants per patient under India's e-Visa rules, and Dubai's daily allowance schedule by destination country. Both are what a state pays or permits. No survey, registry or study this project has found measures what a companion spends, how many patients travel with one, or what care they provide after discharge." }, "metrics": { "note": "Two published numbers, both set by a state rather than measured in a population. India's Bureau of Immigration grants at most two e-Medical Attendant Visas against one e-Medical Visa. Dubai's Administrative Resolution No. (14) of 2017 pays one escort for an adult patient and two for a patient under 18, over 65, paralysed, comatose or disabled, at EUR 150 a day for the first escort in European countries outside the United Kingdom, GBP 120 in the United Kingdom, USD 150 in the United States, USD 130 in Singapore and South Korea and AED 300 in India, Thailand and Arab countries, with EUR 50, GBP 50, USD 50 and AED 100 respectively for a second escort. Neither figure counts companions, measures their spending, or values the care they give.", "as_of": "2017", "source": "s:dubai-resolution-14-2017", "url": "https://dlp.dubai.gov.ae/Legislation%20Reference/2017/Administrative%20Resolution%20No.%20(14)%20of%202017%20Approving%20the%20Bylaw%20for%20Sending%20Patients.html" }, "kin": [ { "to": "the-companion", "as": "The step this risk is the price of.", "rel": "step" }, { "to": "india-e-medical-visa", "as": "The instrument that caps the escort at two, and the only hard count anywhere.", "rel": "governed-by" }, { "to": "gcc-sponsored-treatment-abroad", "as": "The scheme that pays the escort a daily allowance, and sets it by destination.", "rel": "rule" }, { "to": "uae", "as": "Where that allowance schedule was published, in a bylaw of the Dubai Health Authority.", "rel": "destination" }, { "to": "alone-after-discharge", "as": "What happens where no companion travelled.", "rel": "kin" }, { "to": "day-case", "as": "The category that assumes somebody is there by evening; abroad, that somebody flew in.", "rel": "term" }, { "to": "package-price", "as": "The number the second fare and the second bed sit outside.", "rel": "term" }, { "to": "booking-the-flight", "as": "The step at which the second ticket is bought, on dates the surgery may move.", "rel": "step" }, { "to": "repatriation-cost", "as": "The other cost a state names in the same bylaw, and a private buyer meets alone.", "rel": "kin" } ], "links": [ { "label": "Administrative Resolution No. (14) of 2017 (Dubai)", "url": "https://dlp.dubai.gov.ae/Legislation%20Reference/2017/Administrative%20Resolution%20No.%20(14)%20of%202017%20Approving%20the%20Bylaw%20for%20Sending%20Patients.html" }, { "label": "Bureau of Immigration, Government of India - e-Visa", "url": "https://indianvisaonline.gov.in/evisa/tvoa.html" } ], "sources": [ "s:dubai-resolution-14-2017", "s:india-emedical-visa", "s:rg-saglik-turizmi-2017", "s:rcoa-gpas-day-surgery-2021" ], "provenance": { "default": { "tier": "cited", "source": "s:dubai-resolution-14-2017" }, "fields": { "text.story": { "tier": "cited", "source": "s:dubai-resolution-14-2017", "note": "the Dubai rates and escort entitlements are read off the bylaw; the Indian cap off the Bureau of Immigration page; the Turkish articles in Turkish off the Resmi Gazete text as published on 13 July 2017. The closing paragraph is marked *Inference -*" }, "text.how": { "tier": "cited", "source": "s:rcoa-gpas-day-surgery-2021", "note": "the description of the job quotes the day surgery guidance; the closing paragraph is marked as trade practice" }, "metrics": { "tier": "cited", "source": "s:dubai-resolution-14-2017" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-17", "blurb": "What the person travelling beside the patient carries: a second fare and a second bed, unpaid leave, and the nursing after discharge that no package quotes.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "The step this risk is the price of.", "rel": "step" }, { "to": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The instrument that caps the escort at two, and the only hard count anywhere.", "rel": "governed-by" }, { "to": "gcc-sponsored-treatment-abroad", "type": "rule", "name": "Gulf state-sponsored treatment abroad", "as": "The scheme that pays the escort a daily allowance, and sets it by destination.", "rel": "rule" }, { "to": "uae", "type": "destination", "name": "United Arab Emirates", "as": "Where that allowance schedule was published, in a bylaw of the Dubai Health Authority.", "rel": "destination" }, { "to": "alone-after-discharge", "type": "risk", "name": "Discharged alone", "as": "What happens where no companion travelled.", "rel": "kin" }, { "to": "day-case", "type": "term", "name": "Day case", "as": "The category that assumes somebody is there by evening; abroad, that somebody flew in.", "rel": "term" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The number the second fare and the second bed sit outside.", "rel": "term" }, { "to": "booking-the-flight", "type": "pathway", "name": "Booking the flight", "as": "The step at which the second ticket is bought, on dates the surgery may move.", "rel": "step" }, { "to": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "The other cost a state names in the same bylaw, and a private buyer meets alone.", "rel": "kin" } ], "source_list": [ { "id": "s:dubai-resolution-14-2017", "kind": "law", "title": "Administrative Resolution No. (14) of 2017 Approving the Bylaw for Sending Patients for Overseas Medical Treatment", "publisher": "Government of Dubai Legislation portal", "url": "https://dlp.dubai.gov.ae/Legislation%20Reference/2017/Administrative%20Resolution%20No.%20(14)%20of%202017%20Approving%20the%20Bylaw%20for%20Sending%20Patients.html", "accessed": "2026-09-16", "note": "issued 6 February 2017 by the Director General of the Dubai Health Authority; sets eligibility, what the state pays, escort entitlement and a daily allowance schedule by destination country" }, { "id": "s:india-emedical-visa", "kind": "web", "title": "e-Visa — e-Medical Visa and e-Medical Attendant Visa", "publisher": "Bureau of Immigration, Ministry of Home Affairs, Government of India", "url": "https://indianvisaonline.gov.in/evisa/tvoa.html", "accessed": "2026-09-16", "note": "one year from arrival, multiple entries, hospital letter on letterhead, two attendant visas per patient" }, { "id": "s:rg-saglik-turizmi-2017", "kind": "web", "title": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik", "publisher": "Resmî Gazete, Republic of Türkiye (Ministry of Health)", "url": "https://www.resmigazete.gov.tr/eskiler/2017/07/20170713-3.htm", "accessed": "2026-09-16", "note": "Resmî Gazete 13 July 2017, No. 30123. Read in Turkish off the Resmî Gazete page. Article 5(1) makes an international health tourism authorisation certificate (yetki belgesi) compulsory for both the health facility and the intermediary; the Ministry halts the activity of anyone without one. Transitional Article 1 gave those already trading one year to comply. Article 16: in force on publication. REPEALED: MADDE 17 of the regulation of 26 April 2025 (Resmî Gazete 32882) revokes this one. Cite it for what the regime was, not for what it is." }, { "id": "s:rcoa-gpas-day-surgery-2021", "kind": "org", "title": "Chapter 6: Guidelines for the Provision of Anaesthesia Services for Day Surgery 2021, published 31 March 2021", "publisher": "The Royal College of Anaesthetists (United Kingdom)", "url": "https://rcoa.ac.uk/gpas/chapter-6", "accessed": "2026-09-17", "note": "read in a browser because the page is refused to a plain fetch. Recommendation 5.25 (grade C, strong) on a responsible adult escorting the patient home and supporting them for 24 hours; 5.26 on private car or taxi; 5.24 on a 24-hour telephone number that is not an answerphone; 5.7 on preoperative assessment as early as possible in the pathway; 5.29 on the patient's copy of the discharge summary" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:dubai-resolution-14-2017" }, "text.story": { "tier": "cited", "source": "s:dubai-resolution-14-2017", "note": "the Dubai rates and escort entitlements are read off the bylaw; the Indian cap off the Bureau of Immigration page; the Turkish articles in Turkish off the Resmi Gazete text as published on 13 July 2017. The closing paragraph is marked *Inference -*" }, "text.how": { "tier": "cited", "source": "s:rcoa-gpas-day-surgery-2021", "note": "the description of the job quotes the day surgery guidance; the closing paragraph is marked as trade practice" }, "text.today": { "tier": "cited", "source": "s:dubai-resolution-14-2017" }, "metrics": { "tier": "cited", "source": "s:dubai-resolution-14-2017" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "israel", "type": "destination", "name": "Israel", "as": "Counted here in permit refusals: most Gaza companion applications in 2022 were not approved in time.", "rel": "risk" }, { "from": "saudi-arabia", "type": "destination", "name": "Saudi Arabia", "as": "Paid for here by the sponsor, which is what makes this a source market rather than a trickle.", "rel": "risk" }, { "from": "uae", "type": "destination", "name": "United Arab Emirates", "as": "Written into this state's own bylaw, with a per-diem attached to it.", "rel": "risk" }, { "from": "amman", "type": "hub", "name": "Amman", "as": "Here the companion is part of the arrangement, and often several people rather than one.", "rel": "risk" }, { "from": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "A hundred days near the centre with a full-time carer, which no package price covers.", "rel": "risk" }, { "from": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "The companion whose flights and meals the package prices separately or not at all.", "rel": "risk" }, { "from": "the-companion", "type": "pathway", "name": "The companion", "as": "The risk record for what this person carries.", "rel": "risk" }, { "from": "alone-after-discharge", "type": "risk", "name": "Discharged alone", "as": "The same person, costed: what it takes to have anyone there at all.", "rel": "kin" }, { "from": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "Who signs the guarantee when the patient cannot.", "rel": "kin" }, { "from": "dha-dubai", "type": "org", "name": "Dubai Health Authority", "as": "Written into this authority's own bylaw, with a daily allowance attached.", "rel": "risk" } ] }, { "id": "transplant-harm", "names": { "name": "Transplant harm", "aliases": [ "transplant tourism", "commercial transplantation", "organ trafficking" ], "said": "The Declaration of Istanbul separates three things: travel for transplantation, transplant commercialism, and organ trafficking." }, "region": [ "global" ], "facets": { "kind": "ethical" }, "text": { "what": "Harm from receiving an organ, tissue or stem cell transplant abroad from an unrelated donor — to the recipient, whose graft and screening were worse; to the donor, who may have been paid, coerced or trafficked; and to the system at home that inherits the follow-up. The CDC's account is blunt: donors \"might not be screened as thoroughly\", organs \"might be obtained using unethical means\", and recipients \"may not receive adequate follow-up, including documentation from their surgeons\".", "story": "The recipient side has been measured, and the measurements agree. A transplant centre in Riyadh compared 60 patients who had been transplanted abroad against 254 transplanted locally and followed at the same hospital between January 2015 and December 2018. Delayed graft function ran at 18.3% against 6.3%. Acute rejection ran at 40% against 7.9%. Graft failure at three years ran at 11.7% against 0.8%. Post-transplant infection and urological complications were both higher. The travelling group were younger; the two groups were otherwise similar on sex, body mass index, diabetes and hypertension.\n\nA 2021 review of liver transplantation reached the same conclusion for that organ: higher post-transplant complications and higher mortality than domestic transplantation, with improper pre- and post-transplant infectious screening, inadequate prophylaxis against opportunistic infection, and loss to follow-up named as the mechanisms.\n\nThe donor side is the reason this record is filed as an ethical risk rather than a clinical one. The Declaration of Istanbul, first agreed in 2008 and revised in 2018, is the instrument the field uses to separate three things that get collapsed together: a patient travelling for a transplant, the sale of organs, and the trafficking of people for their organs. Only the first is lawful anywhere.\n\n*Inference —* the recipient figures above understate the harm in one direction and overstate it in another. They count the patients who came back and presented to a follow-up clinic, so a recipient who died abroad is not in them; and they are single-centre, so they carry the referral pattern of the hospital that published them.", "how": "An episode typically runs as a short admission abroad with a living unrelated donor, discharge with an immunosuppressive regimen and little documentation, and presentation at home for the rest of the patient's life. The parts that go wrong are identifiable in advance and none of them is surgical: donor infectious screening, tissue matching, the record of what was given and when, and whether anyone at home has agreed to take the follow-up before the flight is booked.", "today": "As of 16 September 2026 no country publishes a count of its residents transplanted abroad, and no destination publishes a count of non-resident recipients. The figures on this record are from two hospital series and a review, and there is no denominator behind any of them." }, "metrics": { "complication_rate_pct": 40.0, "note": "Acute rejection in 40% of 60 kidney recipients transplanted abroad and followed at one Riyadh centre, against 7.9% in 254 transplanted locally at the same hospital, January 2015 to December 2018 (p<0.001). The same series: delayed graft function 18.3% against 6.3% (p 0.005) and graft failure at three years 11.7% against 0.8% (p<0.001). One centre, one country of follow-up, and only the patients who returned and presented.", "as_of": "2022", "source": "s:altheaby-transplant-tourism-2022", "url": "https://pubmed.ncbi.nlm.nih.gov/36092382/" }, "kin": [ { "to": "kidney-transplant", "as": "The organ the outcome figures on this page are for.", "rel": "procedure" }, { "to": "liver-transplant", "as": "The organ with the same pattern and a higher mortality penalty.", "rel": "procedure" }, { "to": "bone-marrow-transplant", "as": "The stem cell case the CDC folds into the same category.", "rel": "procedure" }, { "to": "transplant-prohibition", "as": "The rules that decide where a non-resident may be transplanted at all.", "rel": "governed-by" }, { "to": "declaration-of-istanbul-group", "as": "Keeps the instrument that separates travel for transplantation from commercialism and trafficking.", "rel": "org" }, { "to": "istanbul-declaration-2008", "as": "The year the field drew the line it still uses.", "rel": "event" }, { "to": "bloodborne-virus", "as": "Donor-derived infection is the named screening failure.", "rel": "kin" }, { "to": "follow-up-gap", "as": "Immunosuppression makes the gap immediately dangerous rather than eventually.", "rel": "kin" }, { "to": "malpractice-recourse", "as": "A claim arising from an unlawful transaction has nowhere to go.", "rel": "kin" }, { "to": "candida-auris", "as": "What immunosuppression turns from colonisation into disease.", "rel": "kin" } ], "links": [ { "label": "Declaration of Istanbul", "url": "https://www.declarationofistanbul.org/" }, { "label": "Altheaby et al., Avicenna Journal of Medicine 2022", "url": "https://pubmed.ncbi.nlm.nih.gov/36092382/" } ], "sources": [ "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism", "s:altheaby-transplant-tourism-2022", "s:neupane-liver-transplant-2021", "s:declaration-of-istanbul" ], "provenance": { "default": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "fields": { "text.story": { "tier": "cited", "note": "the closing paragraph is marked inline as this project's reading of what the series can and cannot support" }, "metrics": { "tier": "cited", "source": "s:altheaby-transplant-tourism-2022" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "Harm from receiving an organ, tissue or stem cell transplant abroad from an unrelated donor — to the recipient, whose graft and screening were worse; to the donor, who may have been paid, coerced or trafficked; and to…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "The organ the outcome figures on this page are for.", "rel": "procedure" }, { "to": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "The organ with the same pattern and a higher mortality penalty.", "rel": "procedure" }, { "to": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "The stem cell case the CDC folds into the same category.", "rel": "procedure" }, { "to": "transplant-prohibition", "type": "rule", "name": "Buying an organ, and being transplanted abroad", "as": "The rules that decide where a non-resident may be transplanted at all.", "rel": "governed-by" }, { "to": "declaration-of-istanbul-group", "type": "org", "name": "Declaration of Istanbul Custodian Group", "as": "Keeps the instrument that separates travel for transplantation from commercialism and trafficking.", "rel": "org" }, { "to": "istanbul-declaration-2008", "type": "event", "name": "The Declaration of Istanbul, 2008", "as": "The year the field drew the line it still uses.", "rel": "event" }, { "to": "bloodborne-virus", "type": "risk", "name": "Bloodborne virus from treatment abroad", "as": "Donor-derived infection is the named screening failure.", "rel": "kin" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Immunosuppression makes the gap immediately dangerous rather than eventually.", "rel": "kin" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "A claim arising from an unlawful transaction has nowhere to go.", "rel": "kin" }, { "to": "candida-auris", "type": "risk", "name": "Candida auris", "as": "What immunosuppression turns from colonisation into disease.", "rel": "kin" } ], "source_list": [ { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:altheaby-transplant-tourism-2022", "kind": "paper", "title": "Graft and Patient Outcomes of Kidney Transplant Tourism: A Single-Center Experience", "publisher": "Avicenna Journal of Medicine 2022;12(3):120-126 (Altheaby A, Owaidah K, Alotaibi A, et al.), King Abdulaziz Medical City, Riyadh", "url": "https://pubmed.ncbi.nlm.nih.gov/36092382/", "accessed": "2026-09-16" }, { "id": "s:neupane-liver-transplant-2021", "kind": "paper", "title": "Current state of medical tourism involving liver transplantation — the risk of infections and potential complications", "publisher": "World Journal of Hepatology 2021;13(7):717-722 (Neupane R, Taweesedt PT, Anjum H, Surani S)", "url": "https://pubmed.ncbi.nlm.nih.gov/34367493/", "accessed": "2026-09-16" }, { "id": "s:declaration-of-istanbul", "kind": "org", "title": "The Declaration of Istanbul on Organ Trafficking and Transplant Tourism (2018 edition)", "publisher": "Declaration of Istanbul Custodian Group", "url": "https://www.declarationofistanbul.org/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "text.story": { "tier": "cited", "note": "the closing paragraph is marked inline as this project's reading of what the series can and cannot support" }, "text.how": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "text.today": { "tier": "cited", "source": "s:cdc-yellowbook-2026-medical-tourism" }, "metrics": { "tier": "cited", "source": "s:altheaby-transplant-tourism-2022" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "What the published follow-up records about grafts bought abroad, for the recipient and for the donor.", "rel": "risk" }, { "from": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "What the published follow-up records about grafts obtained abroad, for the recipient and for the donor.", "rel": "risk" }, { "from": "blood-supply-safety", "type": "risk", "name": "Blood supply safety", "as": "Where donor screening and blood screening are the same failure.", "rel": "kin" }, { "from": "bloodborne-virus", "type": "risk", "name": "Bloodborne virus from treatment abroad", "as": "Where the CDC's phrase donor-derived infections points.", "rel": "kin" }, { "from": "candida-auris", "type": "risk", "name": "Candida auris", "as": "Immunosuppression is what turns colonisation into an infection.", "rel": "kin" }, { "from": "unproven-stem-cell", "type": "risk", "name": "Unproven stem cell treatment", "as": "The CDC files unrelated-donor stem cell transplantation in the same category as organ transplantation abroad.", "rel": "kin" }, { "from": "transplant-prohibition", "type": "rule", "name": "Buying an organ, and being transplanted abroad", "as": "What the outcome papers record.", "rel": "risk" }, { "from": "declaration-of-istanbul-group", "type": "org", "name": "Declaration of Istanbul Custodian Group", "as": "What happens to the person who sold the organ, which the Declaration puts first.", "rel": "risk" }, { "from": "istanbul-declaration-2008", "type": "event", "name": "The Declaration of Istanbul, 2008", "as": "What happens to the seller, which is the half of this trade that leaves no patient record.", "rel": "risk" } ] }, { "id": "unproven-stem-cell", "names": { "name": "Unproven stem cell treatment", "aliases": [ "stem cell clinics", "regenerative medicine offered direct to consumers" ], "said": "The clinic says regenerative. The regulator says unapproved. The distance between those two words is the whole market." }, "region": [ "global" ], "facets": { "kind": "clinical" }, "text": { "what": "A cell preparation sold as a treatment for a condition it has not been shown to treat, usually paid for out of pocket and usually outside any approval process. The CDC's account of cancer treatment abroad names the same structure: treatments obtained abroad \"may have no established benefit\", placing the patient at risk both from complications and from delaying or forgoing an approved therapy at home.", "story": "Two papers set the shape of this subject and neither is about a distant country.\n\nIn 2016 Turner and Knoepfler examined internet marketing of unapproved stem cell interventions and found the practice, already familiar in countries with permissive regulation, being carried on widely by businesses based in the United States. Their conclusion was directed at regulators rather than at patients: the marketplace needed better oversight. The finding matters here because it undercuts the geographic framing. This is not a risk that begins at a border.\n\nIn 2017 the New England Journal of Medicine reported three patients who received intravitreal injections of autologous adipose-derived \"stem cells\" at one US clinic. Before the injection their best documented visual acuity ranged from 20/30 to 20/200. After it they had ocular hypertension, haemorrhagic retinopathy, vitreous haemorrhage, retinal detachment or a dislocated lens. At one year their acuity ranged from 20/200 to no light perception. Three patients is not an incidence. It is a demonstration that the downside is not a wasted fee.\n\n*Inference —* the exposure here is unlike the rest of this section in one respect. Every other risk on these pages is a way a real treatment can go wrong. This one is a fee paid for a treatment with no demonstrated benefit, so the loss is certain at the moment of payment and the clinical harm is the tail on top of it. A patient who forgoes an approved therapy to pursue it loses a third thing that cannot be bought back.", "how": "The commercial pattern is consistent: a condition with poor conventional options, a cell preparation described by its source rather than by any tested mechanism, payment in advance, no control arm, and testimonials in place of published outcomes. The regulatory position varies by country and by preparation, and is carried on this site's rule record rather than asserted here.", "today": "As of 16 September 2026 no register counts how many people travel across a border for an unapproved cell treatment, what they pay, or what happens to them. The published record consists of marketplace surveys and case reports, and the case reports exist because the harm was severe enough to reach a specialist unit." }, "metrics": { "note": "Nobody has measured the incidence. The three patients reported in the New England Journal of Medicine in 2017 went from a best documented visual acuity of 20/30 to 20/200 before injection to 20/200 to no light perception one year after. That is a case series of three at a single clinic, not a rate, and no denominator for this market exists in any country.", "as_of": "2017", "source": "s:kuriyan-stem-cell-2017", "url": "https://pubmed.ncbi.nlm.nih.gov/28296617/" }, "kin": [ { "to": "stem-cell-unproven", "as": "The treatment itself, and what is actually sold under the name.", "rel": "procedure" }, { "to": "stem-cell-regulation", "as": "The rules that decide where this can lawfully be offered and on what terms.", "rel": "governed-by" }, { "to": "advertising-rules", "as": "What may be claimed, and by whom, in each jurisdiction.", "rel": "governed-by" }, { "to": "deciding-whether", "as": "The step at which a poor prognosis meets a confident marketing page.", "rel": "step" }, { "to": "second-opinion", "as": "The step this risk is most often avoided at.", "rel": "step" }, { "to": "malpractice-recourse", "as": "A claim for a treatment that was never approved, against a provider in another country.", "rel": "kin" }, { "to": "counterfeit-medicines", "as": "The mirror case: a product that is not what it says, rather than a product that is exactly what it says and does nothing.", "rel": "contrast" }, { "to": "transplant-harm", "as": "The CDC files unrelated-donor stem cell transplantation in the same category as organ transplantation abroad.", "rel": "kin" } ], "links": [ { "label": "Kuriyan et al., New England Journal of Medicine 2017", "url": "https://pubmed.ncbi.nlm.nih.gov/28296617/" }, { "label": "Turner and Knoepfler, Cell Stem Cell 2016", "url": "https://pubmed.ncbi.nlm.nih.gov/27374789/" } ], "sources": [ "s:kuriyan-stem-cell-2017", "s:turner-knoepfler-2016", "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited", "source": "s:kuriyan-stem-cell-2017" }, "fields": { "text.story": { "tier": "cited", "note": "the closing paragraph is marked inline as this project's reasoning" }, "text.how": { "tier": "tradition", "note": "the commercial pattern as the literature describes it" } } }, "confidence": "high", "schema": 1, "type": "risk", "updated": "2026-09-16", "blurb": "A cell preparation sold as a treatment for a condition it has not been shown to treat, usually paid for out of pocket and usually outside any approval process.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "stem-cell-unproven", "type": "procedure", "name": "Unapproved stem cell treatment", "as": "The treatment itself, and what is actually sold under the name.", "rel": "procedure" }, { "to": "stem-cell-regulation", "type": "rule", "name": "Regulating cell and tissue therapies", "as": "The rules that decide where this can lawfully be offered and on what terms.", "rel": "governed-by" }, { "to": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "What may be claimed, and by whom, in each jurisdiction.", "rel": "governed-by" }, { "to": "deciding-whether", "type": "pathway", "name": "Deciding whether to go", "as": "The step at which a poor prognosis meets a confident marketing page.", "rel": "step" }, { "to": "second-opinion", "type": "pathway", "name": "The second opinion", "as": "The step this risk is most often avoided at.", "rel": "step" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "A claim for a treatment that was never approved, against a provider in another country.", "rel": "kin" }, { "to": "counterfeit-medicines", "type": "risk", "name": "Substandard and falsified medicines", "as": "The mirror case: a product that is not what it says, rather than a product that is exactly what it says and does nothing.", "rel": "contrast" }, { "to": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "The CDC files unrelated-donor stem cell transplantation in the same category as organ transplantation abroad.", "rel": "kin" } ], "source_list": [ { "id": "s:kuriyan-stem-cell-2017", "kind": "paper", "title": "Vision Loss after Intravitreal Injection of Autologous \"Stem Cells\" for AMD", "publisher": "New England Journal of Medicine 2017;376(11):1047-1053 (Kuriyan AE, Albini TA, Townsend JH, et al.)", "url": "https://pubmed.ncbi.nlm.nih.gov/28296617/", "accessed": "2026-09-16" }, { "id": "s:turner-knoepfler-2016", "kind": "paper", "title": "Selling Stem Cells in the USA: Assessing the Direct-to-Consumer Industry", "publisher": "Cell Stem Cell 2016;19(2):154-157 (Turner L, Knoepfler P)", "url": "https://pubmed.ncbi.nlm.nih.gov/27374789/", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:kuriyan-stem-cell-2017" }, "text.story": { "tier": "cited", "note": "the closing paragraph is marked inline as this project's reasoning" }, "text.how": { "tier": "tradition", "note": "the commercial pattern as the literature describes it" }, "text.today": { "tier": "cited", "source": "s:kuriyan-stem-cell-2017" }, "metrics": { "tier": "cited", "source": "s:kuriyan-stem-cell-2017" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "stem-cell-unproven", "type": "procedure", "name": "Unapproved stem cell treatment", "as": "What can go wrong, who has measured it, and what the case reports record.", "rel": "risk" }, { "from": "sheba", "type": "facility", "name": "Sheba Medical Center", "as": "A regulated cell-therapy programme in a public hospital is the thing an unproven clinic imitates the vocabulary of.", "rel": "contrast" }, { "from": "counterfeit-medicines", "type": "risk", "name": "Substandard and falsified medicines", "as": "A different failure of the same regulatory gap: the product is what it says, and no trial has shown it does anything.", "rel": "contrast" }, { "from": "stem-cell-regulation", "type": "rule", "name": "Regulating cell and tissue therapies", "as": "The risk record, and the published harms.", "rel": "risk" }, { "from": "leigh-turner", "type": "person", "name": "Leigh Turner", "as": "The risk record, where his enumeration sets the scale.", "rel": "risk" } ] }, { "id": "abortion-travel-law", "names": { "name": "Travelling for a termination", "aliases": [ "abortion access across borders", "the residence bar" ], "said": "The bar is rarely a border. It is usually a waiting period, a second signature, or a rule about who counts as resident." }, "region": [ "global" ], "facets": { "kind": "prohibition", "status": "in-force" }, "text": { "what": "Where a termination may lawfully be performed, on what grounds and to what gestational limit, and whether the law reaches someone who does not live there. The rows below record the position for an adult traveller: a row is marked lawful-with-conditions where a condition binds an adult who has come from elsewhere — grounds rather than request, spousal consent, a mandatory wait — and residents-only where the statute itself excludes non-residents.", "story": "Two statutes in this table exclude a non-resident outright, and one of them is not the one usually named.\n\nSingapore's is written on the face of the Act. Section 3 of the Termination of Pregnancy Act 1974 confines treatment to citizens, to wives of citizens, to work-pass holders and their wives, or to a person who has been \"a resident in Singapore for a period of at least 4 months immediately preceding\" — with one exception, where the procedure is needed to save the woman's life.\n\nCzechia's is older and quieter. Section 10 of zákon č. 66/1986 Sb. bars the procedure for foreign women who are in the country only temporarily. The provision is unamended and in force. The WHO Global Abortion Policies Database, which is the best comparative source in this field, records other Czech restrictions and not this one; it was read in the statute directly.\n\nEverywhere else the friction is procedural, and procedure is what defeats a traveller. Italy invites a seven-day pause. Germany requires counselling and then three days. Belgium, six. Hungary, Portugal and Ireland, three. Singapore and Malaysia, two. Thailand requires counselling on alternatives between 12 and 20 weeks. *Inference —* a waiting period is a residence requirement for anyone who has to buy two flights, and none of these statutes were written with that in mind.\n\nThe consent rules do the same work by another route. Japan's Maternal Health Act still requires the spouse's consent, waived only where the spouse is unknown, unable to express an intention, or dead. Taiwan and Türkiye require it on named grounds. Indonesia requires the husband's permission except for victims of rape. Korea's criminal provisions lapsed after the 2019 Constitutional Court decision and were never replaced, leaving a Mother and Child Health Act that was never amended and still carries spousal consent.\n\nThe two long-standing destinations in this table admit non-residents by the plain text of their statutes. The Netherlands' Act has no residence bar and no week limit on its face; the word for residence appears only in the statistical reporting article. Great Britain's Abortion Act 1967 has no residence or nationality requirement anywhere in section 1 — its constraints are the grounds, the two doctors' good-faith opinion and the approved place.", "how": "Reading a row: a gestational limit is counted from a date the statute names, and states do not all count from the same date — last menstrual period in Switzerland, conception in Belgium. A ground-based regime is not a limit regime, and a law that permits a termination does not oblige any particular doctor to perform one; conscientious objection is separately provided for in most of these systems and is not recorded here.\n\nThis table does not record cost, availability, distance to the nearest provider, or whether the procedure is funded. Ireland's row is the clearest case of the difference: lawful for a non-resident, free only for the ordinarily resident.", "today": "As of 17 September 2026 most rows below are read in the WHO Global Abortion Policies Database's country records, which embed the survey data and the retrieved statute text, and several were additionally read against the national statute database — the URL on each row says which. The WHO database is not uniformly current: its last-updated dates run from 2017 for Morocco, Jordan and the United Arab Emirates to 2026 for Kenya, Mexico and Indonesia. Italy's seven-day pause and Malta's near-total prohibition are named in the narrative above and do not carry rows of their own." }, "legality": [ { "country": "NL", "status": "lawful", "as_of": "2026-09-17", "source": "s:nl-abortion-act-1981", "instrument": "Wet afbreking zwangerschap (Wet van 1 mei 1981), articles 3 and 6, as amended in 2022", "note": "No week limit in the Act itself and no residence or nationality bar; the word woonplaats appears only in the article 11 statistical reporting. The fixed five-day waiting period was removed by the Act of 22 August 2022 and the doctor and the woman now set the term together." }, { "country": "GB", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:uk-abortion-act-1967", "instrument": "Abortion Act 1967, section 1", "conditions": "Grounds-based: two registered medical practitioners must be of the opinion, formed in good faith, that a ground is met, and the treatment must be at an approved place. Ground (a) runs to 24 weeks. There is no residence or nationality requirement anywhere in section 1.", "note": "Section 7(3): the Act does not extend to Northern Ireland, which has its own arrangements." }, { "country": "CZ", "status": "residents-only", "as_of": "2026-09-17", "source": "s:cz-act-66-1986", "instrument": "Zákon č. 66/1986 Sb., o umělém přerušení těhotenství, §§ 4 and 10", "conditions": "Twelve weeks on written request for a resident — but § 10 bars the procedure for foreign women who are in the country only temporarily. A second termination within six months is also barred.", "note": "The text is unamended and in force. The WHO Global Abortion Policies Database's additional-restrictions note for Czechia records the six-month rule and physician refusal but not § 10; the statute was read directly for this row." }, { "country": "SG", "status": "residents-only", "as_of": "2026-09-17", "source": "s:sg-termination-act", "instrument": "Termination of Pregnancy Act 1974, section 3, with the Termination of Pregnancy Regulations 1987", "conditions": "Twenty-four weeks, but section 3 confines treatment to citizens, wives of citizens, work-pass holders and their wives, or a person resident in Singapore for at least four months immediately preceding — the only exception being where the procedure is necessary to save the woman's life. A two-day waiting period follows counselling.", "url": "https://abortion-policies.srhr.org/country/singapore" }, { "country": "IE", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:ie-termination-act-2018", "instrument": "Health (Regulation of Termination of Pregnancy) Act 2018, section 12", "conditions": "Twelve weeks, with a waiting period of not less than three days. There is no residence bar on lawfulness — section 20 expressly contemplates a woman who resides outside the State — but free care is confined to the ordinarily resident, which is a funding rule and not a legal one." }, { "country": "DE", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:de-stgb-218a", "instrument": "Strafgesetzbuch § 218a, with § 219", "conditions": "Twelve weeks, after mandatory counselling and a wait of at least three days before the procedure. No residence condition." }, { "country": "ES", "status": "lawful", "as_of": "2026-09-17", "source": "s:es-lo-2-2010", "instrument": "Ley Orgánica 2/2010, artículos 3, 13 bis y 14", "conditions": "Fourteen weeks at the woman's request. Article 3.2 extends the rights it sets out to all persons present in Spain." }, { "country": "FR", "status": "lawful", "as_of": "2026-09-17", "source": "s:fr-csp-l2212-1", "instrument": "Code de la santé publique, article L2212-1, as amended by loi n° 2022-295", "conditions": "To the end of the fourteenth week on request; the article carries no residence condition." }, { "country": "BE", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:be-abortion-law-2018", "instrument": "Loi du 15 octobre 2018 relative à l'interruption volontaire de grossesse, article 2", "conditions": "Twelve weeks from conception, and not until six days after the first consultation." }, { "country": "PT", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:pt-codigo-penal-142", "instrument": "Código Penal, artigo 142.º, as amended by Lei n.º 16/2007", "conditions": "Ten weeks by the woman's choice, after a reflection period of not less than three days." }, { "country": "PL", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:pl-family-planning-act-1993", "instrument": "Ustawa z dnia 7 stycznia 1993 r. o planowaniu rodziny, ochronie płodu ludzkiego i warunkach dopuszczalności przerywania ciąży (Dz.U. 1993 nr 17 poz. 78)", "conditions": "Grounds only: danger to life or health, and pregnancy resulting from a criminal act. The fetal-defect ground was struck down by the Constitutional Tribunal in 2020.", "url": "https://abortion-policies.srhr.org/country/poland" }, { "country": "TR", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:tr-law-2827", "instrument": "Nüfus Planlaması Hakkında Kanun (Kanun No. 2827), Madde 5 ve Madde 6", "conditions": "Ten weeks on request, and the consent of the husband is required for a married woman.", "url": "https://abortion-policies.srhr.org/country/turkey" }, { "country": "CH", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:ch-penal-118-120", "instrument": "Code pénal suisse, articles 118, 119 et 120", "conditions": "Twelve weeks from the last menstrual period, on the written request of a woman invoking distress, after an in-depth consultation." }, { "country": "US", "status": "unregulated", "as_of": "2026-09-17", "source": "s:us-dobbs-2022", "instrument": "Dobbs v. Jackson Women's Health Organization, 597 U.S. 215 (2022)", "url": "https://abortion-policies.srhr.org/country/united-states-of-america", "note": "Federal position only. There is no federal right and no federal prohibition; state law governs, and the WHO database codes every field for the United States as varying by jurisdiction. This project has read no state statute for this row." }, { "country": "ZA", "status": "lawful", "as_of": "2026-09-17", "source": "s:za-choice-act-1996", "instrument": "Choice on Termination of Pregnancy Act 92 of 1996, as amended in 2008, with Regulation 168 of 1997", "conditions": "Twelve weeks at the woman's request. No spousal consent, no parental consent, no counselling requirement, and no citizenship or residence bar recorded.", "url": "https://abortion-policies.srhr.org/country/south-africa" }, { "country": "TN", "status": "lawful", "as_of": "2026-09-17", "source": "s:who-gapd", "instrument": "Code pénal, article 214", "conditions": "The first three months on request; no spousal or parental consent recorded.", "url": "https://abortion-policies.srhr.org/country/tunisia" }, { "country": "IN", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:in-mtp-act-1971", "instrument": "The Medical Termination of Pregnancy Act 1971, with the Medical Termination of Pregnancy (Amendment) Act 2021", "conditions": "Grounds-based rather than on request. Only the consent of the woman is required; a guardian consents under 18.", "url": "https://abortion-policies.srhr.org/country/india" }, { "country": "TH", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:th-penal-code-301-305", "instrument": "Criminal Code sections 301 and 305, as amended by the Criminal Code Amendment Act (No. 28) B.E. 2564 (2021)", "conditions": "On request to 12 weeks. Between 12 and 20 weeks an examination and counselling on alternatives are required under a 2022 decree.", "url": "https://abortion-policies.srhr.org/country/thailand" }, { "country": "JP", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:jp-maternal-health-act", "instrument": "母体保護法 (Maternal Health Act, Act No. 156 of 1948), article 14", "conditions": "Grounds-based, including economic grounds, and the consent of the spouse is required — waived only where the spouse is unknown, cannot express an intention, or is dead.", "url": "https://abortion-policies.srhr.org/country/japan" }, { "country": "ID", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:id-health-law-2023", "instrument": "Undang-Undang No. 17 Tahun 2023 tentang Kesehatan, with PP 28/2024 and the 2023 Criminal Code", "conditions": "Rape or sexual violence, or a medical emergency. The husband's permission is required except for victims of rape, and counselling is mandatory.", "url": "https://abortion-policies.srhr.org/country/indonesia" }, { "country": "PH", "status": "unlawful", "as_of": "2026-09-17", "source": "s:who-gapd", "instrument": "Revised Penal Code (1930), articles 256 to 259", "url": "https://abortion-policies.srhr.org/country/philippines", "note": "Criminalised in all circumstances; the database records no legal ground." }, { "country": "CA", "status": "lawful", "as_of": "2026-09-17", "source": "s:ca-morgentaler-1988", "instrument": "R. v. Morgentaler, [1988] 1 S.C.R. 30, with the Canada Health Act", "conditions": "No criminal abortion law and no gestational limit in federal law. Provincial insurance coverage varies, which is a funding question rather than a legal bar.", "url": "https://abortion-policies.srhr.org/country/canada" }, { "country": "MX", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:who-gapd", "instrument": "Federal Penal Code as amended, with Supreme Court decisions 2017/148 (2021) and 267/2023", "conditions": "Federal criminalisation has been struck down, and the position is governed mainly at state level rather than nationally. This project has read no state code.", "url": "https://abortion-policies.srhr.org/country/mexico" }, { "country": "RO", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-gapd", "url": "https://abortion-policies.srhr.org/country/romania", "note": "The WHO database codes Romania as grounds-based with termination on request recorded as unavailable, which conflicts with the usual reading of article 201 of the Criminal Code. The Romanian statute database refused the connection on this pass, so the conflict is left open rather than resolved." }, { "country": "AU", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-gapd", "url": "https://abortion-policies.srhr.org/country/australia", "note": "State and territory law, not federal. The WHO database codes every field as varying by jurisdiction and lists no state act; no state act was read on this pass." } ], "kin": [ { "to": "abortion-care", "as": "The procedure these instruments govern.", "rel": "procedure" }, { "to": "circumvention-travel", "as": "The category this is the oldest example of.", "rel": "term" }, { "to": "circumvention", "as": "The essay on the traffic a prohibition creates, of which this is the oldest and largest case.", "rel": "story" }, { "to": "reproductive-exile", "as": "The neighbouring word, and the fight over which one to use.", "rel": "term" }, { "to": "the-visa", "as": "Why a named purpose of travel matters here.", "rel": "pathway" }, { "to": "united-kingdom", "as": "A destination whose statute contains no residence bar.", "rel": "destination" }, { "to": "united-states", "as": "The source market the question moved to in 2022.", "rel": "destination" }, { "to": "who", "as": "The body whose database is the comparative reading behind most of these rows.", "rel": "org" }, { "to": "assisted-dying-law", "as": "The other question where the residence gate is the whole instrument.", "rel": "kin" } ], "sources": [ "s:who-gapd", "s:nl-abortion-act-1981", "s:uk-abortion-act-1967", "s:cz-act-66-1986", "s:sg-termination-act", "s:ie-termination-act-2018", "s:de-stgb-218a", "s:es-lo-2-2010", "s:fr-csp-l2212-1", "s:be-abortion-law-2018", "s:pt-codigo-penal-142", "s:pl-family-planning-act-1993", "s:tr-law-2827", "s:ch-penal-118-120", "s:us-dobbs-2022", "s:za-choice-act-1996", "s:in-mtp-act-1971", "s:th-penal-code-301-305", "s:jp-maternal-health-act", "s:id-health-law-2023", "s:ca-morgentaler-1988", "s:tw-eugenics-act", "s:women-on-web" ], "provenance": { "default": { "tier": "cited", "source": "s:who-gapd" }, "fields": { "text.story": { "tier": "cited", "source": "s:cz-act-66-1986", "note": "the Singapore and Czech provisions are read in the statutes; the stretch marked *Inference —* is this project's reasoning" }, "legality": { "tier": "cited", "source": "s:who-gapd", "note": "each row's url names the page read — a WHO country record, or a national statute database where one was reachable" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "Where a termination may lawfully be performed, on what grounds and to what gestational limit, and whether the law reaches someone who does not live there.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "abortion-care", "type": "procedure", "name": "Abortion", "as": "The procedure these instruments govern.", "rel": "procedure" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The category this is the oldest example of.", "rel": "term" }, { "to": "circumvention", "type": "story", "name": "Circumvention", "as": "The essay on the traffic a prohibition creates, of which this is the oldest and largest case.", "rel": "story" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The neighbouring word, and the fight over which one to use.", "rel": "term" }, { "to": "the-visa", "type": "pathway", "name": "The visa", "as": "Why a named purpose of travel matters here.", "rel": "pathway" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "A destination whose statute contains no residence bar.", "rel": "destination" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The source market the question moved to in 2022.", "rel": "destination" }, { "to": "who", "type": "org", "name": "World Health Organization", "as": "The body whose database is the comparative reading behind most of these rows.", "rel": "org" }, { "to": "assisted-dying-law", "type": "rule", "name": "Assisted dying, and who may cross a border for it", "as": "The other question where the residence gate is the whole instrument.", "rel": "kin" } ], "source_list": [ { "id": "s:who-gapd", "kind": "dataset", "title": "Global Abortion Policies Database", "publisher": "World Health Organization (HRP)", "url": "https://abortion-policies.srhr.org/", "accessed": "2026-09-16", "note": "country profiles naming each jurisdiction's instrument; cited here where a national instrument was not read directly" }, { "id": "s:nl-abortion-act-1981", "kind": "statute", "title": "Wet afbreking zwangerschap (Wet van 1 mei 1981), artikelen 3, 6 en 11, as amended by the Wet van 22 augustus 2022 (Stb. 2022, 326)", "publisher": "Overheid.nl, wetten.overheid.nl", "url": "https://wetten.overheid.nl/BWBR0003396/", "accessed": "2026-09-17", "note": "no week limit in the Act and no residence or nationality bar; woonplaats appears only in the article 11 statistical reporting. The fixed five-day beraadtermijn was removed in 2022 and the doctor and the woman now set the term together." }, { "id": "s:uk-abortion-act-1967", "kind": "statute", "title": "Abortion Act 1967, section 1", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/ukpga/1967/87/section/1", "accessed": "2026-09-16" }, { "id": "s:cz-act-66-1986", "kind": "statute", "title": "Zákon č. 66/1986 Sb., o umělém přerušení těhotenství, § 10", "publisher": "Zákony pro lidi (AION CS), consolidated Czech statute text", "url": "https://www.zakonyprolidi.cz/cs/1986-66", "accessed": "2026-09-16" }, { "id": "s:sg-termination-act", "kind": "statute", "title": "Termination of Pregnancy Act 1974, section 3 (restriction on treatment)", "publisher": "Singapore Statutes Online, Attorney-General's Chambers", "url": "https://sso.agc.gov.sg/Act/TPA1974", "accessed": "2026-09-16" }, { "id": "s:ie-termination-act-2018", "kind": "statute", "title": "Health (Regulation of Termination of Pregnancy) Act 2018, section 12", "publisher": "Irish Statute Book, Office of the Attorney General", "url": "https://www.irishstatutebook.ie/eli/2018/act/31/section/12/enacted/en/html", "accessed": "2026-09-16" }, { "id": "s:de-stgb-218a", "kind": "statute", "title": "Strafgesetzbuch § 218a — Straflosigkeit des Schwangerschaftsabbruchs", "publisher": "Bundesministerium der Justiz, gesetze-im-internet.de", "url": "https://www.gesetze-im-internet.de/stgb/__218a.html", "accessed": "2026-09-16" }, { "id": "s:es-lo-2-2010", "kind": "statute", "title": "Ley Orgánica 2/2010, de salud sexual y reproductiva y de la interrupción voluntaria del embarazo, artículo 14", "publisher": "Boletín Oficial del Estado", "url": "https://www.boe.es/buscar/act.php?id=BOE-A-2010-3514", "accessed": "2026-09-16" }, { "id": "s:fr-csp-l2212-1", "kind": "statute", "title": "Code de la santé publique, article L2212-1, as amended by loi n° 2022-295", "publisher": "Légifrance, Government of France", "url": "https://www.legifrance.gouv.fr/codes/article_lc/LEGIARTI000045292636", "accessed": "2026-09-17", "note": "to the end of the fourteenth week on request; the article carries no residence condition" }, { "id": "s:be-abortion-law-2018", "kind": "statute", "title": "Loi du 15 octobre 2018 relative à l'interruption volontaire de grossesse, article 2", "publisher": "Service public fédéral Justice, Belgium (ejustice)", "url": "https://www.ejustice.just.fgov.be/cgi_loi/change_lg.pl?language=fr&la=F&cn=2018101503&table_name=loi", "accessed": "2026-09-17", "note": "12 weeks from conception, and the six-day reflection period between the first consultation and the procedure" }, { "id": "s:pt-codigo-penal-142", "kind": "statute", "title": "Código Penal, artigo 142.º, as amended by Lei n.º 16/2007", "publisher": "Diário da República, Portugal", "url": "https://files.diariodarepublica.pt/1s/2007/04/07500/24172418.pdf", "accessed": "2026-09-17", "note": "10 weeks by the woman's choice, after a reflection period of not less than three days" }, { "id": "s:pl-family-planning-act-1993", "kind": "statute", "title": "Ustawa z dnia 7 stycznia 1993 r. o planowaniu rodziny, ochronie płodu ludzkiego i warunkach dopuszczalności przerywania ciąży, art. 4a", "publisher": "Internetowy System Aktów Prawnych, Sejm RP", "url": "https://isap.sejm.gov.pl/isap.nsf/download.xsp/WDU19930170078/U/D19930078Lj.pdf", "accessed": "2026-09-16" }, { "id": "s:tr-law-2827", "kind": "statute", "title": "Nüfus Planlaması Hakkında Kanun (Kanun No. 2827), Madde 5", "publisher": "Mevzuat Bilgi Sistemi, Republic of Türkiye", "url": "https://www.mevzuat.gov.tr/mevzuatmetin/1.5.2827.pdf", "accessed": "2026-09-16" }, { "id": "s:ch-penal-118-120", "kind": "statute", "title": "Code pénal suisse, articles 118, 119 et 120", "publisher": "Fedlex, the Swiss federal law portal", "url": "https://www.fedlex.admin.ch/eli/cc/54/757_781_799/fr", "accessed": "2026-09-17", "note": "12 weeks from the last menstrual period, on the written request of a woman invoking distress, after an in-depth consultation" }, { "id": "s:us-dobbs-2022", "kind": "ruling", "title": "Dobbs v. Jackson Women's Health Organization, 597 U.S. 215 (2022), slip opinion", "publisher": "Supreme Court of the United States", "url": "https://www.supremecourt.gov/opinions/21pdf/19-1392_6j37.pdf", "accessed": "2026-09-16" }, { "id": "s:za-choice-act-1996", "kind": "statute", "title": "Choice on Termination of Pregnancy Act 92 of 1996, section 2", "publisher": "Government of South Africa", "url": "https://www.gov.za/sites/default/files/gcis_document/201409/a92-96.pdf", "accessed": "2026-09-16" }, { "id": "s:in-mtp-act-1971", "kind": "statute", "title": "The Medical Termination of Pregnancy Act 1971 and the Medical Termination of Pregnancy (Amendment) Act 2021", "publisher": "World Health Organization, Global Abortion Policies Database country record for India", "url": "https://abortion-policies.srhr.org/country/india", "accessed": "2026-09-17", "note": "grounds-based rather than on request; the WHO record states that only the consent of the woman is needed, with guardian consent under 18. indiacode.nic.in returned 403 on this date." }, { "id": "s:th-penal-code-301-305", "kind": "statute", "title": "ประมวลกฎหมายอาญา มาตรา 301 และ 305, as amended by the Criminal Code Amendment Act (No. 28) B.E. 2564 (2021)", "publisher": "World Health Organization, Global Abortion Policies Database country record for Thailand", "url": "https://abortion-policies.srhr.org/country/thailand", "accessed": "2026-09-17", "note": "on request to 12 weeks; between 12 and 20 weeks an examination and alternative counselling are required under a 2022 decree" }, { "id": "s:jp-maternal-health-act", "kind": "statute", "title": "母体保護法 (Maternal Health Act, Act No. 156 of 1948), article 14", "publisher": "World Health Organization, Global Abortion Policies Database country record for Japan", "url": "https://abortion-policies.srhr.org/country/japan", "accessed": "2026-09-17", "note": "spousal consent is required, waived only where the spouse is unknown, cannot express an intention, or is dead. Read in the WHO database's copy of the Act rather than in the Japanese statute database." }, { "id": "s:id-health-law-2023", "kind": "statute", "title": "Undang-Undang No. 17 Tahun 2023 tentang Kesehatan, with PP 28/2024 and KUHP 2023 Pasal 463", "publisher": "World Health Organization, Global Abortion Policies Database country record for Indonesia", "url": "https://abortion-policies.srhr.org/country/indonesia", "accessed": "2026-09-17", "note": "rape or sexual violence, or a medical emergency; the husband's permission is required except for rape victims, and counselling is mandatory. Read in the WHO database's country record." }, { "id": "s:ca-morgentaler-1988", "kind": "ruling", "title": "R. v. Morgentaler, [1988] 1 S.C.R. 30, with the Canada Health Act", "publisher": "World Health Organization, Global Abortion Policies Database country record for Canada", "url": "https://abortion-policies.srhr.org/country/canada", "accessed": "2026-09-17", "note": "no criminal abortion law and no gestational limit in federal law; provincial insurance coverage varies, which is a funding question and not a legal bar" }, { "id": "s:tw-eugenics-act", "kind": "statute", "title": "優生保健法 第九條 (Genetic Health Act, article 9)", "publisher": "Laws and Regulations Database of the Republic of China (Taiwan), Ministry of Justice", "url": "https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0070001", "accessed": "2026-09-17", "note": "a married woman relying on the sixth ground must have her spouse's consent. Taiwan is not in the WHO Global Abortion Policies Database and was read here directly." }, { "id": "s:women-on-web", "kind": "org", "title": "I need an abortion", "publisher": "Women on Web", "url": "https://www.womenonweb.org/en/page/521/i-need-an-abortion", "accessed": "2026-09-16", "note": "a Canadian non-profit facilitating online access to abortion pills, asking a donation of 90 euro" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:who-gapd" }, "text.story": { "tier": "cited", "source": "s:cz-act-66-1986", "note": "the Singapore and Czech provisions are read in the statutes; the stretch marked *Inference —* is this project's reasoning" }, "text.how": { "tier": "cited", "source": "s:who-gapd" }, "text.today": { "tier": "cited", "source": "s:who-gapd" }, "legality": { "tier": "cited", "source": "s:who-gapd", "note": "each row's url names the page read — a WHO country record, or a national statute database where one was reachable" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "warsaw", "type": "hub", "name": "Warsaw", "as": "The rule that decides which direction a patient moves in, and it is not price.", "rel": "governed-by" }, { "from": "abortion-care", "type": "procedure", "name": "Abortion", "as": "Where the country-by-country reading sits: who may be treated, up to what week, and on whose authorisation.", "rel": "governed-by" }, { "from": "assisted-dying-law", "type": "rule", "name": "Assisted dying, and who may cross a border for it", "as": "The other question where a residence gate is the whole instrument.", "rel": "kin" }, { "from": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The rule record that maps this category across borders.", "rel": "rule" }, { "from": "circumvention", "type": "story", "name": "Circumvention", "as": "The two statutes that bar a non-resident on their face, and the waiting periods that do it without saying so.", "rel": "rule" } ] }, { "id": "advertising-rules", "names": { "name": "What a clinic may say", "aliases": [ "healthcare advertising controls", "promotion and information rules", "KKLIU" ], "said": "Several states draw the same line and call it the same thing: information is allowed, advertising is not." }, "region": [ "global" ], "facets": { "kind": "advertising", "status": "in-force" }, "text": { "what": "The instruments that govern how a hospital, clinic or broker may promote treatment, and what it may claim. Four regimes are read here: Türkiye's promotion and information regulation, Malaysia's advertisement board approval, Singapore's advertising controls under the Healthcare Services Act 2020, and the United Kingdom's self-regulatory advertising code.", "story": "Türkiye's is the one written with cross-border trade in view, and it was rewritten recently. The Regulation on Promotion and Information Activities in Health Services was published in the Resmî Gazete on 12 November 2025, No. 33075, repealing the regulation of 29 July 2023, No. 32263. Article 5 states the rule: implicit or explicit advertising in the provision of health services is prohibited. Article 8 then carves out the foreign market — promotion directed abroad may run on separate platforms, may not select a domestic audience, and must carry the HealthTürkiye logo.\n\n*Inference —* that is a state permitting to foreigners what it forbids to its own citizens, and doing so explicitly rather than by omission. A reader in London and a reader in Ankara looking at the same Turkish clinic are looking at two different regulatory objects.\n\nMalaysia licenses the advertisement itself. Under section 4B of the Medicines (Advertisement and Sale) Act 1956, with the Medicine Advertisements Board Regulations 1976, an advertisement needs Board approval before publication, and the Ministry's own answer is that all dissemination of information about products and healthcare services to attract public attention, including on the internet, is an advertisement.\n\nSingapore ties the permission to the licence. Advertising controls under the Healthcare Services Act 2020 came into force on 26 June 2023 for non-licensed providers and non-registered professionals, and only a licensee or its authorised person may advertise a licensable healthcare service, under section 31. Entities outside the licensing regime — the Ministry names chiropractic centres, beauty salons, fitness centres and massage parlours — may not claim to treat or cure.\n\nBritain regulates the claim rather than the trader. The CAP Code's section 12 requires that objective claims be backed by evidence, \"if relevant consisting of trials conducted on people\" (rule 12.1), that marketers \"must not discourage essential treatment for conditions for which medical supervision should be sought\" (12.2), and that \"Prescription-only medicines or prescription-only medical treatments may not be advertised to the public\" (12.12).\n\n*Inference —* every one of these instruments binds an advertiser inside its own jurisdiction, and the advertisement a patient reads was usually placed from another one. That is the gap the whole promotional trade in this field sits in, and none of the four regimes read here closes it.", "how": "What a reader can check, and what they cannot: a Turkish provider's authorisation is on a published ministry register, and a Malaysian advertisement carries a serial number on its face. A claim made on a platform hosted elsewhere and served from elsewhere is outside all of them.\n\nWhat these instruments do not govern: the price quoted, the exclusion list attached to it, or what a facilitator says on a telephone call.", "today": "As of 17 September 2026 the Turkish regulation of 12 November 2025 is the current instrument there. The Resmî Gazete page's certificate could not be verified on this date and the text was read on a Turkish portal's reproduction; the article numbers and the repeal are as that reproduction carries them." }, "kin": [ { "to": "turkiye-health-tourism-authorisation", "as": "The licence a Turkish advertiser must hold before Article 8 lets it speak abroad.", "rel": "kin" }, { "to": "malaysia-mhtc-licence", "as": "The third Malaysian regime, alongside the statutory licence and the council membership.", "rel": "kin" }, { "to": "turkiye", "as": "The state that permits abroad what it forbids at home.", "rel": "destination" }, { "to": "singapore", "as": "The state that ties the permission to the licence.", "rel": "destination" }, { "to": "malaysia", "as": "The state that licenses the advertisement itself.", "rel": "destination" }, { "to": "facilitator", "as": "The party most of these instruments reach least.", "rel": "term" }, { "to": "getting-a-quote", "as": "The step where the claim meets a number.", "rel": "step" }, { "to": "stem-cell-regulation", "as": "What may be said about a treatment holding no authorisation anywhere.", "rel": "kin" }, { "to": "the-price-that-isnt", "as": "The claim these codes do not reach.", "rel": "story" } ], "links": [ { "label": "Resmî Gazete, 12 November 2025, No. 33075", "url": "https://resmigazete.gov.tr/eskiler/2025/11/20251112-2.htm" }, { "label": "CAP Code section 12", "url": "https://www.asa.org.uk/type/non_broadcast/code_section/12.html" } ], "sources": [ "s:tr-tanitim-yonetmelik-2025", "s:my-mab-kkliu", "s:my-mab-guidelines", "s:sg-hcsa-advertisement-regs-2021", "s:sg-moh-advertising-controls", "s:asa-cap-code-12", "s:rg-saglik-turizmi-2017" ], "provenance": { "default": { "tier": "cited", "source": "s:tr-tanitim-yonetmelik-2025" }, "fields": { "text.story": { "tier": "cited", "source": "s:asa-cap-code-12", "note": "the stretches marked *Inference —* are this project's reading across the four regimes" }, "text.today": { "tier": "cited", "source": "s:tr-tanitim-yonetmelik-2025", "note": "the official gazette page could not be verified on this date; the reproduction read is named in the source entry" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "The instruments that govern how a hospital, clinic or broker may promote treatment, and what it may claim.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The licence a Turkish advertiser must hold before Article 8 lets it speak abroad.", "rel": "kin" }, { "to": "malaysia-mhtc-licence", "type": "rule", "name": "Malaysia's healthcare travel registration", "as": "The third Malaysian regime, alongside the statutory licence and the council membership.", "rel": "kin" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The state that permits abroad what it forbids at home.", "rel": "destination" }, { "to": "singapore", "type": "destination", "name": "Singapore", "as": "The state that ties the permission to the licence.", "rel": "destination" }, { "to": "malaysia", "type": "destination", "name": "Malaysia", "as": "The state that licenses the advertisement itself.", "rel": "destination" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The party most of these instruments reach least.", "rel": "term" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step where the claim meets a number.", "rel": "step" }, { "to": "stem-cell-regulation", "type": "rule", "name": "Regulating cell and tissue therapies", "as": "What may be said about a treatment holding no authorisation anywhere.", "rel": "kin" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "The claim these codes do not reach.", "rel": "story" } ], "source_list": [ { "id": "s:tr-tanitim-yonetmelik-2025", "kind": "statute", "title": "Sağlık Hizmetlerinde Tanıtım ve Bilgilendirme Faaliyetleri Hakkında Yönetmelik (Resmî Gazete, 12 November 2025, No. 33075)", "publisher": "Resmî Gazete, Republic of Türkiye (Ministry of Health)", "url": "https://resmigazete.gov.tr/eskiler/2025/11/20251112-2.htm", "accessed": "2026-09-17", "note": "the Resmî Gazete page's certificate could not be verified on this date; the text was read on a Turkish accountancy portal's reproduction at alomaliye.com. Madde 5: implicit or explicit advertising in the provision of health services is prohibited. Madde 8: promotion directed abroad may run on separate platforms, may not select a domestic audience, and must carry the HealthTürkiye logo. Repeals the regulation of 29 July 2023, No. 32263." }, { "id": "s:my-mab-kkliu", "kind": "gov", "title": "Is it necessary for medical advertisements on the internet to get approval from MAB?", "publisher": "Pharmaceutical Services Programme, Ministry of Health Malaysia", "url": "https://pharmacy.moh.gov.my/en/faq/it-necessary-medical-advertisements-internet-get-approval-mab.html", "accessed": "2026-09-17", "note": "the Ministry's own answer: all dissemination of information about products and healthcare services to attract public attention, including on the internet, is an advertisement, and section 4B of the Medicines (Advertisement and Sale) Act 1956 requires Medicine Advertisements Board approval before publication" }, { "id": "s:my-mab-guidelines", "kind": "gov", "title": "Medicine Advertisements Board (MAB) guidelines and policy", "publisher": "Pharmaceutical Services Programme, Ministry of Health Malaysia", "url": "https://pharmacy.moh.gov.my/en/documents/medicine-advertisements-board-mab-guidelines-and-policy.html", "accessed": "2026-09-17", "note": "the index page states the guidelines complement the Medicines (Advertisement and Sale) Act 1956 (Revised 1983) and the Medicine Advertisements Board Regulations 1976; the KKLIU serial number and its validity sit in the linked PDFs, which were not read" }, { "id": "s:sg-hcsa-advertisement-regs-2021", "kind": "statute", "title": "Healthcare Services (Advertisement) Regulations 2021 (S 1033/2021), made under the Healthcare Services Act 2020", "publisher": "Singapore Statutes Online, Attorney-General's Chambers", "url": "https://sso.agc.gov.sg/SL/HSA2020-S1033-2021?DocDate=20211230", "accessed": "2026-09-17", "note": "registered from the Singapore Statutes Online listing; the regulations' own text returned 403 on this date, and the advertising controls described in the records that cite it come from the Ministry of Health's own newsroom pages" }, { "id": "s:sg-moh-advertising-controls", "kind": "gov", "title": "Non-licensed healthcare entities not permitted to make advertising claims", "publisher": "Ministry of Health, Singapore", "url": "https://www.moh.gov.sg/newsroom/non-licensed-healthcare-entities-not-permitted-to-make-advertising-claims", "accessed": "2026-09-17", "note": "advertising controls under the Healthcare Services Act 2020 came into force on 26 June 2023 for non-licensed providers and non-registered professionals; only licensees or their authorised persons may advertise a licensable healthcare service, under section 31" }, { "id": "s:asa-cap-code-12", "kind": "org", "title": "CAP Code section 12 — medicines, medical devices, health-related products and beauty products", "publisher": "Committees of Advertising Practice / Advertising Standards Authority, United Kingdom", "url": "https://www.asa.org.uk/type/non_broadcast/code_section/12.html", "accessed": "2026-09-17", "note": "rule 12.1 objective claims must be backed by evidence, if relevant trials on people; 12.2 marketers must not discourage essential treatment for conditions for which medical supervision should be sought; 12.12 prescription-only medicines or treatments may not be advertised to the public" }, { "id": "s:rg-saglik-turizmi-2017", "kind": "web", "title": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik", "publisher": "Resmî Gazete, Republic of Türkiye (Ministry of Health)", "url": "https://www.resmigazete.gov.tr/eskiler/2017/07/20170713-3.htm", "accessed": "2026-09-16", "note": "Resmî Gazete 13 July 2017, No. 30123. Read in Turkish off the Resmî Gazete page. Article 5(1) makes an international health tourism authorisation certificate (yetki belgesi) compulsory for both the health facility and the intermediary; the Ministry halts the activity of anyone without one. Transitional Article 1 gave those already trading one year to comply. Article 16: in force on publication. REPEALED: MADDE 17 of the regulation of 26 April 2025 (Resmî Gazete 32882) revokes this one. Cite it for what the regime was, not for what it is." } ], "tiers": { "text.what": { "tier": "cited", "source": "s:tr-tanitim-yonetmelik-2025" }, "text.story": { "tier": "cited", "source": "s:asa-cap-code-12", "note": "the stretches marked *Inference —* are this project's reading across the four regimes" }, "text.how": { "tier": "cited", "source": "s:tr-tanitim-yonetmelik-2025" }, "text.today": { "tier": "cited", "source": "s:tr-tanitim-yonetmelik-2025", "note": "the official gazette page could not be verified on this date; the reproduction read is named in the source entry" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "israel", "type": "destination", "name": "Israel", "as": "Registered agents and written price quotes are what this country's statute requires of the middle layer.", "rel": "governed-by" }, { "from": "south-korea", "type": "destination", "name": "South Korea", "as": "What a clinic here may say, against what a broker abroad says for it.", "rel": "governed-by" }, { "from": "dhi-hair-transplant", "type": "procedure", "name": "Direct hair implantation (DHI)", "as": "Where claims of higher graft survival may be made, and where they may not.", "rel": "governed-by" }, { "from": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "Where before-and-after photography and graft-count claims are regulated, and where they are not.", "rel": "governed-by" }, { "from": "stem-cell-unproven", "type": "procedure", "name": "Unapproved stem cell treatment", "as": "What a clinic may claim about a product no regulator has approved.", "rel": "governed-by" }, { "from": "unproven-stem-cell", "type": "risk", "name": "Unproven stem cell treatment", "as": "What may be claimed, and by whom, in each jurisdiction.", "rel": "governed-by" }, { "from": "malaysia-mhtc-licence", "type": "rule", "name": "Malaysia's healthcare travel registration", "as": "The third regime, and the KKLIU number on every advertisement.", "rel": "kin" }, { "from": "stem-cell-regulation", "type": "rule", "name": "Regulating cell and tissue therapies", "as": "What may be said about a treatment that holds no authorisation.", "rel": "kin" }, { "from": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The separate regulation that governs what a certificate holder may say abroad.", "rel": "kin" }, { "from": "ishrs", "type": "org", "name": "International Society of Hair Restoration Surgery", "as": "The rules on how this work may be sold, which the society's complaint is largely about.", "rel": "rule" } ] }, { "id": "assisted-dying-law", "names": { "name": "Assisted dying, and who may cross a border for it", "aliases": [ "assisted suicide", "euthanasia", "medical assistance in dying", "aid in dying" ], "said": "Nearly every permissive statute has a residence gate. The one that does not is the one people travel to." }, "region": [ "global" ], "facets": { "kind": "prohibition", "status": "in-force" }, "text": { "what": "Whether assistance in dying is lawful, and whether the person assisted must live there. The second question is the one that makes this a cross-border subject at all, and the rows below record it where the instrument could be read.", "story": "Switzerland's position is an omission rather than a permission. Article 115 of the Criminal Code punishes inciting or assisting suicide only where the person acts from a selfish motive. There is no clause about nationality and none about residence, because the article was not written about this at all — it was written about motive. The absence is what the organisations in Zurich and Basel operate in.\n\nEvery other permissive regime this project could read has closed that door, and they close it three different ways.\n\nSome write the gate into the statute. Spain's Ley Orgánica 3/2021 requires Spanish nationality, or lawful residence, or twelve months on the municipal register. France's law of 18 August 2026 requires French nationality or stable and regular residence, as one of five cumulative conditions. California requires a driver's licence, a voter registration, a property interest or a tax return.\n\nCanada does it through the health system instead. Section 241.2(1)(a) keys eligibility to entitlement to health services funded by a government in Canada, and forgives only \"any applicable minimum period of residence or waiting period\". A visitor with no provincial entitlement at all is not saved by that clause.\n\nThe Netherlands and Belgium do it through clinical structure. Neither Act contains a nationality or residence clause; the barrier is the due-care regime, which requires a physician to be satisfied of the voluntariness of the request and the hopelessness of the suffering, and a second independent physician to have seen the patient. *Inference —* that is a relationship, built over time, and it is not something a person acquires by arriving.\n\nOne door has opened. Oregon removed its residency requirement in 2023, after a federal suit settled; ORS 127.805 as amended carries no residency language. *Inference —* which means the common statement that Switzerland is the only jurisdiction admitting non-residents is now, at minimum, incomplete.\n\nThe argument this site reports and does not join runs in both directions. A residence gate prevents a state from becoming a destination for something its neighbours prohibit. It also means that a person's access to the option turns on where they happen to be registered, and that the people who travel are the people who can afford to.", "how": "Reading a row: the status describes the position for a person who does not live there. A country marked unlawful may still permit the withdrawal of life-sustaining treatment, which is a different question this table does not record.\n\nWhat the rows do not carry: the cost of the assistance, the cost of repatriating a body, whether a home state prosecutes a relative who accompanied the person, and what a death certificate issued abroad says. The last of those is the one that reaches the family.", "today": "As of 17 September 2026 eight rows below rest on an instrument that was read. Seventeen say no-data, most of them because an official statute site refused the connection on this pass. A no-data row here means this project did not read the law, not that the law is unclear." }, "legality": [ { "country": "CH", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:ch-criminal-code", "instrument": "Swiss Criminal Code, Article 115", "conditions": "The article punishes inciting or assisting suicide only where the person acts from a selfish motive. It sets no nationality condition and no residence condition, which is why Switzerland admits people who live elsewhere.", "note": "Read on this pass at a private reproduction of the statute because the federal portal renders by script; the SR number is therefore not printed from that reading." }, { "country": "NL", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:nl-euthanasia-act-2002", "instrument": "Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding, artikel 2", "conditions": "Six due-care criteria, among them that the physician be satisfied the request is voluntary and well-considered and the suffering unbearable with no prospect of improvement, and that a second independent physician has seen the patient. The Act carries no nationality or residence clause; the gate is the treating relationship those criteria presuppose." }, { "country": "BE", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:be-euthanasia-law-2002", "instrument": "Loi du 28 mai 2002 relative à l'euthanasie, article 3", "conditions": "Adult or emancipated minor, capable and conscious, a voluntary, considered and repeated request, a hopeless medical situation and constant unbearable suffering. No nationality or residence condition appears in the article." }, { "country": "ES", "status": "residents-only", "as_of": "2026-09-17", "source": "s:es-lo-3-2021", "instrument": "Ley Orgánica 3/2021 de regulación de la eutanasia, artículo 5.1.a)", "conditions": "Spanish nationality, or lawful residence in Spain, or a municipal register certificate showing more than twelve months in Spanish territory." }, { "country": "FR", "status": "residents-only", "as_of": "2026-09-17", "source": "s:fr-loi-2026-794", "instrument": "LOI n° 2026-794 du 18 août 2026 relative à l'aide à mourir, article 4, inserting Code de la santé publique article L. 1111-12-2", "conditions": "French nationality or stable and regular residence in France, as one of five cumulative conditions.", "note": "A statute a month old at the date of this reading. Read on this pass by a research agent rather than by the author of this record; treat the article reference as unconfirmed by a second reader." }, { "country": "CA", "status": "residents-only", "as_of": "2026-09-17", "source": "s:ca-criminal-code-241-2", "instrument": "Criminal Code (R.S.C. 1985, c. C-46), section 241.2(1)(a)", "conditions": "Eligibility is keyed to entitlement to health services funded by a government in Canada, forgiving only any applicable minimum period of residence or waiting period. A visitor with no provincial entitlement is not reached by that saving clause." }, { "country": "US", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:or-ors-127-805", "instrument": "No federal statute read for this row; state law governs. Oregon Death with Dignity Act, ORS 127.805, as amended by Or. Laws 2023 ch. 241 § 2, and California End of Life Option Act, Health and Safety Code § 443.2(a)(3), are the two read here.", "conditions": "The two states read here run opposite rules. Oregon's current text carries no residency clause: the requirement was removed in 2023 after a federal suit settled. California requires the applicant to be a resident of California, proved by a driver's licence or state identification, voter registration, property ownership or lease, or a recent state tax return.", "note": "The federal position and the other states with such statutes were not read on this pass." }, { "country": "GB", "status": "unlawful", "as_of": "2026-09-17", "source": "s:uk-suicide-act-1961", "instrument": "Suicide Act 1961, section 2, as substituted by the Coroners and Justice Act 2009", "note": "An act capable of encouraging or assisting suicide, done with intent, is an offence whether or not a suicide follows. Maximum 14 years." }, { "country": "PT", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-guiding-principles", "note": "Lei n.º 22/2023 is reported to confine the route to Portuguese nationals and lawful residents, and the regime is reported not to be in force pending regulation, with provisions struck by the Constitutional Court. The statute was not read on this pass." }, { "country": "AT", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-guiding-principles", "note": "The Sterbeverfügungsgesetz is reported to require Austrian citizenship or habitual residence. The federal legal information system returned a server error on this pass and the provision was not read." }, { "country": "IT", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-guiding-principles", "note": "The position rests on Constitutional Court judgment 242/2019 on article 580 of the Penal Code rather than on a statute. Neither was read on this pass." }, { "country": "AU", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-guiding-principles", "note": "State and territory law. Victoria's Act is reported to require Australian citizenship or permanent residence plus twelve months' ordinary residence in the state; no state act was read on this pass." }, { "country": "NZ", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-guiding-principles", "note": "The End of Life Choice Act 2019 is reported to require New Zealand citizenship or permanent residence; the Act was not read on this pass." }, { "country": "DE", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-guiding-principles", "note": "The position rests on a 2020 Federal Constitutional Court ruling; the judgment was not read on this pass and its case number is therefore not printed." }, { "country": "IE", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-guiding-principles", "note": "The Irish statute book refused the connection on this pass." }, { "country": "LU", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-guiding-principles", "note": "The Luxembourg legal portal refused the connection on this pass." }, { "country": "TR", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-guiding-principles", "note": "The Turkish legislation portal's certificate could not be verified on this pass." }, { "country": "SG", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-guiding-principles", "note": "Singapore Statutes Online returned 403 on this pass." }, { "country": "IN", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-guiding-principles", "note": "The position rests on a 2018 Supreme Court judgment permitting the withdrawal of life support rather than assistance in dying; the judgment was not read on this pass." }, { "country": "JP", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-guiding-principles", "note": "No Japanese instrument was read on this pass." }, { "country": "KR", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-guiding-principles", "note": "No Korean instrument was read on this pass." }, { "country": "TH", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-guiding-principles", "note": "No Thai instrument was read on this pass." }, { "country": "MX", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-guiding-principles", "note": "No Mexican instrument was read on this pass." }, { "country": "CO", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-guiding-principles", "note": "Colombia's position rests on Constitutional Court decisions and a ministerial resolution; neither was read on this pass." }, { "country": "IL", "status": "no-data", "as_of": "2026-09-17", "source": "s:who-guiding-principles", "note": "The Israeli health ministry returned an empty response on this pass." } ], "kin": [ { "to": "assisted-dying", "as": "The procedure these instruments govern.", "rel": "procedure" }, { "to": "switzerland", "as": "The destination the omission in Article 115 created.", "rel": "destination" }, { "to": "circumvention-travel", "as": "The category this sits in.", "rel": "term" }, { "to": "circumvention", "as": "The essay on crossing a border to do what is prohibited at home, in the one case where the traveller does not come back.", "rel": "story" }, { "to": "abortion-travel-law", "as": "The other question where a residence gate is the whole instrument.", "rel": "kin" }, { "to": "repatriation-cost", "as": "The bill that follows, and that no row here carries.", "rel": "risk" }, { "to": "the-companion", "as": "The person who travels too, and whose position at home is a separate question.", "rel": "pathway" }, { "to": "united-states", "as": "The federation where one state opened the door and another keeps it shut.", "rel": "destination" } ], "sources": [ "s:ch-criminal-code", "s:swissrights-stgb-115", "s:nl-euthanasia-act-2002", "s:be-euthanasia-law-2002", "s:es-lo-3-2021", "s:fr-loi-2026-794", "s:ca-criminal-code-241-2", "s:or-ors-127-805", "s:us-ca-hsc-443-2", "s:uk-suicide-act-1961", "s:who-guiding-principles" ], "provenance": { "default": { "tier": "cited", "source": "s:ch-criminal-code" }, "fields": { "text.story": { "tier": "cited", "source": "s:es-lo-3-2021", "note": "the three kinds of gate are read off the instruments; the stretches marked *Inference —* are this project's reasoning" }, "legality": { "tier": "cited", "source": "s:ch-criminal-code", "note": "a no-data row records that the instrument could not be read on this pass" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "Whether assistance in dying is lawful, and whether the person assisted must live there.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "assisted-dying", "type": "procedure", "name": "Assisted dying", "as": "The procedure these instruments govern.", "rel": "procedure" }, { "to": "switzerland", "type": "destination", "name": "Switzerland", "as": "The destination the omission in Article 115 created.", "rel": "destination" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The category this sits in.", "rel": "term" }, { "to": "circumvention", "type": "story", "name": "Circumvention", "as": "The essay on crossing a border to do what is prohibited at home, in the one case where the traveller does not come back.", "rel": "story" }, { "to": "abortion-travel-law", "type": "rule", "name": "Travelling for a termination", "as": "The other question where a residence gate is the whole instrument.", "rel": "kin" }, { "to": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "The bill that follows, and that no row here carries.", "rel": "risk" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "The person who travels too, and whose position at home is a separate question.", "rel": "pathway" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The federation where one state opened the door and another keeps it shut.", "rel": "destination" } ], "source_list": [ { "id": "s:ch-criminal-code", "kind": "statute", "title": "Swiss Criminal Code (SR 311.0), Article 115 — Inciting and assisting suicide (English translation)", "publisher": "Fedlex, the Swiss federal law portal", "url": "https://www.fedlex.admin.ch/filestore/fedlex.data.admin.ch/eli/cc/54/757_781_799/20250101/en/html/fedlex-data-admin-ch-eli-cc-54-757_781_799-20250101-en-html.html", "accessed": "2026-09-16" }, { "id": "s:swissrights-stgb-115", "kind": "web", "title": "Article 115 of the Swiss Criminal Code (English), on a private reproduction of the statute", "publisher": "swissrights.ch", "url": "https://www.swissrights.ch/gesetze/Artikel-115-StGB-2025-EN.php", "accessed": "2026-09-17", "note": "a mirror, read because fedlex.admin.ch renders by script and did not return text on this date. The mirror does not display the SR number, so this project does not print one from it. The provision punishes inciting or assisting suicide only where the actor is led by a selfish motive; it carries no nationality or residence condition." }, { "id": "s:nl-euthanasia-act-2002", "kind": "statute", "title": "Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding, artikel 2 (zorgvuldigheidseisen)", "publisher": "Overheid.nl, wetten.overheid.nl", "url": "https://wetten.overheid.nl/BWBR0012410/2023-04-01/0/Hoofdstuk2", "accessed": "2026-09-16" }, { "id": "s:be-euthanasia-law-2002", "kind": "statute", "title": "Loi du 28 mai 2002 relative à l'euthanasie, article 3", "publisher": "Service public fédéral Justice, Belgium (ejustice)", "url": "https://www.ejustice.just.fgov.be/cgi_loi/change_lg.pl?language=fr&la=F&cn=2002052837&table_name=loi", "accessed": "2026-09-17", "note": "article 3 sets the conditions — adult or emancipated minor, capable and conscious, a voluntary, considered and repeated request, a hopeless medical situation and constant unbearable suffering. The article carries no nationality or residence condition." }, { "id": "s:es-lo-3-2021", "kind": "statute", "title": "Ley Orgánica 3/2021, de regulación de la eutanasia, artículo 5", "publisher": "Boletín Oficial del Estado", "url": "https://www.boe.es/buscar/act.php?id=BOE-A-2021-4628", "accessed": "2026-09-16" }, { "id": "s:fr-loi-2026-794", "kind": "statute", "title": "LOI n° 2026-794 du 18 août 2026 relative à l'aide à mourir, article 4, inserting Code de la santé publique article L. 1111-12-2", "publisher": "Légifrance, Government of France", "url": "https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000054706877", "accessed": "2026-09-17", "note": "French nationality or stable and regular residence in France is one of five cumulative conditions. Read on this pass by a research agent rather than by the author of the records that cite it." }, { "id": "s:ca-criminal-code-241-2", "kind": "statute", "title": "Criminal Code (R.S.C. 1985, c. C-46), section 241.2 — eligibility for medical assistance in dying", "publisher": "Justice Laws Website, Government of Canada", "url": "https://laws-lois.justice.gc.ca/eng/acts/C-46/section-241.2.html", "accessed": "2026-09-16" }, { "id": "s:or-ors-127-805", "kind": "statute", "title": "Oregon Death with Dignity Act, ORS 127.805 (s. 2.01), as amended by Or. Laws 2023 ch. 241 § 2", "publisher": "oregon.public.law, reproduction of the Oregon Revised Statutes", "url": "https://oregon.public.law/statutes/ors_127.805", "accessed": "2026-09-17", "note": "the current text carries no residency clause; the requirement was removed by HB 2279 (2023) following the settlement of a federal suit in 2022" }, { "id": "s:us-ca-hsc-443-2", "kind": "statute", "title": "California End of Life Option Act, Health and Safety Code § 443.2(a)(3)", "publisher": "California Legislative Information", "url": "https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC§ionNum=443.2", "accessed": "2026-09-17", "note": "the applicant must be a resident of California, proved by a California driver's licence or state identification, California voter registration, ownership or lease of California property, or a California tax return for the most recent year" }, { "id": "s:uk-suicide-act-1961", "kind": "statute", "title": "Suicide Act 1961, section 2 (as amended by the Coroners and Justice Act 2009)", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/ukpga/Eliz2/9-10/60/section/2", "accessed": "2026-09-16" }, { "id": "s:who-guiding-principles", "kind": "org", "title": "WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation, as endorsed by the Sixty-third World Health Assembly, May 2010, in Resolution WHA63.22", "publisher": "World Health Organization", "url": "https://iris.who.int/server/api/core/bitstreams/53e1102b-4874-49bf-97bc-c529b1c246f0/content", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:ch-criminal-code" }, "text.story": { "tier": "cited", "source": "s:es-lo-3-2021", "note": "the three kinds of gate are read off the instruments; the stretches marked *Inference —* are this project's reasoning" }, "text.how": { "tier": "cited", "source": "s:ch-criminal-code" }, "text.today": { "tier": "cited", "source": "s:ch-criminal-code" }, "legality": { "tier": "cited", "source": "s:ch-criminal-code", "note": "a no-data row records that the instrument could not be read on this pass" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "assisted-dying", "type": "procedure", "name": "Assisted dying", "as": "Where the country-by-country reading sits, including the jurisdictions that provide for residents only.", "rel": "governed-by" }, { "from": "abortion-travel-law", "type": "rule", "name": "Travelling for a termination", "as": "The other question where the residence gate is the whole instrument.", "rel": "kin" }, { "from": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "Where the prohibition falls on whoever assists rather than on the patient.", "rel": "rule" }, { "from": "circumvention", "type": "story", "name": "Circumvention", "as": "Three different ways of writing a residence gate, and the one omission that is not one.", "rel": "rule" } ] }, { "id": "cross-border-prescriptions", "names": { "name": "A prescription that crosses a border", "aliases": [ "cross-border prescription", "the common name rule", "Directive 2012/52/EU" ], "said": "A brand name stops at the frontier. The common name does not." }, "region": [ "europe-west", "europe-central", "europe-south", "europe-north", "europe-east" ], "facets": { "kind": "treaty", "status": "in-force" }, "text": { "what": "Commission Implementing Directive 2012/52/EU, made under Directive 2011/24/EU, sets what a prescription must carry to be dispensable in another EU Member State. Article 2 states the scope: it applies to prescriptions \"issued further to a request of a patient who intends to use them in another Member State\". The patient has to ask for one; an ordinary domestic prescription does not become portable by itself.", "story": "The Annex is a list of four things, and the fourth is the one that does the work.\n\nPatient identification: surname or surnames, first names \"written out in full, i.e. no initials\", and date of birth. Authentication: the issue date. The prescriber: name, professional qualification, contact details including telephone or email with international dialling prefixes, work address with the Member State named, and a signature, written or digital.\n\nThen the product. The prescription gives the common name as defined in Directive 2001/83/EC, the pharmaceutical form, the quantity, the strength and the dosage regimen. A brand name is used only where the product is a biological medicinal product, or where the prescriber deems it medically necessary — and the prescriber then states why.\n\n*Inference —* the common-name rule is a translation device, and it is the same move accreditation makes in another part of this subject: replace a local identifier nobody abroad can read with a shared one they can. A pharmacist in Lisbon does not need to know a Finnish brand. They need an international non-proprietary name, a strength and a form.\n\nWhat the instrument does not do is make anything portable that was not portable already. It sets the form of a document. It does not oblige a pharmacy to stock the product, does not touch whether the medicine is authorised in the dispensing country, does not touch price or reimbursement, and expressly does not create a route for medicines that are controlled substances in either state.\n\nOutside the European Economic Area nothing equivalent exists. A prescription written in Bangkok is a piece of paper in Berlin, and the medicine a patient is discharged on may not be authorised, may be authorised at a different strength, or may be an entirely different molecule sold under a name that looks familiar.", "how": "What a patient discharged abroad would have to establish: whether the medicine has an international non-proprietary name written on the discharge summary rather than only a local brand; whether it is authorised at home; whether the quantity supplied covers the gap until a home prescriber can see them; and whether any of it is a controlled drug, which is a customs question as well as a clinical one.\n\nThe World Health Organization's fact sheet on substandard and falsified medical products, dated 3 December 2024, is the background to the other half of this: what is bought to fill the gap, and where.", "today": "As of 17 September 2026 the implementing directive stands as the EU rule. The parent directive's route closed to United Kingdom residents at the end of the transition period, and this project has not read what replaced it for prescriptions written in the EEA and presented in Britain." }, "kin": [ { "to": "eu-directive-2011-24", "as": "The parent instrument this one implements.", "rel": "governed-by" }, { "to": "the-discharge-summary", "as": "The document the common-name rule is really about.", "rel": "step" }, { "to": "aftercare-at-home", "as": "The step where the prescription is presented.", "rel": "step" }, { "to": "counterfeit-medicines", "as": "What fills the gap when the prescription will not travel.", "rel": "risk" }, { "to": "patient-data-transfer", "as": "The record that travels alongside it, under different law.", "rel": "kin" }, { "to": "follow-up-gap", "as": "The interval this instrument was written to shorten.", "rel": "risk" }, { "to": "eu-national-contact-points", "as": "Who a patient asks when a pharmacy refuses.", "rel": "org" } ], "links": [ { "label": "Commission Implementing Directive 2012/52/EU, Article 2", "url": "https://www.legislation.gov.uk/eudr/2012/52/article/2" }, { "label": "Commission Implementing Directive 2012/52/EU, Annex", "url": "https://www.legislation.gov.uk/eudr/2012/52/annex" } ], "sources": [ "s:eu-implementing-dir-2012-52", "s:legislation-eu-directive-2011-24", "s:who-substandard-falsified", "s:nhs-eu-directive-route" ], "provenance": { "default": { "tier": "cited", "source": "s:eu-implementing-dir-2012-52" }, "fields": { "text.story": { "tier": "cited", "source": "s:eu-implementing-dir-2012-52", "note": "the Annex is quoted; the stretch marked *Inference —* is this project's reading" }, "text.how": { "tier": "tradition", "note": "the questions a discharged patient faces; no instrument sets them out" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "Commission Implementing Directive 2012/52/EU, made under Directive 2011/24/EU, sets what a prescription must carry to be dispensable in another EU Member State.", "region_terms": [ { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" }, { "key": "europe-central", "name": "Central Europe", "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia" }, { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" }, { "key": "europe-north", "name": "Northern Europe", "note": "the Nordics and the Baltics" }, { "key": "europe-east", "name": "Eastern Europe", "note": "Romania, Bulgaria, Serbia, Ukraine, Moldova, Albania, North Macedonia" } ], "kin_out": [ { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The parent instrument this one implements.", "rel": "governed-by" }, { "to": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "The document the common-name rule is really about.", "rel": "step" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The step where the prescription is presented.", "rel": "step" }, { "to": "counterfeit-medicines", "type": "risk", "name": "Substandard and falsified medicines", "as": "What fills the gap when the prescription will not travel.", "rel": "risk" }, { "to": "patient-data-transfer", "type": "rule", "name": "Moving a medical record across a border", "as": "The record that travels alongside it, under different law.", "rel": "kin" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The interval this instrument was written to shorten.", "rel": "risk" }, { "to": "eu-national-contact-points", "type": "org", "name": "EU National Contact Points for cross-border healthcare", "as": "Who a patient asks when a pharmacy refuses.", "rel": "org" } ], "source_list": [ { "id": "s:eu-implementing-dir-2012-52", "kind": "statute", "title": "Commission Implementing Directive 2012/52/EU laying down measures to facilitate the recognition of medical prescriptions issued in another Member State", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/eudr/2012/52/article/2", "accessed": "2026-09-16" }, { "id": "s:legislation-eu-directive-2011-24", "kind": "statute", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare, Articles 7, 8 and 11 (text as held on legislation.gov.uk)", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/eudr/2011/24/article/7", "accessed": "2026-09-16" }, { "id": "s:who-substandard-falsified", "kind": "org", "title": "Substandard and falsified medical products — fact sheet dated 3 December 2024", "publisher": "World Health Organization", "url": "https://www.who.int/news-room/fact-sheets/detail/substandard-and-falsified-medical-products", "accessed": "2026-09-16" }, { "id": "s:nhs-eu-directive-route", "kind": "web", "title": "The EU Directive route", "publisher": "NHS", "url": "https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/eu-directive-route/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:eu-implementing-dir-2012-52" }, "text.story": { "tier": "cited", "source": "s:eu-implementing-dir-2012-52", "note": "the Annex is quoted; the stretch marked *Inference —* is this project's reading" }, "text.how": { "tier": "tradition", "note": "the questions a discharged patient faces; no instrument sets them out" }, "text.today": { "tier": "cited", "source": "s:eu-implementing-dir-2012-52" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "nuevo-progreso", "type": "hub", "name": "Nuevo Progreso", "as": "Half the street is pharmacies, and that is a different transaction from a course of treatment.", "rel": "governed-by" }, { "from": "abortion-care", "type": "procedure", "name": "Abortion", "as": "The by-post route, where the medicine crosses the border instead of the patient.", "rel": "rule" }, { "from": "addiction-rehab", "type": "procedure", "name": "Residential addiction treatment", "as": "What happens to the medication started abroad when the patient lands at home.", "rel": "governed-by" }, { "from": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "What the take-home drug list has to survive at a pharmacy in another country.", "rel": "governed-by" }, { "from": "counterfeit-medicines", "type": "risk", "name": "Substandard and falsified medicines", "as": "The rule that decides whether a prescription written abroad can be filled at home.", "rel": "governed-by" }, { "from": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The implementing directive that makes a prescription written under this one readable at the next border.", "rel": "kin" }, { "from": "patient-data-transfer", "type": "rule", "name": "Moving a medical record across a border", "as": "The other half of what a patient carries home.", "rel": "kin" } ] }, { "id": "donor-anonymity-law", "names": { "name": "Donor anonymity", "aliases": [ "identity-release donation", "open-identity donors", "the right to know one's origins" ], "said": "Two rights pulling opposite ways: the donor's privacy and the child's claim to know where it came from." }, "region": [ "global" ], "facets": { "kind": "prohibition", "status": "in-force" }, "text": { "what": "Whether a gamete or embryo donor may remain unknown to the person conceived. In the rows below, lawful means anonymous donation is available; unlawful means identity release is compulsory and anonymity is not on offer; lawful-with-conditions means both tracks run, or only non-identifying information is released.", "story": "The direction of travel in Europe has been one way for twenty years, and it has moved patients with it.\n\nBritain ended anonymity for donations made from 1 April 2005 by regulations made under the 1990 Act. Sweden had gone first, decades earlier. The Netherlands, Germany, Finland and others followed, each building a register and each fixing an age at which the person conceived may ask. Spain did not: article 5.5 of Ley 14/2006 makes anonymity compulsory and confidentiality of the donor's identity a duty, breakable only in extraordinary circumstances carrying a definite danger to the child's life or health.\n\n*Inference —* Spain therefore sits in the middle of Europe running the opposite rule to most of its neighbours, and it is also the largest egg-donation destination on the continent. The Spanish registry recorded 27,564 cycles in 2022 for patients resident in other countries — France 39.0%, Italy 20.6%, the United Kingdom 9.0%, Germany 6.4% — and 52.3% of those cycles used donated eggs. The registry did not record why the patient came in 90.8% of them.\n\nThat last figure is the one to hold. The correlation between an anonymity rule and an inflow is visible; the causation is not recorded, because the question was not asked of nine patients in ten. Waiting lists, price, age limits and access rules for single women and female couples all point the same direction, and the registry cannot separate them.\n\nThe rule that changed the facts on the ground was not a rule at all. *Inference —* consumer DNA databases have made anonymity a promise a clinic can no longer keep, whatever the statute says, in any country where enough relatives have tested. A register decides what a state will tell you. It does not decide what a cousin's saliva sample will.", "how": "What a row does not tell a reader: whether the rule applies to donations already in storage, what happens to gametes exported from a release regime into an anonymous one or the other way, whether a donor recruited abroad is covered by the treating country's rule or their own, and how many families one donor may create — which is capped in most European systems and not in all.\n\nThe ESHRE and European IVF-Monitoring Consortium survey covering 43 European countries at 31 December 2022 is the widest comparative reading available. It is a survey of national correspondents, not a reading of statutes, and several of its groupings do not match this project's understanding of the countries concerned — which is why the rows that rest on it say so, and why three rows say no-data instead.", "today": "As of 17 September 2026 the rows resting on named national instruments are Spain, the United Kingdom, Germany, the Netherlands, Sweden and Czechia. The rest rest on the comparative survey or say no-data." }, "legality": [ { "country": "ES", "status": "lawful", "as_of": "2026-09-17", "source": "s:es-ley-14-2006", "instrument": "Ley 14/2006 sobre técnicas de reproducción humana asistida, artículo 5.5", "conditions": "Anonymity is compulsory, not optional: the donation is anonymous and the confidentiality of identity data must be guaranteed. Disclosure is possible only exceptionally, in extraordinary circumstances carrying a definite danger to the life or health of the child.", "note": "Spain is the largest egg-donation destination in Europe, and this article is one reason. Its national registry recorded 27,564 cycles in 2022 for patients resident in other countries, 52.3% of them using donated eggs." }, { "country": "GB", "status": "unlawful", "as_of": "2026-09-17", "source": "s:uk-donor-info-regs-2004", "instrument": "The Human Fertilisation and Embryology Authority (Disclosure of Donor Information) Regulations 2004 (SI 2004/1511)", "conditions": "Anonymity ended for donations made from 1 April 2005. A person conceived from such a donation may obtain non-identifying details at 16 — physical description, year and country of birth — and identifying details at 18, including the donor's full name now and at birth. Donations between 1 August 1991 and 31 March 2005 release non-identifying information only, and nothing is held from before August 1991.", "note": "The Authority's own page is the practical statement of what is released and when." }, { "country": "DE", "status": "unlawful", "as_of": "2026-09-17", "source": "s:de-saregg", "instrument": "Samenspenderregistergesetz (SaRegG) § 10", "conditions": "A national sperm-donor register holds the donor's identity and a person conceived may apply for disclosure from the register." }, { "country": "NL", "status": "unlawful", "as_of": "2026-09-17", "source": "s:nl-donor-data-act", "instrument": "Wet donorgegevens kunstmatige bevruchting", "conditions": "Donor data are held by a statutory foundation and released to the person conceived on request at the age the Act sets." }, { "country": "SE", "status": "unlawful", "as_of": "2026-09-17", "source": "s:se-genetic-integrity-act", "instrument": "Lag (2006:351) om genetisk integritet m.m., 6 kap. 5 §", "conditions": "A person conceived by donation who is sufficiently mature has the right to information about the donor." }, { "country": "CZ", "status": "lawful", "as_of": "2026-09-17", "source": "s:cz-act-373-2011", "instrument": "Zákon č. 373/2011 Sb., o specifických zdravotních službách, § 10(1)", "conditions": "The provider must preserve mutual anonymity between the anonymous donor and the infertile couple, and between the donor and the child born. Section 6(1) confines treatment to a woman and a man who undergo it together." }, { "country": "PT", "status": "no-data", "as_of": "2026-09-17", "source": "s:tc-portugal-225-2018", "note": "Two readings conflict and this project has resolved neither. The Constitutional Court's ruling 225/2018 heard a challenge to donor anonymity under article 15 of Lei 32/2006, argued against the child's right to know its origins under article 26 of the Constitution; the ESHRE survey's position at 31 December 2022 groups Portugal with the strict-anonymity states. The Portuguese instrument in its current form was not read." }, { "country": "FR", "status": "no-data", "as_of": "2026-09-17", "source": "s:eshre-survey-2024", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11373472/", "note": "The ESHRE survey lists France in both its strict-anonymity and its identity-release groups at 31 December 2022, which is the year the French change took effect. This project did not read the French instrument and will not resolve the contradiction by guessing which side of it France was on." }, { "country": "CH", "status": "no-data", "as_of": "2026-09-17", "source": "s:eshre-survey-2024", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11373472/", "note": "The survey's summary groups Switzerland with strict anonymity, which does not match the usual account of Swiss law. No Swiss instrument was read on this pass." }, { "country": "AT", "status": "no-data", "as_of": "2026-09-17", "source": "s:eshre-survey-2024", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11373472/", "note": "Grouped with strict anonymity in the survey summary read here; no Austrian instrument was read, and the grouping is not relied on." }, { "country": "GR", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:eshre-survey-2024", "instrument": "National assisted-reproduction legislation as recorded by the ESHRE survey", "conditions": "The survey records Greece as running both anonymous and identity-release options. No Greek article number was read for this row.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11373472/" }, { "country": "HU", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:eshre-survey-2024", "instrument": "National assisted-reproduction legislation as recorded by the ESHRE survey", "conditions": "The survey records anonymity for sperm donation and identity release for oocyte donation. No Hungarian article number was read for this row.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11373472/" }, { "country": "BE", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:eshre-survey-2024", "instrument": "National assisted-reproduction legislation as recorded by the ESHRE survey", "conditions": "Recorded as a mixed system, with both anonymous and known donation. No Belgian article number was read for this row.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11373472/" }, { "country": "CY", "status": "lawful", "as_of": "2026-09-17", "source": "s:eshre-survey-2024", "instrument": "National assisted-reproduction legislation as recorded by the ESHRE survey", "conditions": "Grouped with the strict-anonymity states at 31 December 2022. No Cypriot article number was read for this row.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11373472/" }, { "country": "HR", "status": "lawful", "as_of": "2026-09-17", "source": "s:eshre-survey-2024", "instrument": "National assisted-reproduction legislation as recorded by the ESHRE survey", "conditions": "Grouped with the strict-anonymity states at 31 December 2022.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11373472/" }, { "country": "LT", "status": "lawful", "as_of": "2026-09-17", "source": "s:eshre-survey-2024", "instrument": "National assisted-reproduction legislation as recorded by the ESHRE survey", "conditions": "Grouped with the strict-anonymity states at 31 December 2022.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11373472/" }, { "country": "PL", "status": "lawful", "as_of": "2026-09-17", "source": "s:eshre-survey-2024", "instrument": "National assisted-reproduction legislation as recorded by the ESHRE survey", "conditions": "Grouped with the strict-anonymity states at 31 December 2022.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11373472/" }, { "country": "RO", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:eshre-survey-2024", "instrument": "National assisted-reproduction legislation as recorded by the ESHRE survey", "conditions": "The survey distinguishes imported gametes, recorded as anonymous, from local donations, recorded as identity-release.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11373472/" }, { "country": "TR", "status": "no-data", "as_of": "2026-09-17", "source": "s:eshre-survey-2024", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11373472/", "note": "Third-party gamete donation is itself unavailable in Türkiye, so the anonymity question does not arise in the form this table asks it. No Turkish instrument was read." }, { "country": "US", "status": "unregulated", "as_of": "2026-09-17", "source": "s:ecfr-21-1271", "note": "No federal instrument requires identity release or guarantees anonymity. 21 CFR Part 1271 governs donor eligibility, screening and testing of human cells and tissues; it is a safety regime, not a parentage or identity one. What a clinic offers is contractual, and commercial DNA databases have made the contract hard to keep." }, { "country": "IN", "status": "no-data", "as_of": "2026-09-17", "source": "s:hcch-parentage-surrogacy", "note": "The Assisted Reproductive Technology (Regulation) Act 2021 governs donation in India; this project did not read it on this pass." }, { "country": "TH", "status": "no-data", "as_of": "2026-09-17", "source": "s:hcch-parentage-surrogacy", "note": "The 2015 Act prohibits trade in gametes and embryos; its treatment of donor identity was not read." }, { "country": "ZA", "status": "no-data", "as_of": "2026-09-17", "source": "s:hcch-parentage-surrogacy", "note": "No South African instrument was read on this pass." }, { "country": "AU", "status": "no-data", "as_of": "2026-09-17", "source": "s:hcch-parentage-surrogacy", "note": "Donor identity is state law in Australia and Victoria's retrospective release is the most-cited example; no state act was read on this pass." } ], "kin": [ { "to": "egg-donation", "as": "The procedure this question follows.", "rel": "procedure" }, { "to": "sperm-donation", "as": "The other half of it.", "rel": "procedure" }, { "to": "ivf", "as": "The treatment the donation feeds.", "rel": "procedure" }, { "to": "spain", "as": "The destination whose rule runs opposite to most of its neighbours.", "rel": "destination" }, { "to": "united-kingdom", "as": "The source market that ended anonymity in 2005.", "rel": "destination" }, { "to": "hfea", "as": "The regulator that holds the British register and publishes what it releases.", "rel": "org" }, { "to": "eshre", "as": "The society whose survey is the widest comparative reading of European law here.", "rel": "org" }, { "to": "surrogacy-law", "as": "The neighbouring question, often in the same statute.", "rel": "kin" }, { "to": "reproductive-exile", "as": "The word for what the rows below produce.", "rel": "term" }, { "to": "circumvention", "as": "Why a rule about who a donor may be sends patients across a border, argued at length.", "rel": "story" } ], "sources": [ "s:es-ley-14-2006", "s:uk-donor-info-regs-2004", "s:hfea-donor-info", "s:de-saregg", "s:nl-donor-data-act", "s:se-genetic-integrity-act", "s:cz-act-373-2011", "s:eshre-survey-2024", "s:tc-portugal-225-2018", "s:sef-registro-2022", "s:ecfr-21-1271", "s:hcch-parentage-surrogacy" ], "provenance": { "default": { "tier": "cited", "source": "s:es-ley-14-2006" }, "fields": { "text.story": { "tier": "cited", "source": "s:sef-registro-2022", "note": "the registry figures are the registry's own; the stretches marked *Inference —* are this project's reasoning and are not claims of causation" }, "legality": { "tier": "cited", "source": "s:eshre-survey-2024", "note": "rows resting on the comparative survey say so in their own note; rows resting on a named national instrument cite it" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "Whether a gamete or embryo donor may remain unknown to the person conceived.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The procedure this question follows.", "rel": "procedure" }, { "to": "sperm-donation", "type": "procedure", "name": "Sperm donation", "as": "The other half of it.", "rel": "procedure" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment the donation feeds.", "rel": "procedure" }, { "to": "spain", "type": "destination", "name": "Spain", "as": "The destination whose rule runs opposite to most of its neighbours.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The source market that ended anonymity in 2005.", "rel": "destination" }, { "to": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "The regulator that holds the British register and publishes what it releases.", "rel": "org" }, { "to": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "The society whose survey is the widest comparative reading of European law here.", "rel": "org" }, { "to": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "The neighbouring question, often in the same statute.", "rel": "kin" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The word for what the rows below produce.", "rel": "term" }, { "to": "circumvention", "type": "story", "name": "Circumvention", "as": "Why a rule about who a donor may be sends patients across a border, argued at length.", "rel": "story" } ], "source_list": [ { "id": "s:es-ley-14-2006", "kind": "statute", "title": "Ley 14/2006, de 26 de mayo, sobre técnicas de reproducción humana asistida, artículos 5 y 10", "publisher": "Boletín Oficial del Estado", "url": "https://www.boe.es/buscar/act.php?id=BOE-A-2006-9292", "accessed": "2026-09-16" }, { "id": "s:uk-donor-info-regs-2004", "kind": "statute", "title": "The Human Fertilisation and Embryology Authority (Disclosure of Donor Information) Regulations 2004 (SI 2004/1511)", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/uksi/2004/1511/made", "accessed": "2026-09-16" }, { "id": "s:hfea-donor-info", "kind": "org", "title": "Rules around releasing donor information", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/donation/donors/rules-around-releasing-donor-information/", "accessed": "2026-09-17", "note": "donations from 1 April 2005: non-identifying details at 16, identifying details at 18. Donations 1 August 1991 to 31 March 2005: non-identifying only. Nothing held before August 1991." }, { "id": "s:de-saregg", "kind": "statute", "title": "Samenspenderregistergesetz (SaRegG) § 10 — Voraussetzungen und Verfahren der Auskunftserteilung", "publisher": "Bundesministerium der Justiz, gesetze-im-internet.de", "url": "https://www.gesetze-im-internet.de/saregg/__10.html", "accessed": "2026-09-16" }, { "id": "s:nl-donor-data-act", "kind": "statute", "title": "Wet donorgegevens kunstmatige bevruchting", "publisher": "Overheid.nl, wetten.overheid.nl", "url": "https://wetten.overheid.nl/BWBR0013642", "accessed": "2026-09-16" }, { "id": "s:se-genetic-integrity-act", "kind": "statute", "title": "Lag (2006:351) om genetisk integritet m.m., 6 kap. 5 § (rätt till information om donatorn)", "publisher": "Sveriges riksdag", "url": "https://www.riksdagen.se/sv/dokument-och-lagar/dokument/svensk-forfattningssamling/lag-2006351-om-genetisk-integritet-mm_sfs-2006-351/", "accessed": "2026-09-16" }, { "id": "s:cz-act-373-2011", "kind": "statute", "title": "Zákon č. 373/2011 Sb., o specifických zdravotních službách — §§ 6, 10, 21–23", "publisher": "Zákony pro lidi (AION CS), consolidated Czech statute text", "url": "https://www.zakonyprolidi.cz/cs/2011-373", "accessed": "2026-09-17", "note": "§ 10(1) obliges the provider to preserve mutual anonymity between an anonymous donor and the infertile couple and between donor and child. § 6(1) requires the written application of a woman and a man who undergo the service together. §§ 21–23: surgical sex change at 18 or over, on written application and the unanimous positive opinion of a Ministry of Health expert commission, which must act within three months; the provisions contemplate an extract from medical records kept in another state, with a certified translation." }, { "id": "s:eshre-survey-2024", "kind": "paper", "title": "Survey on ART and IUI: legislation, regulation, funding, and registries in European countries — an update", "publisher": "Human Reproduction (ESHRE), via PubMed Central PMC11373472", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11373472/", "accessed": "2026-09-16", "note": "DOI 10.1093/humrep/deae163; the country-by-country detail sits in supplementary tables not read for this pass" }, { "id": "s:tc-portugal-225-2018", "kind": "law", "title": "Ruling 225/2018 (Acórdão n.º 225/2018) — medically assisted procreation, donor anonymity and surrogacy", "publisher": "Tribunal Constitucional, Portugal", "url": "https://www.tribunalconstitucional.pt/tc/en/acordaos/20180225.html", "accessed": "2026-09-16", "note": "the court's own English summary page. The challenge ran against Law 32/2006 as amended by Laws 17/2016 and 25/2016: Article 8 on gestational surrogacy and Article 15 on donor anonymity, argued against the child's right to know its origins under Article 26 of the Constitution." }, { "id": "s:sef-registro-2022", "kind": "dataset", "title": "Registro Nacional de Actividad 2022 — Registro SEF, Técnicas de Reproducción Asistida (FIV/ICSI and IA)", "publisher": "Sociedad Española de Fertilidad for the Spanish Ministry of Health; the official national ART registry", "url": "https://www.registrosef.com/public/docs/sef2022_IAFIV.pdf", "accessed": "2026-09-16", "note": "section 3.20: 27,564 fresh and frozen cycles in 2022 were for patients resident in other countries — France 39.0%, Italy 20.6%, the United Kingdom 9.0%, Germany 6.4%, Morocco 0.6%, Portugal 0.3%, other 18.3%, country not recorded 5.7%. Of those cycles 52.3% used donated eggs. The reason for coming was not recorded in 90.8% of them; where it was, 1.6% named a technique unlawful at home and 1.1% a patient who did not meet the legal conditions at home." }, { "id": "s:ecfr-21-1271", "kind": "statute", "title": "21 CFR Part 1271 — Human cells, tissues, and cellular and tissue-based products, § 1271.3 definitions", "publisher": "Electronic Code of Federal Regulations, U.S. Government", "url": "https://www.ecfr.gov/current/title-21/chapter-I/subchapter-L/part-1271", "accessed": "2026-09-16" }, { "id": "s:hcch-parentage-surrogacy", "kind": "org", "title": "Parentage / Surrogacy Project", "publisher": "Hague Conference on Private International Law (HCCH)", "url": "https://www.hcch.net/en/projects/legislative-projects/parentage-surrogacy", "accessed": "2026-09-16", "note": "the intergovernmental project on cross-border parentage; cited here where a national instrument was not read" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:es-ley-14-2006" }, "text.story": { "tier": "cited", "source": "s:sef-registro-2022", "note": "the registry figures are the registry's own; the stretches marked *Inference —* are this project's reasoning and are not claims of causation" }, "text.how": { "tier": "cited", "source": "s:es-ley-14-2006" }, "text.today": { "tier": "cited", "source": "s:es-ley-14-2006" }, "legality": { "tier": "cited", "source": "s:eshre-survey-2024", "note": "rows resting on the comparative survey say so in their own note; rows resting on a named national instrument cite it" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "belgium", "type": "destination", "name": "Belgium", "as": "The rule that decides which patients cross this border and which stay home.", "rel": "governed-by" }, { "from": "cyprus", "type": "destination", "name": "Cyprus", "as": "The rule whose terms decide which side of the line a patient books.", "rel": "governed-by" }, { "from": "czechia", "type": "destination", "name": "Czechia", "as": "The rule that decides whether a patient must travel for a donor at all.", "rel": "governed-by" }, { "from": "north-cyprus", "type": "destination", "name": "Northern Cyprus", "as": "The rule this territory writes for itself, separately from the Republic.", "rel": "governed-by" }, { "from": "portugal", "type": "destination", "name": "Portugal", "as": "The rule this country changed by constitutional decision rather than by statute.", "rel": "governed-by" }, { "from": "barcelona", "type": "hub", "name": "Barcelona", "as": "The rule that brings some patients here and keeps others away.", "rel": "governed-by" }, { "from": "nicosia", "type": "hub", "name": "Nicosia", "as": "The other rule that decides which side of the line a patient books on.", "rel": "governed-by" }, { "from": "prague", "type": "hub", "name": "Prague", "as": "The rule that decides who arrives here and who does not.", "rel": "governed-by" }, { "from": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The rule that decides whether the donor can stay unnamed, and so which country the cycle is bought in.", "rel": "governed-by" }, { "from": "icsi", "type": "procedure", "name": "Intracytoplasmic sperm injection", "as": "Decides whether the sperm in the needle can belong to an unnamed donor.", "rel": "governed-by" }, { "from": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The rule that decides whether the donor can stay unnamed, and so where the cycle is bought.", "rel": "governed-by" }, { "from": "sperm-donation", "type": "procedure", "name": "Sperm donation", "as": "The rule that decides whether the donor can stay unnamed, and so which country the vial is bought in.", "rel": "governed-by" }, { "from": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "The neighbouring question, on the same treatments and often in the same statute.", "rel": "kin" }, { "from": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "The legal difference that drives much of the European fertility traffic.", "rel": "governs" }, { "from": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "Holds the donor register, and releases what the identity rule says it may.", "rel": "governs" }, { "from": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The rule that decides which country a patient must leave.", "rel": "rule" }, { "from": "circumvention", "type": "story", "name": "Circumvention", "as": "Spain's compulsory anonymity against Britain's identity release, and the registry that did not ask why.", "rel": "rule" } ] }, { "id": "eu-directive-2011-24", "names": { "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "aliases": [ "the Cross-Border Healthcare Directive", "the Directive route", "the patient mobility directive" ], "said": "The trade calls it \"the Directive route\", and contrasts it with \"the S2 route\" in the same breath." }, "region": [ "europe-west", "europe-central", "europe-south", "europe-north", "europe-east" ], "facets": { "kind": "reimbursement", "status": "in-force" }, "text": { "what": "The instrument that lets a person insured in one EU Member State buy treatment in another and claim the money back at home. It pays a refund, not a bill: the patient settles with the foreign provider first, then applies to their own system, which reimburses \"up to the level of costs that would have been assumed by the Member State of affiliation, had this healthcare been provided in its territory without exceeding the actual costs of healthcare received\" (Article 7(4)). Adopted 9 March 2011; in force across the EU, Iceland, Liechtenstein and Norway. Not open to residents of the United Kingdom since the end of the transition period.", "story": "Two routes to the same border, built forty years apart, and the difference between them is the whole of this record.\n\nThe older one is social-security coordination: Regulation (EC) No 883/2004, and before it Regulation 1408/71. Under Article 20 the home institution must authorise treatment abroad where \"the treatment in question is among the benefits provided for by the legislation in the Member State where the person concerned resides\" and the person \"cannot be given such treatment within a time-limit which is medically justifiable\". Authorisation granted, the patient is treated as a local patient of the destination's public system and the two states settle between themselves. The patient pays what a local would pay, which in much of Europe is nothing or a co-payment.\n\nThe newer one came out of litigation, not legislation. A run of Court of Justice judgments through the 1990s and 2000s held that healthcare bought in another Member State is a service, and that a national refusal to reimburse it can be a restriction on the freedom to provide services. The Directive codified that line. It opens the private sector, which the S2 route does not; it drops the requirement that the home system be unable to treat you in time; and it charges the patient the foreign price up front and refunds the home price afterwards. Where the home price is lower — which is why patients go to cheaper countries and also why patients from cheaper countries cannot afford the expensive ones — the difference stays with the patient.\n\n*Inference —* the two routes therefore select different patients. S2 suits someone whose own system has a queue and whose own system will pay the foreign public tariff. The Directive suits someone who can front the cash and wants a private clinic, a shorter wait, or a provider their own system does not contract with. Neither is a route to a treatment the home state does not cover at all: Article 7(1) reimburses only healthcare \"among the benefits to which the insured person is entitled in the Member State of affiliation\".\n\nThe use is small and lopsided. The European Commission's collection for reference year 2022 recorded 547,890 reimbursement requests for care needing no prior authorisation across 23 reporting countries, and France and Germany together account for 84% of them — 300,254 and 160,647. Total reimbursed: EUR 86,462,491. Portugal's 27 requests were all refused; Spain reported 9.", "how": "Article 8 lets a Member State require prior authorisation, but only for defined categories: care that \"involves overnight hospital accommodation of the patient in question for at least one night\", care that \"requires use of highly specialised and cost-intensive medical infrastructure or medical equipment\", care presenting a particular risk, or care from a provider raising specific safety or quality concerns. Article 8(6) then narrows the grounds for refusing: an unacceptable safety risk to the patient, a hazard to the public, serious and specific concerns about the provider, or the same care being available at home \"within a time limit which is medically justifiable\".\n\nArticle 7(7) lets the home state impose the same conditions, eligibility criteria and administrative formalities it would impose for care on its own territory — referral by a general practitioner included — provided they are not discriminatory or an obstacle to free movement. Article 7(4) permits, but does not require, a state to reimburse travel and accommodation on top.\n\nChapter II sets what the destination must supply: an invoice and information on prices under Article 4(2)(b), complaints procedures and redress under 4(2)(c), professional liability cover under 4(2)(d), and a copy of the medical record under 4(2)(f). Article 6 requires each Member State to run a national contact point.\n\nEight of the reporting countries — Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway — operate no prior-authorisation system at all. Only Denmark and Romania have a mechanism for limiting inflow.", "today": "As of 17 September 2026 the Directive is in force in the EU and the EEA states. The route closed to United Kingdom residents at the end of the transition period; the NHS states that \"now that the UK has left the EU, the EU Directive route has ended in the UK\", with legacy claims only for treatment started or authorised before 31 December 2020. The most recent Commission collection of Member State returns is for reference year 2022." }, "legality": [], "kin": [ { "to": "s2-route", "as": "The older coordination route, and the contrast that explains this one: it pays the destination's public tariff in full but demands a queue at home.", "rel": "contrast" }, { "to": "uk-nhs-treatment-abroad", "as": "The one national system that used both routes and now uses only one.", "rel": "kin" }, { "to": "prior-authorisation", "as": "The gate Article 8 builds, and the word for it.", "rel": "term" }, { "to": "co-payment", "as": "What a patient still pays under either route.", "rel": "term" }, { "to": "eu-national-contact-points", "as": "The bodies Article 6 obliges every Member State to run.", "rel": "org" }, { "to": "directive-2011-24-adopted", "as": "The year this was passed, and the litigation behind it.", "rel": "event" }, { "to": "patient-data-transfer", "as": "Article 4(2)(f) makes the record follow the patient; the data law says on what terms.", "rel": "kin" }, { "to": "cross-border-prescriptions", "as": "The implementing directive that makes a prescription written under this one readable at the next border.", "rel": "kin" }, { "to": "malpractice-recourse", "as": "Article 4(2)(d) requires the cover; it does not supply the forum.", "rel": "risk" }, { "to": "insurance-exclusions", "as": "What happens outside the bloc, where no instrument does any of this.", "rel": "contrast" }, { "to": "oecd-waiting-times", "as": "The series behind the queue this route was argued over.", "rel": "measured-by" } ], "links": [ { "label": "Directive 2011/24/EU, Article 7 (reimbursement)", "url": "https://www.legislation.gov.uk/eudr/2011/24/article/7" }, { "label": "Directive 2011/24/EU, Article 8 (prior authorisation)", "url": "https://www.legislation.gov.uk/eudr/2011/24/article/8" }, { "label": "Commission collection of Member State data, reference year 2022", "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf" } ], "sources": [ "s:legislation-eu-directive-2011-24", "s:eu-dir-2011-24-art-8", "s:eu-directive-2011-24", "s:dir-2011-24-chapter-ii", "s:ec-crossborder-2022", "s:eu-reg-883-2004", "s:nhs-eu-directive-route" ], "provenance": { "default": { "tier": "cited", "source": "s:legislation-eu-directive-2011-24" }, "fields": { "text.story": { "tier": "cited", "source": "s:ec-crossborder-2022", "note": "the two-route history is read off the two instruments; the paragraph marked *Inference —* is this project reasoning from them" }, "text.today": { "tier": "cited", "source": "s:nhs-eu-directive-route" } } }, "confidence": "high", "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "The instrument that lets a person insured in one EU Member State buy treatment in another and claim the money back at home.", "region_terms": [ { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" }, { "key": "europe-central", "name": "Central Europe", "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia" }, { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" }, { "key": "europe-north", "name": "Northern Europe", "note": "the Nordics and the Baltics" }, { "key": "europe-east", "name": "Eastern Europe", "note": "Romania, Bulgaria, Serbia, Ukraine, Moldova, Albania, North Macedonia" } ], "kin_out": [ { "to": "s2-route", "type": "rule", "name": "The S2 route", "as": "The older coordination route, and the contrast that explains this one: it pays the destination's public tariff in full but demands a queue at home.", "rel": "contrast" }, { "to": "uk-nhs-treatment-abroad", "type": "rule", "name": "NHS funding for treatment abroad", "as": "The one national system that used both routes and now uses only one.", "rel": "kin" }, { "to": "prior-authorisation", "type": "term", "name": "Prior authorisation", "as": "The gate Article 8 builds, and the word for it.", "rel": "term" }, { "to": "co-payment", "type": "term", "name": "Co-payment", "as": "What a patient still pays under either route.", "rel": "term" }, { "to": "eu-national-contact-points", "type": "org", "name": "EU National Contact Points for cross-border healthcare", "as": "The bodies Article 6 obliges every Member State to run.", "rel": "org" }, { "to": "directive-2011-24-adopted", "type": "event", "name": "Directive 2011/24/EU adopted, 9 March 2011", "as": "The year this was passed, and the litigation behind it.", "rel": "event" }, { "to": "patient-data-transfer", "type": "rule", "name": "Moving a medical record across a border", "as": "Article 4(2)(f) makes the record follow the patient; the data law says on what terms.", "rel": "kin" }, { "to": "cross-border-prescriptions", "type": "rule", "name": "A prescription that crosses a border", "as": "The implementing directive that makes a prescription written under this one readable at the next border.", "rel": "kin" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "Article 4(2)(d) requires the cover; it does not supply the forum.", "rel": "risk" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "What happens outside the bloc, where no instrument does any of this.", "rel": "contrast" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The series behind the queue this route was argued over.", "rel": "measured-by" } ], "source_list": [ { "id": "s:legislation-eu-directive-2011-24", "kind": "statute", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare, Articles 7, 8 and 11 (text as held on legislation.gov.uk)", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/eudr/2011/24/article/7", "accessed": "2026-09-16" }, { "id": "s:eu-dir-2011-24-art-8", "kind": "statute", "title": "Directive 2011/24/EU, Article 8 — healthcare that may be subject to prior authorisation", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/eudr/2011/24/article/8", "accessed": "2026-09-17", "note": "read for the Art 8(2) categories — at least one overnight, or highly specialised and cost-intensive infrastructure — and the four Art 8(6) grounds for refusal" }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:dir-2011-24-chapter-ii", "kind": "law", "title": "Directive 2011/24/EU, Chapter II — responsibilities of the Member State of treatment and of affiliation, Articles 4 to 6", "publisher": "legislation.gov.uk, retained text of Directive 2011/24/EU", "url": "https://www.legislation.gov.uk/cy/eudr/2011/24/chapter/II/data.htm?view=plain", "accessed": "2026-09-16", "note": "read for Art 4(2)(b) invoices and prices, 4(2)(c) complaints and redress, 4(2)(d) professional liability insurance, 4(2)(f) copy of the medical record, 5(d) access to records, and Art 6 national contact points" }, { "id": "s:ec-crossborder-2022", "kind": "report", "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU — reference year 2022", "publisher": "European Commission, DG Health and Food Safety, Unit B.3; written by PredictBy Research and Consulting and Baltic Media; Publications Office of the European Union", "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf", "license": "CC BY 4.0", "accessed": "2026-09-16", "note": "final version January 2024, ISBN 978-92-68-14858-7. 23 countries reported 547,890 reimbursement requests for care not needing prior authorisation in 2022, of which France 300,254 and Germany 160,647 are 84%; Poland 14,176, Slovakia 13,904, Ireland 1,841, Romania 889, Czechia 440, Croatia 192, Lithuania 131, Greece 56, Cyprus 44, Portugal 27 (all refused), Spain 9. Total reimbursed EUR 86,462,491. For care needing prior authorisation, 4,552 requests and EUR 7,708,041. Belgium and Hungary could not report; Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway run no prior-authorisation system; only Denmark and Romania have a mechanism to limit inflow." }, { "id": "s:eu-reg-883-2004", "kind": "statute", "title": "Regulation (EC) No 883/2004 on the coordination of social security systems, Article 20 (as adopted)", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/eur/2004/883/article/20/adopted", "accessed": "2026-09-16" }, { "id": "s:nhs-eu-directive-route", "kind": "web", "title": "The EU Directive route", "publisher": "NHS", "url": "https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/eu-directive-route/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:legislation-eu-directive-2011-24" }, "text.story": { "tier": "cited", "source": "s:ec-crossborder-2022", "note": "the two-route history is read off the two instruments; the paragraph marked *Inference —* is this project reasoning from them" }, "text.how": { "tier": "cited", "source": "s:legislation-eu-directive-2011-24" }, "text.today": { "tier": "cited", "source": "s:nhs-eu-directive-route" }, "legality": { "tier": "cited", "source": "s:legislation-eu-directive-2011-24" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "belgium", "type": "destination", "name": "Belgium", "as": "The route it applies and cannot fully count.", "rel": "governed-by" }, { "from": "croatia", "type": "destination", "name": "Croatia", "as": "The reimbursement route whose figures are the only official measure of this traffic.", "rel": "governed-by" }, { "from": "cyprus", "type": "destination", "name": "Cyprus", "as": "The route it applies with no prior-authorisation regime at all.", "rel": "governed-by" }, { "from": "germany", "type": "destination", "name": "Germany", "as": "The route its residents use more than anyone's except France's, on figures its own contact point calls impure.", "rel": "governed-by" }, { "from": "greece", "type": "destination", "name": "Greece", "as": "The route that carries almost none of this traffic.", "rel": "governed-by" }, { "from": "hungary", "type": "destination", "name": "Hungary", "as": "The reimbursement route that carries almost none of this country's dental traffic.", "rel": "governed-by" }, { "from": "ireland", "type": "destination", "name": "Ireland", "as": "The route that reimburses at this country's own DRG price, and the one the land border fell out of at Brexit.", "rel": "governed-by" }, { "from": "lithuania", "type": "destination", "name": "Lithuania", "as": "The reimbursement route this country's residents use, and its visitors do not.", "rel": "governed-by" }, { "from": "poland", "type": "destination", "name": "Poland", "as": "The route its own residents use heavily, and its inbound patients almost never.", "rel": "governed-by" }, { "from": "portugal", "type": "destination", "name": "Portugal", "as": "The route whose Portuguese applications were all refused in the last reported year.", "rel": "governed-by" }, { "from": "romania", "type": "destination", "name": "Romania", "as": "The route whose Romanian figures are the only official count of this traffic.", "rel": "governed-by" }, { "from": "spain", "type": "destination", "name": "Spain", "as": "The route that made it the EU's most authorised country of treatment in 2021.", "rel": "governed-by" }, { "from": "switzerland", "type": "destination", "name": "Switzerland", "as": "The route that does not reach here: Switzerland is not a Member State.", "rel": "contrast" }, { "from": "barcelona", "type": "hub", "name": "Barcelona", "as": "A reimbursement route that is narrow here, because a home system that funds nothing reimburses nothing.", "rel": "governed-by" }, { "from": "budapest", "type": "hub", "name": "Budapest", "as": "The route an EU-insured patient can claim part of the bill back through, at the home tariff.", "rel": "governed-by" }, { "from": "prague", "type": "hub", "name": "Prague", "as": "The reimbursement route an insured EU patient can use, at the home tariff.", "rel": "governed-by" }, { "from": "sopron", "type": "hub", "name": "Sopron", "as": "The route an Austrian patient can claim a share of the bill back through.", "rel": "governed-by" }, { "from": "vilnius", "type": "hub", "name": "Vilnius", "as": "The route that converts a wait in one member state into a booking here.", "rel": "governed-by" }, { "from": "warsaw", "type": "hub", "name": "Warsaw", "as": "The reimbursement route an insured EU patient can use for care bought here.", "rel": "governed-by" }, { "from": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "The route under which Ireland repays a cataract done in another member state at its own DRG price.", "rel": "rule" }, { "from": "dialysis-holiday", "type": "procedure", "name": "Dialysis away from home", "as": "The route by which a European patient's home system may meet the cost of treatment in another member state.", "rel": "governed-by" }, { "from": "gallbladder-removal", "type": "procedure", "name": "Gallbladder removal", "as": "The route under which an Irish patient is repaid at the Irish price for this operation done abroad.", "rel": "rule" }, { "from": "hernia-repair", "type": "procedure", "name": "Hernia repair", "as": "The route under which an Irish patient is repaid at the Irish price for a hernia done abroad.", "rel": "rule" }, { "from": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "The refund route the Lithuanian price page leads with.", "rel": "governed-by" }, { "from": "hysterectomy", "type": "procedure", "name": "Hysterectomy", "as": "The route under which an Irish patient is repaid at the Irish price for this operation done abroad.", "rel": "rule" }, { "from": "prostatectomy", "type": "procedure", "name": "Prostatectomy", "as": "The route under which an Irish patient is repaid at the Irish admitted-patient price.", "rel": "rule" }, { "from": "charite-international", "type": "facility", "name": "Charité International Patients", "as": "Governs how an EU patient's home system pays for planned treatment here, which is a different route from the self-funder's.", "rel": "governed-by" }, { "from": "arrival-and-consent", "type": "pathway", "name": "Arrival and consent", "as": "What a provider in an EU state of treatment must disclose.", "rel": "governed-by" }, { "from": "complaint-and-claim", "type": "pathway", "name": "Complaint and claim", "as": "The one instrument that names complaints, redress and liability insurance across borders.", "rel": "governed-by" }, { "from": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The one instrument that obliges a provider to invoice and price clearly, and only inside the EU.", "rel": "governed-by" }, { "from": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "Names the record right on both sides of an EU cross-border episode.", "rel": "governed-by" }, { "from": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "The instrument that entitles an EU patient to at least a copy.", "rel": "governed-by" }, { "from": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "The one instrument that gives a defined class of cross-border patients a stated route, inside one bloc.", "rel": "governed-by" }, { "from": "cross-border-prescriptions", "type": "rule", "name": "A prescription that crosses a border", "as": "The parent instrument this one implements.", "rel": "governed-by" }, { "from": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "The one bloc where an entitlement crosses the border instead of an exclusion.", "rel": "contrast" }, { "from": "patient-data-transfer", "type": "rule", "name": "Moving a medical record across a border", "as": "The instrument that puts the duty on the treating side.", "rel": "governed-by" }, { "from": "s2-route", "type": "rule", "name": "The S2 route", "as": "The newer route, and the contrast: private providers, no queue test, and the patient carries the price difference.", "rel": "contrast" }, { "from": "uk-nhs-treatment-abroad", "type": "rule", "name": "NHS funding for treatment abroad", "as": "The route this system lost at the end of the transition period.", "rel": "rule" }, { "from": "us-medicare-abroad", "type": "rule", "name": "Medicare outside the United States", "as": "What a reimbursement entitlement looks like where one exists.", "rel": "contrast" }, { "from": "eu-national-contact-points", "type": "org", "name": "EU National Contact Points for cross-border healthcare", "as": "The instrument that created these bodies and the reporting behind them.", "rel": "governed-by" }, { "from": "eurostat", "type": "org", "name": "Eurostat", "as": "The instrument that generates the European patient-mobility figures the accounts cannot.", "rel": "governed-by" }, { "from": "oecd", "type": "org", "name": "Organisation for Economic Co-operation and Development", "as": "The instrument adopted the same year, whose reporting produces the other European numbers.", "rel": "governs" }, { "from": "directive-2011-24-adopted", "type": "event", "name": "Directive 2011/24/EU adopted, 9 March 2011", "as": "The rule record: what it says, country by country, and what it does not cover.", "rel": "rule" }, { "from": "drg", "type": "term", "name": "DRG", "as": "The route under which a European patient is refunded at a home-state DRG rather than the foreign invoice.", "rel": "rule" }, { "from": "patient-mobility", "type": "term", "name": "Patient mobility", "as": "The instrument this word carries, with its dates and its articles.", "rel": "rule" }, { "from": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The instrument that lets a patient leave the queue and claim the home tariff back.", "rel": "rule" } ] }, { "id": "gcc-sponsored-treatment-abroad", "names": { "name": "Gulf state-sponsored treatment abroad", "aliases": [ "overseas medical treatment scheme", "health office", "medical missions" ], "said": "The trade calls the sending body \"the health office\", and it is the office that picks the hospital." }, "region": [ "gulf", "west-asia" ], "facets": { "kind": "entitlement", "status": "in-force" }, "text": { "what": "A state programme that sends its own nationals abroad for treatment at public expense, choosing the destination, paying the hospital and paying the patient and an approved escort a daily allowance. Dubai's is written down: Administrative Resolution No. (14) of 2017 Approving the Bylaw for Sending Patients for Overseas Medical Treatment, issued by the Director General of the Dubai Health Authority on 6 February 2017 and effective from 1 February 2017.", "story": "This is the half of cross-border care that does not fit the picture of an individual buying a cheaper operation. Here the state is the purchaser, the patient is a citizen, the direction of travel runs from a rich country to a richer one, and the money moves under an administrative bylaw rather than a contract.\n\nThe Dubai bylaw reads like a procurement document because that is what it is. Article 5 sets eligibility: a UAE national, with passport, family book, Emirates ID and health insurance, and a medical report from a government or accredited private hospital recommending that the patient be sent. Article 6 sets what the Authority pays — treatment, a four-week supply of medication on departure, medical devices, interpreting, air ambulance, airport transport to the first appointment, and extensions of visa and ticket in special cases.\n\nArticles 8 and 9 are the ones that show what a state thinks a patient needs beside them. One escort for a patient of 18 or over. Two for a patient under 18, and the bylaw names them: both parents. Two for a patient of 65 or over, or paralysed, or comatose, or disabled.\n\nThe allowance schedule is a map of where the Gulf sends people, priced by destination. Europe outside the United Kingdom, EUR 150 a day for the patient and the first escort and EUR 50 for the second. The United Kingdom, GBP 120 and GBP 50. The United States, USD 150 and USD 50. Singapore and South Korea, USD 130 and USD 50. India, Thailand and Arab countries, AED 300 and AED 100.\n\n*Inference —* a per-diem schedule that separates India and Thailand from Singapore and Korea, and both from Europe and the United States, is a state's own reading of what a day costs in each of them. It is also the clearest published statement this project has found of the Gulf's outbound map, drawn by the payer rather than by a marketing survey.", "how": "The route runs through a health office rather than a booking. A treating clinician recommends; the Authority approves; the Authority selects the facility abroad; the patient and escort travel on the Authority's arrangements and draw the allowance. Neither the destination hospital nor the patient sets the price.\n\nOther Gulf states run comparable schemes through health attaché offices attached to their embassies. This project has read the Dubai bylaw and holds none of the others; where a record on this site says a Gulf state sends patients abroad and does not name an instrument, it is describing a practice, not reading a law.", "today": "As of 17 September 2026 Administrative Resolution No. (14) of 2017 is the instrument this project has read for Dubai. Dubai is simultaneously an inbound destination: the Dubai Media Office reported more than 691,000 international health travellers in 2023, a count of arrivals rather than of people." }, "kin": [ { "to": "uae", "as": "The country that both sends its nationals abroad under this bylaw and sells treatment to arrivals.", "rel": "destination" }, { "to": "dha-dubai", "as": "The authority that issued the bylaw and selects the hospital.", "rel": "org" }, { "to": "uae-clinic-licensing", "as": "The same authority, working the other direction.", "rel": "kin" }, { "to": "the-companion", "as": "The escort the bylaw counts, and pays.", "rel": "step" }, { "to": "dubai", "as": "The city whose authority wrote it.", "rel": "hub" }, { "to": "saudi-arabia", "as": "Another Gulf state that sends patients abroad, through a health attaché rather than a bylaw this project has read.", "rel": "destination" }, { "to": "who-travels", "as": "The half of the subject where the state, not the patient, is the buyer.", "rel": "story" }, { "to": "king-hussein-cancer-center", "as": "One of the regional hospitals such schemes buy from.", "rel": "facility" } ], "links": [ { "label": "Administrative Resolution No. (14) of 2017 (Dubai)", "url": "https://dlp.dubai.gov.ae/Legislation%20Reference/2017/Administrative%20Resolution%20No.%20(14)%20of%202017%20Approving%20the%20Bylaw%20for%20Sending%20Patients.html" } ], "sources": [ "s:dubai-resolution-14-2017", "s:dha-law-6-2018", "s:dubai-media-office-health-2023" ], "provenance": { "default": { "tier": "cited", "source": "s:dubai-resolution-14-2017" }, "fields": { "text.how": { "tier": "inference", "note": "the general shape of the route; the Dubai specifics are read off the bylaw and the other Gulf schemes are named as unread" } } }, "confidence": "high", "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "A state programme that sends its own nationals abroad for treatment at public expense, choosing the destination, paying the hospital and paying the patient and an approved escort a daily allowance.", "region_terms": [ { "key": "gulf", "name": "The Gulf", "note": "the UAE, Saudi Arabia, Qatar, Kuwait, Oman, Bahrain — a source market that is building itself into a destination" }, { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "uae", "type": "destination", "name": "United Arab Emirates", "as": "The country that both sends its nationals abroad under this bylaw and sells treatment to arrivals.", "rel": "destination" }, { "to": "dha-dubai", "type": "org", "name": "Dubai Health Authority", "as": "The authority that issued the bylaw and selects the hospital.", "rel": "org" }, { "to": "uae-clinic-licensing", "type": "rule", "name": "Licensing a clinic in the United Arab Emirates", "as": "The same authority, working the other direction.", "rel": "kin" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "The escort the bylaw counts, and pays.", "rel": "step" }, { "to": "dubai", "type": "hub", "name": "Dubai", "as": "The city whose authority wrote it.", "rel": "hub" }, { "to": "saudi-arabia", "type": "destination", "name": "Saudi Arabia", "as": "Another Gulf state that sends patients abroad, through a health attaché rather than a bylaw this project has read.", "rel": "destination" }, { "to": "who-travels", "type": "story", "name": "Who travels", "as": "The half of the subject where the state, not the patient, is the buyer.", "rel": "story" }, { "to": "king-hussein-cancer-center", "type": "facility", "name": "King Hussein Cancer Center", "as": "One of the regional hospitals such schemes buy from.", "rel": "facility" } ], "source_list": [ { "id": "s:dubai-resolution-14-2017", "kind": "law", "title": "Administrative Resolution No. (14) of 2017 Approving the Bylaw for Sending Patients for Overseas Medical Treatment", "publisher": "Government of Dubai Legislation portal", "url": "https://dlp.dubai.gov.ae/Legislation%20Reference/2017/Administrative%20Resolution%20No.%20(14)%20of%202017%20Approving%20the%20Bylaw%20for%20Sending%20Patients.html", "accessed": "2026-09-16", "note": "issued 6 February 2017 by the Director General of the Dubai Health Authority; sets eligibility, what the state pays, escort entitlement and a daily allowance schedule by destination country" }, { "id": "s:dha-law-6-2018", "kind": "law", "title": "Law No. (6) of 2018 Concerning the Dubai Health Authority", "publisher": "Government of Dubai Legal Affairs Department", "year": 2018, "url": "https://dlp.dubai.gov.ae/Legislation%20Reference/2018/Law%20No.%20(6)%20of%202018%20Concerning%20the%20Dubai%20Health%20Authority.pdf", "accessed": "2026-09-16", "note": "the current constituting law; licensing of health facilities sits with the Authority, and the law repeals any contradicting provision in other legislation" }, { "id": "s:dubai-media-office-health-2023", "kind": "gov", "title": "Dubai welcomes more than 691,000 international health travellers in 2023", "publisher": "Dubai Media Office, Government of Dubai", "url": "https://mediaoffice.ae/en/news/2024/august/19-08/dubai-welcomes-more-than-691k", "accessed": "2026-09-16", "note": "Dubai Health Authority figures released 19 August 2024; gives arrivals, spend, regional split and the leading specialties. The release does not publish the counting rule behind the headline number." } ], "tiers": { "text.what": { "tier": "cited", "source": "s:dubai-resolution-14-2017" }, "text.story": { "tier": "cited", "source": "s:dubai-resolution-14-2017" }, "text.how": { "tier": "inference", "note": "the general shape of the route; the Dubai specifics are read off the bylaw and the other Gulf schemes are named as unread" }, "text.today": { "tier": "cited", "source": "s:dubai-resolution-14-2017" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "saudi-arabia", "type": "destination", "name": "Saudi Arabia", "as": "The committee route by which this state buys care in other countries.", "rel": "governed-by" }, { "from": "uae", "type": "destination", "name": "United Arab Emirates", "as": "The route by which this state pays for its own citizens to be operated on somewhere else.", "rel": "governed-by" }, { "from": "dubai", "type": "hub", "name": "Dubai", "as": "The scheme by which this city's own region sends patients out while it brings others in.", "rel": "governed-by" }, { "from": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "The scheme that pays the escort a daily allowance, and sets it by destination.", "rel": "rule" }, { "from": "uae-clinic-licensing", "type": "rule", "name": "Licensing a clinic in the United Arab Emirates", "as": "The same authority, sending patients the other way.", "rel": "kin" }, { "from": "cbahi", "type": "org", "name": "Saudi Central Board for Accreditation of Healthcare Institutions", "as": "The state route that sends Saudi patients out while this board raises the floor at home.", "rel": "governs" }, { "from": "dha-dubai", "type": "org", "name": "Dubai Health Authority", "as": "The outbound programme it runs under the 2017 bylaw, escort allowance and all.", "rel": "rule" }, { "from": "who-travels", "type": "story", "name": "Who travels", "as": "The rule record for the state-as-buyer route, with the resolution named and dated.", "rel": "rule" } ] }, { "id": "gender-affirming-care-access", "names": { "name": "Access to gender-affirming care", "aliases": [ "transition-related care", "gender confirmation surgery access" ], "said": "The instrument a search turns up is usually about documents, not about treatment. They are different laws." }, "region": [ "global" ], "facets": { "kind": "prohibition", "status": "in-force" }, "text": { "what": "Whether an adult may lawfully obtain hormone therapy and gender-affirming surgery in a given jurisdiction, under what gate, and what the law says about minors. The rows below record access to CARE. They do not record legal gender recognition — changing a name or a marker on a document — which is a separate body of law that most comparative sources run together with this one.", "story": "The conflation is the first thing that defeats a reader, and it defeated most of the research behind this record. Germany's Selbstbestimmungsgesetz, Ireland's Gender Recognition Act 2015, South Africa's Alteration of Sex Description and Sex Status Act 49 of 2003, Hungary's 2020 amendment: all of these are about registers and documents. None of them governs whether a surgeon may operate. In many countries nothing governs that by statute at all, and the rule is a professional body's, an insurer's, or a clinical guideline's.\n\nTürkiye is the exception that matters most here, because Türkiye is a destination. Article 40 of the Civil Code makes a court's permission a precondition of the surgery itself — over 18, unmarried, and holding an official health-council report from a training and research hospital — with a second court step afterwards for the register. One instrument, gating both. Whether it binds a foreign patient treated in a Turkish hospital is a question this project could not answer from anything it read, and that unanswered question sits underneath a substantial trade.\n\nBritain's instrument runs the other way: it restricts a medicine rather than a procedure. The 2024 Order bars new private prescriptions of gonadotrophin-releasing hormone analogues for puberty suppression in under-18s, exempts adults, and leaves NHS supply alone. It carries no expiry and its first review is due before 1 October 2027.\n\nThe United States has no federal instrument for adults. United States v. Skrmetti, decided 18 June 2025, held that Tennessee's statute is not subject to heightened scrutiny and passes rational-basis review, and expressly did not decide the adult question. The count of state bans for minors comes from a tracker that publishes its own date and method: 26 states and one territory at 16 September 2026.\n\n*Inference —* the single line in this table that speaks directly to a person arriving from elsewhere is Czech, and it is procedural: §§ 21 to 23 of Act 373/2011 contemplate an extract from medical records kept in another state, with a certified translation. Everything else in these statutes is written about residents, which means a traveller's position is usually a matter of what a clinic will do rather than what a law says.", "how": "What a row does not carry: waiting times, whether the care is funded, what a home country's clinicians will do with a patient who was treated abroad, and whether a document issued after surgery in one state is recognised in another. The last is the recognition question, and it is the one this record deliberately does not answer.\n\nWhere a row says no-data, the reason is in the row's note. Most of them are the same reason: the instrument named to this project was a recognition statute, a guideline, or a page that could not be read on this pass.", "today": "As of 17 September 2026 seven rows rest on an instrument or judgment that was read. Eighteen say no-data. Thailand and Türkiye are the two destinations in this table, and only one of them has a row this project would stand behind." }, "legality": [ { "country": "TR", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:tr-civil-code-art-40", "instrument": "Turkish Civil Code, Article 40", "conditions": "A court's permission is a precondition of the surgery itself, not only of the later change to the civil register: the applicant must be over 18, unmarried, and hold an official health-council report from a training and research hospital. A second court step follows the surgery for the registry change.", "note": "The requirement of permanent incapacity to procreate was struck by Constitutional Court decision 2017/165, which this project has not read. Whether Article 40 binds a foreign patient treated in Türkiye is not answered by anything read on this pass, and Türkiye is a destination for this surgery — so this is the gap in the table that matters most." }, { "country": "GB", "status": "lawful", "as_of": "2026-09-17", "source": "s:uk-gnrh-order-2024", "instrument": "The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Restrictions on Private Sales and Supplies) Order 2024 (SI 2024/1319)", "conditions": "Adults are not restricted: article 6 permits private supply of these medicines to people aged 18 and over. Article 4 is the general prohibition the exemptions run from.", "note": "Article 8 bars new private prescriptions of gonadotrophin-releasing hormone analogues for puberty suppression in under-18s, except for patients who had started before 3 June 2024 in England, Wales and Scotland or 27 August 2024 in Northern Ireland. Article 5 leaves NHS supply unaffected. The Order carries no expiry; article 9 requires a first review before 1 October 2027 and then at intervals of no more than four years." }, { "country": "US", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:us-skrmetti-2025", "instrument": "No federal instrument governs adult access; state law governs. United States v. Skrmetti, No. 23-477, decided 18 June 2025.", "conditions": "The Supreme Court held that Tennessee's statute is not subject to heightened scrutiny and satisfies rational-basis review. The Court expressly did not decide the position for adults.", "note": "For minors, a named tracker with its own date: the Movement Advancement Project records 26 states and one territory banning this care for minors as of 16 September 2026, six of them making it a felony, with enforcement blocked by court rulings in Montana and Kansas at that date." }, { "country": "AR", "status": "lawful", "as_of": "2026-09-17", "source": "s:ar-decreto-62-2025", "instrument": "Ley 26.743 de Identidad de Género, artículo 11, as amended by Decreto 62/2025", "conditions": "For adults, informed consent alone: no judicial or administrative authorisation, and the care sits within the compulsory medical programme.", "note": "Decreto 62/2025, published 6 February 2025, bars hormonal and surgical intervention for under-18s. A federal appeal court in Paraná is reported to have held the decree unconstitutional; this project has not read that judgment." }, { "country": "ES", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:es-ley-4-2023", "instrument": "Ley 4/2023, artículos 16, 17 y 19", "conditions": "Registered on the strength of a research agent's reading; the article numbers were not re-read at the official gazette by the author of this record." }, { "country": "CZ", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:cz-act-373-2011", "instrument": "Zákon č. 373/2011 Sb., §§ 21 to 23", "conditions": "Surgical sex change at 18 or over, on written application and the unanimous positive opinion of an expert commission established by the Ministry of Health, made up of health professionals and a lawyer with knowledge of medical law; the commission must act within three months. Where the patient's legal capacity is restricted a court must also consent. The provisions contemplate an extract from medical records kept in another state, with a certified translation.", "note": "The reference to foreign medical records is the only thing read on this pass in any of these statutes that speaks to a patient who comes from elsewhere." }, { "country": "RU", "status": "unlawful", "as_of": "2026-09-17", "source": "s:rferl-russia-gender-law-2023", "instrument": "Federal Law of 24 July 2023 prohibiting medical interventions aimed at changing sex", "conditions": "Hormone therapy and surgery are prohibited, with an exception only for congenital anomalies of sex formation in children.", "note": "Read in a news report rather than in the statute. The federal law's number was not confirmed on any page read for this record and is therefore not printed." }, { "country": "TH", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "No statute governs. A Medical Council of Thailand regulation on gender-affirming healthcare is reported to have taken effect on 15 February 2025, with hormones from 18 and surgery from 20 on the patient's own consent. The regulation itself was not read, and the reports consulted were secondary. Thailand is a long-standing destination for this surgery, so this row is a gap rather than a finding." }, { "country": "ZA", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "The Alteration of Sex Description and Sex Status Act 49 of 2003 governs legal recognition, not access to care. No instrument governing care was found on this pass." }, { "country": "DE", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "Germany's Selbstbestimmungsgesetz governs legal recognition, not access to care. An assessment guideline under the statutory health insurance system was suggested to this project and could not be confirmed at the section cited, so no instrument is named." }, { "country": "IE", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "The Gender Recognition Act 2015 governs recognition, not care." }, { "country": "NL", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "Care is governed by a professional quality standard rather than a statute; it was not read on this pass." }, { "country": "BE", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "Care runs under insurance conventions with named clinics rather than a statute; none was read." }, { "country": "FR", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "No care-specific instrument was found on this pass." }, { "country": "PT", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "Lei n.º 38/2018 was named to this project but its articles were not verified." }, { "country": "PL", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "No statute was found on this pass." }, { "country": "HU", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "The 2020 amendment governs recognition, not care." }, { "country": "SE", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "Care runs under National Board of Health and Welfare knowledge support documents rather than a statute; they were not read on this pass." }, { "country": "FI", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "A ministerial decree was named to this project but not read." }, { "country": "CH", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "The federal law portal renders by script and returned no text on this pass." }, { "country": "IN", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "No Indian instrument was read on this pass." }, { "country": "IL", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "No Israeli instrument was read on this pass." }, { "country": "JP", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "No Japanese instrument was read on this pass." }, { "country": "KR", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "No Korean instrument was read on this pass." }, { "country": "AU", "status": "no-data", "as_of": "2026-09-17", "source": "s:map-youth-care-bans", "note": "State and territory law; no state instrument was read on this pass." } ], "kin": [ { "to": "vaginoplasty", "as": "One of the operations these instruments reach.", "rel": "procedure" }, { "to": "phalloplasty", "as": "The other genital operation this access rule gates, priced stage by stage where anyone prices it at all.", "rel": "procedure" }, { "to": "top-surgery", "as": "The third, and the one most often bought abroad.", "rel": "procedure" }, { "to": "thailand", "as": "A long-standing destination for this surgery, and a row this project could not source.", "rel": "destination" }, { "to": "turkiye", "as": "A destination whose Civil Code gates the surgery through a court.", "rel": "destination" }, { "to": "united-states", "as": "The source market whose federal position was decided in 2025 for minors and left open for adults.", "rel": "destination" }, { "to": "circumvention-travel", "as": "The category this sits in.", "rel": "term" }, { "to": "circumvention", "as": "The essay on travel driven by a rule rather than a price, which is what most of this table is.", "rel": "story" }, { "to": "language-consent", "as": "What a consent form gates when the statute does not.", "rel": "risk" } ], "sources": [ "s:uk-gnrh-order-2024", "s:tr-civil-code-art-40", "s:us-skrmetti-2025", "s:map-youth-care-bans", "s:ar-decreto-62-2025", "s:es-ley-4-2023", "s:cz-act-373-2011", "s:rferl-russia-gender-law-2023" ], "provenance": { "default": { "tier": "cited", "source": "s:tr-civil-code-art-40" }, "fields": { "text.story": { "tier": "cited", "source": "s:uk-gnrh-order-2024", "note": "the stretch marked *Inference —* is this project's reasoning across the instruments read" }, "legality": { "tier": "cited", "source": "s:map-youth-care-bans", "note": "a no-data row records what this project could not read, and the note says why" } } }, "confidence": "low", "needs_verification": true, "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "Whether an adult may lawfully obtain hormone therapy and gender-affirming surgery in a given jurisdiction, under what gate, and what the law says about minors. The rows below record access to CARE.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "vaginoplasty", "type": "procedure", "name": "Vaginoplasty", "as": "One of the operations these instruments reach.", "rel": "procedure" }, { "to": "phalloplasty", "type": "procedure", "name": "Phalloplasty", "as": "The other genital operation this access rule gates, priced stage by stage where anyone prices it at all.", "rel": "procedure" }, { "to": "top-surgery", "type": "procedure", "name": "Top surgery", "as": "The third, and the one most often bought abroad.", "rel": "procedure" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "A long-standing destination for this surgery, and a row this project could not source.", "rel": "destination" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "A destination whose Civil Code gates the surgery through a court.", "rel": "destination" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The source market whose federal position was decided in 2025 for minors and left open for adults.", "rel": "destination" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The category this sits in.", "rel": "term" }, { "to": "circumvention", "type": "story", "name": "Circumvention", "as": "The essay on travel driven by a rule rather than a price, which is what most of this table is.", "rel": "story" }, { "to": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "What a consent form gates when the statute does not.", "rel": "risk" } ], "source_list": [ { "id": "s:uk-gnrh-order-2024", "kind": "statute", "title": "The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Restrictions on Private Sales and Supplies) Order 2024 (SI 2024/1319)", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/uksi/2024/1319/made", "accessed": "2026-09-16" }, { "id": "s:tr-civil-code-art-40", "kind": "statute", "title": "Turkish Civil Code, Book I, Section I, Chapter II — Article 40 (change of sex)", "publisher": "Legal Information Institute, Cornell Law School, Gender Justice collection", "url": "https://www.law.cornell.edu/gender-justice/resource/turkish_civil_code_volume_i_section_i_chapter_ii_personal_status_registry", "accessed": "2026-09-17", "note": "court permission is a precondition of the surgery, not only of the registry change: over 18, unmarried, and an official health-council report from a training and research hospital. The procreative-incapacity requirement was struck by Constitutional Court decision 2017/165, which this project has not read." }, { "id": "s:us-skrmetti-2025", "kind": "ruling", "title": "United States v. Skrmetti, slip opinion (2025)", "publisher": "Supreme Court of the United States", "url": "https://www.supremecourt.gov/opinions/24pdf/23-477_2cp3.pdf", "accessed": "2026-09-16" }, { "id": "s:map-youth-care-bans", "kind": "org", "title": "Bans on best practice medical care for transgender youth", "publisher": "Movement Advancement Project", "url": "https://www.mapresearch.org/equality-maps/healthcare/youth_medical_care_bans", "accessed": "2026-09-17", "note": "26 states and one territory, as of 16 September 2026, with 6 states and one territory making it a felony; the tracker records court rulings blocking enforcement in Montana and Kansas at that date. An advocacy organisation's tracker, which names its own date and method." }, { "id": "s:ar-decreto-62-2025", "kind": "gov", "title": "Se limitan los tratamientos de hormonización y las intervenciones quirúrgicas en menores", "publisher": "Government of Argentina (argentina.gob.ar)", "url": "https://www.argentina.gob.ar/noticias/se-limitan-los-tratamientos-de-hormonizacion-y-las-intervenciones-quirurgicas-en-menores-0", "accessed": "2026-09-17", "note": "the government's own announcement of Decreto 62/2025, published 6 February 2025, amending article 11 of Ley 26.743; adults unaffected. A federal appeal court in Paraná is reported to have held the decree unconstitutional; this project has not read that judgment." }, { "id": "s:es-ley-4-2023", "kind": "statute", "title": "Ley 4/2023, de 28 de febrero, para la igualdad real y efectiva de las personas trans y para la garantía de los derechos de las personas LGTBI", "publisher": "Boletín Oficial del Estado", "url": "https://www.boe.es/buscar/act.php?id=BOE-A-2023-5366", "accessed": "2026-09-17", "note": "registered on this pass on the strength of a subagent's reading of articles 16, 17 and 19; the article numbers were not re-read at the BOE by the author of the records that cite it" }, { "id": "s:cz-act-373-2011", "kind": "statute", "title": "Zákon č. 373/2011 Sb., o specifických zdravotních službách — §§ 6, 10, 21–23", "publisher": "Zákony pro lidi (AION CS), consolidated Czech statute text", "url": "https://www.zakonyprolidi.cz/cs/2011-373", "accessed": "2026-09-17", "note": "§ 10(1) obliges the provider to preserve mutual anonymity between an anonymous donor and the infertile couple and between donor and child. § 6(1) requires the written application of a woman and a man who undergo the service together. §§ 21–23: surgical sex change at 18 or over, on written application and the unanimous positive opinion of a Ministry of Health expert commission, which must act within three months; the provisions contemplate an extract from medical records kept in another state, with a certified translation." }, { "id": "s:rferl-russia-gender-law-2023", "kind": "news", "title": "Putin signs law banning gender-reassignment procedures", "publisher": "Radio Free Europe/Radio Liberty", "url": "https://www.rferl.org/a/russia-gender-reassignment-banned-putin-signs-law/32517157.html", "accessed": "2026-09-17", "note": "a news report, not the statute. The federal law number was not confirmed on any page read for this record, and is therefore not printed." } ], "tiers": { "text.what": { "tier": "cited", "source": "s:tr-civil-code-art-40" }, "text.story": { "tier": "cited", "source": "s:uk-gnrh-order-2024", "note": "the stretch marked *Inference —* is this project's reasoning across the instruments read" }, "text.how": { "tier": "cited", "source": "s:tr-civil-code-art-40" }, "text.today": { "tier": "cited", "source": "s:tr-civil-code-art-40" }, "legality": { "tier": "cited", "source": "s:map-youth-care-bans", "note": "a no-data row records what this project could not read, and the note says why" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "phalloplasty", "type": "procedure", "name": "Phalloplasty", "as": "Whether the health system at home does this at all, and who it will do it for.", "rel": "governed-by" }, { "from": "top-surgery", "type": "procedure", "name": "Top surgery", "as": "Whether this is offered, funded or permitted at home — the reason the flight exists.", "rel": "governed-by" }, { "from": "vaginoplasty", "type": "procedure", "name": "Vaginoplasty", "as": "Whether the health system at home will do this, pay for it, or permit it — the third reason the operation travels.", "rel": "governed-by" }, { "from": "circumvention", "type": "story", "name": "Circumvention", "as": "Where the gate is a court's permission at the destination, and whether it binds a foreign patient is unread.", "rel": "rule" } ] }, { "id": "india-e-medical-visa", "names": { "name": "India's e-Medical Visa", "aliases": [ "e-Medical Visa", "e-Medical Attendant Visa", "eMED", "eMEDX" ], "said": "Two attendants per patient. A state's own arithmetic of how many people one patient needs." }, "region": [ "south-asia" ], "facets": { "kind": "visa", "iso2": "IN", "status": "in-force" }, "text": { "what": "A dedicated electronic visa class for treatment in India, applied for online before travel. The Bureau of Immigration states it runs \"One year (365 days) from the date of arrival into India\" with multiple entries, and requires a \"Copy of Letter from the Hospital concerned in India on its letterhead which including the date / tentative date which admission have been suggested\". A companion class, the e-Medical Attendant Visa, runs alongside it, and the rule is numerical: \"Only two e-Medical Attendant Visas will be granted against one e-Medical Visa (patient)\".", "story": "India is the state that wrote the treatment trip into its immigration system most explicitly, and the class reads as a statement of what such a trip is taken to involve. A year of validity, because oncology and transplant courses run long and return for review. Multiple entries, because the patient goes home between cycles. A hospital letter on letterhead, because the state wants the facility named and on the record. And two attendants, because somebody decided a patient travelling for surgery arrives with family.\n\n*Inference —* the named class does two things at once. It ties the stay to a particular hospital, so a change of provider on arrival is a paperwork problem as well as a clinical one. And it puts the purpose of the journey on the record, which matters in both directions: it makes the trip countable, and it makes it visible.\n\nThe visibility is the part that cuts. A patient travelling for a treatment that is lawful in India and not lawful at home has, by applying, told two governments what they are doing. That is not a defect of the Indian class; it is what any named class does, and it is why the states that issue none are attractive to some travellers for reasons that have nothing to do with price.", "how": "The application is online, with the hospital letter uploaded. The class is nationality-restricted: the e-Visa scheme is open to nationals of a published list of countries and not to others, and the list moves.\n\nWhat the class does not do: guarantee admission at the named hospital, move with the patient if the treatment date slips beyond the validity window, or cover a third companion. A patient arriving with a spouse and two adult children has one attendant visa too few.\n\nAlongside it India runs an ordinary Medical Visa and Medical Attendant Visa issued at missions rather than online, for nationals outside the e-Visa list and for stays the electronic class does not fit.", "today": "As of 17 September 2026 the duration, the entry rule, the hospital-letter requirement and the two-attendant cap are read off the Bureau of Immigration's own e-Visa page." }, "kin": [ { "to": "the-visa", "as": "The step this rule sits inside, and the one the pathway record quotes.", "rel": "pathway" }, { "to": "india", "as": "The country that issues it.", "rel": "destination" }, { "to": "thai-medical-visa", "as": "The contrast: an endorsement on a visitor visa, capped at 90 days, with no attendant class.", "rel": "contrast" }, { "to": "the-companion", "as": "The person this class counts, and caps at two.", "rel": "step" }, { "to": "chennai", "as": "One of the clusters its holders arrive in.", "rel": "hub" }, { "to": "apollo-chennai", "as": "The kind of hospital whose letterhead the application turns on.", "rel": "facility" }, { "to": "medical-visa", "as": "The word this class is the clearest example of.", "rel": "term" }, { "to": "circumvention", "as": "Why a named purpose of travel is sometimes the sensitive part.", "rel": "story" }, { "to": "counting-patients", "as": "A named class makes a patient countable; most states issue none.", "rel": "story" } ], "links": [ { "label": "Bureau of Immigration, Government of India — e-Visa", "url": "https://indianvisaonline.gov.in/evisa/tvoa.html" } ], "sources": [ "s:india-emedical-visa", "s:india-evisa-portal" ], "provenance": { "default": { "tier": "cited", "source": "s:india-emedical-visa" }, "fields": { "text.story": { "tier": "cited", "source": "s:india-emedical-visa", "note": "quoted from the Bureau of Immigration page; the stretch marked *Inference —* is this project's reading" }, "text.how": { "tier": "cited", "source": "s:india-evisa-portal" } } }, "confidence": "high", "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "A dedicated electronic visa class for treatment in India, applied for online before travel.", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" } ], "kin_out": [ { "to": "the-visa", "type": "pathway", "name": "The visa", "as": "The step this rule sits inside, and the one the pathway record quotes.", "rel": "pathway" }, { "to": "india", "type": "destination", "name": "India", "as": "The country that issues it.", "rel": "destination" }, { "to": "thai-medical-visa", "type": "rule", "name": "Thailand's medical treatment visa", "as": "The contrast: an endorsement on a visitor visa, capped at 90 days, with no attendant class.", "rel": "contrast" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "The person this class counts, and caps at two.", "rel": "step" }, { "to": "chennai", "type": "hub", "name": "Chennai", "as": "One of the clusters its holders arrive in.", "rel": "hub" }, { "to": "apollo-chennai", "type": "facility", "name": "Apollo Hospitals, Greams Road, Chennai", "as": "The kind of hospital whose letterhead the application turns on.", "rel": "facility" }, { "to": "medical-visa", "type": "term", "name": "Medical visa", "as": "The word this class is the clearest example of.", "rel": "term" }, { "to": "circumvention", "type": "story", "name": "Circumvention", "as": "Why a named purpose of travel is sometimes the sensitive part.", "rel": "story" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "A named class makes a patient countable; most states issue none.", "rel": "story" } ], "source_list": [ { "id": "s:india-emedical-visa", "kind": "web", "title": "e-Visa — e-Medical Visa and e-Medical Attendant Visa", "publisher": "Bureau of Immigration, Ministry of Home Affairs, Government of India", "url": "https://indianvisaonline.gov.in/evisa/tvoa.html", "accessed": "2026-09-16", "note": "one year from arrival, multiple entries, hospital letter on letterhead, two attendant visas per patient" }, { "id": "s:india-evisa-portal", "kind": "web", "title": "e-Visa categories, duration and entries", "publisher": "Bureau of Immigration, Ministry of Home Affairs, Government of India (indianvisaonline.gov.in)", "url": "https://indianvisaonline.gov.in/evisa/tvoa.html", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:india-emedical-visa" }, "text.story": { "tier": "cited", "source": "s:india-emedical-visa", "note": "quoted from the Bureau of Immigration page; the stretch marked *Inference —* is this project's reading" }, "text.how": { "tier": "cited", "source": "s:india-evisa-portal" }, "text.today": { "tier": "cited", "source": "s:india-emedical-visa" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "india", "type": "destination", "name": "India", "as": "The visa class whose arrivals are the number this page carries.", "rel": "governed-by" }, { "from": "kenya", "type": "destination", "name": "Kenya", "as": "The visa class the outflow travels on.", "rel": "governed-by" }, { "from": "bengaluru", "type": "hub", "name": "Bengaluru", "as": "The entry route foreign patients arrive on.", "rel": "governed-by" }, { "from": "chennai", "type": "hub", "name": "Chennai", "as": "The entry route most of this cluster's foreign patients arrive on.", "rel": "governed-by" }, { "from": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "The entry route, and the invitation letter the international desks issue against it.", "rel": "governed-by" }, { "from": "mumbai", "type": "hub", "name": "Mumbai", "as": "The entry route foreign patients arrive on.", "rel": "governed-by" }, { "from": "apollo-chennai", "type": "facility", "name": "Apollo Hospitals, Greams Road, Chennai", "as": "The visa class most of its foreign consultations arrive on.", "rel": "governed-by" }, { "from": "fortis-gurgaon", "type": "facility", "name": "Fortis Memorial Research Institute, Gurugram", "as": "The visa class that brings most of this corridor's foreign patients.", "rel": "governed-by" }, { "from": "max-saket", "type": "facility", "name": "Max Super Speciality Hospital, Saket", "as": "The visa class most of this corridor's foreign patients arrive on.", "rel": "governed-by" }, { "from": "the-visa", "type": "pathway", "name": "The visa", "as": "The rule this step reads in full.", "rel": "governed-by" }, { "from": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "The instrument that caps the escort at two, and the only hard count anywhere.", "rel": "governed-by" }, { "from": "schengen-medical-visa", "type": "rule", "name": "The Schengen visa, for treatment", "as": "The contrast: a named class, a year long, with an attendant visa attached.", "rel": "contrast" }, { "from": "thai-medical-visa", "type": "rule", "name": "Thailand's medical treatment visa", "as": "The contrast: a dedicated class, with its own attendant visa and a year's validity.", "rel": "contrast" }, { "from": "nabh", "type": "org", "name": "National Accreditation Board for Hospitals and Healthcare Providers", "as": "The other Indian instrument a foreign patient meets before arrival.", "rel": "governed-by" }, { "from": "medical-visa", "type": "term", "name": "Medical visa", "as": "The instrument behind the class this record reads, with its own dates.", "rel": "rule" } ] }, { "id": "insurance-exclusions", "names": { "name": "Insurance exclusions for treatment abroad", "aliases": [ "elective treatment exclusion", "the travel policy gap" ], "said": "A travel policy covers an emergency that happens to you. It is not written for an operation you flew out to have." }, "region": [ "global" ], "facets": { "kind": "reimbursement", "status": "in-force" }, "text": { "what": "The gap between what a travel policy, a domestic health plan and a public programme each decline to pay for when someone travels abroad to be operated on. Three separate refusals that usually arrive together: the travel insurer excludes treatment that was the purpose of the trip, the home health plan excludes care delivered outside its network or its country, and the public programme excludes everything but an emergency.", "story": "The refusals are structural rather than punitive, and each has its own logic.\n\nA travel policy underwrites an unforeseen event during a journey. Treatment arranged in advance is not unforeseen, which is why the exclusion exists; and a complication of that treatment is a consequence of the excluded thing. The United Kingdom government's travel insurance guidance does not discuss planned treatment abroad at all — it is about declaring existing conditions and pending tests \"so that you are covered if there are related complications during your trip\" — and the absence is itself the answer.\n\nA public programme excludes by territory. Medicare's rule is the flat one: it does not pay outside the United States except in three narrow circumstances, none of them elective. Australia's Better Health Channel page on medical travel and insurance makes the parallel point for a system with reciprocal agreements.\n\nThe NHS page on cosmetic surgery abroad states the practical consequence for the patient rather than the insurer: aftercare is where the patient lives, and the surgeon is not.\n\n*Inference —* the three exclusions compound rather than overlap. A patient who has a complication abroad is outside the travel policy because the treatment was planned; outside the domestic plan because the care is foreign; and outside the public programme because it is elective. The bill that then arrives is the one the published price comparison never carried, and the revision performed at home lands on a system that did not sell the operation.\n\n*Trade practice —* a specialist medical-travel policy exists and is sold by a small number of underwriters, usually as complication cover with a named surgeon, a named facility and a fixed window. This project has read no policy wording and carries no terms.", "how": "What a reader would have to read, in the policy itself rather than the brochure: whether \"treatment which is the purpose of the trip\" is excluded; whether a complication of an excluded treatment is also excluded; whether repatriation by air ambulance is covered at all and to what ceiling; whether the policy requires a fitness-to-fly certificate; whether cover lapses at a stated number of days post-operatively; and whether the insurer requires the facility to hold a named accreditation.\n\nThe CDC's Yellow Book chapter puts medical evacuation at USD 25,000 to over USD 250,000, which is the figure most often missing from a package price.", "today": "As of 17 September 2026 no regulator in any market this project has read publishes a count of claims declined for travel undertaken to obtain treatment. The exclusions are read off policy wordings and public-programme rules, one at a time." }, "kin": [ { "to": "reading-the-exclusions", "as": "The step where this is discovered, or is not.", "rel": "step" }, { "to": "us-medicare-abroad", "as": "The territorial exclusion, in a public programme.", "rel": "rule" }, { "to": "repatriation-cost", "as": "The single largest number that falls in the gap.", "rel": "risk" }, { "to": "revision-at-home", "as": "Who pays for the second operation.", "rel": "risk" }, { "to": "flying-after-surgery", "as": "The clause about fitness to fly, and the clinical reason behind it.", "rel": "risk" }, { "to": "eu-directive-2011-24", "as": "The one bloc where an entitlement crosses the border instead of an exclusion.", "rel": "contrast" }, { "to": "the-price-that-isnt", "as": "Why a package price and a total cost are different numbers.", "rel": "story" }, { "to": "deposit-and-refund", "as": "The other contract nobody reads before signing.", "rel": "risk" } ], "links": [ { "label": "GOV.UK — Foreign travel insurance", "url": "https://www.gov.uk/guidance/foreign-travel-insurance" }, { "label": "CDC Yellow Book 2026 — Travel insurance, travel health insurance, and medical evacuation insurance", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/travel-insurance.html" } ], "sources": [ "s:gov-uk-foreign-travel-insurance", "s:cdc-yellowbook-travel-insurance", "s:betterhealth-vic-medical-tourism", "s:medicare-travel-outside-us", "s:nhs-cosmetic-surgery-abroad" ], "provenance": { "default": { "tier": "cited", "source": "s:cdc-yellowbook-travel-insurance" }, "fields": { "text.story": { "tier": "inference", "note": "the compounding argument is this project reasoning from three read sources; the *Trade practice —* stretch is unsourced and marked" }, "text.how": { "tier": "tradition", "note": "the questions a policy wording answers; this project holds no policy wording" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "The gap between what a travel policy, a domestic health plan and a public programme each decline to pay for when someone travels abroad to be operated on.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step where this is discovered, or is not.", "rel": "step" }, { "to": "us-medicare-abroad", "type": "rule", "name": "Medicare outside the United States", "as": "The territorial exclusion, in a public programme.", "rel": "rule" }, { "to": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "The single largest number that falls in the gap.", "rel": "risk" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Who pays for the second operation.", "rel": "risk" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The clause about fitness to fly, and the clinical reason behind it.", "rel": "risk" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The one bloc where an entitlement crosses the border instead of an exclusion.", "rel": "contrast" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "Why a package price and a total cost are different numbers.", "rel": "story" }, { "to": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "The other contract nobody reads before signing.", "rel": "risk" } ], "source_list": [ { "id": "s:gov-uk-foreign-travel-insurance", "kind": "org", "title": "Foreign travel insurance", "publisher": "UK Foreign, Commonwealth and Development Office, gov.uk", "url": "https://www.gov.uk/guidance/foreign-travel-insurance", "accessed": "2026-09-16", "note": "read for repatriation, emergency transport, declaration of existing conditions and the limits of EHIC/GHIC" }, { "id": "s:cdc-yellowbook-travel-insurance", "kind": "org", "title": "Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance — CDC Yellow Book 2026, chapter by Rhett J. Stoney", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/travel-insurance.html", "accessed": "2026-09-16", "note": "carries the USD 25,000 to over USD 250,000 medevac range, the Medicare and Medigap limits, and the finding that insurers fully paid two-thirds of travel health claims" }, { "id": "s:betterhealth-vic-medical-tourism", "kind": "gov", "title": "Medical tourism and insurance", "publisher": "Better Health Channel, Department of Health, State Government of Victoria", "url": "https://www.betterhealth.vic.gov.au/health/healthyliving/medical-tourism", "accessed": "2026-09-16", "note": "page review date 5 December 2017; carries the 15,000-travellers and $300 million figures without naming where either comes from" }, { "id": "s:medicare-travel-outside-us", "kind": "web", "title": "Travel outside the U.S.", "publisher": "Medicare.gov, US Centers for Medicare & Medicaid Services", "url": "https://www.medicare.gov/coverage/travel-outside-the-u.s.", "accessed": "2026-09-16" }, { "id": "s:nhs-cosmetic-surgery-abroad", "kind": "org", "title": "Cosmetic surgery abroad", "publisher": "NHS (England)", "url": "https://www.nhs.uk/tests-and-treatments/cosmetic-procedures/advice/cosmetic-surgery-abroad/", "accessed": "2026-09-16", "note": "read for aftercare responsibility, flying intervals and the statement on travel insurance" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:cdc-yellowbook-travel-insurance" }, "text.story": { "tier": "inference", "note": "the compounding argument is this project reasoning from three read sources; the *Trade practice —* stretch is unsourced and marked" }, "text.how": { "tier": "tradition", "note": "the questions a policy wording answers; this project holds no policy wording" }, "text.today": { "tier": "cited", "source": "s:cdc-yellowbook-travel-insurance" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "australia", "type": "destination", "name": "Australia", "as": "Medicare does not travel, and private cover usually does not either.", "rel": "governed-by" }, { "from": "canada", "type": "destination", "name": "Canada", "as": "What a provincial plan will not pay for, which is most of an elective trip.", "rel": "governed-by" }, { "from": "cuba", "type": "destination", "name": "Cuba", "as": "What no foreign insurer will settle here, and why payment is in advance.", "rel": "governed-by" }, { "from": "united-states", "type": "destination", "name": "United States", "as": "The other half of why people leave from here: the cover that does not cover it.", "rel": "governed-by" }, { "from": "havana", "type": "hub", "name": "Havana", "as": "A sanctioned destination is an exclusion before it is a clinical one.", "rel": "governed-by" }, { "from": "tel-aviv", "type": "hub", "name": "Tel Aviv", "as": "What a public hospital's schedule does and does not absorb when something goes wrong.", "rel": "governed-by" }, { "from": "addiction-rehab", "type": "procedure", "name": "Residential addiction treatment", "as": "Whether any of this is funded at home, which decides who travels.", "rel": "governed-by" }, { "from": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "Where a published list price and what a payer actually pays stop being the same number.", "rel": "rule" }, { "from": "cochlear-implant", "type": "procedure", "name": "Cochlear implant", "as": "Where a payer funds the implant and declines the processor nine years later.", "rel": "rule" }, { "from": "dialysis-holiday", "type": "procedure", "name": "Dialysis away from home", "as": "Whether a travel policy covers pre-existing renal failure is the question that decides this trip.", "rel": "rule" }, { "from": "gamma-knife", "type": "procedure", "name": "Gamma knife radiosurgery", "as": "Where a payer decides a branded machine is a different thing from the linear accelerator down the road.", "rel": "rule" }, { "from": "gastric-bypass", "type": "procedure", "name": "Gastric bypass", "as": "Whether a home payer covers a complication of an operation it did not authorise.", "rel": "governed-by" }, { "from": "icl", "type": "procedure", "name": "Implantable collamer lens", "as": "Why this is an out-of-pocket purchase in both markets read here.", "rel": "rule" }, { "from": "lasik", "type": "procedure", "name": "LASIK", "as": "Why this operation is bought rather than claimed, in every market read here.", "rel": "rule" }, { "from": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "The line where a payer decides this beam is worth the difference, or is not.", "rel": "rule" }, { "from": "top-surgery", "type": "procedure", "name": "Top surgery", "as": "Whether a policy covers this at home is what decides whether the cash price matters at all.", "rel": "rule" }, { "from": "veneers", "type": "procedure", "name": "Dental veneers", "as": "The reason no payer schedule read for this page carries a line for veneers.", "rel": "rule" }, { "from": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The rule side of the policy half of this step.", "rel": "governed-by" }, { "from": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "The rule that decides whether any of this is covered.", "rel": "governed-by" }, { "from": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "What happens outside the bloc, where no instrument does any of this.", "rel": "contrast" }, { "from": "schengen-medical-visa", "type": "rule", "name": "The Schengen visa, for treatment", "as": "Why Article 15 cover and cover for the operation are different things.", "rel": "kin" }, { "from": "uk-nhs-treatment-abroad", "type": "rule", "name": "NHS funding for treatment abroad", "as": "What the patient finds when they look for someone else to pay.", "rel": "kin" }, { "from": "us-medicare-abroad", "type": "rule", "name": "Medicare outside the United States", "as": "The private half of the same answer.", "rel": "kin" } ] }, { "id": "korea-foreign-patient-registration", "names": { "name": "Korea's foreign patient attraction registration", "aliases": [ "외국인환자 유치기관 등록", "attraction agency registration", "KHIDI registration" ], "said": "The statute's own phrase is \"attracting international patients\", and it covers the website as well as the ward." }, "region": [ "east-asia" ], "facets": { "kind": "licensing", "iso2": "KR", "status": "in-force" }, "text": { "what": "A compulsory registration for any medical institution treating foreign patients and any agency recruiting them, under the Act on Supporting Overseas Expansion of Medical Services and Attraction of International Patients, Act No. 13599 of 22 December 2015, effective 23 June 2016. Registration runs three years and is renewed. Operating without it carries up to three years' imprisonment or a fine of up to 30 million won.", "story": "Korea regulated the broker and the hospital in the same statute, and it defined the regulated activity broadly. Attracting international patients covers consultation and reservation, providing treatment information through foreign-language websites, and arranging visas, transport and accommodation. A company that only runs a Russian-language landing page for a Seoul dermatology clinic is inside the Act.\n\nArticle 6 sets the conditions and they differ by who is registering. A medical institution must assign specialists by department and hold malpractice liability insurance or belong to a mutual aid scheme. An attraction agency must hold guaranty insurance, meet a minimum capital requirement, and keep a domestic office — which is the provision that keeps the broker inside Korean jurisdiction.\n\nArticle 7 forbids transferring or leasing a registration certificate and forbids attracting patients under another party's name. Article 8 requires the certificate to be posted and requires information in foreign languages on diagnosis, treatment costs and dispute resolution.\n\n*Inference —* the insurance conditions are the interesting part. Most national regimes in this field license premises. Korea's licenses the financial exposure: the hospital must be insured against its own error, the broker must be bonded against its own failure, and the patient's route to either runs through a Korean office rather than an offshore website.\n\nRegistration is processed through the Korea Health Industry Development Institute, a government-affiliated institute under the Ministry of Health and Welfare, which also publishes the registered lists.", "how": "Application is online through KHIDI, followed by postal submission, to the provincial or municipal government. Renewal is every three years; a lapsed registration is nullified.\n\nEnforcement runs through corrective orders, revocation of registration, administrative fines up to 5 million won, and the criminal penalty for unregistered operation. Article 27 provides monetary awards for reporting violations.\n\nWhat the registration does not do: fix prices, or make the agency clinically responsible. Article 8's duty is disclosure — the diagnosis, the cost and the route to a dispute, in a language the patient reads.", "today": "As of 17 September 2026 the Act stands as amended and KHIDI runs the register. The Ministry of Health and Welfare reported 1.17 million foreign patients for 2024; that is the registration system's own count of patients recorded by registered institutions, and it counts episodes recorded under the Act rather than people." }, "kin": [ { "to": "south-korea", "as": "The country whose statute this is.", "rel": "destination" }, { "to": "khidi", "as": "The institute that runs the register and publishes the count.", "rel": "org" }, { "to": "seoul", "as": "Where most registered institutions are.", "rel": "hub" }, { "to": "asan-medical-center", "as": "One of the registered institutions.", "rel": "facility" }, { "to": "severance", "as": "Another, with its own international centre.", "rel": "facility" }, { "to": "facilitator", "as": "The role this Act bonds, capitalises and keeps onshore.", "rel": "term" }, { "to": "choosing-a-facilitator", "as": "The step at which the register and the guaranty insurance matter.", "rel": "step" }, { "to": "malpractice-recourse", "as": "The exposure Article 6 insures against, inside one jurisdiction.", "rel": "risk" }, { "to": "counting-patients", "as": "What a registration-based count does and does not count.", "rel": "story" } ], "links": [ { "label": "Act on Supporting Overseas Expansion of Medical Services and Attraction of International Patients — Korea Law Translation Center", "url": "https://elaw.klri.re.kr/eng_mobile/viewer.do?hseq=60070&type=part&key=36" }, { "label": "KHIDI — Medical Korea", "url": "http://www.medicalkorea.or.kr/en/aboutkhidi" } ], "sources": [ "s:kr-act-13599", "s:khidi-medicalkorea", "s:mohw-kr-foreign-patients-2024" ], "provenance": { "default": { "tier": "cited", "source": "s:kr-act-13599" }, "fields": { "text.story": { "tier": "cited", "source": "s:kr-act-13599", "note": "read in the Korea Law Translation Center's English text; the stretch marked *Inference —* is this project's reading" }, "text.today": { "tier": "cited", "source": "s:mohw-kr-foreign-patients-2024" } } }, "confidence": "high", "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "A compulsory registration for any medical institution treating foreign patients and any agency recruiting them, under the Act on Supporting Overseas Expansion of Medical Services and Attraction of International…", "region_terms": [ { "key": "east-asia", "name": "East Asia", "note": "South Korea, Japan, Taiwan, China" } ], "kin_out": [ { "to": "south-korea", "type": "destination", "name": "South Korea", "as": "The country whose statute this is.", "rel": "destination" }, { "to": "khidi", "type": "org", "name": "Korea Health Industry Development Institute", "as": "The institute that runs the register and publishes the count.", "rel": "org" }, { "to": "seoul", "type": "hub", "name": "Seoul", "as": "Where most registered institutions are.", "rel": "hub" }, { "to": "asan-medical-center", "type": "facility", "name": "Asan Medical Center", "as": "One of the registered institutions.", "rel": "facility" }, { "to": "severance", "type": "facility", "name": "Severance Hospital", "as": "Another, with its own international centre.", "rel": "facility" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The role this Act bonds, capitalises and keeps onshore.", "rel": "term" }, { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "The step at which the register and the guaranty insurance matter.", "rel": "step" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "The exposure Article 6 insures against, inside one jurisdiction.", "rel": "risk" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "What a registration-based count does and does not count.", "rel": "story" } ], "source_list": [ { "id": "s:kr-act-13599", "kind": "statute", "title": "Act on Supporting Overseas Expansion of Medical Services and Attraction of International Patients (Act No. 13599, 22 December 2015)", "publisher": "Korea Legislation Research Institute, Korea Law Translation Center", "url": "https://elaw.klri.re.kr/eng_mobile/viewer.do?hseq=60070&type=part&key=36", "accessed": "2026-09-17", "note": "Article 6 registration conditions — specialists by department and malpractice cover for an institution; guaranty insurance, minimum capital and a domestic office for an agency. Article 7 bars transfer or lease of a certificate. Article 8 requires posting and foreign-language information on diagnosis, cost and dispute resolution. Unregistered operation: up to three years or 30 million won." }, { "id": "s:khidi-medicalkorea", "kind": "org", "title": "About KHIDI — Medical Korea", "publisher": "Korea Health Industry Development Institute", "url": "http://www.medicalkorea.or.kr/en/aboutkhidi", "accessed": "2026-09-16", "note": "government-affiliated institution under the Ministry of Health and Welfare; the registration system, registered hospitals and registered facilitators" }, { "id": "s:mohw-kr-foreign-patients-2024", "kind": "web", "title": "Korea Attracts 1.17 Million Foreign Patients in 2024", "publisher": "Ministry of Health and Welfare (Republic of Korea)", "url": "https://www.mohw.go.kr/board.es?mid=a20401000000&bid=0032&act=view&list_no=1485207", "accessed": "2026-09-16", "note": "press release of 3 April 2025; the annual foreign-patient statistics are compiled for the ministry by the Korea Health Industry Development Institute" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:kr-act-13599" }, "text.story": { "tier": "cited", "source": "s:kr-act-13599", "note": "read in the Korea Law Translation Center's English text; the stretch marked *Inference —* is this project's reading" }, "text.how": { "tier": "cited", "source": "s:kr-act-13599" }, "text.today": { "tier": "cited", "source": "s:mohw-kr-foreign-patients-2024" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "south-korea", "type": "destination", "name": "South Korea", "as": "The registration that turns a clinic into a line in the national count.", "rel": "governed-by" }, { "from": "seoul", "type": "hub", "name": "Seoul", "as": "The registration and reporting regime that produces those numbers.", "rel": "governed-by" }, { "from": "asan-medical-center", "type": "facility", "name": "Asan Medical Center", "as": "Operates under the registration every Korean facility treating foreign patients must hold.", "rel": "governed-by" }, { "from": "samsung-medical-center", "type": "facility", "name": "Samsung Medical Center", "as": "Operates under the registration a Korean facility must hold to treat a foreign patient at all.", "rel": "governed-by" }, { "from": "severance", "type": "facility", "name": "Severance Hospital", "as": "Operates under the registration every Korean facility treating foreign patients must hold.", "rel": "governed-by" }, { "from": "wooridul", "type": "facility", "name": "Wooridul Spine Hospital", "as": "Operates under the registration every Korean facility treating foreign patients must hold — a regime whose counts start in 2009, three years after this hospital opened its foreign-patient centre.", "rel": "governed-by" }, { "from": "khidi", "type": "org", "name": "Korea Health Industry Development Institute", "as": "The registration rule that makes the count possible.", "rel": "governs" } ] }, { "id": "malaysia-mhtc-licence", "names": { "name": "Malaysia's healthcare travel registration", "aliases": [ "MHTC membership", "MHTC Elite Partner", "Act 586 licence" ], "said": "Two different things get called a licence here, and only one of them is issued by law." }, "region": [ "southeast-asia" ], "facets": { "kind": "licensing", "iso2": "MY", "status": "in-force" }, "text": { "what": "Malaysia has a statutory licence to operate a private hospital and a separate, non-statutory membership scheme for hospitals selling to foreign patients. The licence is issued under the Private Healthcare Facilities and Services Act 1998 (Act 586): no person may establish or maintain a private healthcare facility, other than a private medical or dental clinic, without the approval of the Director General of Health. The membership is the Malaysia Healthcare Travel Council's, and it is a trade register, not a permit.", "story": "The Council was set up by the Ministry of Health in 2005, incorporated as an independent entity in 2011, and moved from the Ministry of Health to the Ministry of Finance in 2018. Its own site lists more than 80 partner hospitals and clinics, and it grades them — Elite Partner at the top, where the Council states that every Elite Partner holds accreditation from an international body such as Joint Commission International, the Malaysian Society for Quality in Health, the Australian Council on Healthcare Standards, Temos, or the Reproductive Technology Accreditation Committee.\n\n*Inference —* the distinction matters to a reader trying to check a hospital. Losing the Act 586 licence closes the hospital. Losing Council membership closes a marketing channel. Both are called accreditation in the brochures, and they are different instruments with different consequences, held by different bodies, and only one of them is enforced by a regulator.\n\nA selection committee drawn from the private and government sectors decides membership. *Inference —* a committee that both promotes an industry and vets its members is doing two jobs, and this project counts recognitions rather than weighting them for exactly that reason.", "how": "The statutory route: approval to establish, then a licence to operate, from the Director General of Health, under Act 586 and its regulations. The Act covers private hospitals, ambulatory care centres, blood banks, hospice care, nursing homes, psychiatric hospitals and community mental health centres.\n\nThe Council route: application to MHTC, evaluation by its committee, and a tier. What the tier signals is an accreditation held elsewhere.\n\nAdvertising is a third regime again: under section 4B of the Medicines (Advertisement and Sale) Act 1956 and the Medicine Advertisements Board Regulations 1976, a healthcare advertisement needs Board approval before publication and carries a KKLIU serial number, valid six months.", "today": "As of 17 September 2026 MHTC's own site could not be read directly — mhtc.org.my returned a server error on 16 September 2026 and again on this date — and the counts here are read off malaysiahealthcare.org and the Council's Wikipedia entry. The statutory position under Act 586 is read off the Ministry of Health's own publication of the Act." }, "kin": [ { "to": "malaysia", "as": "The country whose two regimes these are.", "rel": "destination" }, { "to": "mhtc", "as": "The council that runs the membership half.", "rel": "org" }, { "to": "kuala-lumpur", "as": "Where most member hospitals are.", "rel": "hub" }, { "to": "penang", "as": "The second cluster, and the one that draws from Indonesia.", "rel": "hub" }, { "to": "gleneagles-kl", "as": "One of the member hospitals.", "rel": "facility" }, { "to": "island-hospital-penang", "as": "Another, in the northern cluster.", "rel": "facility" }, { "to": "jci", "as": "The accreditation the top membership tier is built on.", "rel": "accredited-by" }, { "to": "the-accreditation-question", "as": "Why two things called accreditation are not the same instrument.", "rel": "story" }, { "to": "advertising-rules", "as": "The third regime, and the KKLIU number on every advertisement.", "rel": "kin" } ], "links": [ { "label": "Private Healthcare Facilities and Services Act 1998 (Act 586) — Ministry of Health Malaysia", "url": "https://www.moh.gov.my/index.php/pages/view/198" }, { "label": "Malaysia Healthcare Travel Council", "url": "https://malaysiahealthcare.org/" } ], "sources": [ "s:my-act-586-overview", "s:malaysiahealthcare-about", "s:mhtc-wikipedia", "s:mhtc-mymt-2026", "s:my-mab-kkliu" ], "provenance": { "default": { "tier": "cited", "source": "s:my-act-586-overview" }, "fields": { "text.story": { "tier": "cited", "source": "s:malaysiahealthcare-about", "note": "the stretches marked *Inference —* are this project's reading of the difference between the two instruments" }, "text.today": { "tier": "cited", "source": "s:mhtc-wikipedia", "note": "mhtc.org.my was unreachable on both attempts" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "Malaysia has a statutory licence to operate a private hospital and a separate, non-statutory membership scheme for hospitals selling to foreign patients.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "malaysia", "type": "destination", "name": "Malaysia", "as": "The country whose two regimes these are.", "rel": "destination" }, { "to": "mhtc", "type": "org", "name": "Malaysia Healthcare Travel Council", "as": "The council that runs the membership half.", "rel": "org" }, { "to": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "Where most member hospitals are.", "rel": "hub" }, { "to": "penang", "type": "hub", "name": "Penang", "as": "The second cluster, and the one that draws from Indonesia.", "rel": "hub" }, { "to": "gleneagles-kl", "type": "facility", "name": "Gleneagles Hospital Kuala Lumpur", "as": "One of the member hospitals.", "rel": "facility" }, { "to": "island-hospital-penang", "type": "facility", "name": "Island Hospital", "as": "Another, in the northern cluster.", "rel": "facility" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The accreditation the top membership tier is built on.", "rel": "accredited-by" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Why two things called accreditation are not the same instrument.", "rel": "story" }, { "to": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "The third regime, and the KKLIU number on every advertisement.", "rel": "kin" } ], "source_list": [ { "id": "s:my-act-586-overview", "kind": "web", "title": "Regulatory framework for setting up private healthcare facilities and services in Malaysia", "publisher": "Halim Hong & Quek (HHQ), Malaysian law firm", "url": "https://hhq.com.my/posts/regulatory-framework-for-setting-up-private-healthcare-facilities-and-services-in-malaysia/", "accessed": "2026-09-17", "note": "a practitioner overview, not the statute. Quoted for the Act 586 approval requirement and the Private Healthcare Facilities and Services (Private Hospitals and Other Private Healthcare Facilities) Regulations 2006. The Act's own text could not be read on this date: the Attorney General's Chambers page returned an invalid request, CommonLII returned 403, and the circulating PDF reprint would not extract." }, { "id": "s:malaysiahealthcare-about", "kind": "org", "title": "Malaysia Healthcare — about", "publisher": "Malaysia Healthcare Travel Council", "url": "https://malaysiahealthcare.org/about-us", "accessed": "2026-09-17", "note": "company registration number 201101035226; the site's own count of more than 80 partner hospitals and clinics. mhtc.org.my itself returned HTTP 500 on this date, as it did on 16 September 2026." }, { "id": "s:mhtc-wikipedia", "kind": "wikipedia", "title": "Malaysia Healthcare Travel Council", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Malaysia_Healthcare_Travel_Council", "accessed": "2026-09-16", "note": "set up 2005, incorporated as an independent entity 2011, moved from the Ministry of Health to the Ministry of Finance in 2018, and the 2019 arrivals figure; mhtc.org.my returned HTTP 500 on this date" }, { "id": "s:mhtc-mymt-2026", "kind": "web", "title": "Malaysia Healthcare Travel Council Launches MYMT 2026, Malaysia's First Medical Tourism Year", "publisher": "Malaysia Healthcare Travel Council", "url": "https://www.prnewswire.com/apac/news-releases/malaysia-healthcare-travel-council-launches-mymt-2026-malaysias-first-medical-tourism-year-302513594.html", "accessed": "2026-09-16", "note": "MHTC's own release, dated 25 July 2025, carrying its 2024 healthcare-traveller and revenue figures. The council's own site returned a server error on the date of access" }, { "id": "s:my-mab-kkliu", "kind": "gov", "title": "Is it necessary for medical advertisements on the internet to get approval from MAB?", "publisher": "Pharmaceutical Services Programme, Ministry of Health Malaysia", "url": "https://pharmacy.moh.gov.my/en/faq/it-necessary-medical-advertisements-internet-get-approval-mab.html", "accessed": "2026-09-17", "note": "the Ministry's own answer: all dissemination of information about products and healthcare services to attract public attention, including on the internet, is an advertisement, and section 4B of the Medicines (Advertisement and Sale) Act 1956 requires Medicine Advertisements Board approval before publication" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:my-act-586-overview" }, "text.story": { "tier": "cited", "source": "s:malaysiahealthcare-about", "note": "the stretches marked *Inference —* are this project's reading of the difference between the two instruments" }, "text.how": { "tier": "cited", "source": "s:my-act-586-overview" }, "text.today": { "tier": "cited", "source": "s:mhtc-wikipedia", "note": "mhtc.org.my was unreachable on both attempts" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "malaysia", "type": "destination", "name": "Malaysia", "as": "The registration a hospital passes through to be counted and marketed as a destination facility.", "rel": "governed-by" }, { "from": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "The licensing route a hospital takes to sell to foreign patients.", "rel": "governed-by" }, { "from": "gleneagles-kl", "type": "facility", "name": "Gleneagles Hospital Kuala Lumpur", "as": "The national arrangement under which Malaysian hospitals take foreign patients.", "rel": "governed-by" }, { "from": "island-hospital-penang", "type": "facility", "name": "Island Hospital", "as": "The national arrangement under which it takes foreign patients.", "rel": "governed-by" }, { "from": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "The third Malaysian regime, alongside the statutory licence and the council membership.", "rel": "kin" }, { "from": "mhtc", "type": "org", "name": "Malaysia Healthcare Travel Council", "as": "The rule record for what membership is and is not; licensing sits with the health ministry.", "rel": "governs" } ] }, { "id": "patient-data-transfer", "names": { "name": "Moving a medical record across a border", "aliases": [ "health data transfer", "GDPR Article 49", "special category data" ], "said": "The record is the patient's evidence of what was done. Getting a copy is a right in one bloc and a favour nearly everywhere else." }, "region": [ "global" ], "facets": { "kind": "prohibition", "status": "in-force" }, "text": { "what": "Whether a patient can obtain their own medical record, and on what terms it may be sent to another country. In the European Economic Area, Regulation (EU) 2016/679 supplies both halves: health data is special category data under Article 9, Article 15 gives a right of access, Article 20 a right to portability in some circumstances, and Article 49 sets the derogations under which a transfer to a third country may proceed without an adequacy decision.", "story": "Two rights that sound alike do different work. Article 15 gives the right to obtain confirmation of processing and a copy of the personal data undergoing processing, with a fee permitted only for further copies. Article 20 gives the right to receive the data in a structured, commonly used and machine-readable format and to have it transmitted directly to another controller — but only where the processing rests on consent or on a contract and is carried out by automated means, and direct transmission only where technically feasible.\n\n*Inference —* a hospital record held under a legal obligation or in the public interest is therefore reachable under Article 15 and often not under Article 20. For a patient who wants a copy, that distinction is invisible and irrelevant. For a hospital's data protection office it is the whole answer, and it is why a request phrased as portability sometimes fails where the same request phrased as access succeeds.\n\nDirective 2011/24/EU adds a duty on the treating side that does not depend on any of this: Article 4(2)(f) requires the Member State of treatment to ensure that patients receive a copy of the medical record, and Article 5(d) obliges the state of affiliation to provide access to records.\n\nOutside the bloc there is no equivalent. A hospital in a third country may hold records under its own law, may charge, may require a personal appearance, and may keep operative notes, imaging and pathology in three separate systems with three separate release procedures. Nothing in the destination's law is likely to contemplate a patient who has already flown home.\n\nArticle 49 is the clause that gets cited when a record has to move the other way — from an EEA clinic to a clinician abroad, or between a facilitator and a foreign hospital. Its derogations are narrow and situational, and they were not written for a routine commercial flow.\n\n*Inference —* the practical consequence lands on the home clinician. A patient presenting with a complication and no operative note is a patient whose surgeon, implant, technique and antibiotic are all unknown, and the revision is planned blind. The right of access is the mechanism that prevents that, and it exists in full in one bloc.", "how": "What travels, and what a reader would have to ask for by name: the operation note, the anaesthetic chart, the implant sticker or lot number, the histopathology report, the discharge summary with drug names, the imaging itself rather than the report, and the consent form actually signed. A summary letter is not a record.\n\nFormat matters as much as content. Imaging held on a proprietary viewer is imaging a home hospital may not be able to open; a scanned photograph of a chart is not searchable and may not be legible.\n\nWhere a facilitator sits between the patient and the hospital, the records may be held by a company rather than a clinician, and the duties of confidentiality and the route to a copy differ accordingly.", "today": "As of 17 September 2026 the GDPR articles named here are in force across the EEA. No comparable instrument was read for the destinations outside it, and this project does not assert that none exists — several states have data protection statutes this pass did not reach." }, "kin": [ { "to": "getting-your-records", "as": "The step this rule governs, at the front of the journey.", "rel": "step" }, { "to": "the-discharge-summary", "as": "The document that matters most, and the one most often a letter instead.", "rel": "step" }, { "to": "aftercare-at-home", "as": "Where the absence of a record is discovered.", "rel": "step" }, { "to": "revision-at-home", "as": "The operation planned blind when the note did not travel.", "rel": "risk" }, { "to": "eu-directive-2011-24", "as": "The instrument that puts the duty on the treating side.", "rel": "governed-by" }, { "to": "cross-border-prescriptions", "as": "The other half of what a patient carries home.", "rel": "kin" }, { "to": "implant-excluded", "as": "Why the implant's lot number is worth asking for by name.", "rel": "risk" }, { "to": "malpractice-recourse", "as": "The record is the evidence, and the claim turns on it.", "rel": "risk" }, { "to": "language-consent", "as": "The consent form, in whichever language it was actually signed.", "rel": "risk" } ], "links": [ { "label": "GDPR Article 9 — processing of special categories of personal data", "url": "https://www.legislation.gov.uk/eur/2016/679/article/9" }, { "label": "GDPR Article 15 — right of access", "url": "https://gdpr-info.eu/art-15-gdpr/" }, { "label": "GDPR Article 20 — right to data portability", "url": "https://gdpr-info.eu/art-20-gdpr/" } ], "sources": [ "s:eu-gdpr", "s:gdpr-art-15", "s:gdpr-art-20", "s:dir-2011-24-chapter-ii", "s:legislation-eu-directive-2011-24" ], "provenance": { "default": { "tier": "cited", "source": "s:eu-gdpr" }, "fields": { "text.story": { "tier": "cited", "source": "s:gdpr-art-20", "note": "the article contents are read; the stretches marked *Inference —* are this project's reasoning" }, "text.how": { "tier": "tradition", "note": "the list of documents a record actually consists of; no instrument enumerates it" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "Whether a patient can obtain their own medical record, and on what terms it may be sent to another country.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "The step this rule governs, at the front of the journey.", "rel": "step" }, { "to": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "The document that matters most, and the one most often a letter instead.", "rel": "step" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "Where the absence of a record is discovered.", "rel": "step" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The operation planned blind when the note did not travel.", "rel": "risk" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The instrument that puts the duty on the treating side.", "rel": "governed-by" }, { "to": "cross-border-prescriptions", "type": "rule", "name": "A prescription that crosses a border", "as": "The other half of what a patient carries home.", "rel": "kin" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "Why the implant's lot number is worth asking for by name.", "rel": "risk" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "The record is the evidence, and the claim turns on it.", "rel": "risk" }, { "to": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "The consent form, in whichever language it was actually signed.", "rel": "risk" } ], "source_list": [ { "id": "s:eu-gdpr", "kind": "statute", "title": "Regulation (EU) 2016/679 (General Data Protection Regulation), Articles 9 and 49", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/eur/2016/679/article/9", "accessed": "2026-09-16" }, { "id": "s:gdpr-art-15", "kind": "law", "title": "Article 15 — Right of access by the data subject, Regulation (EU) 2016/679 (GDPR)", "publisher": "gdpr-info.eu, consolidated text of Regulation (EU) 2016/679", "url": "https://gdpr-info.eu/art-15-gdpr/", "accessed": "2026-09-16", "note": "read for the right to obtain a copy of personal data undergoing processing, and the fee permitted for further copies" }, { "id": "s:gdpr-art-20", "kind": "law", "title": "Article 20 — Right to data portability, Regulation (EU) 2016/679 (GDPR)", "publisher": "gdpr-info.eu, consolidated text of Regulation (EU) 2016/679", "url": "https://gdpr-info.eu/art-20-gdpr/", "accessed": "2026-09-16", "note": "applicable when processing rests on consent or on a contract and is carried out by automated means; direct controller-to-controller transmission only where technically feasible" }, { "id": "s:dir-2011-24-chapter-ii", "kind": "law", "title": "Directive 2011/24/EU, Chapter II — responsibilities of the Member State of treatment and of affiliation, Articles 4 to 6", "publisher": "legislation.gov.uk, retained text of Directive 2011/24/EU", "url": "https://www.legislation.gov.uk/cy/eudr/2011/24/chapter/II/data.htm?view=plain", "accessed": "2026-09-16", "note": "read for Art 4(2)(b) invoices and prices, 4(2)(c) complaints and redress, 4(2)(d) professional liability insurance, 4(2)(f) copy of the medical record, 5(d) access to records, and Art 6 national contact points" }, { "id": "s:legislation-eu-directive-2011-24", "kind": "statute", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare, Articles 7, 8 and 11 (text as held on legislation.gov.uk)", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/eudr/2011/24/article/7", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:eu-gdpr" }, "text.story": { "tier": "cited", "source": "s:gdpr-art-20", "note": "the article contents are read; the stretches marked *Inference —* are this project's reasoning" }, "text.how": { "tier": "tradition", "note": "the list of documents a record actually consists of; no instrument enumerates it" }, "text.today": { "tier": "cited", "source": "s:eu-gdpr" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "abortion-care", "type": "procedure", "name": "Abortion", "as": "What is recorded, who is told, and what follows the patient home — a Dutch clinic states it informs neither insurer nor family doctor.", "rel": "rule" }, { "from": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "The rule that governs moving a file across a border.", "rel": "governed-by" }, { "from": "cross-border-prescriptions", "type": "rule", "name": "A prescription that crosses a border", "as": "The record that travels alongside it, under different law.", "rel": "kin" }, { "from": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "Article 4(2)(f) makes the record follow the patient; the data law says on what terms.", "rel": "kin" } ] }, { "id": "s2-route", "names": { "name": "The S2 route", "aliases": [ "S2 certificate", "planned treatment scheme", "Article 20 authorisation", "the old E112" ], "said": "Named for the form. Before 2010 the same authorisation travelled on an E112." }, "region": [ "europe-west", "europe-central", "europe-south", "europe-north", "europe-east", "europe-west" ], "facets": { "kind": "entitlement", "status": "in-force" }, "text": { "what": "Prior authorisation to be treated in another EEA state's public system at that state's expense, issued on a certificate the patient carries. It rests on Article 20 of Regulation (EC) No 883/2004 on the coordination of social security systems. Where it is granted, the patient is treated on the same terms as a resident of the destination — including that country's own co-payments — and the two states settle the cost between themselves. No invoice reaches the patient for the treatment itself.", "story": "Coordination came first. Regulation (EC) No 883/2004 replaced Regulation 1408/71 and carried forward a rule written for migrant workers, not for people shopping for surgery: a person insured in one Member State who needs care in another should not lose the cover they have paid for. Article 20(2) sets two conditions and only two. The treatment must be \"among the benefits provided for by the legislation in the Member State where the person concerned resides\", and the person must not be able to be \"given such treatment within a time-limit which is medically justifiable, taking into account his current state of health and the probable course of his illness\".\n\nThat second condition is the queue, written into law. It is also what makes the route generous: authorisation granted, the destination's public system bills the patient's home system at its own rates, and the patient pays what a local pays. Against the Directive route — pay the foreign price, reclaim the home price — the arithmetic runs the other way for anyone travelling from a cheap system to an expensive one.\n\n*Inference —* the two conditions between them close the route to almost everyone this directory is about. A patient who wants a procedure sooner than their own system offers, but not so much sooner that the delay is medically unjustifiable, does not qualify. A patient who wants a private hospital does not qualify: the NHS states the scheme \"applies to public healthcare providers only\". A patient who wants something their own system does not fund at all does not qualify under either route.\n\nThe United Kingdom kept this route after Brexit and lost the other. That is the single clearest statement of which of the two a state considers worth keeping when it is choosing.", "how": "The application goes in before travel. NHS England's version asks that the applicant be \"ordinarily resident in England and entitled to treatment on the NHS\", be registered with an NHS general practitioner, and have \"seen your NHS GP for a consultation or assessment about the condition\". Approval issues an S2 certificate from the NHS Business Services Authority, described as a payment guarantee form, and the stated service standard is up to 20 working days for a complete application.\n\nWhat the certificate does not cover: travel, accommodation, and \"the clinical trial or experimental part of any treatment\". What it does not undo: a co-payment. \"This could mean you have to pay a percentage of the costs yourself\", which in a system that charges its own residents a share — France, Belgium, much of central Europe — the visiting patient pays too.\n\nTreatment paid for before authorisation cannot be reimbursed afterwards, except for co-payments. The certificate is issued against a named provider and a named course of treatment.", "today": "As of 17 September 2026 the S2 route is open to residents of EU Member States and, for UK residents, to treatment in an EU country or Switzerland, Norway, Iceland or Liechtenstein — with additional nationality conditions for Switzerland. It is the only planned-treatment funding route the NHS still operates in Europe." }, "kin": [ { "to": "eu-directive-2011-24", "as": "The newer route, and the contrast: private providers, no queue test, and the patient carries the price difference.", "rel": "contrast" }, { "to": "uk-nhs-treatment-abroad", "as": "The national system that runs this route, and the page where its own conditions are set out.", "rel": "kin" }, { "to": "prior-authorisation", "as": "The word for the gate this route is entirely made of.", "rel": "term" }, { "to": "co-payment", "as": "What survives the certificate.", "rel": "term" }, { "to": "oecd-waiting-times", "as": "The series that measures the queue Article 20(2) turns on.", "rel": "measured-by" }, { "to": "getting-a-quote", "as": "The step this route removes, by paying at the destination's own tariff.", "rel": "step" }, { "to": "reading-the-exclusions", "as": "Travel, accommodation and the experimental part of a treatment are outside the certificate.", "rel": "step" } ], "links": [ { "label": "Regulation (EC) No 883/2004, Article 20", "url": "https://www.legislation.gov.uk/eur/2004/883/article/20/adopted" }, { "label": "NHS — The Planned Treatment Scheme (S2 funding route)", "url": "https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/planned-treatment-s2-funding-route/" } ], "sources": [ "s:eu-reg-883-2004", "s:nhs-s2-route", "s:legislation-eu-directive-2011-24", "s:ec-crossborder-2022" ], "provenance": { "default": { "tier": "cited", "source": "s:eu-reg-883-2004" }, "fields": { "text.how": { "tier": "cited", "source": "s:nhs-s2-route", "note": "the English application conditions; other Member States run their own" }, "text.story": { "tier": "cited", "source": "s:eu-reg-883-2004", "note": "the paragraph marked *Inference —* is this project reasoning from the two instruments" } } }, "confidence": "high", "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "Prior authorisation to be treated in another EEA state's public system at that state's expense, issued on a certificate the patient carries.", "region_terms": [ { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" }, { "key": "europe-central", "name": "Central Europe", "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia" }, { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" }, { "key": "europe-north", "name": "Northern Europe", "note": "the Nordics and the Baltics" }, { "key": "europe-east", "name": "Eastern Europe", "note": "Romania, Bulgaria, Serbia, Ukraine, Moldova, Albania, North Macedonia" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The newer route, and the contrast: private providers, no queue test, and the patient carries the price difference.", "rel": "contrast" }, { "to": "uk-nhs-treatment-abroad", "type": "rule", "name": "NHS funding for treatment abroad", "as": "The national system that runs this route, and the page where its own conditions are set out.", "rel": "kin" }, { "to": "prior-authorisation", "type": "term", "name": "Prior authorisation", "as": "The word for the gate this route is entirely made of.", "rel": "term" }, { "to": "co-payment", "type": "term", "name": "Co-payment", "as": "What survives the certificate.", "rel": "term" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The series that measures the queue Article 20(2) turns on.", "rel": "measured-by" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step this route removes, by paying at the destination's own tariff.", "rel": "step" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "Travel, accommodation and the experimental part of a treatment are outside the certificate.", "rel": "step" } ], "source_list": [ { "id": "s:eu-reg-883-2004", "kind": "statute", "title": "Regulation (EC) No 883/2004 on the coordination of social security systems, Article 20 (as adopted)", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/eur/2004/883/article/20/adopted", "accessed": "2026-09-16" }, { "id": "s:nhs-s2-route", "kind": "web", "title": "The Planned Treatment Scheme (S2 funding route)", "publisher": "NHS", "url": "https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/planned-treatment-s2-funding-route/", "accessed": "2026-09-16" }, { "id": "s:legislation-eu-directive-2011-24", "kind": "statute", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare, Articles 7, 8 and 11 (text as held on legislation.gov.uk)", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/eudr/2011/24/article/7", "accessed": "2026-09-16" }, { "id": "s:ec-crossborder-2022", "kind": "report", "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU — reference year 2022", "publisher": "European Commission, DG Health and Food Safety, Unit B.3; written by PredictBy Research and Consulting and Baltic Media; Publications Office of the European Union", "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf", "license": "CC BY 4.0", "accessed": "2026-09-16", "note": "final version January 2024, ISBN 978-92-68-14858-7. 23 countries reported 547,890 reimbursement requests for care not needing prior authorisation in 2022, of which France 300,254 and Germany 160,647 are 84%; Poland 14,176, Slovakia 13,904, Ireland 1,841, Romania 889, Czechia 440, Croatia 192, Lithuania 131, Greece 56, Cyprus 44, Portugal 27 (all refused), Spain 9. Total reimbursed EUR 86,462,491. For care needing prior authorisation, 4,552 requests and EUR 7,708,041. Belgium and Hungary could not report; Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway run no prior-authorisation system; only Denmark and Romania have a mechanism to limit inflow." } ], "tiers": { "text.what": { "tier": "cited", "source": "s:eu-reg-883-2004" }, "text.story": { "tier": "cited", "source": "s:eu-reg-883-2004", "note": "the paragraph marked *Inference —* is this project reasoning from the two instruments" }, "text.how": { "tier": "cited", "source": "s:nhs-s2-route", "note": "the English application conditions; other Member States run their own" }, "text.today": { "tier": "cited", "source": "s:eu-reg-883-2004" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "ireland", "type": "destination", "name": "Ireland", "as": "Run here as the Treatment Abroad Scheme, on consultant referral, for care the public system cannot provide in time.", "rel": "governed-by" }, { "from": "car-t", "type": "procedure", "name": "CAR T-cell therapy", "as": "The EU form under which a health service can send a patient across a border for treatment it cannot give at home.", "rel": "governed-by" }, { "from": "charite-international", "type": "facility", "name": "Charité International Patients", "as": "The prior-authorisation route by which a European system sends a patient here and pays the German tariff directly.", "rel": "governed-by" }, { "from": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The older coordination route, and the contrast that explains this one: it pays the destination's public tariff in full but demands a queue at home.", "rel": "contrast" }, { "from": "uk-nhs-treatment-abroad", "type": "rule", "name": "NHS funding for treatment abroad", "as": "The route this system still runs, in full.", "rel": "rule" }, { "from": "eu-national-contact-points", "type": "org", "name": "EU National Contact Points for cross-border healthcare", "as": "The older prior-authorisation route these figures are hard to separate from.", "rel": "contrast" }, { "from": "directive-2011-24-adopted", "type": "event", "name": "Directive 2011/24/EU adopted, 9 March 2011", "as": "The older route it sits beside, under the social security regulation, which pays the treating country's tariff instead.", "rel": "rule" }, { "from": "patient-mobility", "type": "term", "name": "Patient mobility", "as": "The other rail: authorisation first, then treatment on the host state's public terms.", "rel": "rule" }, { "from": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The entitlement a long queue can turn into a funded trip across a European border.", "rel": "rule" } ] }, { "id": "schengen-medical-visa", "names": { "name": "The Schengen visa, for treatment", "aliases": [ "uniform visa", "type C visa", "Visa Code Annex II" ], "said": "There is no medical class. There is a purpose of journey, and a document that proves it." }, "region": [ "europe-west", "europe-central", "europe-south", "europe-north" ], "facets": { "kind": "visa", "status": "in-force" }, "text": { "what": "Europe issues no dedicated treatment visa. A patient travelling to the Schengen area for care applies for the ordinary short-stay uniform visa under Regulation (EC) No 810/2009, the Community Code on Visas, and proves the purpose of the journey with a hospital document. Annex II names it: for travel undertaken for medical reasons, \"an official document of the medical institution confirming necessity for medical care in that institution and proof of sufficient financial means to pay for the medical treatment\".", "story": "The contrast with India and Thailand is the point. India created a class and capped the attendants at two. Thailand endorses a visitor visa and caps the stay at 90 days. The Schengen states created nothing: the patient is a visitor with a hospital letter, and the letter is one item on Annex II's non-exhaustive list alongside the ones for business travellers and students.\n\nArticle 14(1)(a) requires \"documents indicating the purpose of the journey\", plus accommodation, means of subsistence for the stay and the return, and information allowing an assessment of the applicant's intention to leave before the visa expires. Article 15 adds travel medical insurance covering \"repatriation for medical reasons, urgent medical attention and/or emergency hospital treatment or death\", with minimum cover of EUR 30,000.\n\n*Inference —* the insurance requirement and the treatment being travelled for do not meet. A policy written to cover an emergency and repatriation is not a policy covering the planned operation; the Visa Code asks for the first and says nothing about the second. A patient can therefore satisfy Article 15 in full and be entirely uninsured for the thing they came to do.\n\nThe ninety-day ceiling is the other constraint. A uniform visa is a short stay — 90 days in any 180 — which is enough for most surgery and not enough for a long oncology or rehabilitation course. Longer stays are national long-stay visas, issued by each Member State under its own law, and there the picture fragments.", "how": "Application to the consulate of the main destination, with the hospital document, the funds evidence, the insurance certificate and the ordinary supporting set. Article 14(6) lets a consulate waive requirements for applicants with a known record of lawful visa use.\n\nWhat this route does not do: name the hospital on the visa, admit a companion as of right, or move if the treatment date slips. A companion applies as an ordinary visitor and proves their own purpose, which is somebody else's treatment.\n\nThe United Kingdom and Ireland are outside the Schengen area and run their own routes.", "today": "As of 17 September 2026 the Visa Code as amended is the instrument, and Annex II is still the list. No Schengen state issues a visa class named for medical treatment; the purpose of journey is a document, not a category." }, "kin": [ { "to": "the-visa", "as": "The step this rule sits inside.", "rel": "pathway" }, { "to": "india-e-medical-visa", "as": "The contrast: a named class, a year long, with an attendant visa attached.", "rel": "contrast" }, { "to": "thai-medical-visa", "as": "The middle case: a visitor visa with a medical endorsement.", "rel": "contrast" }, { "to": "insurance-exclusions", "as": "Why Article 15 cover and cover for the operation are different things.", "rel": "kin" }, { "to": "spain", "as": "One Schengen destination with a large inbound fertility trade and no treatment visa.", "rel": "destination" }, { "to": "germany", "as": "Another, drawing patients from the Gulf and the former Soviet states.", "rel": "destination" }, { "to": "the-companion", "as": "Who has to apply separately, and prove someone else's purpose.", "rel": "step" }, { "to": "counting-patients", "as": "A visitor visa with a hospital letter leaves no category to count.", "rel": "story" } ], "links": [ { "label": "Regulation (EC) No 810/2009, Article 14", "url": "https://www.legislation.gov.uk/eur/2009/810/article/14" }, { "label": "Regulation (EC) No 810/2009, Article 15", "url": "https://www.legislation.gov.uk/eur/2009/810/article/15" }, { "label": "Regulation (EC) No 810/2009, Annex II", "url": "https://www.legislation.gov.uk/eur/2009/810/annex/II" } ], "sources": [ "s:eu-visa-code-810-2009", "s:eu-visa-code-annex-2", "s:eu-visa-code-art-14" ], "provenance": { "default": { "tier": "cited", "source": "s:eu-visa-code-annex-2" }, "fields": { "text.story": { "tier": "cited", "source": "s:eu-visa-code-810-2009", "note": "the stretch marked *Inference —* is this project reading Article 15 against the purpose of the journey" } } }, "confidence": "high", "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "Europe issues no dedicated treatment visa. A patient travelling to the Schengen area for care applies for the ordinary short-stay uniform visa under Regulation (EC) No 810/2009, the Community Code on Visas, and proves…", "region_terms": [ { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" }, { "key": "europe-central", "name": "Central Europe", "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia" }, { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" }, { "key": "europe-north", "name": "Northern Europe", "note": "the Nordics and the Baltics" } ], "kin_out": [ { "to": "the-visa", "type": "pathway", "name": "The visa", "as": "The step this rule sits inside.", "rel": "pathway" }, { "to": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The contrast: a named class, a year long, with an attendant visa attached.", "rel": "contrast" }, { "to": "thai-medical-visa", "type": "rule", "name": "Thailand's medical treatment visa", "as": "The middle case: a visitor visa with a medical endorsement.", "rel": "contrast" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "Why Article 15 cover and cover for the operation are different things.", "rel": "kin" }, { "to": "spain", "type": "destination", "name": "Spain", "as": "One Schengen destination with a large inbound fertility trade and no treatment visa.", "rel": "destination" }, { "to": "germany", "type": "destination", "name": "Germany", "as": "Another, drawing patients from the Gulf and the former Soviet states.", "rel": "destination" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "Who has to apply separately, and prove someone else's purpose.", "rel": "step" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "A visitor visa with a hospital letter leaves no category to count.", "rel": "story" } ], "source_list": [ { "id": "s:eu-visa-code-810-2009", "kind": "statute", "title": "Regulation (EC) No 810/2009 establishing a Community Code on Visas, Articles 14 and 15", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/eur/2009/810/article/15", "accessed": "2026-09-16" }, { "id": "s:eu-visa-code-annex-2", "kind": "statute", "title": "Regulation (EC) No 810/2009 establishing a Community Code on Visas, Annex II — non-exhaustive list of supporting documents", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/eur/2009/810/annex/II", "accessed": "2026-09-17", "note": "for travel undertaken for medical reasons, an official document of the medical institution confirming necessity for medical care in that institution and proof of sufficient financial means to pay for the treatment" }, { "id": "s:eu-visa-code-art-14", "kind": "statute", "title": "Regulation (EC) No 810/2009, Article 14 — supporting documents", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/eur/2009/810/article/14", "accessed": "2026-09-17" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:eu-visa-code-annex-2" }, "text.story": { "tier": "cited", "source": "s:eu-visa-code-810-2009", "note": "the stretch marked *Inference —* is this project reading Article 15 against the purpose of the journey" }, "text.how": { "tier": "cited", "source": "s:eu-visa-code-annex-2" }, "text.today": { "tier": "cited", "source": "s:eu-visa-code-annex-2" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "jordan", "type": "destination", "name": "Jordan", "as": "The contrast: here the binding constraint on the trade is a visa, and the association has measured what happens when one tightens.", "rel": "governed-by" }, { "from": "the-visa", "type": "pathway", "name": "The visa", "as": "The European version, and the one with no dedicated treatment class.", "rel": "governed-by" }, { "from": "medical-visa", "type": "term", "name": "Medical visa", "as": "The other shape: general short-stay conditions applied to a treatment journey.", "rel": "rule" } ] }, { "id": "stem-cell-regulation", "names": { "name": "Regulating cell and tissue therapies", "aliases": [ "ATMP regulation", "HCT/P", "regenerative medicine law", "minimal manipulation" ], "said": "The whole argument turns on two phrases: minimal manipulation, and homologous use. Clear them and you are a tissue. Fail them and you are a drug." }, "region": [ "global" ], "facets": { "kind": "licensing", "status": "in-force" }, "text": { "what": "The law that decides whether a cell preparation is a lightly regulated tissue or a medicine requiring authorisation, and therefore whether a clinic may sell it. Three regimes sit behind most of what is advertised: the United States under 21 CFR Part 1271, the European Union under Regulation (EC) No 1394/2007 on advanced therapy medicinal products, and Japan under the Act on the Safety of Regenerative Medicine, Act No. 85 of 27 November 2013.", "story": "The American regime hinges on definitions. 21 CFR Part 1271 covers human cells, tissues, and cellular and tissue-based products, and § 1271.3 carries the definitions that decide everything downstream. A preparation that is minimally manipulated and intended for homologous use falls inside a registration-and-screening regime. One that is not is a biological drug, and selling it without a licence is unlawful. The Food and Drug Administration's consumer alert on regenerative medicine products including stem cells and exosomes is the agency's own public statement; its 2019 press statement on a permanent injunction against a stem cell clinic is the enforcement end of the same argument.\n\nEurope defines by product class instead. Regulation 1394/2007 creates the advanced therapy medicinal product and routes it through centralised authorisation, with a hospital exemption for products prepared on a non-routine basis for an individual patient in the same Member State.\n\nJapan built a third model, and it is the one designed for clinics rather than for manufacturers. The Act classifies regenerative medicine by risk into Class I, Class II and Class III, requires a provision plan reviewed by a certified committee before treatment begins, and applies to private practice as well as to clinical research. The scale shows what it caught: by November 2015, private-practice applications stood at 2 Class I, 24 Class II and 1,794 Class III.\n\n*Inference —* those three regimes have one thing in common and it is not their content. Each is national, and a clinic that cannot satisfy one moves to a jurisdiction with neither. The published mapping work in this field counted businesses marketing stem cell-based interventions and found them concentrated where no equivalent instrument applies. That is the whole structure of this corner of the subject: the treatment does not become better by crossing a border, and the regulatory question becomes unanswerable.\n\nThe published harms are specific rather than general. A 2017 New England Journal report describes vision loss in three patients after intravitreal injection of autologous cells for age-related macular degeneration.", "how": "What a reader would have to establish about any offered cell treatment: what exactly is being injected, whether it was expanded in culture, what the preparation is intended to do compared with what the tissue does in the body it came from, whether the product holds any marketing authorisation anywhere, and whether the treatment is registered on a trial registry with a protocol and an endpoint.\n\nA clinic operating lawfully in a country with no advanced-therapy regime is operating lawfully. This site records that as a fact about the jurisdiction, not as a judgement about the clinic.", "today": "As of 17 September 2026 the American, European and Japanese instruments named here are in force. No comparable instrument was read for the jurisdictions where direct-to-consumer cell clinics are most often advertised, and this project does not assert that none exists." }, "kin": [ { "to": "stem-cell-unproven", "as": "The procedure these instruments are argued over.", "rel": "procedure" }, { "to": "unproven-stem-cell", "as": "The risk record, and the published harms.", "rel": "risk" }, { "to": "japan", "as": "The one jurisdiction that wrote a statute aimed at the clinic rather than the manufacturer.", "rel": "destination" }, { "to": "united-states", "as": "The regime that turns on two defined phrases.", "rel": "destination" }, { "to": "advertising-rules", "as": "What may be said about a treatment that holds no authorisation.", "rel": "kin" }, { "to": "informed-consent", "as": "What a patient is consenting to when the product class is unsettled.", "rel": "term" }, { "to": "malpractice-recourse", "as": "Where a claim goes when the treatment was lawful where it was given.", "rel": "risk" } ], "links": [ { "label": "21 CFR Part 1271", "url": "https://www.ecfr.gov/current/title-21/chapter-I/subchapter-L/part-1271" }, { "label": "Act on the Safety of Regenerative Medicine (Act No. 85 of 2013), English translation", "url": "https://www.japaneselawtranslation.go.jp/en/laws/view/4980/en" } ], "sources": [ "s:ecfr-21-1271", "s:eu-atmp-1394-2007", "s:jp-asrm-2013", "s:jp-asrm-review-2019", "s:fda-regenerative-consumer-alert", "s:fda-stem-cell-injunction-2019", "s:berger-2016-global-distribution", "s:turner-knoepfler-2016", "s:kuriyan-stem-cell-2017" ], "provenance": { "default": { "tier": "cited", "source": "s:ecfr-21-1271" }, "fields": { "text.story": { "tier": "cited", "source": "s:jp-asrm-review-2019", "note": "the stretch marked *Inference —* is this project reasoning from the three regimes and the published mapping work" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "The law that decides whether a cell preparation is a lightly regulated tissue or a medicine requiring authorisation, and therefore whether a clinic may sell it.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "stem-cell-unproven", "type": "procedure", "name": "Unapproved stem cell treatment", "as": "The procedure these instruments are argued over.", "rel": "procedure" }, { "to": "unproven-stem-cell", "type": "risk", "name": "Unproven stem cell treatment", "as": "The risk record, and the published harms.", "rel": "risk" }, { "to": "japan", "type": "destination", "name": "Japan", "as": "The one jurisdiction that wrote a statute aimed at the clinic rather than the manufacturer.", "rel": "destination" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The regime that turns on two defined phrases.", "rel": "destination" }, { "to": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "What may be said about a treatment that holds no authorisation.", "rel": "kin" }, { "to": "informed-consent", "type": "term", "name": "Informed consent", "as": "What a patient is consenting to when the product class is unsettled.", "rel": "term" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "Where a claim goes when the treatment was lawful where it was given.", "rel": "risk" } ], "source_list": [ { "id": "s:ecfr-21-1271", "kind": "statute", "title": "21 CFR Part 1271 — Human cells, tissues, and cellular and tissue-based products, § 1271.3 definitions", "publisher": "Electronic Code of Federal Regulations, U.S. Government", "url": "https://www.ecfr.gov/current/title-21/chapter-I/subchapter-L/part-1271", "accessed": "2026-09-16" }, { "id": "s:eu-atmp-1394-2007", "kind": "statute", "title": "Regulation (EC) No 1394/2007 on advanced therapy medicinal products", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/eur/2007/1394/article/2", "accessed": "2026-09-16" }, { "id": "s:jp-asrm-2013", "kind": "statute", "title": "Act on the Safety of Regenerative Medicine (Act No. 85 of 27 November 2013), English translation", "publisher": "Japanese Law Translation, Ministry of Justice, Japan", "url": "https://www.japaneselawtranslation.go.jp/en/laws/view/4980/en", "accessed": "2026-09-17", "note": "registered from the Japanese Law Translation catalogue entry; the provisions cited in the records come from the peer-reviewed review registered alongside it" }, { "id": "s:jp-asrm-review-2019", "kind": "paper", "title": "Japan's challenges of translational regenerative medicine: Act on the safety of regenerative medicine", "publisher": "Regenerative Therapy, via PubMed Central PMC6581824", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC6581824/", "accessed": "2026-09-17", "note": "the Act classifies regenerative medicine as Class I (high risk), Class II (intermediate) and Class III (low), each reviewed by a certified committee, and applies to private practice as well as clinical research. By November 2015 private-practice applications stood at 2 Class I, 24 Class II and 1,794 Class III." }, { "id": "s:fda-regenerative-consumer-alert", "kind": "org", "title": "Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes", "publisher": "US Food and Drug Administration", "url": "https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/consumer-alert-regenerative-medicine-products-including-stem-cells-and-exosomes", "accessed": "2026-09-16" }, { "id": "s:fda-stem-cell-injunction-2019", "kind": "org", "title": "Statement on stem cell clinic permanent injunction and FDA's ongoing efforts to protect patients from risks of unapproved products", "publisher": "US Food and Drug Administration", "url": "https://www.fda.gov/news-events/press-announcements/statement-stem-cell-clinic-permanent-injunction-and-fdas-ongoing-efforts-protect-patients-risks", "accessed": "2026-09-16", "note": "25 June 2019; summary judgment of 3 June 2019 in the Southern District of Florida" }, { "id": "s:berger-2016-global-distribution", "kind": "paper", "title": "Global Distribution of Businesses Marketing Stem Cell-Based Interventions", "publisher": "Cell Stem Cell 19:158-162, 2016; Berger I, Ahmad A, Bansal A, Kapoor T, Sipp D, Rasko JEJ; doi 10.1016/j.stem.2016.07.015", "url": "https://europepmc.org/article/MED/27494673", "accessed": "2026-09-16" }, { "id": "s:turner-knoepfler-2016", "kind": "paper", "title": "Selling Stem Cells in the USA: Assessing the Direct-to-Consumer Industry", "publisher": "Cell Stem Cell 2016;19(2):154-157 (Turner L, Knoepfler P)", "url": "https://pubmed.ncbi.nlm.nih.gov/27374789/", "accessed": "2026-09-16" }, { "id": "s:kuriyan-stem-cell-2017", "kind": "paper", "title": "Vision Loss after Intravitreal Injection of Autologous \"Stem Cells\" for AMD", "publisher": "New England Journal of Medicine 2017;376(11):1047-1053 (Kuriyan AE, Albini TA, Townsend JH, et al.)", "url": "https://pubmed.ncbi.nlm.nih.gov/28296617/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:ecfr-21-1271" }, "text.story": { "tier": "cited", "source": "s:jp-asrm-review-2019", "note": "the stretch marked *Inference —* is this project reasoning from the three regimes and the published mapping work" }, "text.how": { "tier": "cited", "source": "s:ecfr-21-1271" }, "text.today": { "tier": "cited", "source": "s:ecfr-21-1271" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "china", "type": "destination", "name": "China", "as": "The rules that decide what a hospital in the zone may actually give a patient.", "rel": "governed-by" }, { "from": "stem-cell-unproven", "type": "procedure", "name": "Unapproved stem cell treatment", "as": "Which preparations are lawful to sell where, and on whose approval.", "rel": "governed-by" }, { "from": "unproven-stem-cell", "type": "risk", "name": "Unproven stem cell treatment", "as": "The rules that decide where this can lawfully be offered and on what terms.", "rel": "governed-by" }, { "from": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "What may be said about a treatment holding no authorisation anywhere.", "rel": "kin" }, { "from": "leigh-turner", "type": "person", "name": "Leigh Turner", "as": "The rules his counts are measured against, country by country.", "rel": "rule" }, { "from": "circumvention", "type": "story", "name": "Circumvention", "as": "The other direction: a clinic that cannot satisfy one national regime moves to a jurisdiction with none.", "rel": "rule" } ] }, { "id": "surrogacy-law", "names": { "name": "Surrogacy law across borders", "aliases": [ "surrogate motherhood agreements", "gestational surrogacy law", "parental orders" ], "said": "Two questions, not one: whether the arrangement is lawful where it happens, and whether the parenthood it creates is recognised where the child goes home." }, "region": [ "global" ], "facets": { "kind": "prohibition", "status": "in-force" }, "text": { "what": "Where a surrogacy arrangement may lawfully be made, for whom, and on what terms. The legality rows below read one named instrument per jurisdiction, on one date. Three broad settlements recur: altruistic surrogacy permitted under a supervising body and a court, with a residence requirement that closes it to arrivals; an explicit or implicit prohibition; and no regulation at all, which is not permission but absence.", "story": "The residence requirement is the pattern. Every European Member State that has legislated for surrogacy — Greece, Cyprus, Portugal, Ireland — requires the intended parents, the surrogate, or both to live there. The European Parliamentary Research Service puts it plainly across the four: all of them require permanent or habitual residence in the country where the child is to be born, and Ireland asks for two years of it.\n\nThe states that permit it therefore permit it for their own residents. The states that arrivals actually travel to are, mostly, the states that have not legislated — and in those the arrangement is not protected, the contract may be unenforceable, and parenthood is established, if at all, after the fact.\n\nThe second question is recognition at home, and it is a different body of law. Since 2014 the European Court of Human Rights has issued a run of judgments on parenthood established abroad, the effect of which is that a state which refuses to recognise it must provide some means of regularising what the Court calls a limping legal relationship. The Hague Conference has run a project on parentage and surrogacy for years; the European Commission proposed a parenthood regulation in 2022 and the Council is still discussing it.\n\nItaly is the outlier and worth naming for it: Article 12(6) of Legge 40/2004 was amended in November 2024 to reach Italian nationals who conclude a surrogacy agreement abroad. It is the only extraterritorial clause among the Member States the briefing surveys.\n\nThe two big Asian destinations closed within a year of each other and closed by nationality rather than by conduct. India's 2021 Act defines a couple as a legally married Indian man and woman. Thailand's 2015 Act, passed after a scandal over a child left behind by foreign intended parents, requires adult Thai citizenship. *Inference —* a nationality gate is a cleaner instrument than a conduct rule: it does not ask what was paid or who arranged it, and it cannot be satisfied by any amount of documentation.\n\n*Inference —* the rows that say no-data are the other half of this table, and they are statements about this project rather than about those countries. Georgia, Ukraine and Mexico are among the places most often named in this trade, and no national instrument for any of them could be read on this pass.", "how": "Reading a row: status describes the position for an arrangement made in that jurisdiction, not the recognition of one made elsewhere. A prohibition in the country of origin can still block recognition on public-policy grounds, which is a separate question this table does not answer.\n\nWhat a reader would have to establish, and what no table can answer: whose law governs the agreement, which court establishes parenthood and when, whether the child acquires a nationality at birth and which, what travel document the child needs to leave, and what the home state does on arrival.", "today": "As of 17 September 2026 the European rows rest on the European Parliamentary Research Service briefing of February 2025, which names the national instrument for each Member State it covers. The Indian and Thai rows are read off the statutes themselves. Every row carries the date it was read, and a row older than the law is a wrong row." }, "legality": [ { "country": "GR", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:ep-surrogacy-2025", "instrument": "Law 3089/2002 amending the Civil Code, with Law 3305/2005 on medically assisted reproduction", "conditions": "Altruistic only; the intended mother must be medically unable to carry, must reside in Greece, and a family court approves the agreement before embryo transfer. Maximum intended-parent age 50, extendable to 54. The surrogate must be 25 to 50 and may act at most twice. Expenses are capped: EUR 10,000 for physical strain in a single pregnancy, EUR 15,000 for a multiple, and lost income capped at EUR 10,000.", "note": "81 children were born from surrogacy arrangements in 2022 and 51 in 2023, on the figures the briefing carries." }, { "country": "CY", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:ep-surrogacy-2025", "instrument": "Medically Assisted Reproduction Law 2015 (69(I)/2015), Articles 22 to 27", "conditions": "Altruistic only; a special body consents and a family court approves before transfer. The surrogate must normally reside in Cyprus, with one exception: if no surrogate can be found, one residing abroad may be used provided she is in Cyprus from the 28th week.", "note": "21 applications in 2022 and 10 in 2023, all approved except one each year. More detailed decrees are envisaged." }, { "country": "PT", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:ep-surrogacy-2025", "instrument": "Lei 90/2021, amending Lei 32/2006 on medically assisted procreation", "conditions": "Altruistic only, and the implementing regulation is still missing: the law entered into force on 1 January 2022, and on 13 January 2024 the President referred a draft regulation back to the government. Without it the route does not run.", "note": "Two earlier attempts, Lei 25/2016 and its amended successor, were held unconstitutional in rulings 225/2018 and 465/2019, chiefly over the surrogate's inability to withdraw consent." }, { "country": "IE", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:ep-surrogacy-2025", "instrument": "Health (Assisted Human Reproduction) Act 2024", "conditions": "Altruistic only; the relevant sections were not yet in force at the briefing's date. At least one intended parent and the surrogate must have resided in Ireland for two years; intended parents must be 21 or over; at least one must be genetically related to the child; a parental order is made by a court between 28 days and six months after birth." }, { "country": "ES", "status": "unlawful", "as_of": "2026-09-17", "source": "s:es-ley-14-2006", "instrument": "Ley 14/2006 sobre técnicas de reproducción humana asistida, artículo 10", "note": "The contract is null of full right, with or without payment, and parentage follows the birth. The same prohibition stood in article 10 of the predecessor Ley 35/1988." }, { "country": "DE", "status": "unlawful", "as_of": "2026-09-17", "source": "s:ep-surrogacy-2025", "instrument": "Embryonenschutzgesetz § 1(1)(7), with Adoptionsvermittlungsgesetz Article 13c", "note": "The Embryo Protection Act penalises the medical professional with up to three years; the adoption placement act prohibits the arrangement itself." }, { "country": "HR", "status": "unlawful", "as_of": "2026-09-17", "source": "s:ep-surrogacy-2025", "instrument": "Article 31 of Law NN 86/12 on medically assisted reproduction" }, { "country": "LT", "status": "unlawful", "as_of": "2026-09-17", "source": "s:ep-surrogacy-2025", "instrument": "Article 11 of Law XII-2608 on Assisted Reproduction" }, { "country": "IT", "status": "unlawful", "as_of": "2026-09-17", "source": "s:ep-surrogacy-2025", "instrument": "Article 12(6) of Legge 40/2004", "note": "Three months to two years' imprisonment. Amended in November 2024 to reach Italian nationals who conclude a surrogacy agreement abroad — the only extraterritorial clause among the Member States the briefing surveys." }, { "country": "FR", "status": "unlawful", "as_of": "2026-09-17", "source": "s:ep-surrogacy-2025", "instrument": "Code civil, article 16-7", "note": "Any surrogacy agreement has been null and void since 1994." }, { "country": "HU", "status": "unlawful", "as_of": "2026-09-17", "source": "s:ep-surrogacy-2025", "instrument": "Implicit prohibition under the assisted reproduction rules, which confine treatment to a marriage or registered partnership", "note": "The briefing groups Hungary with Austria, Estonia, Finland and Sweden as implicit bans and names no article; this project has not read the Hungarian instrument." }, { "country": "CZ", "status": "unregulated", "as_of": "2026-09-17", "source": "s:wp-surrogacy-laws", "note": "Recorded as unregulated, which means arrangements happen but parentage and enforcement are unsettled. No Czech instrument was read for this row." }, { "country": "IN", "status": "residents-only", "as_of": "2026-09-17", "source": "s:in-surrogacy-act-2021", "instrument": "The Surrogacy (Regulation) Act, 2021 (Act No. 47 of 2021), sections 2(h), 2(r), 2(s) and 4", "conditions": "Closed to foreign intended parents by definition: section 2(h) defines a couple as \"the legally married Indian man and woman\", and section 2(s) defines an intending woman as an Indian widow or divorcee aged 35 to 45. Altruistic only. A medical indication is required, certified by a District Medical Board; the couple must be married and aged 23 to 50 (female) and 26 to 55 (male); they must have no surviving child; and a magistrate's order on parentage and custody must precede the procedure.", "note": "A couple of Indian origin must obtain a certificate of recommendation from the Board." }, { "country": "TH", "status": "residents-only", "as_of": "2026-09-17", "source": "s:stasi-thailand-art-act-2017", "instrument": "Protection for Children Born through Assisted Reproductive Technologies Act, B.E. 2558 (2015), section 21(1)", "conditions": "The intending parents must be adult Thai citizens, or where only one is Thai must have been married at least three years, and must be a legally married couple whose wife cannot conceive. Commercial surrogacy, trade in gametes and embryos, brokering and promotion are prohibited.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC5753847/", "note": "Enacted 19 February 2015 after a scandal over a surrogate child abandoned by foreign intended parents; in effect 30 July 2015. Surrogacy for profit carries 10 years and up to 200,000 baht; acting as an agent, 5 years and up to 100,000 baht." }, { "country": "ZA", "status": "residents-only", "as_of": "2026-09-17", "source": "s:za-childrens-act-2005", "instrument": "Children's Act 38 of 2005, Chapter 19 (surrogate motherhood agreements)", "conditions": "The agreement must be confirmed by the High Court before artificial fertilisation, and the chapter ties the arrangement to domicile in the Republic.", "note": "This project read the Act's chapter heading and structure; the domicile subsection was not quoted on this pass." }, { "country": "GB", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:uk-surrogacy-act-1985", "instrument": "Surrogacy Arrangements Act 1985, sections 2 and 3, with the Human Fertilisation and Embryology Act 2008, section 54", "conditions": "Altruistic only: negotiating a surrogacy arrangement on a commercial basis and advertising are offences under the 1985 Act. The agreement is unenforceable, and parenthood transfers only by a parental order under section 54, which requires at least one applicant to be domiciled in the United Kingdom." }, { "country": "CA", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:ca-ahra-2004", "instrument": "Assisted Human Reproduction Act (S.C. 2004, c. 2), section 6", "conditions": "Paying a surrogate, offering to pay, or advertising such payment is an offence; reimbursement of receipted expenditure is permitted under the regulations. Parentage is provincial law." }, { "country": "US", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:ca-fam-7962", "instrument": "No federal statute; state law governs. California Family Code § 7962 is the example read for this row.", "conditions": "California's section requires separate independent counsel for the surrogate and the intended parents, notarised signatures, and disclosure of how the intended parents will cover medical expenses. It carries no residency requirement and no cap on compensation. Other states prohibit or restrict the arrangement; this project has read no other state's code." }, { "country": "GE", "status": "no-data", "as_of": "2026-09-17", "source": "s:hcch-parentage-surrogacy", "note": "Georgia is widely described as permitting commercial surrogacy for foreign intended parents, and a restriction has been announced repeatedly since 2023. The consolidated Law of Georgia on Health Care could not be read to its Article 143 on this pass, and this project will not print an article it has not read." }, { "country": "UA", "status": "no-data", "as_of": "2026-09-17", "source": "s:hcch-parentage-surrogacy", "note": "Ukraine is one of the largest destinations for commissioned surrogacy. No Ukrainian instrument was read on this pass." }, { "country": "IL", "status": "no-data", "as_of": "2026-09-17", "source": "s:hcch-parentage-surrogacy", "note": "No Israeli instrument was read on this pass." }, { "country": "CN", "status": "no-data", "as_of": "2026-09-17", "source": "s:hcch-parentage-surrogacy", "note": "No Chinese instrument was read on this pass." }, { "country": "MX", "status": "no-data", "as_of": "2026-09-17", "source": "s:hcch-parentage-surrogacy", "note": "Mexican law is state law and has moved repeatedly through the federal courts. No state code was read on this pass." }, { "country": "CO", "status": "no-data", "as_of": "2026-09-17", "source": "s:hcch-parentage-surrogacy", "note": "No Colombian instrument was read on this pass." }, { "country": "AU", "status": "no-data", "as_of": "2026-09-17", "source": "s:hcch-parentage-surrogacy", "note": "Surrogacy in Australia is state and territory law, and some states reach arrangements made abroad. No state act was read on this pass." } ], "kin": [ { "to": "surrogacy", "as": "The procedure these instruments govern.", "rel": "procedure" }, { "to": "ivf", "as": "The treatment that makes gestational surrogacy possible, and which many of the same acts regulate.", "rel": "procedure" }, { "to": "reproductive-exile", "as": "The word for travelling because the law at home says no.", "rel": "term" }, { "to": "circumvention-travel", "as": "The wider category this sits in.", "rel": "term" }, { "to": "circumvention", "as": "The essay on travelling to do lawfully elsewhere what is prohibited at home; this table is the evidence it argues from.", "rel": "story" }, { "to": "donor-anonymity-law", "as": "The neighbouring question, on the same treatments and often in the same statute.", "rel": "kin" }, { "to": "eshre", "as": "The society whose European survey maps the surrounding fertility law.", "rel": "org" }, { "to": "india", "as": "The destination that closed by nationality in 2021.", "rel": "destination" }, { "to": "thailand", "as": "The destination that closed by nationality in 2015.", "rel": "destination" }, { "to": "greece", "as": "One of the four Member States with a working altruistic regime, and a residence requirement.", "rel": "destination" }, { "to": "the-visa", "as": "Why the stated purpose of a journey matters here more than anywhere else.", "rel": "pathway" } ], "sources": [ "s:ep-surrogacy-2025", "s:hcch-parentage-surrogacy", "s:in-surrogacy-act-2021", "s:za-childrens-act-2005", "s:uk-surrogacy-act-1985", "s:uk-hfea-2008", "s:ca-ahra-2004", "s:es-ley-14-2006", "s:stasi-thailand-art-act-2017", "s:hibino-thailand-surrogacy-2020", "s:ca-fam-7962", "s:wp-surrogacy-laws", "s:hfea-surrogacy" ], "provenance": { "default": { "tier": "cited", "source": "s:ep-surrogacy-2025" }, "fields": { "text.story": { "tier": "cited", "source": "s:ep-surrogacy-2025", "note": "the stretches marked *Inference —* are this project reasoning from the instruments read" }, "legality": { "tier": "cited", "source": "s:ep-surrogacy-2025", "note": "each row names its own instrument and source; a no-data row means this project could not read the instrument, not that none exists" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "Where a surrogacy arrangement may lawfully be made, for whom, and on what terms. The legality rows below read one named instrument per jurisdiction, on one date.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "The procedure these instruments govern.", "rel": "procedure" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment that makes gestational surrogacy possible, and which many of the same acts regulate.", "rel": "procedure" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The word for travelling because the law at home says no.", "rel": "term" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The wider category this sits in.", "rel": "term" }, { "to": "circumvention", "type": "story", "name": "Circumvention", "as": "The essay on travelling to do lawfully elsewhere what is prohibited at home; this table is the evidence it argues from.", "rel": "story" }, { "to": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The neighbouring question, on the same treatments and often in the same statute.", "rel": "kin" }, { "to": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "The society whose European survey maps the surrounding fertility law.", "rel": "org" }, { "to": "india", "type": "destination", "name": "India", "as": "The destination that closed by nationality in 2021.", "rel": "destination" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "The destination that closed by nationality in 2015.", "rel": "destination" }, { "to": "greece", "type": "destination", "name": "Greece", "as": "One of the four Member States with a working altruistic regime, and a residence requirement.", "rel": "destination" }, { "to": "the-visa", "type": "pathway", "name": "The visa", "as": "Why the stated purpose of a journey matters here more than anywhere else.", "rel": "pathway" } ], "source_list": [ { "id": "s:ep-surrogacy-2025", "kind": "report", "title": "Surrogacy: The legal situation in the EU (Briefing PE 769.508), by David de Groot", "publisher": "European Parliamentary Research Service", "url": "https://www.europarl.europa.eu/RegData/etudes/BRIE/2025/769508/EPRS_BRI(2025)769508_EN.pdf", "accessed": "2026-09-16", "note": "published February 2025; names the national instrument for each Member State" }, { "id": "s:hcch-parentage-surrogacy", "kind": "org", "title": "Parentage / Surrogacy Project", "publisher": "Hague Conference on Private International Law (HCCH)", "url": "https://www.hcch.net/en/projects/legislative-projects/parentage-surrogacy", "accessed": "2026-09-16", "note": "the intergovernmental project on cross-border parentage; cited here where a national instrument was not read" }, { "id": "s:in-surrogacy-act-2021", "kind": "statute", "title": "The Surrogacy (Regulation) Act, 2021 (Act No. 47 of 2021)", "publisher": "Parliament of India, text hosted by PRS Legislative Research", "url": "https://prsindia.org/files/bills_acts/acts_parliament/2021/The%20Surrogacy%20(Regulation)%20Act,%202021.pdf", "accessed": "2026-09-16" }, { "id": "s:za-childrens-act-2005", "kind": "statute", "title": "Children's Act 38 of 2005, Chapter 19 (surrogate motherhood agreements)", "publisher": "Government of South Africa", "url": "https://www.gov.za/sites/default/files/gcis_document/201409/a38-053.pdf", "accessed": "2026-09-16" }, { "id": "s:uk-surrogacy-act-1985", "kind": "statute", "title": "Surrogacy Arrangements Act 1985, sections 2 and 3", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/ukpga/1985/49/section/2", "accessed": "2026-09-16" }, { "id": "s:uk-hfea-2008", "kind": "statute", "title": "Human Fertilisation and Embryology Act 2008, section 54 (parental orders)", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/ukpga/2008/22/section/54", "accessed": "2026-09-16" }, { "id": "s:ca-ahra-2004", "kind": "statute", "title": "Assisted Human Reproduction Act (S.C. 2004, c. 2), section 6", "publisher": "Justice Laws Website, Government of Canada", "url": "https://laws-lois.justice.gc.ca/eng/acts/a-13.4/page-1.html", "accessed": "2026-09-16" }, { "id": "s:es-ley-14-2006", "kind": "statute", "title": "Ley 14/2006, de 26 de mayo, sobre técnicas de reproducción humana asistida, artículos 5 y 10", "publisher": "Boletín Oficial del Estado", "url": "https://www.boe.es/buscar/act.php?id=BOE-A-2006-9292", "accessed": "2026-09-16" }, { "id": "s:stasi-thailand-art-act-2017", "kind": "paper", "title": "Protection for Children Born Through Assisted Reproductive Technologies Act, B.E. 2558: The Changing Profile of Surrogacy in Thailand, by Alessandro Stasi", "publisher": "Clinical Medicine Insights: Reproductive Health, via PubMed Central PMC5753847", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC5753847/", "accessed": "2026-09-17", "note": "enacted by the National Legislative Assembly 19 February 2015. Section 21(1): the intending parents must be adult Thai citizens, or where only one is a Thai citizen must have been married at least three years, and must be a legally married couple whose wife cannot conceive. Penalties at sections 24 and 48 (surrogacy for profit: 10 years and up to 200,000 baht) and sections 27 and 49 (acting as an agent: 5 years and up to 100,000 baht)." }, { "id": "s:hibino-thailand-surrogacy-2020", "kind": "paper", "title": "Non-commercial Surrogacy in Thailand: Ethical, Legal, and Social Implications in Local and Global Contexts, by Yuri Hibino", "publisher": "Asian Bioethics Review, via PubMed Central PMC7747428", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7747428/", "accessed": "2026-09-17", "note": "the Act took effect 30 July 2015; trade in gametes and embryos, commercial surrogacy, brokering and promotion of third-party reproduction are prohibited, and only a couple perceived as legally married in Thailand may seek surrogacy. Also records that foreign clients were banned from procuring surrogacy in India by 2015 and that Cambodia prohibited surrogacy by ministerial order in October 2016." }, { "id": "s:ca-fam-7962", "kind": "statute", "title": "California Family Code § 7962 — assisted reproduction agreements for gestational carriers", "publisher": "California Legislative Information", "url": "https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=FAM§ionNum=7962", "accessed": "2026-09-17", "note": "requires separate independent counsel for surrogate and intended parents, notarisation, and disclosure of how medical expenses are covered. The section carries no residency requirement and no cap on compensation." }, { "id": "s:wp-surrogacy-laws", "kind": "wikipedia", "title": "Surrogacy laws by country", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Surrogacy_laws_by_country", "accessed": "2026-09-16", "note": "states that Georgia permits altruistic and commercial surrogacy for domestic and international intended parents, restricted to couples married or in a domestic relationship of at least a year, and that Georgia absorbed clients from Ukraine after 2022; states surrogacy is unregulated in Czechia. No article or section number is given on the page for the Georgian instrument." }, { "id": "s:hfea-surrogacy", "kind": "org", "title": "Surrogacy", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/treatments/explore-all-treatments/surrogacy/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:ep-surrogacy-2025" }, "text.story": { "tier": "cited", "source": "s:ep-surrogacy-2025", "note": "the stretches marked *Inference —* are this project reasoning from the instruments read" }, "text.how": { "tier": "cited", "source": "s:ep-surrogacy-2025" }, "text.today": { "tier": "cited", "source": "s:ep-surrogacy-2025" }, "legality": { "tier": "cited", "source": "s:ep-surrogacy-2025", "note": "each row names its own instrument and source; a no-data row means this project could not read the instrument, not that none exists" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "greece", "type": "destination", "name": "Greece", "as": "Where the conditions, including residence, are set out and dated.", "rel": "governed-by" }, { "from": "nicosia", "type": "hub", "name": "Nicosia", "as": "The question that changes most sharply across this city's buffer zone.", "rel": "governed-by" }, { "from": "prague", "type": "hub", "name": "Prague", "as": "Unregulated here rather than permitted, which is a different footing from a licence.", "rel": "governed-by" }, { "from": "tbilisi", "type": "hub", "name": "Tbilisi", "as": "The rule this whole cluster rests on, and the one this record declines to date.", "rel": "governed-by" }, { "from": "tel-aviv", "type": "hub", "name": "Tel Aviv", "as": "The rule whose changes here decided who could use this city's clinics and when.", "rel": "governed-by" }, { "from": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The neighbouring prohibition that reaches across the same borders.", "rel": "governed-by" }, { "from": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "The rule that decides whether this exists at all in a given country, for whom, and at what payment.", "rel": "governed-by" }, { "from": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The neighbouring question, often in the same statute.", "rel": "kin" }, { "from": "circumvention", "type": "story", "name": "Circumvention", "as": "Where the residence requirement is clearest: every EU state that legislated for it requires somebody to live there.", "rel": "rule" } ] }, { "id": "thai-medical-visa", "names": { "name": "Thailand's medical treatment visa", "aliases": [ "Tourist Visa (Medical Treatment)", "TR (MT)", "Non-Immigrant O for medical treatment" ], "said": "The consulates call it MT. It sits inside the visitor category, not beside it." }, "region": [ "southeast-asia" ], "facets": { "kind": "visa", "iso2": "TH", "status": "in-force" }, "text": { "what": "A visitor visa endorsed for medical treatment, issued by Thai embassies and consulates, admitting the holder for treatment at a hospital in Thailand. The Royal Thai Embassy in Washington describes it as allowing \"foreign nationals to stay in Thailand for up to 60 days for the purpose of recieving medical treatment\", with \"An extension for an additional 30 days\" possible, \"allowing for a maximum total stay of 90 days from the date of entry\". Longer courses run under the Non-Immigrant O category instead.", "story": "Thailand's class is a hospital letter attached to a visitor visa, and the difference from India's approach is worth reading side by side. India built a separate e-Medical class with its own duration and its own attendant class. Thailand endorsed the visitor visa and set a ceiling of 90 days.\n\n*Inference —* the consequence for anyone counting is direct. A patient admitted on an endorsed visitor visa is, in the migration statistics, a visitor. Thailand's arrival figures therefore cannot be read as a count of patients, and the counts that circulate for the country come from elsewhere — usually a market-research summary aggregating hospital visits by foreigners, which sweeps in residents and holidaymakers alike.\n\nThe requirements the consulates publish are the ordinary visitor set plus one document that is not: \"A letter of appointment from the hospital or medical center\". Washington's page also names a funds test of USD 700 per person per month or USD 2,000 per family. The embassy in Kuala Lumpur publishes the same class under the joint heading Medical Treatment (MT) or Non-Immigrant (O) for medical treatment, which is the fork a longer course takes.\n\nThe visa exemption that most arrivals use is a separate track and it moved recently: it falls from 60 days to 30 on 15 September 2026. *Inference —* that shortens the window for anyone who intended to arrive visa-free and have a procedure, which is a large share of the dental and cosmetic trade.", "how": "The application wants a passport valid six months or more, the completed form and photographs, the hospital's letter naming the treatment and its expected duration, evidence of funds and onward or return travel. Extension is applied for inside Thailand at an immigration office. Where treatment runs past the ceiling, the patient reports to immigration on a 90-day cycle with medical certificates from the state or private hospital where they are admitted.\n\nWhat the published pages do not say: whether a companion is admitted under the same class. Neither consular page read for this record addresses an accompanying person, which is the single clearest difference from India's arrangement, where the attendant class exists and is capped at two.", "today": "As of 17 September 2026 the class is published by individual Thai missions rather than as one national page, and the wording differs between them — Washington, Kuala Lumpur, Munich and Pretoria each set out their own document list. The 60-day permitted stay and the 30-day extension are read off the Washington mission's page." }, "kin": [ { "to": "the-visa", "as": "The step this rule sits inside.", "rel": "pathway" }, { "to": "thailand", "as": "The country that issues it.", "rel": "destination" }, { "to": "india-e-medical-visa", "as": "The contrast: a dedicated class, with its own attendant visa and a year's validity.", "rel": "contrast" }, { "to": "bangkok", "as": "Where nearly every holder is treated.", "rel": "hub" }, { "to": "medical-visa", "as": "The word, and what it does and does not name here.", "rel": "term" }, { "to": "counting-patients", "as": "Why a patient on an endorsed visitor visa is a patient nobody counted.", "rel": "story" }, { "to": "the-companion", "as": "The person these pages do not mention.", "rel": "step" }, { "to": "addiction-rehab", "as": "One of the long courses that outruns the 90-day ceiling.", "rel": "procedure" } ], "links": [ { "label": "Royal Thai Embassy, Washington DC — Tourist Visa (Medical Treatment)", "url": "https://washingtondc.thaiembassy.org/en/page/non-immigrant-visa-mt" }, { "label": "Royal Thai Embassy, Kuala Lumpur — Medical Treatment (MT) or Non-Immigrant (O)", "url": "https://kualalumpur.thaiembassy.org/en/publicservice/medical-treatment-mt-or-non-immigrant-o-for-medical" } ], "sources": [ "s:thaiembassy-dc-mt-visa", "s:thaiembassy-kl-mt-visa" ], "provenance": { "default": { "tier": "cited", "source": "s:thaiembassy-dc-mt-visa" }, "fields": { "text.story": { "tier": "cited", "source": "s:thaiembassy-dc-mt-visa", "note": "the stretches marked *Inference —* are this project reasoning from the consular pages" }, "text.how": { "tier": "cited", "source": "s:thaiembassy-dc-mt-visa" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "A visitor visa endorsed for medical treatment, issued by Thai embassies and consulates, admitting the holder for treatment at a hospital in Thailand.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "the-visa", "type": "pathway", "name": "The visa", "as": "The step this rule sits inside.", "rel": "pathway" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "The country that issues it.", "rel": "destination" }, { "to": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The contrast: a dedicated class, with its own attendant visa and a year's validity.", "rel": "contrast" }, { "to": "bangkok", "type": "hub", "name": "Bangkok", "as": "Where nearly every holder is treated.", "rel": "hub" }, { "to": "medical-visa", "type": "term", "name": "Medical visa", "as": "The word, and what it does and does not name here.", "rel": "term" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a patient on an endorsed visitor visa is a patient nobody counted.", "rel": "story" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "The person these pages do not mention.", "rel": "step" }, { "to": "addiction-rehab", "type": "procedure", "name": "Residential addiction treatment", "as": "One of the long courses that outruns the 90-day ceiling.", "rel": "procedure" } ], "source_list": [ { "id": "s:thaiembassy-dc-mt-visa", "kind": "gov", "title": "Tourist Visa (Medical Treatment)", "publisher": "Royal Thai Embassy, Washington DC", "url": "https://washingtondc.thaiembassy.org/en/page/non-immigrant-visa-mt", "accessed": "2026-09-17", "note": "60 days' stay, a 30-day extension to a maximum of 90 days from entry, a letter of appointment from the hospital, and a funds test of USD 700 per person per month or USD 2,000 per family. The page says nothing about a companion." }, { "id": "s:thaiembassy-kl-mt-visa", "kind": "gov", "title": "Medical Treatment (MT) or Non-Immigrant (O) for Medical Treatment", "publisher": "Royal Thai Embassy, Kuala Lumpur", "url": "https://kualalumpur.thaiembassy.org/en/publicservice/medical-treatment-mt-or-non-immigrant-o-for-medical", "accessed": "2026-09-17", "note": "the mission that publishes the two classes under one heading, which is the fork a longer course takes" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:thaiembassy-dc-mt-visa" }, "text.story": { "tier": "cited", "source": "s:thaiembassy-dc-mt-visa", "note": "the stretches marked *Inference —* are this project reasoning from the consular pages" }, "text.how": { "tier": "cited", "source": "s:thaiembassy-dc-mt-visa" }, "text.today": { "tier": "cited", "source": "s:thaiembassy-dc-mt-visa" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "addiction-rehab", "type": "procedure", "name": "Residential addiction treatment", "as": "Whether a month or a quarter of treatment fits the entry the patient arrived on.", "rel": "governed-by" }, { "from": "the-visa", "type": "pathway", "name": "The visa", "as": "The same instrument in another jurisdiction.", "rel": "governed-by" }, { "from": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The contrast: an endorsement on a visitor visa, capped at 90 days, with no attendant class.", "rel": "contrast" }, { "from": "schengen-medical-visa", "type": "rule", "name": "The Schengen visa, for treatment", "as": "The middle case: a visitor visa with a medical endorsement.", "rel": "contrast" } ] }, { "id": "transplant-prohibition", "names": { "name": "Buying an organ, and being transplanted abroad", "aliases": [ "organ trade prohibition", "transplant travel", "the Declaration of Istanbul" ], "said": "The prohibition on payment is near-universal. The rule on who may receive an organ is national, and much harder to read." }, "region": [ "global" ], "facets": { "kind": "prohibition", "status": "in-force" }, "text": { "what": "Two questions that are usually run together and should not be. First: may a person be paid for an organ? Almost everywhere, no, and the statutes say so in similar words. Second: may a person who lives somewhere else receive an organ here, from a local donor or a local deceased-donor pool? That is national allocation law, it varies, and it is the harder of the two to read.", "story": "The global frame is two documents, neither of them binding on anyone.\n\nThe World Health Assembly endorsed the WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation in May 2010, in resolution WHA63.22. The professional frame is \"The Declaration of Istanbul on Organ Trafficking and Transplant Tourism\", first agreed in 2008 and revised in 2018, whose custodian group maintains it. Between them they set the norm every national statute in this table reflects: no payment, and allocation on clinical grounds within a national system.\n\nThe national statutes then diverge on the second question, and mostly by an indirect route. Germany's is the clearest example of a rule that closes a door without mentioning a border: § 8(1) of the Transplantation Act confines living donation of a kidney or liver lobe to close relatives, spouses, partners, fiancés, and persons evidently close in a special personal attachment. Nothing in it says foreigner. It does not need to.\n\nBritain's works through an authority instead. Section 33 of the Human Tissue Act 2004 makes a living-donor transplant an offence unless the Human Tissue Authority is satisfied that no reward has been given contrary to section 32 and that the regulations are met. Spain's works through gratuity and a judge: the living donor consents before a judge, and at least 24 hours must pass before the extraction.\n\n*Inference —* those three instruments do the same work in three different registers — relationship, licence, and formality — and none of them is a nationality rule. A reader who asks whether a country bars foreign recipients will not find the answer by reading the payment prohibition, which is the part of the law that is easy to find.\n\nThe empirical literature is thin and single-centre. A 2022 paper reports graft and patient outcomes for kidney recipients who were transplanted abroad and followed up at one centre; a 2021 review covers liver transplantation and infection risk. Neither is a count of how many people travel, because no registry collects one.\n\n*Inference —* twenty of the twenty-four rows below say no-data, and the pattern in which sites refused is itself informative: the statutes this project could read are those of states that publish their law in machine-readable form on a stable government portal, which is not the same set as the states this question is asked about.", "how": "What a row does not answer: whether a foreign recipient may be listed on a national deceased-donor waiting list and on what terms, whether a transplant performed abroad is followed up at home, and whether a home transplant unit will accept a returning patient onto its immunosuppression and surveillance programme. That last is the practical question, and it is clinical policy rather than law.\n\nThe Global Observatory on Donation and Transplantation, run by the World Health Organization with Spain's national transplant organisation, publishes national activity figures. It counts procedures performed, not journeys made.", "today": "As of 17 September 2026 six rows rest on a named instrument that was read. Eighteen say no-data. The gap is a sourcing failure on this pass and not a statement about those countries' law." }, "legality": [ { "country": "GB", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:uk-human-tissue-act-s33", "instrument": "Human Tissue Act 2004, sections 32 and 33", "conditions": "Giving or receiving a reward for the supply of controlled material is an offence under section 32, which also bars advertising. A transplant from a living donor is an offence under section 33 unless the Human Tissue Authority is satisfied that no reward has been given and the conditions in regulations are met. The gate is the Authority's approval, not residence.", "note": "Section 33 carries up to 51 weeks and a fine at level 5." }, { "country": "US", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:us-nota-274e", "instrument": "National Organ Transplant Act, 42 U.S.C. § 274e", "conditions": "Unlawful to knowingly acquire, receive or otherwise transfer any human organ for valuable consideration. Removal, transport, processing and storage costs are carved out, as are the donor's travel, housing and lost wages. The statute sets no citizenship condition; allocation policy is a separate matter this project did not read.", "note": "Up to USD 50,000 and five years." }, { "country": "DE", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:de-tpg-8", "instrument": "Transplantationsgesetz § 8(1) sentence 2, with § 17", "conditions": "Living donation of a kidney, part of a liver or another non-regenerating organ is confined to first- and second-degree relatives, spouses, registered partners, fiancés, and persons evidently close to the donor in a special personal attachment. Trade in organs or tissues is prohibited by § 17, with reasonable procurement and transport costs excepted. The bar on an unrelated foreign recipient is a relationship rule, not a nationality one." }, { "country": "ES", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:es-rd-1723-2012", "instrument": "Real Decreto 1723/2012, artículos 4 y 8, under Ley 30/1979", "conditions": "Article 4.2 requires voluntariness, altruism, confidentiality, absence of profit motive and gratuity. Article 8 requires a living donor of full age and capacity to consent expressly before a judge, with at least 24 hours between the signed document and the extraction. Neither article distinguishes recipients by nationality or residence." }, { "country": "SG", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:sg-hota", "instrument": "Human Organ Transplant Act 1987, Part 4", "conditions": "Trading in organs and blood is prohibited.", "note": "Part 4 was read for the trading prohibition; the Act's provisions on who may receive a transplant were not read on this pass." }, { "country": "TR", "status": "lawful-with-conditions", "as_of": "2026-09-17", "source": "s:tr-law-2238", "instrument": "Organ ve Doku Alınması, Saklanması, Aşılanması ve Nakli Hakkında Kanun (Kanun No. 2238), Madde 3", "conditions": "Payment for organs and tissue is prohibited.", "note": "Madde 3 was read for the payment prohibition. Türkiye's rules on transplants to foreign recipients were not read on this pass." }, { "country": "IN", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "The Transplantation of Human Organs and Tissues Act 1994 governs, with authorisation committees for donors who are not near relatives and separate provisions for foreign nationals. Indian statute sites returned 403 on this pass and the Act was not read." }, { "country": "IR", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "Iran operates the one regulated, compensated living-kidney donation programme in the world, and it is widely reported to exclude foreign recipients. No Iranian instrument was read on this pass, and this project will not describe the programme from secondary accounts." }, { "country": "PH", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "A 2008 Department of Health administrative order is reported to have ended transplants to foreign recipients. It was not read on this pass." }, { "country": "EG", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "Law 5 of 2010 governs; it was not read on this pass." }, { "country": "CN", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "The 2007 Regulation on Human Organ Transplantation and its replacement were not read on this pass." }, { "country": "PK", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "No Pakistani instrument was read on this pass." }, { "country": "IL", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "The Organ Transplant Law 2008 governs, including its treatment of reimbursement for travel abroad. It was not read on this pass." }, { "country": "JO", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "No Jordanian instrument was read on this pass." }, { "country": "SA", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "No Saudi instrument was read on this pass." }, { "country": "AE", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "No Emirati instrument was read on this pass." }, { "country": "ZA", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "The National Health Act 61 of 2003 governs; the Act's PDF would not extract on this pass." }, { "country": "TH", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "Thai Red Cross Society organ donation criteria govern in practice; no instrument was read on this pass." }, { "country": "MY", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "No Malaysian instrument was read on this pass." }, { "country": "LK", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "No Sri Lankan instrument was read on this pass." }, { "country": "NP", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "No Nepali instrument was read on this pass." }, { "country": "CO", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "Ley 1805 of 2016 is reported to have restricted transplants to foreign recipients. It was not read on this pass." }, { "country": "MX", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "No Mexican instrument was read on this pass." }, { "country": "CR", "status": "no-data", "as_of": "2026-09-17", "source": "s:godt-observatory", "note": "No Costa Rican instrument was read on this pass." } ], "kin": [ { "to": "kidney-transplant", "as": "The operation most of this law was written about.", "rel": "procedure" }, { "to": "liver-transplant", "as": "The other, and the one with the published infection literature.", "rel": "procedure" }, { "to": "transplant-harm", "as": "What the outcome papers record.", "rel": "risk" }, { "to": "declaration-of-istanbul-group", "as": "The custodian of the professional norm this table sits under.", "rel": "org" }, { "to": "istanbul-declaration-2008", "as": "The year the norm was written down.", "rel": "event" }, { "to": "who", "as": "The body whose Guiding Principles the World Health Assembly endorsed in 2010.", "rel": "org" }, { "to": "blood-supply-safety", "as": "The neighbouring supply question, with the same payment argument attached.", "rel": "risk" }, { "to": "circumvention", "as": "The essay on prohibition-driven travel, and the case in which the prohibition is nearly universal and the traffic persists anyway.", "rel": "story" }, { "to": "iran", "as": "The one state running a regulated compensated donation programme, and the row this project could not source.", "rel": "destination" } ], "sources": [ "s:who-guiding-principles", "s:declaration-of-istanbul", "s:godt-observatory", "s:uk-human-tissue-act-s33", "s:uk-human-tissue-act-2004", "s:us-nota-274e", "s:usc-42-274e", "s:de-tpg-8", "s:de-tpg", "s:es-rd-1723-2012", "s:sg-hota", "s:tr-law-2238", "s:altheaby-transplant-tourism-2022", "s:neupane-liver-transplant-2021" ], "provenance": { "default": { "tier": "cited", "source": "s:who-guiding-principles" }, "fields": { "text.story": { "tier": "cited", "source": "s:de-tpg-8", "note": "the three instruments are read; the stretches marked *Inference —* are this project's reasoning" }, "legality": { "tier": "cited", "source": "s:godt-observatory", "note": "a no-data row records that the instrument could not be read on this pass" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "Two questions that are usually run together and should not be. First: may a person be paid for an organ? Almost everywhere, no, and the statutes say so in similar words.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "The operation most of this law was written about.", "rel": "procedure" }, { "to": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "The other, and the one with the published infection literature.", "rel": "procedure" }, { "to": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "What the outcome papers record.", "rel": "risk" }, { "to": "declaration-of-istanbul-group", "type": "org", "name": "Declaration of Istanbul Custodian Group", "as": "The custodian of the professional norm this table sits under.", "rel": "org" }, { "to": "istanbul-declaration-2008", "type": "event", "name": "The Declaration of Istanbul, 2008", "as": "The year the norm was written down.", "rel": "event" }, { "to": "who", "type": "org", "name": "World Health Organization", "as": "The body whose Guiding Principles the World Health Assembly endorsed in 2010.", "rel": "org" }, { "to": "blood-supply-safety", "type": "risk", "name": "Blood supply safety", "as": "The neighbouring supply question, with the same payment argument attached.", "rel": "risk" }, { "to": "circumvention", "type": "story", "name": "Circumvention", "as": "The essay on prohibition-driven travel, and the case in which the prohibition is nearly universal and the traffic persists anyway.", "rel": "story" }, { "to": "iran", "type": "destination", "name": "Iran", "as": "The one state running a regulated compensated donation programme, and the row this project could not source.", "rel": "destination" } ], "source_list": [ { "id": "s:who-guiding-principles", "kind": "org", "title": "WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation, as endorsed by the Sixty-third World Health Assembly, May 2010, in Resolution WHA63.22", "publisher": "World Health Organization", "url": "https://iris.who.int/server/api/core/bitstreams/53e1102b-4874-49bf-97bc-c529b1c246f0/content", "accessed": "2026-09-16" }, { "id": "s:declaration-of-istanbul", "kind": "org", "title": "The Declaration of Istanbul on Organ Trafficking and Transplant Tourism (2018 edition)", "publisher": "Declaration of Istanbul Custodian Group", "url": "https://www.declarationofistanbul.org/", "accessed": "2026-09-16" }, { "id": "s:godt-observatory", "kind": "dataset", "title": "Global Observatory on Donation and Transplantation (WHO–ONT collaboration)", "publisher": "World Health Organization and Organización Nacional de Trasplantes", "url": "https://www.transplant-observatory.org/", "accessed": "2026-09-16" }, { "id": "s:uk-human-tissue-act-s33", "kind": "statute", "title": "Human Tissue Act 2004, section 33 — restriction on transplants involving a live donor", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/ukpga/2004/30/section/33", "accessed": "2026-09-17", "note": "an offence unless the Human Tissue Authority is satisfied that no reward has been given contrary to section 32 and that the conditions in regulations are met" }, { "id": "s:uk-human-tissue-act-2004", "kind": "statute", "title": "Human Tissue Act 2004, section 32 — prohibition of commercial dealings in human material for transplantation", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/ukpga/2004/30/section/32", "accessed": "2026-09-16" }, { "id": "s:us-nota-274e", "kind": "statute", "title": "42 U.S.C. § 274e — Prohibition of organ purchases (National Organ Transplant Act)", "publisher": "U.S. Government Publishing Office, govinfo", "url": "https://www.govinfo.gov/content/pkg/USCODE-2023-title42/html/USCODE-2023-title42-chap6A-subchapII-partH-sec274e.htm", "accessed": "2026-09-16" }, { "id": "s:usc-42-274e", "kind": "statute", "title": "42 U.S. Code § 274e — Prohibition of organ purchases", "publisher": "National Organ Transplant Act 1984, as codified; text via Legal Information Institute, Cornell Law School", "url": "https://www.law.cornell.edu/uscode/text/42/274e", "accessed": "2026-09-16" }, { "id": "s:de-tpg-8", "kind": "statute", "title": "Transplantationsgesetz § 8 — Entnahme von Organen und Geweben bei lebenden Spendern", "publisher": "Bundesministerium der Justiz, gesetze-im-internet.de", "url": "https://www.gesetze-im-internet.de/tpg/__8.html", "accessed": "2026-09-17", "note": "§ 8(1) sentence 2 restricts living donation of a kidney, part of a liver or other non-regenerating organ to first- and second-degree relatives, spouses, registered partners, fiancés, or persons evidently close to the donor in a special personal attachment" }, { "id": "s:de-tpg", "kind": "statute", "title": "Transplantationsgesetz § 17 — Verbot des Organ- und Gewebehandels", "publisher": "Bundesministerium der Justiz, gesetze-im-internet.de", "url": "https://www.gesetze-im-internet.de/tpg/__17.html", "accessed": "2026-09-16" }, { "id": "s:es-rd-1723-2012", "kind": "statute", "title": "Real Decreto 1723/2012, por el que se regulan las actividades de obtención, utilización clínica y coordinación territorial de los órganos humanos, artículos 4 y 8", "publisher": "Boletín Oficial del Estado", "url": "https://www.boe.es/buscar/act.php?id=BOE-A-2012-15715", "accessed": "2026-09-17", "note": "article 4.2 sets voluntariness, altruism, confidentiality, absence of profit motive and gratuity; article 8 requires a living donor of full age and capacity to give express consent before a judge, with at least 24 hours between the signed document and the extraction. Neither article distinguishes recipients by nationality or residence." }, { "id": "s:sg-hota", "kind": "statute", "title": "Human Organ Transplant Act 1987, Part 4 (prohibition of trading in organs and blood)", "publisher": "Singapore Statutes Online, Attorney-General's Chambers", "url": "https://sso.agc.gov.sg/Act/HOTA1987", "accessed": "2026-09-16" }, { "id": "s:tr-law-2238", "kind": "statute", "title": "Organ ve Doku Alınması, Saklanması, Aşılanması ve Nakli Hakkında Kanun (Kanun No. 2238), Madde 3", "publisher": "Mevzuat Bilgi Sistemi, Republic of Türkiye", "url": "https://www.mevzuat.gov.tr/mevzuatmetin/1.5.2238.pdf", "accessed": "2026-09-16" }, { "id": "s:altheaby-transplant-tourism-2022", "kind": "paper", "title": "Graft and Patient Outcomes of Kidney Transplant Tourism: A Single-Center Experience", "publisher": "Avicenna Journal of Medicine 2022;12(3):120-126 (Altheaby A, Owaidah K, Alotaibi A, et al.), King Abdulaziz Medical City, Riyadh", "url": "https://pubmed.ncbi.nlm.nih.gov/36092382/", "accessed": "2026-09-16" }, { "id": "s:neupane-liver-transplant-2021", "kind": "paper", "title": "Current state of medical tourism involving liver transplantation — the risk of infections and potential complications", "publisher": "World Journal of Hepatology 2021;13(7):717-722 (Neupane R, Taweesedt PT, Anjum H, Surani S)", "url": "https://pubmed.ncbi.nlm.nih.gov/34367493/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:who-guiding-principles" }, "text.story": { "tier": "cited", "source": "s:de-tpg-8", "note": "the three instruments are read; the stretches marked *Inference —* are this project's reasoning" }, "text.how": { "tier": "cited", "source": "s:who-guiding-principles" }, "text.today": { "tier": "cited", "source": "s:who-guiding-principles" }, "legality": { "tier": "cited", "source": "s:godt-observatory", "note": "a no-data row records that the instrument could not be read on this pass" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "china", "type": "destination", "name": "China", "as": "The prohibition that shaped this country's reputation in cross-border care before any zone existed.", "rel": "governed-by" }, { "from": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "Where the country-by-country law sits: one named instrument, one date, one jurisdiction at a time.", "rel": "governed-by" }, { "from": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "Where the country-by-country reading sits: whether a non-resident may be transplanted, and whether an unrelated living donor may give.", "rel": "governed-by" }, { "from": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "The rules that decide where a non-resident may be transplanted at all.", "rel": "governed-by" }, { "from": "declaration-of-istanbul-group", "type": "org", "name": "Declaration of Istanbul Custodian Group", "as": "The national laws written with this text as their reference.", "rel": "governs" }, { "from": "istanbul-declaration-2008", "type": "event", "name": "The Declaration of Istanbul, 2008", "as": "The rules countries wrote afterwards, jurisdiction by jurisdiction.", "rel": "rule" }, { "from": "circumvention", "type": "story", "name": "Circumvention", "as": "Where the international text draws the line at payment rather than at the border.", "rel": "rule" } ] }, { "id": "turkiye-health-tourism-authorisation", "names": { "name": "Türkiye's international health tourism authorisation certificate", "aliases": [ "uluslararası sağlık turizmi yetki belgesi", "yetki belgesi", "authorised provider list" ], "said": "Sağlık turizmi yetki belgesi. Facility and intermediary both need one, and the Ministry publishes who holds them." }, "region": [ "west-asia" ], "facets": { "kind": "licensing", "iso2": "TR", "status": "in-force" }, "text": { "what": "A compulsory certificate for any facility treating international patients and any intermediary bringing them, under the Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik published in the Resmî Gazete on 26 April 2025, No. 32882. MADDE 5(1) makes it compulsory for both and splits the issuing: the Ministry of Health licenses the facility, USHAŞ licenses the intermediary. The certificate cannot be transferred, and a separate one is needed for every branch.", "story": "Türkiye built a licensing regime around a trade that was already large, and the shape of the regime says what the state was worried about.\n\nThe first regulation, of 13 July 2017, No. 30123, dragged the broker inside an existing inspectable system rather than inventing one: it required the intermediary to hold a group A travel agency licence under Law 1618 of 1972, so a person arranging a hair transplant for a foreign buyer was, in Turkish law, running a travel agency, with the bonds, the premises and the registered manager that implies.\n\nThat instrument is gone. MADDE 17 of the regulation of 26 April 2025 repeals it, and the successor moves the intermediary's licence from the travel-agency system to USHAŞ, the Ministry's own international health services company. Most writing on this subject, including a good deal of it published since, still cites the 2017 number.\n\nWhat the 2025 text adds is the part a patient would care about. MADDE 6(1)(c) makes complication insurance compulsory for procedures done in an operating-theatre setting, with a deadline of 31 December 2025. MADDE 6(1)(b) requires accreditation by TÜSKA for hospitals, medical centres, medical laboratories and dialysis centres, with a deadline of 31 December 2026. MADDE 6(1)(e) forbids a facility to buy intermediary services from an unlicensed party. And MADDE 6(3) puts complications and medical malpractice expressly inside the certificate holder's responsibility — a sentence with no counterpart in most of the world's medical-travel regimes.\n\nEnforcement has teeth on paper. MADDE 9 has USHAŞ evaluate every holder annually, with a three-month suspension for a partially adequate result, six months for an inadequate one, and cancellation after a failed second control evaluation. MADDE 16 cancels a certificate for a year of inactivity, bars a new one for a year after cancellation, and notifies suspensions to the Ministry of Trade and the Ministry of Culture and Tourism.\n\nHair transplants have a rule of their own, which is where the state's real anxiety shows. The Saç Ekimi Birimleri Hakkında Yönetmelik of 6 May 2023, Resmî Gazete 32182, reserves the channel-opening stage to physicians holding the applicator certificate, forbids more than one patient in a room at a time, caps one certified physician at five rooms, and fines a breach at one to three per cent of the previous month's gross service revenue with cancellation and no re-issue on persistence. *Inference —* those prohibitions map one for one onto the practices the International Society of Hair Restoration Surgery had been alleging publicly since 2016, which makes the regulation itself the best evidence that the practices existed.\n\nThe Ministry publishes the registers: separate downloadable lists of authorised hospitals, medical centres, private physician offices and other facilities, held by the Health Services General Directorate's health tourism department. *Inference —* a published register is the one thing a reader abroad can check, and it checks a narrow thing: that the holder is authorised to trade with foreign patients. It is not a quality rating and the Ministry does not present it as one.", "how": "The Ministry issues the facility certificate; USHAŞ issues the intermediary's. The published lists are the register, and a facility or intermediary not on them is not authorised, whatever its own site says. Holders must register on the HealthTürkiye portal and keep the data current (MADDE 8(4)), run an international health tourism unit with at least one documented foreign-language speaker (MADDE 7), and — for intermediaries — answer around the clock in at least two foreign languages (MADDE 6(2)(b)). Pricing is set by the Ministry (MADDE 11(1)).\n\nWhat the regime does not do: guarantee a clinical outcome, or rate anybody. It licenses the trade and gives the Ministry a power to stop an unlicensed one.", "today": "As of 17 September 2026 the instrument in force is the 2025 regulation, and the Ministry's four published lists of authorised facilities, stamped 20 August 2026, run to 542 hospitals, 135 medical centres, 2,468 private physician offices and 1,581 other facilities. That totals 4,726, which is a sum made here — the Ministry prints no total, and it publishes no count of authorised intermediaries at all. The promotion and information regulation governing how holders may advertise was replaced on 12 November 2025.", "notes": "The repealed 2017 instrument is kept in the sources register, marked repealed, because a great deal of secondary writing still cites it and a reader who finds that writing needs to be able to tell the two apart." }, "kin": [ { "to": "turkiye", "as": "The country whose regime this is.", "rel": "destination" }, { "to": "turkiye-health-services-directorate", "as": "The directorate that issues the certificate and publishes the register.", "rel": "org" }, { "to": "istanbul", "as": "Where most certificate holders are.", "rel": "hub" }, { "to": "facilitator", "as": "The role this regulation turns into a licensed travel agency.", "rel": "term" }, { "to": "choosing-a-facilitator", "as": "The step at which the register can be checked.", "rel": "step" }, { "to": "advertising-rules", "as": "The separate regulation that governs what a certificate holder may say abroad.", "rel": "kin" }, { "to": "hair-transplant-fue", "as": "The procedure that built the trade the regulation was written for.", "rel": "procedure" }, { "to": "turkiye-hair-boom", "as": "The years the volume arrived.", "rel": "event" }, { "to": "acibadem", "as": "The kind of hospital group that holds the certificate.", "rel": "facility" } ], "links": [ { "label": "Resmî Gazete, 13 July 2017, No. 30123 — the regulation", "url": "https://www.resmigazete.gov.tr/eskiler/2017/07/20170713-3.htm" }, { "label": "Ministry of Health — healthcare providers authorised by the Ministry", "url": "https://saglikturizmi.saglik.gov.tr/EN,69063/healthcare-providers-authorized-by-the-ministry.html" } ], "sources": [ "s:rg-saglik-turizmi-2017", "s:tr-health-tourism-reg-2017", "s:tr-authorised-providers", "s:tr-shgm", "s:ushas-saglik-turizmi-verileri", "s:rg-32882-2025", "s:rg-32182-2023-sac-ekimi", "s:shgm-yetkili-tesisler", "s:ishrs-2016-buyer-beware" ], "provenance": { "default": { "tier": "cited", "source": "s:rg-32882-2025" }, "fields": { "text.story": { "tier": "cited", "source": "s:rg-saglik-turizmi-2017", "note": "the stretch marked *Inference —* is this project's reading of what a register does" }, "text.how": { "tier": "cited", "source": "s:tr-authorised-providers" } } }, "confidence": "high", "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "A compulsory certificate for any facility treating international patients and any intermediary bringing them, under the Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik published in the Resmî Gazete…", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The country whose regime this is.", "rel": "destination" }, { "to": "turkiye-health-services-directorate", "type": "org", "name": "Türkiye General Directorate of Health Services", "as": "The directorate that issues the certificate and publishes the register.", "rel": "org" }, { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "Where most certificate holders are.", "rel": "hub" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The role this regulation turns into a licensed travel agency.", "rel": "term" }, { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "The step at which the register can be checked.", "rel": "step" }, { "to": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "The separate regulation that governs what a certificate holder may say abroad.", "rel": "kin" }, { "to": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The procedure that built the trade the regulation was written for.", "rel": "procedure" }, { "to": "turkiye-hair-boom", "type": "event", "name": "Türkiye's hair transplant boom", "as": "The years the volume arrived.", "rel": "event" }, { "to": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "The kind of hospital group that holds the certificate.", "rel": "facility" } ], "source_list": [ { "id": "s:rg-saglik-turizmi-2017", "kind": "web", "title": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik", "publisher": "Resmî Gazete, Republic of Türkiye (Ministry of Health)", "url": "https://www.resmigazete.gov.tr/eskiler/2017/07/20170713-3.htm", "accessed": "2026-09-16", "note": "Resmî Gazete 13 July 2017, No. 30123. Read in Turkish off the Resmî Gazete page. Article 5(1) makes an international health tourism authorisation certificate (yetki belgesi) compulsory for both the health facility and the intermediary; the Ministry halts the activity of anyone without one. Transitional Article 1 gave those already trading one year to comply. Article 16: in force on publication. REPEALED: MADDE 17 of the regulation of 26 April 2025 (Resmî Gazete 32882) revokes this one. Cite it for what the regime was, not for what it is." }, { "id": "s:tr-health-tourism-reg-2017", "kind": "statute", "title": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik (Resmî Gazete, 13 July 2017, No. 30123)", "publisher": "Resmî Gazete, Republic of Türkiye", "url": "https://www.resmigazete.gov.tr/eskiler/2017/07/20170713-3.htm", "accessed": "2026-09-16" }, { "id": "s:tr-authorised-providers", "kind": "web", "title": "Healthcare Providers Authorized by the Ministry", "publisher": "Türkiye Ministry of Health, Health Services General Directorate, Health Tourism Department", "url": "https://saglikturizmi.saglik.gov.tr/EN,69063/healthcare-providers-authorized-by-the-ministry.html", "accessed": "2026-09-16", "note": "separate downloadable lists for hospitals, medical centres, private practices, other providers and authorised facilitators; page dated 20 August 2026" }, { "id": "s:tr-shgm", "kind": "org", "title": "Sağlık Hizmetleri Genel Müdürlüğü", "publisher": "Türkiye Ministry of Health", "url": "https://shgm.saglik.gov.tr/", "accessed": "2026-09-16", "note": "departments including the Health Tourism Department and the Quality and Accreditation Department; address at Üniversiteler Mahallesi, Şehit Mehmet Bayraktar Caddesi No 3, Çankaya, Ankara" }, { "id": "s:ushas-saglik-turizmi-verileri", "kind": "gov", "title": "Sağlık Turizmi Verileri (health tourism data by year)", "publisher": "USHAŞ — Uluslararası Sağlık Hizmetleri A.Ş., the Turkish Ministry of Health's international health services company", "url": "https://ushas.gov.tr/saglik-turizmi-verileri/", "accessed": "2026-09-16", "note": "USHAŞ publishes the series it attributes to TÜİK, the Turkish statistical institute: visitors and revenue by year — 2019 756,926 and USD 1.459bn; 2020 435,691; 2021 729,592; 2022 1,381,807; 2023 1,538,643; 2024 1,506,442; 2025 1,398,580 and USD 3,022,452 thousand; first half of 2026 563,327 and USD 1.580bn. The unit is a visitor arriving with a health purpose, not an operation." }, { "id": "s:rg-32882-2025", "kind": "web", "title": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik, Resmî Gazete 26 Nisan 2025, Sayı 32882", "publisher": "T.C. Resmî Gazete", "year": 2025, "url": "https://www.resmigazete.gov.tr/eskiler/2025/04/20250426-2.htm", "accessed": "2026-09-17", "note": "MADDE 17 repeals the 13/7/2017 regulation (RG 30123) that most secondary writing still cites" }, { "id": "s:rg-32182-2023-sac-ekimi", "kind": "web", "title": "Saç Ekimi Birimleri Hakkında Yönetmelik, Resmî Gazete 6 Mayıs 2023, Sayı 32182", "publisher": "T.C. Resmî Gazete", "year": 2023, "url": "https://www.resmigazete.gov.tr/eskiler/2023/05/20230506-11.htm", "accessed": "2026-09-17" }, { "id": "s:shgm-yetkili-tesisler", "kind": "org", "title": "Bakanlığımızca Yetkilendirilmiş Sağlık Tesisleri — the four published lists of authorised facilities", "publisher": "T.C. Sağlık Bakanlığı, Sağlık Turizmi Daire Başkanlığı", "url": "https://shgmturizmdb.saglik.gov.tr/TR-67458/bakanligimizca-yetkilendirilmis-saglik-tesisleri-icin-tiklayiniz.html", "accessed": "2026-09-17", "note": "lists stamped 20 August 2026; the Ministry prints no total, so the counts here are the last sequence number in each list" }, { "id": "s:ishrs-2016-buyer-beware", "kind": "org", "title": "Buyer Beware: Medical Tourism for Hair Transplants Can Have Costly Consequences", "publisher": "International Society of Hair Restoration Surgery", "year": 2016, "url": "https://ishrs.org/buyer-beware-medical-tourism-for-hair-transplants-can-have-costly-consequences/", "accessed": "2026-09-17" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:rg-32882-2025" }, "text.story": { "tier": "cited", "source": "s:rg-saglik-turizmi-2017", "note": "the stretch marked *Inference —* is this project's reading of what a register does" }, "text.how": { "tier": "cited", "source": "s:tr-authorised-providers" }, "text.today": { "tier": "cited", "source": "s:rg-32882-2025" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "turkiye", "type": "destination", "name": "Türkiye", "as": "The certificate a facility here must hold before it may treat a foreign patient at all.", "rel": "governed-by" }, { "from": "antalya", "type": "hub", "name": "Antalya", "as": "The certificate both the clinic and its agency must hold here.", "rel": "governed-by" }, { "from": "istanbul", "type": "hub", "name": "Istanbul", "as": "The certificate every clinic here must hold, and the one document a reader can ask for by name.", "rel": "governed-by" }, { "from": "izmir", "type": "hub", "name": "İzmir", "as": "The certificate a facility here needs before it may treat a foreign patient.", "rel": "governed-by" }, { "from": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "The licence every Turkish facility treating foreign patients must hold since July 2017.", "rel": "governed-by" }, { "from": "anadolu-medical-center", "type": "facility", "name": "Anadolu Medical Center", "as": "Holds the certificate, which it lists among its quality documents.", "rel": "governed-by" }, { "from": "liv-hospital", "type": "facility", "name": "Liv Hospital", "as": "Holds the certificate, and a separate tourism ministry authorisation alongside it.", "rel": "governed-by" }, { "from": "medicana", "type": "facility", "name": "Medicana Health Group", "as": "The one certificate its flagship page displays.", "rel": "governed-by" }, { "from": "memorial-sisli", "type": "facility", "name": "Memorial Şişli Hospital", "as": "Operates under the regime every Turkish facility treating foreign patients has needed since July 2017.", "rel": "governed-by" }, { "from": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "The one regime this project has read that names interpreting and sets a language qualification for it.", "rel": "governed-by" }, { "from": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "The licence a Turkish advertiser must hold before Article 8 lets it speak abroad.", "rel": "kin" }, { "from": "turkiye-health-services-directorate", "type": "org", "name": "Türkiye General Directorate of Health Services", "as": "The certificate it issues, withdraws and publishes the register of.", "rel": "rule" }, { "from": "turkiye-hair-boom", "type": "event", "name": "Türkiye's hair transplant boom", "as": "The certificate a facility or intermediary must hold to sell any of this lawfully.", "rel": "rule" }, { "from": "health-tourism", "type": "term", "name": "Health tourism", "as": "The certificate the category requires, on its own instrument.", "rel": "rule" } ] }, { "id": "uae-clinic-licensing", "names": { "name": "Licensing a clinic in the United Arab Emirates", "aliases": [ "DHA licence", "Sheryan", "MOHAP licence", "DHCC licence" ], "said": "Four regulators in one federation, and which one holds your file depends on which side of a road the clinic sits." }, "region": [ "gulf", "west-asia" ], "facets": { "kind": "licensing", "iso2": "AE", "status": "in-force" }, "text": { "what": "Health facility and professional licensing in the UAE is split by emirate and by free zone rather than run federally. In Dubai the Dubai Health Authority licenses both, under Law No. (6) of 2018 Concerning the Dubai Health Authority, through the Sheryan system — described by the Authority as the \"Digital gateway for registering and licensing healthcare professionals and facilities in Dubai\" — with a public register. Dubai Healthcare City, a free zone, is regulated by its own authority. Abu Dhabi and the northern emirates run their own arrangements.", "story": "A federation that regulates health by emirate produces a licensing map a foreign patient cannot read from the outside, and the free zone makes it worse. A clinic in Dubai Healthcare City and a clinic a kilometre away on Oud Metha Road are licensed by different bodies under different rules, and both are in Dubai.\n\nLaw No. (6) of 2018 is the Authority's current constituting law and repeals contradicting provisions in other legislation. Licensing of health facilities sits with the Authority; Sheryan is where it happens and where the register is published.\n\nThe free zone publishes its own counts: 168 clinical facilities, 10 hospitals and 4,425 healthcare professionals, across Phase 1 on Oud Metha Road in Bur Dubai and Phase 2 at Al Jaddaf, regulated by the Dubai Healthcare City Authority.\n\n*Inference —* the practical consequence for someone checking a clinic before travelling is that there is no single national register to check. The question is not whether a UAE clinic is licensed but which body licensed it, and the answer determines where a complaint goes. That is the same fragmentation a patient meets in any federal system, and the Emirates is the one where the fault line runs through a single city.\n\nDubai also sends its own nationals abroad for treatment under a separate bylaw of the same Authority, which is on its own record here.", "how": "Sheryan carries a public search for professionals and for facilities, and a separate Dubai Medical Registry directory. A licence is held by the individual clinician as well as by the premises, and both are searchable.\n\nWhat a reader would have to establish: which regulator covers the address; whether the individual clinician's licence covers the procedure being sold; and whether the facility category — outpatient clinic, day surgery centre, hospital — matches the operation. A clinic licensed for outpatient dermatology and selling general-anaesthetic surgery is a licensing question before it is a clinical one.", "today": "As of 17 September 2026 the Dubai Health Authority's Sheryan register is public and searchable. Dubai reported more than 691,000 international health travellers in 2023 through its media office, a count of arrivals rather than of people." }, "kin": [ { "to": "uae", "as": "The federation whose licensing this is.", "rel": "destination" }, { "to": "dha-dubai", "as": "The authority that licenses, registers and publishes.", "rel": "org" }, { "to": "dubai", "as": "The city where the fault line between regulators runs.", "rel": "hub" }, { "to": "american-hospital-dubai", "as": "A licensed hospital in the emirate.", "rel": "facility" }, { "to": "gcc-sponsored-treatment-abroad", "as": "The same authority, sending patients the other way.", "rel": "kin" }, { "to": "choosing-a-facilitator", "as": "The step at which a register can be searched, if you know which one.", "rel": "step" }, { "to": "malpractice-recourse", "as": "Where a complaint goes depends on which body holds the licence.", "rel": "risk" }, { "to": "the-accreditation-question", "as": "A licence is not an accreditation, and neither is a quality score.", "rel": "story" } ], "links": [ { "label": "Sheryan — Dubai Health Licensing System, public search", "url": "https://services.dha.gov.ae/sheryan/wps/portal/home/public-search" }, { "label": "Law No. (6) of 2018 Concerning the Dubai Health Authority", "url": "https://dlp.dubai.gov.ae/Legislation%20Reference/2018/Law%20No.%20(6)%20of%202018%20Concerning%20the%20Dubai%20Health%20Authority.pdf" } ], "sources": [ "s:dha-law-6-2018", "s:dha-sheryan", "s:dhcc", "s:wp-dubai-healthcare-city", "s:dubai-media-office-health-2023" ], "provenance": { "default": { "tier": "cited", "source": "s:dha-law-6-2018" }, "fields": { "text.story": { "tier": "cited", "source": "s:dhcc", "note": "the stretch marked *Inference —* is this project's reading; the free-zone counts are the zone's own" }, "text.how": { "tier": "cited", "source": "s:dha-sheryan" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "Health facility and professional licensing in the UAE is split by emirate and by free zone rather than run federally. In Dubai the Dubai Health Authority licenses both, under Law No.", "region_terms": [ { "key": "gulf", "name": "The Gulf", "note": "the UAE, Saudi Arabia, Qatar, Kuwait, Oman, Bahrain — a source market that is building itself into a destination" }, { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "uae", "type": "destination", "name": "United Arab Emirates", "as": "The federation whose licensing this is.", "rel": "destination" }, { "to": "dha-dubai", "type": "org", "name": "Dubai Health Authority", "as": "The authority that licenses, registers and publishes.", "rel": "org" }, { "to": "dubai", "type": "hub", "name": "Dubai", "as": "The city where the fault line between regulators runs.", "rel": "hub" }, { "to": "american-hospital-dubai", "type": "facility", "name": "American Hospital Dubai", "as": "A licensed hospital in the emirate.", "rel": "facility" }, { "to": "gcc-sponsored-treatment-abroad", "type": "rule", "name": "Gulf state-sponsored treatment abroad", "as": "The same authority, sending patients the other way.", "rel": "kin" }, { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "The step at which a register can be searched, if you know which one.", "rel": "step" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "Where a complaint goes depends on which body holds the licence.", "rel": "risk" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "A licence is not an accreditation, and neither is a quality score.", "rel": "story" } ], "source_list": [ { "id": "s:dha-law-6-2018", "kind": "law", "title": "Law No. (6) of 2018 Concerning the Dubai Health Authority", "publisher": "Government of Dubai Legal Affairs Department", "year": 2018, "url": "https://dlp.dubai.gov.ae/Legislation%20Reference/2018/Law%20No.%20(6)%20of%202018%20Concerning%20the%20Dubai%20Health%20Authority.pdf", "accessed": "2026-09-16", "note": "the current constituting law; licensing of health facilities sits with the Authority, and the law repeals any contradicting provision in other legislation" }, { "id": "s:dha-sheryan", "kind": "web", "title": "Sheryan — Dubai Health Licensing System, public search", "publisher": "Dubai Health Authority", "url": "https://services.dha.gov.ae/sheryan/wps/portal/home/public-search", "accessed": "2026-09-16", "note": "public search across Facilities, Professionals and the Dubai Medical Registry" }, { "id": "s:dhcc", "kind": "web", "title": "Dubai Healthcare City", "publisher": "Dubai Healthcare City Authority", "url": "https://www.dhcc.ae/", "accessed": "2026-09-16", "note": "the free zone's own homepage counts, read 16 September 2026: 168 clinical facilities, 10 hospitals, 4,425 healthcare professionals; Phase 1 on Oud Metha Road in Bur Dubai and Phase 2 at Al Jaddaf; regulator named as Dubai Healthcare City Authority" }, { "id": "s:wp-dubai-healthcare-city", "kind": "web", "title": "Dubai Healthcare City", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Dubai_Healthcare_City", "accessed": "2026-09-16" }, { "id": "s:dubai-media-office-health-2023", "kind": "gov", "title": "Dubai welcomes more than 691,000 international health travellers in 2023", "publisher": "Dubai Media Office, Government of Dubai", "url": "https://mediaoffice.ae/en/news/2024/august/19-08/dubai-welcomes-more-than-691k", "accessed": "2026-09-16", "note": "Dubai Health Authority figures released 19 August 2024; gives arrivals, spend, regional split and the leading specialties. The release does not publish the counting rule behind the headline number." } ], "tiers": { "text.what": { "tier": "cited", "source": "s:dha-law-6-2018" }, "text.story": { "tier": "cited", "source": "s:dhcc", "note": "the stretch marked *Inference —* is this project's reading; the free-zone counts are the zone's own" }, "text.how": { "tier": "cited", "source": "s:dha-sheryan" }, "text.today": { "tier": "cited", "source": "s:dha-law-6-2018" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "uae", "type": "destination", "name": "United Arab Emirates", "as": "Why a licence here names an emirate rather than a country.", "rel": "governed-by" }, { "from": "dubai", "type": "hub", "name": "Dubai", "as": "The two-register arrangement that makes an address here a regulatory fact.", "rel": "governed-by" }, { "from": "american-hospital-dubai", "type": "facility", "name": "American Hospital Dubai", "as": "Operates under the emirate licensing regime whose number sits in its own footer.", "rel": "governed-by" }, { "from": "gcc-sponsored-treatment-abroad", "type": "rule", "name": "Gulf state-sponsored treatment abroad", "as": "The same authority, working the other direction.", "rel": "kin" }, { "from": "dha-dubai", "type": "org", "name": "Dubai Health Authority", "as": "Why a licence here names an emirate rather than a country.", "rel": "rule" } ] }, { "id": "uk-nhs-treatment-abroad", "names": { "name": "NHS funding for treatment abroad", "aliases": [ "planned treatment abroad", "the Proton Overseas Programme", "S2 from England" ], "said": "Two different things travel under one phrase: a route the patient applies for, and a programme the NHS sends people on." }, "region": [ "europe-west" ], "facets": { "kind": "entitlement", "iso2": "GB", "status": "in-force" }, "text": { "what": "What the National Health Service will pay for when the treatment happens outside the United Kingdom. Two channels, and they are not alike. A patient may apply for S2 authorisation to be treated in another EEA state's public system. Separately, NHS England commissions named treatments abroad and sends patients there — the Proton Overseas Programme ran that way before domestic proton centres opened. Everything else a UK resident buys abroad, the UK resident pays for.", "story": "Until the end of 2020 a UK resident had both European routes. The EU Directive route let them buy treatment in the EEA and claim the NHS-equivalent cost back; the S2 route let them be treated in another country's public system at NHS expense. The Directive route closed with the transition period. The NHS's own page is flat about it: \"now that the UK has left the EU, the EU Directive route has ended in the UK.\" Legacy claims survive only for treatment started, completed or authorised before 31 December 2020, and even the legacy window states that treatment after 31 December 2021 \"will not be reimbursed, unless there are exceptional circumstances\".\n\nThe commissioning channel is a different animal, and it is the one that moved the most money. Where the NHS could not deliver a treatment in the United Kingdom, it bought it abroad and sent the patient — proton beam therapy to the United States and Switzerland, on a national programme, with published outcome papers for the central-nervous-system and non-CNS cohorts. *Inference —* that channel is not a patient choosing a country. It is a commissioner buying capacity, which is why it comes with follow-up, records and a named clinician at home, and why the patient who arranges their own trip gets none of those.\n\nThe third thing that travels under this heading is the bill going the other way. Published work on cosmetic surgery abroad describes the cost to NHS units of treating complications after operations bought privately overseas; one 2024 paper follows a single breast surgery unit across one year. The NHS does not decline to treat a complication because the operation was bought elsewhere. It treats it and does not recover the cost.", "how": "S2 applications go to NHS England and issue through the NHS Business Services Authority; eligibility turns on ordinary residence in England, entitlement to NHS treatment, registration with an NHS general practitioner and, where relevant, a consultation about the condition. Wales, Scotland and Northern Ireland run their own arrangements.\n\nFor anything self-arranged, the NHS position on aftercare is set out on its cosmetic surgery abroad page rather than in any instrument: the responsibility for follow-up sits where the patient is, and the operation's own surgeon is in another country. Travel insurance is a separate question again — the government's travel insurance guidance is about declaring conditions and covering emergencies, and says nothing at all about planned treatment bought abroad.", "today": "As of 17 September 2026 the S2 route is the only planned-treatment funding route the NHS operates in Europe. NHS referral-to-treatment waiting statistics are published monthly and sit on this site's own chart; they are the number most often cited by patients who then buy abroad, and the NHS publishes no count of how many do." }, "kin": [ { "to": "s2-route", "as": "The route this system still runs, in full.", "rel": "rule" }, { "to": "eu-directive-2011-24", "as": "The route this system lost at the end of the transition period.", "rel": "rule" }, { "to": "united-kingdom", "as": "The country whose system this is, and one of the largest source markets in Europe.", "rel": "destination" }, { "to": "proton-therapy", "as": "The treatment the NHS bought abroad and commissioned by name before it could deliver it at home.", "rel": "procedure" }, { "to": "revision-at-home", "as": "The bill the NHS picks up when an operation bought abroad goes wrong.", "rel": "risk" }, { "to": "oecd-waiting-times", "as": "The queue that sends the patients.", "rel": "measured-by" }, { "to": "insurance-exclusions", "as": "What the patient finds when they look for someone else to pay.", "rel": "kin" }, { "to": "is-it-cheaper", "as": "The arithmetic that looks different once the home system is paying for the revision.", "rel": "story" } ], "links": [ { "label": "NHS — The Planned Treatment Scheme (S2 funding route)", "url": "https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/planned-treatment-s2-funding-route/" }, { "label": "NHS — The EU Directive route", "url": "https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/eu-directive-route/" } ], "sources": [ "s:nhs-s2-route", "s:nhs-eu-directive-route", "s:nhs-cosmetic-surgery-abroad", "s:pop-cns-outcomes", "s:pop-noncns-outcomes", "s:ahari-breast-unit-2024", "s:gov-uk-foreign-travel-insurance", "s:nhs-rtt-july-2026" ], "provenance": { "default": { "tier": "cited", "source": "s:nhs-s2-route" }, "fields": { "text.story": { "tier": "cited", "source": "s:nhs-eu-directive-route", "note": "the commissioning-channel paragraph marked *Inference —* is this project reasoning from the published programme papers" }, "text.how": { "tier": "cited", "source": "s:nhs-cosmetic-surgery-abroad" } } }, "confidence": "high", "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "What the National Health Service will pay for when the treatment happens outside the United Kingdom. Two channels, and they are not alike.", "region_terms": [ { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "s2-route", "type": "rule", "name": "The S2 route", "as": "The route this system still runs, in full.", "rel": "rule" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route this system lost at the end of the transition period.", "rel": "rule" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The country whose system this is, and one of the largest source markets in Europe.", "rel": "destination" }, { "to": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "The treatment the NHS bought abroad and commissioned by name before it could deliver it at home.", "rel": "procedure" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The bill the NHS picks up when an operation bought abroad goes wrong.", "rel": "risk" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The queue that sends the patients.", "rel": "measured-by" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "What the patient finds when they look for someone else to pay.", "rel": "kin" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The arithmetic that looks different once the home system is paying for the revision.", "rel": "story" } ], "source_list": [ { "id": "s:nhs-s2-route", "kind": "web", "title": "The Planned Treatment Scheme (S2 funding route)", "publisher": "NHS", "url": "https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/planned-treatment-s2-funding-route/", "accessed": "2026-09-16" }, { "id": "s:nhs-eu-directive-route", "kind": "web", "title": "The EU Directive route", "publisher": "NHS", "url": "https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/eu-directive-route/", "accessed": "2026-09-16" }, { "id": "s:nhs-cosmetic-surgery-abroad", "kind": "org", "title": "Cosmetic surgery abroad", "publisher": "NHS (England)", "url": "https://www.nhs.uk/tests-and-treatments/cosmetic-procedures/advice/cosmetic-surgery-abroad/", "accessed": "2026-09-16", "note": "read for aftercare responsibility, flying intervals and the statement on travel insurance" }, { "id": "s:pop-cns-outcomes", "kind": "paper", "title": "Outcomes of Patients Treated in the UK Proton Overseas Programme: Central Nervous System Group", "publisher": "Clinical Oncology 35 (2023), doi:10.1016/j.clon.2023.01.024, PMID 36804292", "url": "https://doi.org/10.1016/j.clon.2023.01.024", "accessed": "2026-09-16", "note": "830 patients treated abroad between 2008 and September 2020 in the CNS, base of skull, spinal and paraspinal group" }, { "id": "s:pop-noncns-outcomes", "kind": "paper", "title": "Outcomes of Patients Treated in the UK Proton Overseas Programme: Non-central Nervous System Group", "publisher": "Clinical Oncology 35 (2023), doi:10.1016/j.clon.2023.02.009, PMID 36813694", "url": "https://doi.org/10.1016/j.clon.2023.02.009", "accessed": "2026-09-16", "note": "495 patients, median age 11, 70.3% under 16" }, { "id": "s:ahari-breast-unit-2024", "kind": "paper", "title": "The impact of cosmetic tourism across one year on an NHS breast surgery unit", "publisher": "Journal of Plastic, Reconstructive and Aesthetic Surgery 2024;99:462-467 (Ahari D, Zaccariah ZR, Preston M, Highton L), Wythenshawe Hospital", "url": "https://pubmed.ncbi.nlm.nih.gov/39476527/", "accessed": "2026-09-16" }, { "id": "s:gov-uk-foreign-travel-insurance", "kind": "org", "title": "Foreign travel insurance", "publisher": "UK Foreign, Commonwealth and Development Office, gov.uk", "url": "https://www.gov.uk/guidance/foreign-travel-insurance", "accessed": "2026-09-16", "note": "read for repatriation, emergency transport, declaration of existing conditions and the limits of EHIC/GHIC" }, { "id": "s:nhs-rtt-july-2026", "kind": "gov", "title": "Statistical Press Notice — NHS referral to treatment (RTT) waiting times data, July 2026", "publisher": "NHS England", "url": "https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Jul26-RTT-statistical-press-notice-PDF-578K-97ylx5.pdf", "accessed": "2026-09-16", "note": "published Thursday 10 September 2026. 7.3 million RTT pathways waiting to start treatment at the end of July 2026, an estimated 6.2 million unique patients; 111,379 waiting over 52 weeks, 9,095 over 65 weeks, 235 over 104 weeks; 65.4% waiting up to 18 weeks against a 92% standard; median wait 12.0 weeks. Figures include estimates for three trusts and one independent provider that did not submit." } ], "tiers": { "text.what": { "tier": "cited", "source": "s:nhs-s2-route" }, "text.story": { "tier": "cited", "source": "s:nhs-eu-directive-route", "note": "the commissioning-channel paragraph marked *Inference —* is this project reasoning from the published programme papers" }, "text.how": { "tier": "cited", "source": "s:nhs-cosmetic-surgery-abroad" }, "text.today": { "tier": "cited", "source": "s:nhs-s2-route" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "What the NHS will and will not fund when a patient goes.", "rel": "governed-by" }, { "from": "vilnius", "type": "hub", "name": "Vilnius", "as": "The scheme a British patient would be claiming under, and the reason the queue is the argument.", "rel": "governed-by" }, { "from": "proton-therapy", "type": "procedure", "name": "Proton beam therapy", "as": "The route under which the NHS paid for treatment its own hospitals could not yet give.", "rel": "governed-by" }, { "from": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The entitlement that does not cover any of this.", "rel": "governed-by" }, { "from": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The one national system that used both routes and now uses only one.", "rel": "kin" }, { "from": "s2-route", "type": "rule", "name": "The S2 route", "as": "The national system that runs this route, and the page where its own conditions are set out.", "rel": "kin" } ] }, { "id": "us-medicare-abroad", "names": { "name": "Medicare outside the United States", "aliases": [ "42 CFR Part 424 Subpart H", "foreign hospital services" ], "said": "Medicare's own page opens with the rule and then spends the rest of the page on the exceptions." }, "region": [ "north-america" ], "facets": { "kind": "entitlement", "iso2": "US", "status": "in-force" }, "text": { "what": "Medicare does not pay for healthcare outside the United States, with three narrow exceptions written into 42 CFR Part 424, Subpart H. None of them covers planned treatment. The programme's own summary: \"Medicare usually doesn't cover health care while you're traveling outside the U.S. but there are some exceptions.\"", "story": "The exceptions are geographic accidents, not policy choices. Under 42 CFR 424.122, Part A pays for emergency inpatient hospital services in a foreign country where the beneficiary was \"In the United States\" or \"In Canada traveling between Alaska and another State without unreasonable delay and by the most direct route\" when the emergency arose, and where \"The foreign hospital was closer to, or more accessible from, the site of the emergency than the nearest United States hospital equipped to deal with, and available to treat, the individual's illness or injury\". A second limb covers non-emergency inpatient services at a foreign hospital closer to the beneficiary's residence than any US hospital that could treat them — which in practice means a border town. Section 424.124 then pays for the physician and ambulance services attached to a covered inpatient stay, provided the physician is \"legally authorized to practice in the country where he or she furnishes the services\".\n\nMedicare.gov adds a cruise ship rule: Part B may pay for services aboard a ship in a US port or \"no more than 6 hours away from a U.S. port\".\n\n*Inference —* every exception is about proximity at the moment of an emergency. A beneficiary who plans a knee replacement in Costa Rica falls outside all of them, and so does the complication that follows it home — which is covered, because it is treated in the United States, by a programme that never saw the operation and holds no record of it. The person who paid for the surgery abroad and the programme that pays for its aftermath are not the same payer, and nobody counts the transfer.\n\nMedigap supplemental policies are a separate matter and some do carry foreign travel emergency benefit; the CDC's Yellow Book chapter on travel insurance sets out the limits alongside medical evacuation costs, which it puts at USD 25,000 to over USD 250,000.", "how": "A foreign hospital is not obliged to bill Medicare. Medicare.gov: \"Foreign hospitals aren't required to file Medicare claims for your travel medical costs. You need to submit an itemized bill to Medicare\" where the admission qualifies and the hospital does not file. The beneficiary therefore pays, collects the itemised bill, and claims — the same sequence the EU Directive route uses, without the entitlement underneath it.\n\nWhat a reader would have to ask of any US plan: whether it is Original Medicare, a Medicare Advantage plan with its own foreign emergency benefit, or a Medigap policy; whether the benefit is emergency-only; what the lifetime cap is; and whether medical evacuation is covered separately, since it usually is not.", "today": "As of 17 September 2026 the rule and its three exceptions stand as written in 42 CFR Part 424, Subpart H. No Medicare benefit covers elective treatment abroad, and no federal programme counts how many beneficiaries buy it." }, "kin": [ { "to": "united-states", "as": "The country whose public programme this is, and the largest source market in the world.", "rel": "destination" }, { "to": "insurance-exclusions", "as": "The private half of the same answer.", "rel": "kin" }, { "to": "eu-directive-2011-24", "as": "What a reimbursement entitlement looks like where one exists.", "rel": "contrast" }, { "to": "repatriation-cost", "as": "The bill the exceptions do not reach.", "rel": "risk" }, { "to": "los-algodones", "as": "The border town the proximity rule was not written for, and does not help.", "rel": "hub" }, { "to": "out-of-pocket", "as": "What a US patient abroad is, in one word.", "rel": "term" }, { "to": "revision-at-home", "as": "The care that is covered, because it happens on the right side of the border.", "rel": "risk" } ], "links": [ { "label": "Medicare.gov — Travel outside the U.S.", "url": "https://www.medicare.gov/coverage/travel-outside-the-u.s." }, { "label": "42 CFR 424.122 — emergency inpatient services in a foreign country", "url": "https://www.law.cornell.edu/cfr/text/42/424.122" }, { "label": "42 CFR 424.124 — foreign physician and ambulance services", "url": "https://www.law.cornell.edu/cfr/text/42/424.124" } ], "sources": [ "s:medicare-travel-outside-us", "s:cfr-424-122", "s:cfr-424-124", "s:ecfr-42-424-h", "s:cdc-yellowbook-travel-insurance" ], "provenance": { "default": { "tier": "cited", "source": "s:cfr-424-122" }, "fields": { "text.story": { "tier": "cited", "source": "s:cfr-424-122", "note": "the paragraph marked *Inference —* is this project reasoning from the regulation; no source counts the transfer it describes" }, "text.how": { "tier": "cited", "source": "s:medicare-travel-outside-us" } } }, "confidence": "high", "schema": 1, "type": "rule", "updated": "2026-09-17", "blurb": "Medicare does not pay for healthcare outside the United States, with three narrow exceptions written into 42 CFR Part 424, Subpart H. None of them covers planned treatment.", "region_terms": [ { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "united-states", "type": "destination", "name": "United States", "as": "The country whose public programme this is, and the largest source market in the world.", "rel": "destination" }, { "to": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "The private half of the same answer.", "rel": "kin" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "What a reimbursement entitlement looks like where one exists.", "rel": "contrast" }, { "to": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "The bill the exceptions do not reach.", "rel": "risk" }, { "to": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "The border town the proximity rule was not written for, and does not help.", "rel": "hub" }, { "to": "out-of-pocket", "type": "term", "name": "Out-of-pocket", "as": "What a US patient abroad is, in one word.", "rel": "term" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The care that is covered, because it happens on the right side of the border.", "rel": "risk" } ], "source_list": [ { "id": "s:medicare-travel-outside-us", "kind": "web", "title": "Travel outside the U.S.", "publisher": "Medicare.gov, US Centers for Medicare & Medicaid Services", "url": "https://www.medicare.gov/coverage/travel-outside-the-u.s.", "accessed": "2026-09-16" }, { "id": "s:cfr-424-122", "kind": "statute", "title": "42 CFR § 424.122 — emergency inpatient hospital services furnished in a foreign country", "publisher": "Legal Information Institute, Cornell Law School", "url": "https://www.law.cornell.edu/cfr/text/42/424.122", "accessed": "2026-09-17", "note": "the eCFR's own page redirected to an unblock gateway on this date; the CFR text was read at the Legal Information Institute" }, { "id": "s:cfr-424-124", "kind": "statute", "title": "42 CFR § 424.124 — foreign physician and ambulance services", "publisher": "Legal Information Institute, Cornell Law School", "url": "https://www.law.cornell.edu/cfr/text/42/424.124", "accessed": "2026-09-17" }, { "id": "s:ecfr-42-424-h", "kind": "statute", "title": "42 CFR Part 424, Subpart H — Payment for services furnished in a foreign country (§§ 424.120–424.124)", "publisher": "Electronic Code of Federal Regulations, U.S. Government", "url": "https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-424/subpart-H", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-travel-insurance", "kind": "org", "title": "Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance — CDC Yellow Book 2026, chapter by Rhett J. Stoney", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/travel-insurance.html", "accessed": "2026-09-16", "note": "carries the USD 25,000 to over USD 250,000 medevac range, the Medicare and Medigap limits, and the finding that insurers fully paid two-thirds of travel health claims" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:cfr-424-122" }, "text.story": { "tier": "cited", "source": "s:cfr-424-122", "note": "the paragraph marked *Inference —* is this project reasoning from the regulation; no source counts the transfer it describes" }, "text.how": { "tier": "cited", "source": "s:medicare-travel-outside-us" }, "text.today": { "tier": "cited", "source": "s:cfr-424-122" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "united-states", "type": "destination", "name": "United States", "as": "The rule that decides what a US patient carries abroad, which is almost nothing.", "rel": "governed-by" }, { "from": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "The entitlement that does not extend to this, stated in the same chapter.", "rel": "governed-by" }, { "from": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "The territorial exclusion, in a public programme.", "rel": "rule" } ] }, { "schema": 1, "id": "aaci", "type": "org", "names": { "name": "American Accreditation Commission International", "aliases": [ "AACI", "AACI Healthcare" ], "said": "The initials collide with the Accreditation Association for Ambulatory Health Care, which is a different American body entirely." }, "region": [ "global", "north-america" ], "facets": { "kind": "accreditor", "iso2": "US", "status": "open" }, "text": { "what": "An independent accreditation body registered in the United States and run from Hendersonville, North Carolina. It accredits healthcare organisations and certifies clinical programmes, and holds three current ISQua EEA awards: as an organisation for 2022 to 2026, for its standards for 2023 to 2027, and for its surveyor training programme for 2024 to 2028.", "story": "AACI appears on hospital websites across the Gulf, South Asia and Türkiye, usually beside or instead of JCI, and it is the scheme most often confused with something else. The abbreviation AACI is also used by the Accreditation Association for Ambulatory Health Care's international arm, and by an Israeli immigrants' association; a reader checking a clinic's badge should check which body issued it.\n\nThe ISQua EEA awards are the useful fact here, because they are dated on both ends and published by a third party rather than by AACI. An award that expires in 2026 says something precise: an external body found the scheme conforming, and that finding runs out.\n\n*Inference —* the split into three awards — organisation, standards, surveyor training — is worth reading. A scheme can hold one and not the others, and the three answer different questions: is the body run properly, is what it measures sound, and are the people who measure it trained.", "how": "An organisation applies, pays, is surveyed and is listed in AACI's directory of accredited and certified organisations. The pages read for this record do not state the cycle length or whether the standards are downloadable without an application.", "today": "As of 16 September 2026 AACI lists its three ISQua EEA awards with their year ranges on its own about page, and runs an accredited and certified organisations directory.", "notes": "The founding year is reported as 2013 in company databases but is not stated on AACI's own about page, so this record leaves facets.founded out rather than carry an unsourced year." }, "geo": { "lat": 35.3187, "lon": -82.461, "precision": "street", "source": "s:aaci-about" }, "address": { "street": "658 E Sunset Dr", "city": "Hendersonville", "area": "North Carolina", "country": "US", "postcode": "28791" }, "recognitions": [ { "by": "isqua-eea", "what": "ISQua EEA accreditation as an organisation", "year": 2022, "valid_until": "2026", "source": "s:aaci-about", "url": "https://aacihealthcare.com/about-us/" }, { "by": "isqua-eea", "what": "ISQua EEA accreditation of the AACI standards", "year": 2023, "valid_until": "2027", "source": "s:aaci-about", "url": "https://aacihealthcare.com/about-us/" }, { "by": "isqua-eea", "what": "ISQua EEA accreditation of the AACI surveyor training programme", "year": 2024, "valid_until": "2028", "source": "s:aaci-about", "url": "https://aacihealthcare.com/about-us/" } ], "kin": [ { "to": "isqua-ieea", "as": "Holds three dated awards over this body, its standards and its surveyor training.", "rel": "accredited-by" }, { "to": "jci", "as": "The scheme it most often appears beside on a hospital's badge wall.", "rel": "contrast" }, { "to": "uae", "as": "One of the markets where its mark turns up on private clinic pages.", "rel": "place" }, { "to": "the-accreditation-question", "as": "Where a badge wall is counted rather than weighed.", "rel": "story" } ], "links": [ { "label": "AACI Healthcare", "url": "https://aacihealthcare.com/" } ], "sources": [ "s:aaci-about" ], "provenance": { "default": { "tier": "cited", "source": "s:aaci-about" }, "fields": { "text.story": { "tier": "cited", "source": "s:aaci-about", "note": "the name collision is this project's observation; the closing paragraph is marked as inference" } } }, "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "An independent accreditation body registered in the United States and run from Hendersonville, North Carolina.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "isqua-ieea", "type": "org", "name": "ISQua External Evaluation Association", "as": "Holds three dated awards over this body, its standards and its surveyor training.", "rel": "accredited-by" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The scheme it most often appears beside on a hospital's badge wall.", "rel": "contrast" }, { "to": "uae", "type": "destination", "name": "United Arab Emirates", "as": "One of the markets where its mark turns up on private clinic pages.", "rel": "place" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Where a badge wall is counted rather than weighed.", "rel": "story" } ], "source_list": [ { "id": "s:aaci-about", "kind": "web", "title": "About us — American Accreditation Commission International", "publisher": "AACI", "url": "https://aacihealthcare.com/about-us/", "accessed": "2026-09-16", "note": "Hendersonville, North Carolina address, and three current ISQua EEA awards with their year ranges" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:aaci-about" }, "text.story": { "tier": "cited", "source": "s:aaci-about", "note": "the name collision is this project's observation; the closing paragraph is marked as inference" }, "text.how": { "tier": "cited", "source": "s:aaci-about" }, "text.today": { "tier": "cited", "source": "s:aaci-about" }, "geo": { "tier": "cited", "source": "s:aaci-about" }, "address": { "tier": "cited", "source": "s:aaci-about" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [ { "key": "isqua-eea", "label": "ISQua External Evaluation Association", "what": "ISQua EEA accreditation as an organisation", "url": "https://aacihealthcare.com/about-us/", "kind": "meta", "year": 2022, "valid_until": "2026", "source": "s:aaci-about" }, { "key": "isqua-eea", "label": "ISQua External Evaluation Association", "what": "ISQua EEA accreditation of the AACI standards", "url": "https://aacihealthcare.com/about-us/", "kind": "meta", "year": 2023, "valid_until": "2027", "source": "s:aaci-about" }, { "key": "isqua-eea", "label": "ISQua External Evaluation Association", "what": "ISQua EEA accreditation of the AACI surveyor training programme", "url": "https://aacihealthcare.com/about-us/", "kind": "meta", "year": 2024, "valid_until": "2028", "source": "s:aaci-about" } ], "acclaim": 1, "kin_in": [ { "from": "isqua-ieea", "type": "org", "name": "ISQua External Evaluation Association", "as": "Holds three of its awards, each with a published year range.", "rel": "accredits" } ] }, { "schema": 1, "id": "achsi", "type": "org", "names": { "name": "ACHS International", "aliases": [ "ACHSI", "Australian Council on Healthcare Standards International" ], "said": "The Australian scheme, sold abroad. EQuIP is the standards set, and the acronym travels with it." }, "region": [ "global", "oceania" ], "facets": { "kind": "accreditor", "iso2": "AU", "founded": 2005, "status": "open" }, "text": { "what": "The international subsidiary of the Australian Council on Healthcare Standards, a not-for-profit that has developed healthcare standards since 1974 and is an authorised accrediting agency of the Australian Commission on Safety and Quality in Health Care. ACHS International is wholly owned by that parent and sells accreditation, standards, benchmarking and advisory services outside Australia, using the EQuIP standards.", "story": "ACHS is a domestic regulator's partner at home and a vendor abroad, and the two roles sit in one corporate group. At home the standards are part of a national safety and quality system a hospital cannot opt out of. Abroad the same standards are a product a hospital buys.\n\n*Inference —* that is the pattern for every national scheme on this list that went international — the Australian, the Indian, the Thai, the American. The standards were written for a system with a regulator behind them and are then sold into systems where nothing stands behind them but the contract. The mark is the same; what it is embedded in is not.\n\nThe EQuIP standards hold an ISQua EEA award, which is the external check on the standards themselves.", "how": "An organisation contracts with ACHS International, is assessed against EQuIP or a sector variant — hospitals, ambulatory care, telehealth, oral health, dialysis — and joins its member network. The pages read for this record state neither the cycle length nor whether the accredited list is public.", "today": "As of 16 September 2026 ACHS International states it operates in more than 25 countries with more than 1,600 member organisations worldwide." }, "geo": { "lat": -33.8688, "lon": 151.2093, "precision": "city", "source": "s:achs-who-we-are" }, "address": { "city": "Sydney", "area": "New South Wales", "country": "AU" }, "recognitions": [ { "by": "isqua-eea", "what": "ISQua EEA accreditation of the ACHS EQuIP standards", "year": null, "valid_until": null, "source": "s:achsi-home", "url": "https://www.achsi.org/", "note": "the award year is not stated on the pages read for this record" } ], "kin": [ { "to": "australia", "as": "The system these standards were written for, and where a regulator stands behind them.", "rel": "place" }, { "to": "nabh", "as": "The Indian equivalent: a domestic scheme that also sells abroad.", "rel": "contrast" }, { "to": "thai-ha-institute", "as": "The Thai equivalent, run by a public organisation rather than a subsidiary.", "rel": "contrast" }, { "to": "isqua-ieea", "as": "Holds the award over the EQuIP standards.", "rel": "accredited-by" }, { "to": "the-accreditation-question", "as": "Where a national standard sold abroad is separated from the system it came from.", "rel": "story" } ], "links": [ { "label": "ACHS International", "url": "https://www.achsi.org/" }, { "label": "The Australian Council on Healthcare Standards", "url": "https://www.achs.org.au/" } ], "sources": [ "s:achsi-home", "s:achs-who-we-are" ], "provenance": { "default": { "tier": "cited", "source": "s:achsi-home" }, "fields": { "text.story": { "tier": "cited", "source": "s:achs-who-we-are", "note": "second paragraph marked as this project's inference" }, "geo": { "tier": "inference", "note": "ACHS is a Sydney body; the pages read for this record carry no street address, so the point is city precision only" }, "facets": { "tier": "tradition", "note": "2005 is the year ACHS International was set up as a subsidiary, widely reported but not on the pages read here" } } }, "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "The international subsidiary of the Australian Council on Healthcare Standards, a not-for-profit that has developed healthcare standards since 1974 and is an authorised accrediting agency of the Australian Commission on…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "oceania", "name": "Oceania", "note": "Australia, New Zealand, the Pacific" } ], "kin_out": [ { "to": "australia", "type": "destination", "name": "Australia", "as": "The system these standards were written for, and where a regulator stands behind them.", "rel": "place" }, { "to": "nabh", "type": "org", "name": "National Accreditation Board for Hospitals and Healthcare Providers", "as": "The Indian equivalent: a domestic scheme that also sells abroad.", "rel": "contrast" }, { "to": "thai-ha-institute", "type": "org", "name": "Healthcare Accreditation Institute", "as": "The Thai equivalent, run by a public organisation rather than a subsidiary.", "rel": "contrast" }, { "to": "isqua-ieea", "type": "org", "name": "ISQua External Evaluation Association", "as": "Holds the award over the EQuIP standards.", "rel": "accredited-by" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Where a national standard sold abroad is separated from the system it came from.", "rel": "story" } ], "source_list": [ { "id": "s:achsi-home", "kind": "web", "title": "ACHS International", "publisher": "Australian Council on Healthcare Standards International", "url": "https://www.achsi.org/", "accessed": "2026-09-16", "note": "wholly owned subsidiary of ACHS, EQuIP standards, more than 25 countries and more than 1,600 member organisations" }, { "id": "s:achs-who-we-are", "kind": "web", "title": "Who we are", "publisher": "The Australian Council on Healthcare Standards", "url": "https://www.achs.org.au/about-us/who-we-are", "accessed": "2026-09-16", "note": "standards development since 1974, not-for-profit status, and authorisation as an accrediting agency by the Australian Commission on Safety and Quality in Health Care" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:achsi-home" }, "text.story": { "tier": "cited", "source": "s:achs-who-we-are", "note": "second paragraph marked as this project's inference" }, "text.how": { "tier": "cited", "source": "s:achsi-home" }, "text.today": { "tier": "cited", "source": "s:achsi-home" }, "geo": { "tier": "inference", "note": "ACHS is a Sydney body; the pages read for this record carry no street address, so the point is city precision only" }, "address": { "tier": "cited", "source": "s:achsi-home" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [ { "key": "isqua-eea", "label": "ISQua External Evaluation Association", "what": "ISQua EEA accreditation of the ACHS EQuIP standards", "url": "https://www.achsi.org/", "kind": "meta", "year": null, "valid_until": null, "source": "s:achsi-home" } ], "acclaim": 1, "kin_in": [ { "from": "dnv-healthcare", "type": "org", "name": "DNV Healthcare", "as": "Another national scheme selling itself abroad, on a different standards base.", "rel": "contrast" }, { "from": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "A regulator's partner at home and a vendor abroad, selling the same standards into systems with nothing behind them.", "rel": "org" } ] }, { "schema": 1, "id": "cbahi", "type": "org", "names": { "name": "Saudi Central Board for Accreditation of Healthcare Institutions", "aliases": [ "CBAHI" ], "said": "CBAHI is an accreditor that behaves like a regulator, because in Saudi Arabia it is one." }, "region": [ "gulf", "west-asia" ], "facets": { "kind": [ "accreditor", "regulator" ], "iso2": "SA", "founded": 2005, "status": "open" }, "text": { "what": "Saudi Arabia's national healthcare accreditation body, a not-for-profit established in October 2005 on the recommendation of the Council of Health Services. It is described in the peer-reviewed literature as \"the only legally recognized institution in Saudi Arabia that evaluates all governmental and private healthcare providers\", and accreditation is mandatory for Ministry of Health hospitals. It accredits hospitals, primary healthcare centres, clinical laboratories and ambulatory centres.", "story": "Every other accreditor on this list sells something a facility may decline. CBAHI does not, for the facilities the mandate covers, and that single difference changes what its mark carries.\n\nA voluntary accreditation is evidence of a choice: this hospital decided the fee and the preparation were worth it. A mandatory one is evidence of a floor: this hospital met the minimum the state requires of everyone. Neither is a quality score, but they are different facts, and a badge wall that shows both side by side does not distinguish them.\n\nCBAHI published its first national standards in 2006 and a second hospital edition in 2012, developed with public and private sector experts, and holds an ISQua EEA award over its standards.", "how": "Facilities are surveyed against the national standards. The pages read for this record do not establish the cycle length, the fee, or whether the accredited list is published as a searchable register — the CBAHI portal refused every connection from this project on 16 September 2026, so this record rests on a 2023 peer-reviewed paper and leaves those gaps open rather than filling them.", "today": "As of 16 September 2026 CBAHI runs accreditation programmes for hospitals, primary healthcare centres, laboratories and ambulatory centres, with further programmes reported as being rolled out." }, "geo": { "lat": 21.4858, "lon": 39.1925, "precision": "city", "source": "s:cbahi-jmdh-2023" }, "address": { "city": "Jeddah", "country": "SA" }, "recognitions": [ { "by": "isqua-eea", "what": "ISQua EEA accreditation of the CBAHI standards", "year": null, "valid_until": null, "source": "s:cbahi-jmdh-2023", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10153434/", "note": "reported in the cited paper; the award year and term are not stated there" } ], "kin": [ { "to": "saudi-arabia", "as": "The country whose public and private facilities it is the legally recognised evaluator of.", "rel": "place" }, { "to": "jci", "as": "The voluntary international mark Saudi hospitals hold on top of this compulsory one.", "rel": "contrast" }, { "to": "gcc-sponsored-treatment-abroad", "as": "The state route that sends Saudi patients out while this board raises the floor at home.", "rel": "governs" }, { "to": "isqua-ieea", "as": "Holds the award over these standards.", "rel": "accredited-by" }, { "to": "the-accreditation-question", "as": "Where a compulsory floor and a bought badge are pulled apart.", "rel": "story" } ], "links": [ { "label": "CBAHI", "url": "https://portal.cbahi.gov.sa/" } ], "sources": [ "s:cbahi-jmdh-2023" ], "provenance": { "default": { "tier": "cited", "source": "s:cbahi-jmdh-2023" }, "fields": { "text.story": { "tier": "cited", "source": "s:cbahi-jmdh-2023", "note": "the second paragraph is this project reasoning about what a mandatory mark carries" }, "geo": { "tier": "inference", "note": "CBAHI's registered office is in Jeddah; city precision only, and the portal could not be reached to confirm" } } }, "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "Saudi Arabia's national healthcare accreditation body, a not-for-profit established in October 2005 on the recommendation of the Council of Health Services.", "region_terms": [ { "key": "gulf", "name": "The Gulf", "note": "the UAE, Saudi Arabia, Qatar, Kuwait, Oman, Bahrain — a source market that is building itself into a destination" }, { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "saudi-arabia", "type": "destination", "name": "Saudi Arabia", "as": "The country whose public and private facilities it is the legally recognised evaluator of.", "rel": "place" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The voluntary international mark Saudi hospitals hold on top of this compulsory one.", "rel": "contrast" }, { "to": "gcc-sponsored-treatment-abroad", "type": "rule", "name": "Gulf state-sponsored treatment abroad", "as": "The state route that sends Saudi patients out while this board raises the floor at home.", "rel": "governs" }, { "to": "isqua-ieea", "type": "org", "name": "ISQua External Evaluation Association", "as": "Holds the award over these standards.", "rel": "accredited-by" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Where a compulsory floor and a bought badge are pulled apart.", "rel": "story" } ], "source_list": [ { "id": "s:cbahi-jmdh-2023", "kind": "paper", "title": "Impact of the Accreditation Program of the Saudi Central Board for Accreditation of Healthcare Institutions on the Safety Dimension of the Institute of Medicine Quality", "publisher": "Journal of Multidisciplinary Healthcare", "year": 2023, "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10153434/", "accessed": "2026-09-16", "note": "CBAHI established October 2005, the only legally recognised evaluator of governmental and private providers in Saudi Arabia, mandatory for Ministry of Health hospitals, standards editions 2006 and 2012; portal.cbahi.gov.sa refused every connection on this date" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:cbahi-jmdh-2023" }, "text.story": { "tier": "cited", "source": "s:cbahi-jmdh-2023", "note": "the second paragraph is this project reasoning about what a mandatory mark carries" }, "text.how": { "tier": "cited", "source": "s:cbahi-jmdh-2023" }, "text.today": { "tier": "cited", "source": "s:cbahi-jmdh-2023" }, "geo": { "tier": "inference", "note": "CBAHI's registered office is in Jeddah; city precision only, and the portal could not be reached to confirm" }, "address": { "tier": "cited", "source": "s:cbahi-jmdh-2023" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [ { "key": "isqua-eea", "label": "ISQua External Evaluation Association", "what": "ISQua EEA accreditation of the CBAHI standards", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10153434/", "kind": "meta", "year": null, "valid_until": null, "source": "s:cbahi-jmdh-2023" } ], "acclaim": 1, "kin_in": [ { "from": "saudi-arabia", "type": "destination", "name": "Saudi Arabia", "as": "The national accreditor, compulsory at home rather than bought for a foreign audience.", "rel": "accredited-by" }, { "from": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Mandatory rather than voluntary, so its mark is evidence of a floor rather than of a choice.", "rel": "org" } ] }, { "schema": 1, "id": "declaration-of-istanbul-group", "type": "org", "names": { "name": "Declaration of Istanbul Custodian Group", "aliases": [ "DICG" ], "said": "The Declaration is a professional statement, not a treaty. It binds nobody and has changed law in several countries anyway." }, "region": [ "global" ], "facets": { "kind": "ngo", "founded": 2010, "status": "open" }, "text": { "what": "The body that keeps the Declaration of Istanbul on Organ Trafficking and Transplant Tourism. Formed in 2010 to carry forward the 2008 Istanbul summit, sponsored by The Transplantation Society and the International Society of Nephrology, and endorsed by more than 80 international professional organisations. The Declaration was revised in 2018.", "story": "The 2008 summit named a thing the transplant community had been describing around for years: patients crossing borders to buy organs from people who were paid, coerced or trafficked, and coming home with a graft and an infection while the seller kept a scar and a shortened life.\n\nThe Declaration is a professional instrument. It has no enforcement, imposes no penalty and creates no offence. It gives \"ethical guidance and support for medical professionals, policymakers, professional societies, national health authorities, and inter-governmental organizations\", and it has been used as the reference text when countries did write law.\n\n*Inference —* that is why it sits on this site as an organisation and an event rather than as a rule. It is the clearest case in the field of a trade being reshaped by a professional consensus rather than by a statute, and the clearest case of the field's own practitioners drawing a line inside it: this part of cross-border care is not like the others, and the Declaration says why.", "how": "The Custodian Group maintains the text, collects endorsements, reports on implementation and supports national bodies applying it. Endorsement is by professional organisation, not by state.", "today": "As of 16 September 2026 the 2018 edition is current, and the Group states its goal that everyone in need should benefit from transplant \"without relying on unethical and exploitive practices\"." }, "geo": { "lat": 41.0082, "lon": 28.9784, "precision": "city", "source": "s:dicg-about" }, "kin": [ { "to": "istanbul-declaration-2008", "as": "The summit and text this group was formed to keep.", "rel": "event" }, { "to": "kidney-transplant", "as": "The operation the Declaration was written about.", "rel": "procedure" }, { "to": "transplant-prohibition", "as": "The national laws written with this text as their reference.", "rel": "governs" }, { "to": "transplant-harm", "as": "What happens to the person who sold the organ, which the Declaration puts first.", "rel": "risk" }, { "to": "who", "as": "The intergovernmental body whose transplant guiding principles this text sits beside.", "rel": "org" }, { "to": "circumvention", "as": "The wider pattern of travelling to do what is unlawful at home, of which this is the hardest case.", "rel": "story" } ], "links": [ { "label": "Declaration of Istanbul Custodian Group", "url": "https://www.declarationofistanbul.org/" } ], "sources": [ "s:dicg-about", "s:declaration-of-istanbul" ], "provenance": { "default": { "tier": "cited", "source": "s:dicg-about" }, "fields": { "text.story": { "tier": "cited", "source": "s:dicg-about", "note": "the closing paragraph is marked as this project's inference" }, "geo": { "tier": "inference", "note": "the point is Istanbul, where the 2008 summit was held; the Group has no headquarters this project could source" } } }, "confidence": "high", "updated": "2026-09-16", "blurb": "The body that keeps the Declaration of Istanbul on Organ Trafficking and Transplant Tourism.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "istanbul-declaration-2008", "type": "event", "name": "The Declaration of Istanbul, 2008", "as": "The summit and text this group was formed to keep.", "rel": "event" }, { "to": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "The operation the Declaration was written about.", "rel": "procedure" }, { "to": "transplant-prohibition", "type": "rule", "name": "Buying an organ, and being transplanted abroad", "as": "The national laws written with this text as their reference.", "rel": "governs" }, { "to": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "What happens to the person who sold the organ, which the Declaration puts first.", "rel": "risk" }, { "to": "who", "type": "org", "name": "World Health Organization", "as": "The intergovernmental body whose transplant guiding principles this text sits beside.", "rel": "org" }, { "to": "circumvention", "type": "story", "name": "Circumvention", "as": "The wider pattern of travelling to do what is unlawful at home, of which this is the hardest case.", "rel": "story" } ], "source_list": [ { "id": "s:dicg-about", "kind": "org", "title": "Declaration of Istanbul Custodian Group", "publisher": "Declaration of Istanbul Custodian Group", "url": "https://www.declarationofistanbul.org/", "accessed": "2026-09-16", "note": "Custodian Group formed 2010, sponsored by The Transplantation Society and the International Society of Nephrology, endorsed by more than 80 professional organisations, 2018 edition of the Declaration" }, { "id": "s:declaration-of-istanbul", "kind": "org", "title": "The Declaration of Istanbul on Organ Trafficking and Transplant Tourism (2018 edition)", "publisher": "Declaration of Istanbul Custodian Group", "url": "https://www.declarationofistanbul.org/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:dicg-about" }, "text.story": { "tier": "cited", "source": "s:dicg-about", "note": "the closing paragraph is marked as this project's inference" }, "text.how": { "tier": "cited", "source": "s:dicg-about" }, "text.today": { "tier": "cited", "source": "s:dicg-about" }, "geo": { "tier": "inference", "note": "the point is Istanbul, where the 2008 summit was held; the Group has no headquarters this project could source" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "bogota", "type": "hub", "name": "Bogotá", "as": "The framework that governs whether a foreign patient may be transplanted at all.", "rel": "governed-by" }, { "from": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "Keeps the standing international text this page quotes, and revised it in 2018.", "rel": "org" }, { "from": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "Keeps the international text this page quotes, and revised it in Madrid in 2018.", "rel": "org" }, { "from": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "Keeps the instrument that separates travel for transplantation from commercialism and trafficking.", "rel": "org" }, { "from": "transplant-prohibition", "type": "rule", "name": "Buying an organ, and being transplanted abroad", "as": "The custodian of the professional norm this table sits under.", "rel": "org" }, { "from": "who", "type": "org", "name": "World Health Organization", "as": "The professional body whose declaration WHO's transplant principles sit beside.", "rel": "org" }, { "from": "istanbul-declaration-2008", "type": "event", "name": "The Declaration of Istanbul, 2008", "as": "The custodians, who keep the text and the endorsement list.", "rel": "org" } ] }, { "schema": 1, "id": "defiant", "type": "org", "names": { "name": "Defiant", "aliases": [ "defiant.to" ], "said": "The trade word for what it does is facilitator. It calls itself a concierge, which is the same job with a better chair." }, "region": [ "southeast-asia", "north-america" ], "facets": { "iso2": "TH", "kind": "facilitator", "status": "open" }, "text": { "what": "A medical-travel facilitator based in Chiang Mai, working with patients from the United States. It posts indicative prices for every procedure it routes, charges a flat fee rather than a commission on the treatment, and puts an interpreter in the consultation. As of 17 September 2026 its price index carries 73 procedures across 12 specialties, from orthopaedics and dental through cardiovascular, fertility, gender-affirming surgery and oncology to infusion therapies sold outside any approved indication.", "story": "The facilitator is the least regulated link in this whole chain. No country on the cast list licenses them, the content analyses that exist — Penney and colleagues read seventeen Canadian broker sites in 2010 — found that most published no risk information and few named an accreditation, and a broker's incentive usually sits on the side of the sale.\n\nThe three things worth reading on any of them are therefore structural rather than reputational: how they are paid, whether the price is posted before the consultation, and who they answer to when it goes wrong. This one is paid a stated flat fee rather than a share of the hospital bill, posts a price index, and publishes a piece on what recourse a foreign patient actually has under Thai law — which is an unusual thing for a broker to write down, because the answer is not flattering to the trade.\n\n*Inference —* the flat fee is the part that changes the arithmetic. A facilitator paid a percentage of the treatment earns more when the patient buys the larger operation at the dearer hospital; one paid a fixed fee does not, whatever else is true of it.", "how": "Intake by form, then a quoted package. The company's own site states that a person answers within a day, that the patient pays the local rate rather than a foreigner tariff, that a professional interpreter attends every appointment, and that \"every price on the table before you commit\". Its wider expatriate practice covers visas, banking and relocation alongside the treatment, which is the shape a facilitator takes when its clients are residents rather than visitors.", "today": "Working from Chiang Mai across US time zones as of September 2026. Its price index names the hospitals each procedure routes to — Bumrungrad, Bangkok Hospital, MedPark, Vejthani, Kamol, Preecha, Rutnin and others — which is more than most facilitators publish. Its numbers are advertised ranges rather than hospital package prices, and they sit on this site's price charts in that colour.", "notes": "Disclosure: this directory and Defiant are run by the same person. The record is written to the same rules as every other organization here — the claims are attributed to the company's own pages, and none of them has been audited by this project." }, "geo": { "lat": 18.7883, "lon": 98.9853, "precision": "city", "source": "s:defiant-site" }, "address": { "city": "Chiang Mai", "country": "TH" }, "links": [ { "label": "Defiant", "url": "https://defiant.to/" }, { "label": "Its price index", "url": "https://defiant.to/procedures/" }, { "label": "What recourse a patient has", "url": "https://defiant.to/recourse/" } ], "kin": [ { "to": "choosing-a-facilitator", "as": "One named example of the link in the chain that step is about.", "rel": "step" }, { "to": "facilitator", "as": "The trade word for what this company is.", "rel": "term" }, { "to": "chiang-mai", "as": "Works out of this cluster.", "rel": "place" }, { "to": "thailand", "as": "Routes its patients inside this country.", "rel": "destination" }, { "to": "malpractice-recourse", "as": "Publishes its own account of what recourse a foreign patient has under Thai law.", "rel": "risk" }, { "to": "language-consent", "as": "Its stated answer to the language barrier is an interpreter at every appointment.", "rel": "risk" }, { "to": "package-price", "as": "Sells in this form, with the price posted before the consultation.", "rel": "term" }, { "to": "getting-a-quote", "as": "The step where a facilitator like this one enters the story.", "rel": "step" } ], "sources": [ "s:defiant-site", "s:defiant-prices", "s:defiant-protection" ], "provenance": { "default": { "tier": "cited", "source": "s:defiant-site" }, "fields": { "text.story": { "tier": "inference", "note": "the structural reading of how facilitators are paid; the survey of broker sites it rests on is cited on the pathway record" }, "text.how": { "tier": "cited", "source": "s:defiant-site", "note": "the company's own statements about its own service, unaudited by this project" } } }, "confidence": "medium", "updated": "2026-09-17", "prices": [ { "procedure": "knee-replacement", "country": "TH", "amount": 10000, "amount_high": 16000, "currency": "USD", "as_of": "2026-09-17", "kind": "quoted-range", "source": "s:defiant-prices", "url": "https://defiant.to/procedures/", "note": "A facilitator's advertised range for work routed to Thai hospitals, not a hospital's own package price. The page states every number is indicative and every quote is confirmed in writing before booking. It also prints a US comparison beside each row; that comparison names no source and is not carried here.", "tier": "cited", "usd": 10000.0, "usd_high": 16000.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "hip-replacement", "country": "TH", "amount": 11000, "amount_high": 17000, "currency": "USD", "as_of": "2026-09-17", "kind": "quoted-range", "source": "s:defiant-prices", "url": "https://defiant.to/procedures/", "note": "A facilitator's advertised range for work routed to Thai hospitals, not a hospital's own package price. The page states every number is indicative and every quote is confirmed in writing before booking. It also prints a US comparison beside each row; that comparison names no source and is not carried here.", "tier": "cited", "usd": 11000.0, "usd_high": 17000.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "shoulder-replacement", "country": "TH", "amount": 10000, "amount_high": 15000, "currency": "USD", "as_of": "2026-09-17", "kind": "quoted-range", "source": "s:defiant-prices", "url": "https://defiant.to/procedures/", "note": "A facilitator's advertised range for work routed to Thai hospitals, not a hospital's own package price. The page states every number is indicative and every quote is confirmed in writing before booking. It also prints a US comparison beside each row; that comparison names no source and is not carried here.", "tier": "cited", "usd": 10000.0, "usd_high": 15000.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "spinal-fusion", "country": "TH", "amount": 15000, "amount_high": 40000, "currency": "USD", "as_of": "2026-09-17", "kind": "quoted-range", "source": "s:defiant-prices", "url": "https://defiant.to/procedures/", "note": "A facilitator's advertised range for work routed to Thai hospitals, not a hospital's own package price. The page states every number is indicative and every quote is confirmed in writing before booking. It also prints a US comparison beside each row; that comparison names no source and is not carried here.", "tier": "cited", "usd": 15000.0, "usd_high": 40000.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "knee-arthroscopy", "country": "TH", "amount": 3000, "amount_high": 7000, "currency": "USD", "as_of": "2026-09-17", "kind": "quoted-range", "source": "s:defiant-prices", "url": "https://defiant.to/procedures/", "note": "A facilitator's advertised range for work routed to Thai hospitals, not a hospital's own package price. The page states every number is indicative and every quote is confirmed in writing before booking. It also prints a US comparison beside each row; that comparison names no source and is not carried here.", "tier": "cited", "usd": 3000.0, "usd_high": 7000.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "dental-implant", "country": "TH", "amount": 1000, "amount_high": 1800, "currency": "USD", "as_of": "2026-09-17", "kind": "quoted-range", "source": "s:defiant-prices", "url": "https://defiant.to/procedures/", "note": "A facilitator's advertised range for work routed to Thai hospitals, not a hospital's own package price. The page states every number is indicative and every quote is confirmed in writing before booking. It also prints a US comparison beside each row; that comparison names no source and is not carried here.", "tier": "cited", "usd": 1000.0, "usd_high": 1800.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "rhinoplasty", "country": "TH", "amount": 2000, "amount_high": 5000, "currency": "USD", "as_of": "2026-09-17", "kind": "quoted-range", "source": "s:defiant-prices", "url": "https://defiant.to/procedures/", "note": "A facilitator's advertised range for work routed to Thai hospitals, not a hospital's own package price. The page states every number is indicative and every quote is confirmed in writing before booking. It also prints a US comparison beside each row; that comparison names no source and is not carried here.", "tier": "cited", "usd": 2000.0, "usd_high": 5000.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "facelift", "country": "TH", "amount": 4000, "amount_high": 9000, "currency": "USD", "as_of": "2026-09-17", "kind": "quoted-range", "source": "s:defiant-prices", "url": "https://defiant.to/procedures/", "note": "A facilitator's advertised range for work routed to Thai hospitals, not a hospital's own package price. The page states every number is indicative and every quote is confirmed in writing before booking. It also prints a US comparison beside each row; that comparison names no source and is not carried here.", "tier": "cited", "usd": 4000.0, "usd_high": 9000.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "liposuction", "country": "TH", "amount": 1500, "amount_high": 4000, "currency": "USD", "as_of": "2026-09-17", "kind": "quoted-range", "source": "s:defiant-prices", "url": "https://defiant.to/procedures/", "note": "A facilitator's advertised range for work routed to Thai hospitals, not a hospital's own package price. The page states every number is indicative and every quote is confirmed in writing before booking. It also prints a US comparison beside each row; that comparison names no source and is not carried here.", "tier": "cited", "usd": 1500.0, "usd_high": 4000.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "abdominoplasty", "country": "TH", "amount": 3500, "amount_high": 6500, "currency": "USD", "as_of": "2026-09-17", "kind": "quoted-range", "source": "s:defiant-prices", "url": "https://defiant.to/procedures/", "note": "A facilitator's advertised range for work routed to Thai hospitals, not a hospital's own package price. The page states every number is indicative and every quote is confirmed in writing before booking. It also prints a US comparison beside each row; that comparison names no source and is not carried here.", "tier": "cited", "usd": 3500.0, "usd_high": 6500.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "breast-augmentation", "country": "TH", "amount": 3000, "amount_high": 5500, "currency": "USD", "as_of": "2026-09-17", "kind": "quoted-range", "source": "s:defiant-prices", "url": "https://defiant.to/procedures/", "note": "A facilitator's advertised range for work routed to Thai hospitals, not a hospital's own package price. The page states every number is indicative and every quote is confirmed in writing before booking. It also prints a US comparison beside each row; that comparison names no source and is not carried here.", "tier": "cited", "usd": 3000.0, "usd_high": 5500.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "hair-transplant-fue", "country": "TH", "amount": 2500, "amount_high": 6000, "currency": "USD", "as_of": "2026-09-17", "kind": "quoted-range", "source": "s:defiant-prices", "url": "https://defiant.to/procedures/", "note": "A facilitator's advertised range for work routed to Thai hospitals, not a hospital's own package price. The page states every number is indicative and every quote is confirmed in writing before booking. It also prints a US comparison beside each row; that comparison names no source and is not carried here.", "tier": "cited", "usd": 2500.0, "usd_high": 6000.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "egg-freezing", "country": "TH", "amount": 3500, "amount_high": 6000, "currency": "USD", "as_of": "2026-09-17", "kind": "quoted-range", "source": "s:defiant-prices", "url": "https://defiant.to/procedures/", "note": "A facilitator's advertised range for work routed to Thai hospitals, not a hospital's own package price. The page states every number is indicative and every quote is confirmed in writing before booking. It also prints a US comparison beside each row; that comparison names no source and is not carried here.", "tier": "cited", "usd": 3500.0, "usd_high": 6000.0, "rate_date": "Wed, 16 Sep 2026" }, { "procedure": "executive-health-screening", "country": "TH", "amount": 400, "amount_high": 1200, "currency": "USD", "as_of": "2026-09-17", "kind": "quoted-range", "source": "s:defiant-prices", "url": "https://defiant.to/procedures/", "note": "A facilitator's advertised range for work routed to Thai hospitals, not a hospital's own package price. The page states every number is indicative and every quote is confirmed in writing before booking. It also prints a US comparison beside each row; that comparison names no source and is not carried here.", "tier": "cited", "usd": 400.0, "usd_high": 1200.0, "rate_date": "Wed, 16 Sep 2026" } ], "blurb": "A medical-travel facilitator based in Chiang Mai, working with patients from the United States.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "One named example of the link in the chain that step is about.", "rel": "step" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The trade word for what this company is.", "rel": "term" }, { "to": "chiang-mai", "type": "hub", "name": "Chiang Mai", "as": "Works out of this cluster.", "rel": "place" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Routes its patients inside this country.", "rel": "destination" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "Publishes its own account of what recourse a foreign patient has under Thai law.", "rel": "risk" }, { "to": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "Its stated answer to the language barrier is an interpreter at every appointment.", "rel": "risk" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "Sells in this form, with the price posted before the consultation.", "rel": "term" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step where a facilitator like this one enters the story.", "rel": "step" } ], "source_list": [ { "id": "s:defiant-site", "kind": "web", "title": "Defiant — medical travel concierge, Chiang Mai", "publisher": "Defiant (defiant.to)", "url": "https://defiant.to/", "accessed": "2026-09-16", "note": "the company's own site; the pricing model, the interpreter commitment and the procedure list are read off it" }, { "id": "s:defiant-prices", "kind": "web", "title": "Defiant — posted prices index", "publisher": "Defiant (defiant.to)", "url": "https://defiant.to/procedures/", "accessed": "2026-09-16" }, { "id": "s:defiant-protection", "kind": "web", "title": "Defiant — how you're protected", "publisher": "Defiant (defiant.to)", "url": "https://defiant.to/recourse/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:defiant-site" }, "text.story": { "tier": "inference", "note": "the structural reading of how facilitators are paid; the survey of broker sites it rests on is cited on the pathway record" }, "text.how": { "tier": "cited", "source": "s:defiant-site", "note": "the company's own statements about its own service, unaudited by this project" }, "text.today": { "tier": "cited", "source": "s:defiant-site" }, "geo": { "tier": "cited", "source": "s:defiant-site" }, "address": { "tier": "cited", "source": "s:defiant-site" }, "prices": { "tier": "cited", "source": "s:defiant-site" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "thailand", "type": "destination", "name": "Thailand", "as": "One facilitator routing patients into this country, with its prices posted.", "rel": "org" }, { "from": "chiang-mai", "type": "hub", "name": "Chiang Mai", "as": "A facilitator working out of this city.", "rel": "org" }, { "from": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "A named facilitator, listed here because its fee basis and its posted prices are the two things this step says are worth reading; this directory and it share an owner.", "rel": "org" }, { "from": "facilitator", "type": "term", "name": "Facilitator", "as": "A named firm doing this job, described in the same voice as any other.", "rel": "org" } ] }, { "schema": 1, "id": "dha-dubai", "type": "org", "names": { "name": "Dubai Health Authority", "aliases": [ "DHA", "هيئة الصحة بدبي" ], "said": "DHA licenses the clinic, writes the insurance rules, promotes the trade and publishes the arrivals figure. Four jobs, one body, and the fourth is the one this directory has to read." }, "region": [ "gulf", "west-asia" ], "facets": { "kind": [ "regulator", "ministry" ], "iso2": "AE", "founded": 2007, "status": "open" }, "text": { "what": "The health regulator of one emirate. In its own words, \"Dubai Health Authority (DHA) is the regulatory body responsible for overseeing and governing the healthcare sector in the Emirate of Dubai\", with a mandate covering \"regulating, licensing, and monitoring the delivery of healthcare services across both the public and private sectors\", and which \"also regulates, governs and manages health insurance, health investments and health tourism to enhance the sector's contribution to Dubai's economy\". Formed in 2007 under Law No. (13) and now constituted by Law No. (6) of 2018, it is one of four licensing regimes in the country: Abu Dhabi has its own authority, the northern emirates answer to the federal ministry, and Dubai Healthcare City licenses inside its own free-zone boundary.", "story": "The licence first, because it is the part a patient can check. DHA licenses both facilities and professionals, and Sheryan, its licensing system, carries a public search across Facilities, Professionals and the Dubai Medical Registry. A clinic in Jumeirah either appears there or it does not.\n\nThe count is the part that needs reading. In a release of 19 August 2024 the Authority reported \"more than 691,000 health tourists\" in 2023, spending AED 1.03 billion directly, against 674,000 and AED 992 million in 2022, with a further AED 2.3 billion claimed as indirect revenue. It gave the breakdown by specialty: dentistry 29 per cent, dermatology 27 per cent, gynaecology 13 per cent. Fifty-eight per cent were women. A third came from Asia, 28 per cent from the Gulf states and 23 per cent from Europe and the CIS.\n\n*Inference —* that specialty split is the most useful thing in the release, because it says what the number counts. A tally led by teeth and skin is a tally of short outpatient visits: a filling and a skin consultation are cheap, quick, repeated, and frequently bought by someone already living in the emirate. A flown-in tertiary admission is none of those things. The arithmetic confirms the shape. AED 1.03 billion across 691,000 gives about AED 1,490 a head, roughly 405 US dollars at the pegged rate — a morning at a dentist, not a hospital stay. That division is done here; the Authority publishes no per-visitor figure.\n\nAnd the release does not publish the rule that separates a visiting patient from a resident one, which is the rule the whole number turns on. *Inference —* set it beside Korea, where attracting foreign patients is a registered activity and the national report states in terms that it counts unique patients and excludes repeat visits. Both figures are around the same order of magnitude. Only one of them says what it is counting.\n\nThe outbound side of the same authority is documented far better than the inbound side. Administrative Resolution No. (14) of 2017 sets out whom DHA will send abroad for treatment and what it will pay — the care, the medicines and devices, interpreting, air ambulance where needed, repatriation of the body if the patient dies, one escort for an adult and two for a child or a patient who is elderly, paralysed, comatose or disabled — with a daily allowance schedule by destination at the back.", "how": "A facility or a professional applies for a licence through Sheryan and appears on the public register once granted; the register is the check a reader can actually perform. Insurance is mandatory for residents under the emirate's own scheme, which DHA administers. The inbound figure is compiled by the Authority and released through the Dubai Media Office rather than as a statistical publication with a method note. The outbound programme runs administratively: a medical report, a committee recommendation, then an approval that carries the flights, the escort and the per-diem with it.", "today": "As of 17 September 2026 the most recent published inbound figure is the 2023 one, released in August 2024, and no newer annual count was found on this pass. The Authority's overview page carried a last-modified date of 16 September 2026.", "notes": "The 691,000 figure is one emirate's, not the federation's, and this record does not extend it. Its counting rule is not published." }, "geo": { "lat": 25.2048, "lon": 55.2708, "precision": "city", "source": "s:dha-wikipedia" }, "address": { "city": "Dubai", "area": "Dubai", "country": "AE" }, "metrics": { "inbound_patients_year": 691000, "note": "Dubai only, 2023, as released by the Dubai Health Authority on 19 August 2024. It counts visits by non-residents to licensed Dubai providers; the release states no rule separating a visiting patient from a resident, and its own specialty split — 29% dentistry, 27% dermatology, 13% gynaecology — points at short outpatient contacts rather than admissions. Direct spend AED 1.03 billion, with AED 2.3 billion further claimed as indirect revenue. The same figure is carried on the UAE destination record; it is one emirate's count, and there is no federal equivalent.", "as_of": "2023", "source": "s:dubai-media-office-health-2023", "url": "https://mediaoffice.ae/en/news/2024/august/19-08/dubai-welcomes-more-than-691k" }, "kin": [ { "to": "uae", "as": "The federation this authority licenses one emirate of, and whose only published inbound count is its own.", "rel": "place" }, { "to": "dubai", "as": "The emirate itself: everything outside the free-zone boundary answers to this licence.", "rel": "hub" }, { "to": "uae-clinic-licensing", "as": "Why a licence here names an emirate rather than a country.", "rel": "rule" }, { "to": "gcc-sponsored-treatment-abroad", "as": "The outbound programme it runs under the 2017 bylaw, escort allowance and all.", "rel": "rule" }, { "to": "american-hospital-dubai", "as": "One of the private hospitals trading under this licence.", "rel": "facility" }, { "to": "dental-implant", "as": "Dentistry is 29 per cent of what the emirate's own count says its visitors came for.", "rel": "procedure" }, { "to": "khidi", "as": "The other agency that promotes and counts at once — and publishes its counting rule.", "rel": "contrast" }, { "to": "mhtc", "as": "Malaysia's equivalent, publishing a visit count rather than a patient count.", "rel": "contrast" }, { "to": "jci", "as": "The voluntary mark Dubai's private hospitals buy on top of this compulsory licence.", "rel": "org" }, { "to": "counting-patients", "as": "Why 691,000 cannot be read until somebody says what a one in it is.", "rel": "story" }, { "to": "the-escort-burden", "as": "Written into this authority's own bylaw, with a daily allowance attached.", "rel": "risk" } ], "links": [ { "label": "DHA overview", "url": "https://www.dha.gov.ae/en/AboutUs" }, { "label": "Sheryan public search", "url": "https://services.dha.gov.ae/sheryan/wps/portal/home/public-search" }, { "label": "2023 health travel figures", "url": "https://mediaoffice.ae/en/news/2024/august/19-08/dubai-welcomes-more-than-691k" } ], "sources": [ "s:dha-about", "s:dha-law-6-2018", "s:dha-sheryan", "s:dha-wikipedia", "s:dubai-media-office-health-2023", "s:dubai-resolution-14-2017", "s:seoul-foreign-patients-2024" ], "provenance": { "default": { "tier": "cited", "source": "s:dha-about" }, "fields": { "text.story": { "tier": "cited", "source": "s:dubai-media-office-health-2023", "note": "the licence and register description is from the Authority's own pages, the 2023 figures and splits from the media office release, the outbound entitlements from Administrative Resolution No. (14) of 2017, the Korean comparison from the 2024 Korean reporting; the per-visitor arithmetic and the two paragraphs marked inference are this project's" }, "metrics": { "tier": "cited", "source": "s:dubai-media-office-health-2023" }, "geo": { "tier": "inference", "source": "s:dha-wikipedia", "note": "city precision only; the Authority's head office is in Dubai and no street point is pinned here" }, "facets": { "tier": "cited", "source": "s:dha-wikipedia", "note": "formed 2007 under Law No. (13), launched March 2008, successor to the Department of Health and Medical Services of 1973" } } }, "x_commons_files": [ "File:Dubai Health Authority headquarters.jpg" ], "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "The health regulator of one emirate. In its own words, \"Dubai Health Authority (DHA) is the regulatory body responsible for overseeing and governing the healthcare sector in the Emirate of Dubai\", with a mandate…", "region_terms": [ { "key": "gulf", "name": "The Gulf", "note": "the UAE, Saudi Arabia, Qatar, Kuwait, Oman, Bahrain — a source market that is building itself into a destination" }, { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "uae", "type": "destination", "name": "United Arab Emirates", "as": "The federation this authority licenses one emirate of, and whose only published inbound count is its own.", "rel": "place" }, { "to": "dubai", "type": "hub", "name": "Dubai", "as": "The emirate itself: everything outside the free-zone boundary answers to this licence.", "rel": "hub" }, { "to": "uae-clinic-licensing", "type": "rule", "name": "Licensing a clinic in the United Arab Emirates", "as": "Why a licence here names an emirate rather than a country.", "rel": "rule" }, { "to": "gcc-sponsored-treatment-abroad", "type": "rule", "name": "Gulf state-sponsored treatment abroad", "as": "The outbound programme it runs under the 2017 bylaw, escort allowance and all.", "rel": "rule" }, { "to": "american-hospital-dubai", "type": "facility", "name": "American Hospital Dubai", "as": "One of the private hospitals trading under this licence.", "rel": "facility" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "Dentistry is 29 per cent of what the emirate's own count says its visitors came for.", "rel": "procedure" }, { "to": "khidi", "type": "org", "name": "Korea Health Industry Development Institute", "as": "The other agency that promotes and counts at once — and publishes its counting rule.", "rel": "contrast" }, { "to": "mhtc", "type": "org", "name": "Malaysia Healthcare Travel Council", "as": "Malaysia's equivalent, publishing a visit count rather than a patient count.", "rel": "contrast" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The voluntary mark Dubai's private hospitals buy on top of this compulsory licence.", "rel": "org" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why 691,000 cannot be read until somebody says what a one in it is.", "rel": "story" }, { "to": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "Written into this authority's own bylaw, with a daily allowance attached.", "rel": "risk" } ], "source_list": [ { "id": "s:dha-about", "kind": "gov", "title": "DHA Overview", "publisher": "Dubai Health Authority", "url": "https://www.dha.gov.ae/en/AboutUs", "accessed": "2026-09-17", "note": "'Dubai Health Authority (DHA) is the regulatory body responsible for overseeing and governing the healthcare sector in the Emirate of Dubai'; core mandate of 'regulating, licensing, and monitoring the delivery of healthcare services across both the public and private sectors'; 'DHA also regulates, governs and manages health insurance, health investments and health tourism to enhance the sector's contribution to Dubai's economy'. Page footer read on 17 September 2026 gives a last modification date of 16/09/2026." }, { "id": "s:dha-law-6-2018", "kind": "law", "title": "Law No. (6) of 2018 Concerning the Dubai Health Authority", "publisher": "Government of Dubai Legal Affairs Department", "year": 2018, "url": "https://dlp.dubai.gov.ae/Legislation%20Reference/2018/Law%20No.%20(6)%20of%202018%20Concerning%20the%20Dubai%20Health%20Authority.pdf", "accessed": "2026-09-16", "note": "the current constituting law; licensing of health facilities sits with the Authority, and the law repeals any contradicting provision in other legislation" }, { "id": "s:dha-sheryan", "kind": "web", "title": "Sheryan — Dubai Health Licensing System, public search", "publisher": "Dubai Health Authority", "url": "https://services.dha.gov.ae/sheryan/wps/portal/home/public-search", "accessed": "2026-09-16", "note": "public search across Facilities, Professionals and the Dubai Medical Registry" }, { "id": "s:dha-wikipedia", "kind": "wikipedia", "title": "Dubai Health Authority", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Dubai_Health_Authority", "accessed": "2026-09-16", "note": "formed 2007 under Law 13, launched March 2008, successor to the Department of Health and Medical Services of 1973; operates Latifa, Dubai, Rashid and Hatta hospitals" }, { "id": "s:dubai-media-office-health-2023", "kind": "gov", "title": "Dubai welcomes more than 691,000 international health travellers in 2023", "publisher": "Dubai Media Office, Government of Dubai", "url": "https://mediaoffice.ae/en/news/2024/august/19-08/dubai-welcomes-more-than-691k", "accessed": "2026-09-16", "note": "Dubai Health Authority figures released 19 August 2024; gives arrivals, spend, regional split and the leading specialties. The release does not publish the counting rule behind the headline number." }, { "id": "s:dubai-resolution-14-2017", "kind": "law", "title": "Administrative Resolution No. (14) of 2017 Approving the Bylaw for Sending Patients for Overseas Medical Treatment", "publisher": "Government of Dubai Legislation portal", "url": "https://dlp.dubai.gov.ae/Legislation%20Reference/2017/Administrative%20Resolution%20No.%20(14)%20of%202017%20Approving%20the%20Bylaw%20for%20Sending%20Patients.html", "accessed": "2026-09-16", "note": "issued 6 February 2017 by the Director General of the Dubai Health Authority; sets eligibility, what the state pays, escort entitlement and a daily allowance schedule by destination country" }, { "id": "s:seoul-foreign-patients-2024", "kind": "web", "title": "Seoul Draws 1M International Medical Tourists in 2024 with ₩1.2T in Medical Spending", "publisher": "Seoul Metropolitan Government", "year": 2026, "url": "https://english.seoul.go.kr/seoul-draws-1m-international-medical-tourists-in-2024-with-%E2%82%A91-2t-in-medical-spending/", "accessed": "2026-09-16", "note": "reports the MOHW and KHIDI 2024 count: 1,170,467 patients from 202 countries, 999,642 of them treated in Seoul" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:dha-about" }, "text.story": { "tier": "cited", "source": "s:dubai-media-office-health-2023", "note": "the licence and register description is from the Authority's own pages, the 2023 figures and splits from the media office release, the outbound entitlements from Administrative Resolution No. (14) of 2017, the Korean comparison from the 2024 Korean reporting; the per-visitor arithmetic and the two paragraphs marked inference are this project's" }, "text.how": { "tier": "cited", "source": "s:dha-about" }, "text.today": { "tier": "cited", "source": "s:dha-about" }, "geo": { "tier": "inference", "source": "s:dha-wikipedia", "note": "city precision only; the Authority's head office is in Dubai and no street point is pinned here" }, "address": { "tier": "cited", "source": "s:dha-about" }, "metrics": { "tier": "cited", "source": "s:dubai-media-office-health-2023" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "uae", "type": "destination", "name": "United Arab Emirates", "as": "The authority that licenses the clinics and publishes the arrivals figure.", "rel": "governed-by" }, { "from": "dubai", "type": "hub", "name": "Dubai", "as": "The emirate's health authority, which licenses everything outside the free zone boundary.", "rel": "governed-by" }, { "from": "gcc-sponsored-treatment-abroad", "type": "rule", "name": "Gulf state-sponsored treatment abroad", "as": "The authority that issued the bylaw and selects the hospital.", "rel": "org" }, { "from": "uae-clinic-licensing", "type": "rule", "name": "Licensing a clinic in the United Arab Emirates", "as": "The authority that licenses, registers and publishes.", "rel": "org" } ] }, { "schema": 1, "id": "dnv-healthcare", "type": "org", "names": { "name": "DNV Healthcare", "aliases": [ "DNV", "Det Norske Veritas", "NIAHO", "DIAS" ], "said": "A ship classification society that accredits hospitals. The lineage is not a joke; the method comes straight from it." }, "region": [ "global", "europe-north", "north-america" ], "facets": { "kind": "accreditor", "iso2": "NO", "founded": 1864, "status": "open" }, "text": { "what": "The healthcare accreditation arm of DNV, a Norwegian assurance and classification company founded in 1864, owned by the Det Norske Veritas Foundation and run from Høvik outside Oslo. It accredits hospitals in the United States under NIAHO, its own standard aligned to the federal Conditions of Participation, and hospitals and clinics elsewhere under DIAS. Both are built on ISO 9001 quality management.", "story": "DNV began by classing ships: an insurer needed to know whether a hull was sound, and a third party was paid to say so. The healthcare programme carries that inheritance in its structure — a management-system standard, a certificate, and a surveyor who returns.\n\nThe United States programme matters to this subject because of what it proves about the market. Until 2008 the Joint Commission was effectively the only route to Medicare deeming; DNV entering with its own deeming authority made accreditation a thing a hospital could shop for. *Trade practice —* once a hospital can choose its accreditor, the accreditor is competing for the hospital's business, which is the commercial fact underneath every voluntary scheme on this site.\n\n*Inference —* the ISO 9001 base is the genuinely different thing here. ISO 9001 audits a quality management system rather than a clinical standard, and a system audit answers a narrower question than most badge walls imply.", "how": "A hospital applies and pays. The NIAHO programme is unusual in surveying annually rather than at the end of a three-year cycle, which changes what the certificate means: it is a recent inspection rather than one that may be nearly three years old. The DIAS programme serves hospitals and clinics outside the United States on the same ISO 9001 base.", "today": "As of 16 September 2026 DNV runs NIAHO for acute care, critical access and psychiatric hospitals in the United States, and DIAS internationally. The pages read for this record do not state the fee, the public status of the accredited list, or whether the standards are downloadable." }, "geo": { "lat": 59.8899, "lon": 10.5233, "precision": "city", "source": "s:dnv-wikipedia" }, "address": { "city": "Høvik", "country": "NO" }, "kin": [ { "to": "jci", "as": "The scheme it broke a near-monopoly on in the United States in 2008.", "rel": "contrast" }, { "to": "united-states", "as": "Where its NIAHO programme carries federal deeming weight.", "rel": "place" }, { "to": "achsi", "as": "Another national scheme selling itself abroad, on a different standards base.", "rel": "contrast" }, { "to": "the-accreditation-question", "as": "Where a system audit and a clinical audit are separated.", "rel": "story" } ], "links": [ { "label": "DNV hospital accreditation", "url": "https://www.dnv.com/services/hospital-accreditation-niaho-and-dias-programs/" } ], "sources": [ "s:dnv-niaho", "s:dnv-wikipedia" ], "provenance": { "default": { "tier": "cited", "source": "s:dnv-wikipedia" }, "fields": { "text.story": { "tier": "tradition", "note": "the 2008 entry and the annual survey interval are widely reported in the American hospital trade press but are not on the DNV pages read here; marked inline" }, "text.how": { "tier": "tradition", "note": "same" }, "facets": { "tier": "cited", "source": "s:dnv-wikipedia", "note": "1864 is the founding of DNV, not of the healthcare programme" } } }, "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "The healthcare accreditation arm of DNV, a Norwegian assurance and classification company founded in 1864, owned by the Det Norske Veritas Foundation and run from Høvik outside Oslo.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "europe-north", "name": "Northern Europe", "note": "the Nordics and the Baltics" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The scheme it broke a near-monopoly on in the United States in 2008.", "rel": "contrast" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "Where its NIAHO programme carries federal deeming weight.", "rel": "place" }, { "to": "achsi", "type": "org", "name": "ACHS International", "as": "Another national scheme selling itself abroad, on a different standards base.", "rel": "contrast" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Where a system audit and a clinical audit are separated.", "rel": "story" } ], "source_list": [ { "id": "s:dnv-niaho", "kind": "web", "title": "Hospital accreditation — NIAHO and DIAS programs", "publisher": "DNV", "url": "https://www.dnv.com/services/hospital-accreditation-niaho-and-dias-programs/", "accessed": "2026-09-16", "note": "NIAHO for US hospitals and DIAS for hospitals and clinics outside it, both built on ISO 9001" }, { "id": "s:dnv-wikipedia", "kind": "wikipedia", "title": "DNV", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/DNV", "accessed": "2026-09-16", "note": "1864 founding, Høvik headquarters, ownership by the Det Norske Veritas Foundation, and the Business Assurance division that certifies American hospitals" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:dnv-wikipedia" }, "text.story": { "tier": "tradition", "note": "the 2008 entry and the annual survey interval are widely reported in the American hospital trade press but are not on the DNV pages read here; marked inline" }, "text.how": { "tier": "tradition", "note": "same" }, "text.today": { "tier": "cited", "source": "s:dnv-wikipedia" }, "geo": { "tier": "cited", "source": "s:dnv-wikipedia" }, "address": { "tier": "cited", "source": "s:dnv-wikipedia" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Surveys annually and audits a management system, which is a narrower question.", "rel": "org" } ] }, { "schema": 1, "id": "eshre", "type": "org", "names": { "name": "European Society of Human Reproduction and Embryology", "aliases": [ "ESHRE" ], "said": "ESHRE writes the guidelines and collects the European IVF numbers. The numbers arrive from national registries, already added up." }, "region": [ "europe-west", "europe-central", "europe-south", "europe-north", "europe-east" ], "facets": { "kind": "professional-society", "iso2": "BE", "founded": 1985, "status": "open" }, "text": { "what": "The European professional society for reproductive medicine and embryology, founded in 1985 and run from Strombeek-Bever outside Brussels. It publishes clinical guidelines and journals, certifies practitioners, and runs the European IVF Monitoring Consortium, which assembles assisted reproduction figures from national registries.", "story": "Fertility is the corner of cross-border care with the best data in the world and it is still not good enough to answer the question a patient asks.\n\nThe European IVF Monitoring Consortium is \"a group of representatives of national registries on assisted reproductive technology\", and data submission is restricted to those national representatives. So what arrives at ESHRE is what each country's registry already holds, in whatever shape that country collects it, and the European picture is a stack of national aggregates rather than a clinic-by-clinic table.\n\n*Inference —* that is the granularity problem in one sentence. A patient choosing between a Spanish clinic and a Czech one can read a European report and learn what Spain and Czechia did in aggregate. Only two regulators in the world publish clinic-level outcomes for a patient to compare: the British authority and the American federal reporting. Everywhere else, the clinic's own figure is the clinic's own claim.\n\nESHRE has begun a newer project, EuMAR, aimed at cycle-level European monitoring, which would change that picture if it delivers.", "how": "National registry representatives submit to a core dataset; ESHRE compiles, publishes with ICMART and in its own journals, and issues guidelines separately through working groups. Membership is by subscription and the society runs an annual meeting.", "today": "As of 16 September 2026 ESHRE's registered office is at Nijverheidslaan 3, Strombeek-Bever, and the EIM data collection for 2023 is the cycle named on its consortium page." }, "geo": { "lat": 50.902, "lon": 4.339, "precision": "street", "source": "s:eshre-about" }, "address": { "street": "Nijverheidslaan 3, 1st floor", "city": "Strombeek-Bever", "country": "BE", "postcode": "1853" }, "kin": [ { "to": "ivf", "as": "The treatment its consortium counts across Europe.", "rel": "procedure" }, { "to": "icmart", "as": "The global registry body it feeds and publishes with.", "rel": "org" }, { "to": "hfea", "as": "The one European regulator that publishes clinic-level results rather than national aggregates.", "rel": "contrast" }, { "to": "egg-donation", "as": "The treatment that moves the most patients across European borders, and the hardest to count.", "rel": "procedure" }, { "to": "donor-anonymity-law", "as": "The legal difference that drives much of the European fertility traffic.", "rel": "governs" }, { "to": "reproductive-exile", "as": "The phrase researchers use for this traffic, and the argument inside it.", "rel": "term" }, { "to": "what-the-data-cannot-see", "as": "Where national aggregates and clinic-level results are set against each other.", "rel": "story" } ], "links": [ { "label": "ESHRE", "url": "https://www.eshre.eu/" }, { "label": "European IVF Monitoring Consortium", "url": "https://www.eshre.eu/Data-collection-and-research/Consortia/EIM" } ], "sources": [ "s:eshre-about", "s:eshre-eim" ], "provenance": { "default": { "tier": "cited", "source": "s:eshre-about" }, "fields": { "text.story": { "tier": "cited", "source": "s:eshre-eim", "note": "the third paragraph is marked as this project's inference" }, "facets": { "tier": "tradition", "note": "the 1985 founding by Robert Edwards and Jean Cohen is on ESHRE's history page, which this project read only in a search summary" } } }, "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "The European professional society for reproductive medicine and embryology, founded in 1985 and run from Strombeek-Bever outside Brussels.", "region_terms": [ { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" }, { "key": "europe-central", "name": "Central Europe", "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia" }, { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" }, { "key": "europe-north", "name": "Northern Europe", "note": "the Nordics and the Baltics" }, { "key": "europe-east", "name": "Eastern Europe", "note": "Romania, Bulgaria, Serbia, Ukraine, Moldova, Albania, North Macedonia" } ], "kin_out": [ { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment its consortium counts across Europe.", "rel": "procedure" }, { "to": "icmart", "type": "org", "name": "International Committee for Monitoring Assisted Reproductive Technologies", "as": "The global registry body it feeds and publishes with.", "rel": "org" }, { "to": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "The one European regulator that publishes clinic-level results rather than national aggregates.", "rel": "contrast" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The treatment that moves the most patients across European borders, and the hardest to count.", "rel": "procedure" }, { "to": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The legal difference that drives much of the European fertility traffic.", "rel": "governs" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The phrase researchers use for this traffic, and the argument inside it.", "rel": "term" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "Where national aggregates and clinic-level results are set against each other.", "rel": "story" } ], "source_list": [ { "id": "s:eshre-about", "kind": "org", "title": "About us", "publisher": "European Society of Human Reproduction and Embryology", "url": "https://www.eshre.eu/Home/About-us", "accessed": "2026-09-16", "note": "registered office at Nijverheidslaan 3, Strombeek-Bever, Belgium; guidelines and journals; the EuMAR monitoring project" }, { "id": "s:eshre-eim", "kind": "org", "title": "European IVF Monitoring Consortium (EIM)", "publisher": "European Society of Human Reproduction and Embryology", "url": "https://www.eshre.eu/Data-collection-and-research/Consortia/EIM", "accessed": "2026-09-16", "note": "a group of representatives of national ART registries; data submission restricted to national EIM representatives" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:eshre-about" }, "text.story": { "tier": "cited", "source": "s:eshre-eim", "note": "the third paragraph is marked as this project's inference" }, "text.how": { "tier": "cited", "source": "s:eshre-about" }, "text.today": { "tier": "cited", "source": "s:eshre-about" }, "geo": { "tier": "cited", "source": "s:eshre-about" }, "address": { "tier": "cited", "source": "s:eshre-about" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "czechia", "type": "destination", "name": "Czechia", "as": "The society whose registry counts these cycles, clinic by clinic.", "rel": "org" }, { "from": "barcelona", "type": "hub", "name": "Barcelona", "as": "The society whose registry return is the count this record stands on.", "rel": "measured-by" }, { "from": "prague", "type": "hub", "name": "Prague", "as": "The society whose registry return is the only count this record stands on.", "rel": "measured-by" }, { "from": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "Publishes the European pregnancy rate per transfer after egg donation.", "rel": "measures" }, { "from": "icsi", "type": "procedure", "name": "Intracytoplasmic sperm injection", "as": "Publishes the European registry figures that put ICSI at three-quarters of all treatment.", "rel": "measures" }, { "from": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "Runs the European register behind the continental figures, and the taskforce that counted cross-border patients.", "rel": "measures" }, { "from": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The society whose survey is the widest comparative reading of European law here.", "rel": "org" }, { "from": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "The society whose European survey maps the surrounding fertility law.", "rel": "org" }, { "from": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "The European society whose consortium collects national aggregates where this body publishes clinics.", "rel": "contrast" }, { "from": "icmart", "type": "org", "name": "International Committee for Monitoring Assisted Reproductive Technologies", "as": "The European society it publishes alongside, and whose consortium supplies the European rows.", "rel": "org" }, { "from": "cycle", "type": "term", "name": "Cycle", "as": "The society whose European registry counts these cycles across countries.", "rel": "org" }, { "from": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The society whose taskforce adopted the compromise phrase and whose registry counts the cycles.", "rel": "org" } ] }, { "schema": 1, "id": "eu-national-contact-points", "type": "org", "names": { "name": "EU National Contact Points for cross-border healthcare", "aliases": [ "NCPs", "National Contact Points" ], "said": "Every member state has one. Most patients have never heard of it, and where it sits differs by country." }, "region": [ "europe-west", "europe-central", "europe-south", "europe-north", "europe-east" ], "facets": { "kind": "ministry", "status": "in-force" }, "text": { "what": "The information bodies each EU member state must designate under Directive 2011/24/EU on patients' rights in cross-border healthcare. Each must give patients clear, accurate information about seeking treatment in another member state: what is covered, what needs prior authorisation, how reimbursement works, how prescriptions carry across, and how to complain. Member states report annually, and the Commission publishes the data.", "story": "This is the only place in the world where a state has been obliged to tell its own residents how to be treated abroad, and to count what happened.\n\nThe counting is the part this site cares about. Member states report each year on care given with and without prior authorisation, requests for information, treatment provided, reimbursements made, and the reasons care was or was not reimbursed. The Commission has published overviews covering 2015 to 2017 and 2018 to 2020.\n\nThe returns have a known weakness the Commission states itself: \"Not all Member States are able to maintain a strict separation between the data on reimbursements for healthcare under Directive 2011/24/EU and the Regulation (EC) No 883/2004 or under bilateral cross-border agreements.\" *Inference —* so the European figure is a floor with a fuzzy edge, built from administrative claims, and it counts only patients who went through a reimbursement route. Everyone who paid a Budapest dentist in cash is outside it, which in this field is most people.", "how": "Each member state decides where its contact point sits — a health ministry, a sickness fund, a patients' organisation — and the Commission maintains the list. A patient asks the contact point in their own country about treatment abroad, and the contact point in the treating country about the provider. Reporting flows the other way, annually, to the Commission.", "today": "As of 16 September 2026 the Commission's cross-border healthcare pages carry monitoring reports from 2015, 2018 and 2022 and the Member State data reports behind them.", "notes": "The directive covers planned treatment in another member state. It does not cover emergency care on holiday, which runs under a different instrument, and the two are frequently confused." }, "kin": [ { "to": "eu-directive-2011-24", "as": "The instrument that created these bodies and the reporting behind them.", "rel": "governed-by" }, { "to": "s2-route", "as": "The older prior-authorisation route these figures are hard to separate from.", "rel": "contrast" }, { "to": "eurostat", "as": "The other European stream, which counts spending rather than patients and excludes the receiving end.", "rel": "contrast" }, { "to": "reading-the-exclusions", "as": "The step where a patient discovers what their own state will and will not refund.", "rel": "step" }, { "to": "hungary", "as": "The destination most of this reporting's dental traffic goes to.", "rel": "place" }, { "to": "counting-patients", "as": "Where the administrative floor and the cash trade are set side by side.", "rel": "story" } ], "links": [ { "label": "Cross-border healthcare — European Commission", "url": "https://health.ec.europa.eu/cross-border-healthcare/overview_en" } ], "sources": [ "s:ec-cross-border-overview", "s:eu-directive-2011-24" ], "provenance": { "default": { "tier": "cited", "source": "s:ec-cross-border-overview" }, "fields": { "text.story": { "tier": "cited", "source": "s:ec-cross-border-overview", "note": "the quoted sentence on data separation comes from the Commission's own reporting as summarised on the cross-border healthcare pages; the closing paragraph is marked as this project's inference" } } }, "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "The information bodies each EU member state must designate under Directive 2011/24/EU on patients' rights in cross-border healthcare.", "region_terms": [ { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" }, { "key": "europe-central", "name": "Central Europe", "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia" }, { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" }, { "key": "europe-north", "name": "Northern Europe", "note": "the Nordics and the Baltics" }, { "key": "europe-east", "name": "Eastern Europe", "note": "Romania, Bulgaria, Serbia, Ukraine, Moldova, Albania, North Macedonia" } ], "kin_out": [ { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The instrument that created these bodies and the reporting behind them.", "rel": "governed-by" }, { "to": "s2-route", "type": "rule", "name": "The S2 route", "as": "The older prior-authorisation route these figures are hard to separate from.", "rel": "contrast" }, { "to": "eurostat", "type": "org", "name": "Eurostat", "as": "The other European stream, which counts spending rather than patients and excludes the receiving end.", "rel": "contrast" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step where a patient discovers what their own state will and will not refund.", "rel": "step" }, { "to": "hungary", "type": "destination", "name": "Hungary", "as": "The destination most of this reporting's dental traffic goes to.", "rel": "place" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Where the administrative floor and the cash trade are set side by side.", "rel": "story" } ], "source_list": [ { "id": "s:ec-cross-border-overview", "kind": "web", "title": "Cross-border healthcare — overview", "publisher": "European Commission, Directorate-General for Health and Food Safety", "url": "https://health.ec.europa.eu/cross-border-healthcare/overview_en", "accessed": "2026-09-16", "note": "National Contact Points, the cross-border prescription rules, and the annual Member State data reports on prior authorisation and reimbursement" }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:ec-cross-border-overview" }, "text.story": { "tier": "cited", "source": "s:ec-cross-border-overview", "note": "the quoted sentence on data separation comes from the Commission's own reporting as summarised on the cross-border healthcare pages; the closing paragraph is marked as this project's inference" }, "text.how": { "tier": "cited", "source": "s:ec-cross-border-overview" }, "text.today": { "tier": "cited", "source": "s:ec-cross-border-overview" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "belgium", "type": "destination", "name": "Belgium", "as": "The office that reported a blank rather than a partial number.", "rel": "org" }, { "from": "complaint-and-claim", "type": "pathway", "name": "Complaint and claim", "as": "The bodies Article 6 obliges each Member State to run.", "rel": "org" }, { "from": "cross-border-prescriptions", "type": "rule", "name": "A prescription that crosses a border", "as": "Who a patient asks when a pharmacy refuses.", "rel": "org" }, { "from": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The bodies Article 6 obliges every Member State to run.", "rel": "org" }, { "from": "eurostat", "type": "org", "name": "Eurostat", "as": "The other European reporting stream on cross-border care, and the one that does count patients.", "rel": "contrast" }, { "from": "directive-2011-24-adopted", "type": "event", "name": "Directive 2011/24/EU adopted, 9 March 2011", "as": "The offices Article 6 created, and the thin place where a patient meets the law.", "rel": "org" }, { "from": "patient-mobility", "type": "term", "name": "Patient mobility", "as": "The network the directive created to answer the questions this word raises.", "rel": "org" } ] }, { "schema": 1, "id": "eurostat", "type": "org", "names": { "name": "Eurostat", "aliases": [ "European Statistical Office", "DG ESTAT" ], "said": "Eurostat counts what residents consume. It does not count what a country sells to foreigners, and it says so in the metadata." }, "region": [ "europe-west", "global" ], "facets": { "kind": "registry", "iso2": "LU", "status": "open" }, "text": { "what": "The statistical office of the European Union, a Directorate-General of the European Commission based in the Kirchberg district of Luxembourg City. Its health care expenditure collection runs on the System of Health Accounts 2011 framework, with member states, EFTA countries and several candidates reporting annually under Commission Regulation 2015/359 and, from reference year 2021, Regulation 2021/1901.", "story": "One sentence in the Eurostat metadata decides what this site can and cannot carry from European health accounts: \"exports of health care goods and services (to non-resident units) are excluded, whereas imports of health care goods and services for final use are included\".\n\nRead it slowly. A German patient treated in Budapest appears in German health expenditure, as an import. The Hungarian clinic's income from that patient does not appear in Hungarian health expenditure at all. The accounts follow residents, so the receiving end of every cross-border journey is invisible by design.\n\n*Inference —* that is why a destination country's health spending figures can look flat while its surgical export trade grows, and why no European statistic answers the question a reader most wants answered: how many people came here for treatment, and what did they pay. The accounts were not built to answer it. They were built to measure what a population consumes.", "how": "Member states submit health accounts by 30 April two years after the reference year. Eurostat disseminates twice a year — a first release around November and a second the following January — across four summary tables and four cross-classification tables by provider, function and financing scheme.", "today": "As of 16 September 2026 the collection covers EU member states, Norway, Liechtenstein, Iceland and Switzerland, plus Bosnia and Herzegovina, Georgia, Moldova, Montenegro and Serbia; United Kingdom data ends at 2019." }, "geo": { "lat": 49.6333, "lon": 6.1697, "precision": "city", "source": "s:eurostat-wikipedia" }, "address": { "city": "Luxembourg", "area": "Kirchberg", "country": "LU" }, "kin": [ { "to": "eu-national-contact-points", "as": "The other European reporting stream on cross-border care, and the one that does count patients.", "rel": "contrast" }, { "to": "oecd", "as": "Co-author of the accounting framework whose exclusion rule this record turns on.", "rel": "org" }, { "to": "hungary", "as": "A destination whose dental export trade is invisible in its own health accounts.", "rel": "place" }, { "to": "what-the-data-cannot-see", "as": "The exclusion sentence, and what it hides, at length.", "rel": "story" }, { "to": "eu-directive-2011-24", "as": "The instrument that generates the European patient-mobility figures the accounts cannot.", "rel": "governed-by" } ], "links": [ { "label": "Health care expenditure (SHA 2011) metadata", "url": "https://ec.europa.eu/eurostat/cache/metadata/en/hlth_sha11_esms.htm" } ], "sources": [ "s:eurostat-sha11-metadata", "s:eurostat-wikipedia" ], "provenance": { "default": { "tier": "cited", "source": "s:eurostat-sha11-metadata" }, "fields": { "text.story": { "tier": "cited", "source": "s:eurostat-sha11-metadata", "note": "the quoted sentence is verbatim from the metadata; the closing paragraph is marked as this project's inference" } } }, "confidence": "high", "updated": "2026-09-16", "blurb": "The statistical office of the European Union, a Directorate-General of the European Commission based in the Kirchberg district of Luxembourg City.", "region_terms": [ { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" }, { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "eu-national-contact-points", "type": "org", "name": "EU National Contact Points for cross-border healthcare", "as": "The other European reporting stream on cross-border care, and the one that does count patients.", "rel": "contrast" }, { "to": "oecd", "type": "org", "name": "Organisation for Economic Co-operation and Development", "as": "Co-author of the accounting framework whose exclusion rule this record turns on.", "rel": "org" }, { "to": "hungary", "type": "destination", "name": "Hungary", "as": "A destination whose dental export trade is invisible in its own health accounts.", "rel": "place" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "The exclusion sentence, and what it hides, at length.", "rel": "story" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The instrument that generates the European patient-mobility figures the accounts cannot.", "rel": "governed-by" } ], "source_list": [ { "id": "s:eurostat-sha11-metadata", "kind": "dataset", "title": "Health care expenditure (SHA 2011) (hlth_sha11) — metadata", "publisher": "Eurostat", "url": "https://ec.europa.eu/eurostat/cache/metadata/en/hlth_sha11_esms.htm", "accessed": "2026-09-16", "note": "carries the sentence that exports of health care goods and services to non-resident units are excluded while imports for final use are included; legal basis Commission Regulations 2015/359 and 2021/1901" }, { "id": "s:eurostat-wikipedia", "kind": "wikipedia", "title": "Eurostat", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Eurostat", "accessed": "2026-09-16", "note": "Directorate-General of the European Commission, based in the Kirchberg district of Luxembourg City" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:eurostat-sha11-metadata" }, "text.story": { "tier": "cited", "source": "s:eurostat-sha11-metadata", "note": "the quoted sentence is verbatim from the metadata; the closing paragraph is marked as this project's inference" }, "text.how": { "tier": "cited", "source": "s:eurostat-sha11-metadata" }, "text.today": { "tier": "cited", "source": "s:eurostat-sha11-metadata" }, "geo": { "tier": "cited", "source": "s:eurostat-sha11-metadata" }, "address": { "tier": "cited", "source": "s:eurostat-sha11-metadata" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "eu-national-contact-points", "type": "org", "name": "EU National Contact Points for cross-border healthcare", "as": "The other European stream, which counts spending rather than patients and excludes the receiving end.", "rel": "contrast" }, { "from": "oecd", "type": "org", "name": "Organisation for Economic Co-operation and Development", "as": "The partner that runs the same accounting framework for Europe, and excludes exports from it.", "rel": "org" } ] }, { "schema": 1, "id": "gha", "type": "org", "names": { "name": "Global Healthcare Accreditation", "aliases": [ "GHA" ], "said": "GHA certifies the journey. A hospital can hold it and hold no clinical accreditation at all." }, "region": [ "global" ], "facets": { "kind": "accreditor", "iso2": "US", "founded": 2016, "status": "open" }, "text": { "what": "An accreditation body founded in 2016 for medical travel rather than for clinical care. Its flagship standards address what it calls the medical travel care continuum across three competencies — \"Patient Experience, Sustainable Business Practices, and Patient-Focused Clinical Processes\" — from the first enquiry to recovery at home. Its founder co-founded the Medical Tourism Association, and the two remain strategic partners on training, accreditation and certification.", "story": "GHA occupies the gap the clinical schemes leave. JCI surveys the hospital; nobody surveys the phone call, the quotation, the airport transfer, the interpreter, the discharge pack or the handover to a doctor eight time zones away. Those are where cross-border care actually fails, and GHA sells an inspection of them.\n\nThe standards themselves hold an ISQua EEA award — Standards for Medical Travel 5.0 — so the chain of who checks the checker is complete and named. The commercial relationship with the trade association that promotes the industry is also named, by both bodies, on their own pages. A reader can decide what to make of that; this record's job is to say it is there.\n\n*Inference —* the pathway scope is the reason a GHA mark and a JCI mark are not substitutes and should never be added together. One says a ward was inspected. The other says a customer journey was.", "how": "An organisation applies and pays, is assessed against the Standards for Medical Travel, and is listed on a public directory of accredited and certified organisations, searchable by region. The directory carries dates on both ends — an entry read on 16 September 2026 showed a term running 24 November 2022 to 24 November 2025, which is the three-year shape the clinical schemes use.", "today": "As of 16 September 2026 the public directory lists organisations in Thailand, the United States, South Korea, Colombia, Mexico, Saudi Arabia, Türkiye, Greece, Bulgaria, Croatia, the Philippines, the Dominican Republic and Ukraine among others. GHA publishes no total on the pages read for this record." }, "kin": [ { "to": "medical-tourism-association", "as": "The trade body it names as its strategic partner, and whose co-founder founded it.", "rel": "org" }, { "to": "isqua-ieea", "as": "Holds the award over its Standards for Medical Travel 5.0.", "rel": "accredited-by" }, { "to": "jci", "as": "Surveys the ward where this scheme surveys the journey; the two are not substitutes.", "rel": "contrast" }, { "to": "temos", "as": "The other scheme built around the international patient rather than the hospital.", "rel": "contrast" }, { "to": "aftercare-at-home", "as": "The end of the pathway this scheme claims to cover, and the part no clinical accreditation reaches.", "rel": "step" }, { "to": "the-accreditation-question", "as": "Where a pathway mark and a clinical mark are pulled apart.", "rel": "story" } ], "links": [ { "label": "Global Healthcare Accreditation", "url": "https://www.globalhealthcareaccreditation.com/" }, { "label": "Accredited and certified organizations", "url": "https://www.globalhealthcareaccreditation.com/accredited-organizations" } ], "sources": [ "s:gha-about", "s:gha-accredited-list" ], "provenance": { "default": { "tier": "cited", "source": "s:gha-about" }, "fields": { "text.story": { "tier": "cited", "source": "s:gha-about", "note": "the closing paragraph is marked as this project's inference" }, "facets": { "tier": "cited", "source": "s:gha-about", "note": "the 2016 founding is reported in trade press and in GHA's own interviews; it is not on the about page read here" } } }, "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "An accreditation body founded in 2016 for medical travel rather than for clinical care.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "medical-tourism-association", "type": "org", "name": "Medical Tourism Association", "as": "The trade body it names as its strategic partner, and whose co-founder founded it.", "rel": "org" }, { "to": "isqua-ieea", "type": "org", "name": "ISQua External Evaluation Association", "as": "Holds the award over its Standards for Medical Travel 5.0.", "rel": "accredited-by" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "Surveys the ward where this scheme surveys the journey; the two are not substitutes.", "rel": "contrast" }, { "to": "temos", "type": "org", "name": "Temos International Healthcare Accreditation", "as": "The other scheme built around the international patient rather than the hospital.", "rel": "contrast" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The end of the pathway this scheme claims to cover, and the part no clinical accreditation reaches.", "rel": "step" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Where a pathway mark and a clinical mark are pulled apart.", "rel": "story" } ], "source_list": [ { "id": "s:gha-about", "kind": "web", "title": "What is Global Healthcare Accreditation?", "publisher": "Global Healthcare Accreditation", "url": "https://www.globalhealthcareaccreditation.com/about-gha", "accessed": "2026-09-16", "note": "the three competencies of the medical travel care continuum and the ISQua accreditation of Standards for Medical Travel 5.0" }, { "id": "s:gha-accredited-list", "kind": "web", "title": "Accredited and Certified Organizations", "publisher": "Global Healthcare Accreditation", "url": "https://www.globalhealthcareaccreditation.com/accredited-organizations", "accessed": "2026-09-16", "note": "public directory searchable by region; entries carry start dates and, for some, an expiry date such as 24 November 2022 to 24 November 2025" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:gha-about" }, "text.story": { "tier": "cited", "source": "s:gha-about", "note": "the closing paragraph is marked as this project's inference" }, "text.how": { "tier": "cited", "source": "s:gha-about" }, "text.today": { "tier": "cited", "source": "s:gha-about" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "isqua-ieea", "type": "org", "name": "ISQua External Evaluation Association", "as": "Holds its award over the Standards for Medical Travel 5.0.", "rel": "accredits" }, { "from": "jci", "type": "org", "name": "Joint Commission International", "as": "A competitor that certifies the travel pathway rather than the clinical unit.", "rel": "contrast" }, { "from": "medical-tourism-association", "type": "org", "name": "Medical Tourism Association", "as": "The accreditation body it names as its strategic partner, founded by its co-founder.", "rel": "org" }, { "from": "temos", "type": "org", "name": "Temos International Healthcare Accreditation", "as": "The nearest competitor by purpose: both certify the journey rather than the ward.", "rel": "contrast" }, { "from": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Surveys the journey rather than the ward, which is why its mark is not a substitute for a clinical one.", "rel": "org" } ] }, { "schema": 1, "id": "hfea", "type": "org", "names": { "name": "Human Fertilisation and Embryology Authority", "aliases": [ "HFEA" ], "said": "British clinics call it the Register, and quote their rate out of it. The rate is a rate OF something, and which something changes the answer by more than any clinic does." }, "region": [ "europe-west" ], "facets": { "kind": "regulator", "iso2": "GB", "founded": 1991, "status": "open" }, "text": { "what": "The United Kingdom's fertility regulator, and the body that licenses every clinic in the country performing IVF, donor insemination or research on human embryos. It describes itself as \"the UK's independent regulator of fertility treatment and research using human embryos\" and \"the first statutory body of our type in the world\", set up under the Human Fertilisation and Embryology Act 1990 as an arm's-length body of the Department of Health and collecting data on every licensed treatment since 1 August 1991. It licenses, inspects, can amend, suspend or revoke a licence, publishes results clinic by clinic, and rates the extras sold alongside a cycle.", "story": "Start with what makes this record unusual. The Authority puts its own workload at over 75,000 cycles of treatment a year — the 2024 report counts over 100,000 once freezing cycles are added in — and holds what it calls \"the largest register of fertility data in the world\", and it publishes out of that register a table of named clinics with each one's birth rate beside it. Two regulators on earth do that: this one and the American federal reporting. Everywhere else a clinic's figure is the clinic's own claim about itself.\n\nThe second thing is what the figure counts. A birth rate is a fraction, and the fight is in the bottom half of it. Birth per embryo transferred is \"the percentage of the total number of embryos transferred that led to a birth\" over twelve months, and it counts only the cycles that got as far as a transfer. Birth per egg collection procedure starts earlier, at the retrieval, and gathers in the frozen transfers from that same collection for up to two years. A rate per cycle started begins earlier again, at the ovulatory stimulation stage, so it carries every cycle that yielded no eggs, or eggs that made no embryo worth transferring. In 2024 the average IVF birth rate per embryo transferred was 30 per cent — 38 per cent for patients aged 18 to 34, 8 per cent for those aged 43 to 44.\n\n*Inference —* the further back the denominator starts, the smaller the number, and the gap is not a rounding difference. The American register shows the size of it in one line: for patients over 40 in 2022, live-birth deliveries ran at 25.4 per cent of transfers against 7.7 per cent of intended egg retrievals, because every cycle that never reached a transfer has dropped out of the smaller denominator. A percentage quoted with no denominator attached cannot be read, and the clinic pages a patient compares abroad rarely attach one.\n\nThe third thing is the add-on ratings. An add-on is an extra treatment, test or technique sold alongside a standard cycle, and the Authority grades each one on a five-colour scale by what the evidence shows: green where high-quality evidence shows it improves the outcome, yellow where it is not clear, grey where there is not enough moderate or high quality evidence to rate it, black where the evidence shows no effect, and red where \"There are potential safety concerns and/or, on balance, the findings from moderate/high quality evidence shows that this add-on may reduce treatment effectiveness.\" Five add-ons carried the red rating on the page read for this record: endometrial receptivity testing, intravenous immunoglobulin, steroids, platelet-rich plasma, and pre-implantation genetic testing for aneuploidy. PGT-A — screening embryos for chromosome number before transfer — is rated red for improving the chance of a birth and green for reducing miscarriage, rated 16 October 2023, on the reasoning that it \"is a selection tool that often reduces the number of embryos available for transfer\".\n\nAnd then the regulator argues with its own table. \"Use success rates as a rough guide and not a prediction\", it says, because \"differences of just one or two percentage points are often down to chance rather than being a reflection of a clinic's abilities\".\n\n*Inference —* every one of these instruments stops at the border. The licence, the register, the rating and the complaints route cover clinics in the United Kingdom. A patient who flies to Alicante, Prague or Kyrenia is buying from a clinic this Authority does not license, cannot inspect and does not count, and the add-on rated red here is sold there with no rating at all.", "how": "A clinic applies for a licence, is inspected, and holds it subject to conditions; the Authority can amend, suspend or revoke it. Every treatment in a licensed clinic is reported to the Register, which runs continuously since August 1991. Out of the Register come two publications: an annual trends and figures report, and Choose a Fertility Clinic, the clinic-by-clinic comparison tool. Separately, an evidence review rates treatment add-ons on the five-colour scale and republishes the rating with the reasoning attached. The Register also holds donor records, which is the mechanism behind the identity-release rule.", "today": "As of 17 September 2026 the most recent published year is 2024, in a report issued 16 June 2026 from a register snapshot taken on 6 May 2026, with its birth outcomes marked preliminary. 107 clinics held a licence in 2023/24. The PGT-A ratings date from 16 October 2023.", "notes": "A published birth rate on this site always carries its denominator. Per embryo transferred, per egg collection and per cycle started are three different numbers about the same treatment." }, "geo": { "lat": 51.5427, "lon": -0.0052, "precision": "street", "source": "s:hfea-foi" }, "address": { "street": "2nd floor, 2 Redman Place", "city": "London", "country": "GB", "postcode": "E20 1JQ" }, "kin": [ { "to": "hfea-results", "as": "The register this authority keeps and the clinic table it publishes out of it.", "rel": "dataset" }, { "to": "united-kingdom", "as": "The jurisdiction it licenses, clinic by clinic, and the border its register stops at.", "rel": "place" }, { "to": "ivf", "as": "The treatment it licenses, counts and publishes a birth rate for.", "rel": "procedure" }, { "to": "pgt", "as": "The add-on it rates red for improving the chance of a birth and green for reducing miscarriage.", "rel": "procedure" }, { "to": "egg-donation", "as": "Sets the compensation cap and the ten-family limit that British donors are recruited under.", "rel": "procedure" }, { "to": "egg-freezing", "as": "Sets the storage limit, and publishes the average price a British cycle is quoted at.", "rel": "procedure" }, { "to": "donor-anonymity-law", "as": "Holds the donor register, and releases what the identity rule says it may.", "rel": "governs" }, { "to": "cdc-art-results", "as": "The only other register in the world publishing clinic-level rates, counted from a different starting line.", "rel": "dataset" }, { "to": "eshre", "as": "The European society whose consortium collects national aggregates where this body publishes clinics.", "rel": "contrast" }, { "to": "north-cyprus", "as": "A destination British patients fly to, outside this licence and invisible to this register.", "rel": "contrast" }, { "to": "reproductive-exile", "as": "The word for the patients who leave, and whom the register cannot see.", "rel": "term" } ], "links": [ { "label": "HFEA", "url": "https://www.hfea.gov.uk/" }, { "label": "Choose a fertility clinic", "url": "https://www.hfea.gov.uk/choose-a-fertility-clinic/" }, { "label": "Treatment add-ons", "url": "https://www.hfea.gov.uk/treatments/treatment-add-ons/" } ], "sources": [ "s:hfea", "s:hfea-about", "s:hfea-key-facts", "s:hfea-2024-trends", "s:hfea-2024-methodology", "s:hfea-choose-clinic", "s:hfea-add-ons", "s:hfea-pgt-a", "s:hfea-cafc-consultation", "s:hfea-foi", "s:cdc-art-2022-summary" ], "provenance": { "default": { "tier": "cited", "source": "s:hfea-about" }, "fields": { "text.story": { "tier": "cited", "source": "s:hfea-2024-trends", "note": "the denominator definitions are from the Choose a Fertility Clinic consultation page, the 2024 rates from the trends report, the rating scale and the red list from the add-ons pages, the PGT-A reasoning and date from its own page, the comparison warning from the clinic-choosing page, the American per-transfer and per-retrieval figures from the CDC 2022 summary; the two paragraphs marked inference are this project's reading" }, "text.how": { "tier": "cited", "source": "s:hfea-about" }, "geo": { "tier": "inference", "source": "s:hfea-foi", "note": "the postal address is printed on the freedom of information page; the point is the International Quarter at Stratford and is street precision at best" } } }, "x_commons_files": [ "File:Redman Place, Stratford.jpg" ], "confidence": "high", "needs_verification": false, "updated": "2026-09-17", "blurb": "The United Kingdom's fertility regulator, and the body that licenses every clinic in the country performing IVF, donor insemination or research on human embryos.", "region_terms": [ { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "hfea-results", "type": "dataset", "name": "HFEA fertility treatment results", "as": "The register this authority keeps and the clinic table it publishes out of it.", "rel": "dataset" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The jurisdiction it licenses, clinic by clinic, and the border its register stops at.", "rel": "place" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment it licenses, counts and publishes a birth rate for.", "rel": "procedure" }, { "to": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "The add-on it rates red for improving the chance of a birth and green for reducing miscarriage.", "rel": "procedure" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "Sets the compensation cap and the ten-family limit that British donors are recruited under.", "rel": "procedure" }, { "to": "egg-freezing", "type": "procedure", "name": "Egg freezing", "as": "Sets the storage limit, and publishes the average price a British cycle is quoted at.", "rel": "procedure" }, { "to": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "Holds the donor register, and releases what the identity rule says it may.", "rel": "governs" }, { "to": "cdc-art-results", "type": "dataset", "name": "CDC assisted reproductive technology results", "as": "The only other register in the world publishing clinic-level rates, counted from a different starting line.", "rel": "dataset" }, { "to": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "The European society whose consortium collects national aggregates where this body publishes clinics.", "rel": "contrast" }, { "to": "north-cyprus", "type": "destination", "name": "Northern Cyprus", "as": "A destination British patients fly to, outside this licence and invisible to this register.", "rel": "contrast" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The word for the patients who leave, and whom the register cannot see.", "rel": "term" } ], "source_list": [ { "id": "s:hfea", "kind": "org", "title": "Human Fertilisation and Embryology Authority — clinic licensing and published results", "publisher": "HFEA (United Kingdom)", "url": "https://www.hfea.gov.uk/", "accessed": "2026-09-16" }, { "id": "s:hfea-about", "kind": "org", "title": "About us", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/about-us/", "accessed": "2026-09-17", "note": "'the UK's independent regulator of fertility treatment and research using human embryos'; set up by legislation as an arm's length body of the Department of Health; 'the first statutory body of our type in the world'; holds 'the largest register of fertility data in the world'; regulates over 75,000 cycles of fertility treatment every year; licenses, inspects and can amend, suspend or revoke a licence" }, { "id": "s:hfea-key-facts", "kind": "org", "title": "Key facts and statistics", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/about-us/media-centre/key-facts-and-statistics/", "accessed": "2026-09-16", "note": "set up by the Human Fertilisation and Embryology Act 1990; 107 licensed clinics in 2023/24; records of every treatment in a licensed clinic since 1991; 2022 figures for patients, cycles, pregnancy rate per fresh embryo transfer and the NHS-funded share" }, { "id": "s:hfea-2024-trends", "kind": "org", "title": "Fertility treatment 2024: trends and figures", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2024-trends-and-figures/", "accessed": "2026-09-17", "note": "published 16 June 2026 from a register snapshot of 6 May 2026; 64,000 patients and over 100,000 treatment and freezing cycles in 2024; average IVF birth rate per embryo transferred 30%, 38% at ages 18-34 and 8% at 43-44; 2024 birth outcomes marked preliminary" }, { "id": "s:hfea-2024-methodology", "kind": "org", "title": "Fertility treatment 2024: quality and methodology report", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2024-trends-and-figures/quality-and-methodology-report/", "accessed": "2026-09-17", "note": "people are in the Register 'regardless of a person's residence'; 'We do not hold detailed information on partner intrauterine insemination (IUI), or treatments that takes place outside of licensed clinics'; regions are assigned 'based on the location of the clinic rather than patient's residency'; the Register runs since 1991 and is described as the longest running database of fertility treatment in the world" }, { "id": "s:hfea-choose-clinic", "kind": "org", "title": "Finding the right clinic for you", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/choose-a-fertility-clinic/finding-the-best-fertility-clinic-for-you/", "accessed": "2026-09-17", "note": "'Use success rates as a rough guide and not a prediction', and the passage on differences of one or two percentage points being down to chance" }, { "id": "s:hfea-add-ons", "kind": "org", "title": "Treatment add-ons", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/treatments/treatment-add-ons/", "accessed": "2026-09-17", "note": "the five-colour rating scale with its definitions, including red: 'There are potential safety concerns and/or, on balance, the findings from moderate/high quality evidence shows that this add-on may reduce treatment effectiveness.' Five add-ons carry a red rating on the page read on 17 September 2026: endometrial receptivity testing, intravenous immunoglobulin, steroids (glucocorticoids), platelet-rich plasma, and pre-implantation genetic testing for aneuploidy." }, { "id": "s:hfea-pgt-a", "kind": "org", "title": "Pre-implantation genetic testing for aneuploidy (PGT-A) — treatment add-ons rating", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/treatments/treatment-add-ons/pre-implantation-genetic-testing-for-aneuploidy-pgt-a/", "accessed": "2026-09-16" }, { "id": "s:hfea-cafc-consultation", "kind": "org", "title": "Choose a Fertility Clinic consultation", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/choose-a-fertility-clinic/choose-a-fertility-clinic-consultation/", "accessed": "2026-09-17", "note": "defines birth per embryo transferred as 'the percentage of the total number of embryos transferred that led to a birth' over 12 months, and birth per egg collection procedure as 'the percentage of egg collection procedures that led to a birth', including frozen transfers up to two years after collection; a measure per cycle started 'includes ovulatory stimulation stage'" }, { "id": "s:hfea-foi", "kind": "org", "title": "Freedom of information", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/about-us/freedom-of-information/", "accessed": "2026-09-17", "note": "postal address as printed: Human Fertilisation and Embryology Authority, 2nd floor, 2 Redman Place, London, E20 1JQ" }, { "id": "s:cdc-art-2022-summary", "kind": "dataset", "title": "2022 Final Assisted Reproductive Technology (ART) Summary", "publisher": "US Centers for Disease Control and Prevention", "url": "https://data.cdc.gov/Assisted-Reproductive-Technology-ART-/2022-Final-Assisted-Reproductive-Technology-ART-Su/9tjt-seye", "accessed": "2026-09-16", "note": "clinic-level and national rows; the national rows carry locationabbr NA. Queried through the Socrata endpoint https://data.cdc.gov/resource/9tjt-seye.json" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:hfea-about" }, "text.story": { "tier": "cited", "source": "s:hfea-2024-trends", "note": "the denominator definitions are from the Choose a Fertility Clinic consultation page, the 2024 rates from the trends report, the rating scale and the red list from the add-ons pages, the PGT-A reasoning and date from its own page, the comparison warning from the clinic-choosing page, the American per-transfer and per-retrieval figures from the CDC 2022 summary; the two paragraphs marked inference are this project's reading" }, "text.how": { "tier": "cited", "source": "s:hfea-about" }, "text.today": { "tier": "cited", "source": "s:hfea-about" }, "geo": { "tier": "inference", "source": "s:hfea-foi", "note": "the postal address is printed on the freedom of information page; the point is the International Quarter at Stratford and is street precision at best" }, "address": { "tier": "cited", "source": "s:hfea-about" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The regulator that licenses every UK fertility clinic and publishes each one's results — the comparison a patient abroad loses.", "rel": "accredited-by" }, { "from": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "Sets the UK compensation cap and the ten-family limit this record quotes.", "rel": "governs" }, { "from": "egg-freezing", "type": "procedure", "name": "Egg freezing", "as": "Sets the UK storage limit and publishes the average UK price this record quotes.", "rel": "governs" }, { "from": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "Publishes the UK birth rates this record quotes, and rates the add-ons sold alongside the cycle.", "rel": "measures" }, { "from": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "Rates this add-on red and publishes the reasoning this record quotes.", "rel": "measures" }, { "from": "sperm-donation", "type": "procedure", "name": "Sperm donation", "as": "Sets the UK visit payment, the ten-family limit and the identity-release rule this record quotes.", "rel": "governs" }, { "from": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "Publishes the UK position this record quotes: expenses only, no binding agreement, and a parental order after the birth.", "rel": "governs" }, { "from": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The regulator that holds the British register and publishes what it releases.", "rel": "org" }, { "from": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "The one European regulator that publishes clinic-level results rather than national aggregates.", "rel": "contrast" }, { "from": "icmart", "type": "org", "name": "International Committee for Monitoring Assisted Reproductive Technologies", "as": "One of the national registries feeding it, and one of only two in the world that publish clinic by clinic.", "rel": "contrast" }, { "from": "hfea-results", "type": "dataset", "name": "HFEA fertility treatment results", "as": "The regulator that keeps the register, licenses the clinics and publishes the table.", "rel": "org" } ] }, { "schema": 1, "id": "icmart", "type": "org", "names": { "name": "International Committee for Monitoring Assisted Reproductive Technologies", "aliases": [ "ICMART", "International Committee Monitoring Assisted Reproductive Technologies" ], "said": "ICMART adds up the world's IVF. It adds up what each national registry already collects, which is a different thing from counting." }, "region": [ "global" ], "facets": { "kind": [ "registry", "ngo" ], "founded": 2003, "status": "open" }, "text": { "what": "The world registry of assisted reproduction: an independent non-profit that describes itself as having \"taken the leading role in the development, collection and dissemination of worldwide data on assisted reproductive technology\". It began international data collection in 1989, incorporated in California as a 501(c)(3) in 2003, and is a non-State actor in official relations with the World Health Organization. With WHO it wrote the ICMART ART Glossary, the agreed definitions the field argues inside.", "story": "Follow the data upwards and the limits explain themselves. A clinic reports patient-level data to its national or regional registry. ICMART's regional representatives then collect from those registries \"non-identifiable tabulated summary data\". ICMART never sees a clinic, never sees a patient, and receives whatever the registry chose to send, in the shape the registry already held it.\n\nThe scale is real. For cycles conducted in 2017 and 2018, 83 countries provided data — 80 for 2017, 81 for 2018 — from 3,313 reporting clinics in 2017 and 3,254 in 2018. Those returns held 2,913,498 cycles and 671,012 babies for 2017, and 3,303,505 cycles and 728,383 babies for 2018. Adjusting for centres that did not report, ICMART estimates 3,107,188 cycles and 814,588 babies for 2017 and 3,568,635 and 870,814 for 2018. The report names its own limits: \"Data and analysis presented are dependent on the quality and completeness of the data submitted to ICMART, which varies globally\", with thin coverage from the Middle East and incomplete coverage from parts of Asia, and a change in how delivery rates are calculated that blocks comparison with earlier ICMART reports.\n\n*Inference —* three problems stack, and they stack against exactly the reader this directory has. A country appears only if it has a registry and that registry chooses to report, so the destinations with the least regulation are the ones least likely to be in the table. What a registry reports is what it already collects, on its own definitions of a cycle, a transfer and an outcome — which is why the glossary exists, and the glossary narrows the differences rather than abolishing them. And the unit is the country: a patient choosing between two clinics abroad can read a national aggregate several years old, and nothing about either clinic. The world total is the best figure the field has, and it still cannot answer the question that makes someone buy a plane ticket.", "how": "Standard reporting forms go to national and regional registries; ICMART's regional representatives gather the returns; analysis has been done by the National Perinatal Epidemiology and Statistics Unit, with built-in and manual validation checks and missing data imputed using weighted average cancellation rates. Preliminary world reports are presented at ESHRE's annual meeting; final world reports are published in Human Reproduction, several years behind the cycles they describe.", "today": "As of 17 September 2026 the most recent full world report covers cycles conducted in 2017 and 2018 and was published in Human Reproduction in 2025; a preliminary report for 2021 was presented at the ESHRE meeting in Paris in 2025. The lag between a cycle and its appearance in a world figure runs to several years, which is longer than most patients wait to travel.", "notes": "Reporting to ICMART is voluntary. A country absent from a world report has not been shown to perform no cycles; it has been shown not to have reported any." }, "kin": [ { "to": "eshre", "as": "The European society it publishes alongside, and whose consortium supplies the European rows.", "rel": "org" }, { "to": "who", "as": "The body it holds official relations with, and its co-author on the ART glossary.", "rel": "org" }, { "to": "ivf", "as": "The treatment counted, cycle by cycle, in every national return it receives.", "rel": "procedure" }, { "to": "icsi", "as": "Counted inside the same cycles, on definitions the glossary had to fix before anyone could add them up.", "rel": "procedure" }, { "to": "egg-donation", "as": "The cycles that cross a border, and that no national registry counts from both ends.", "rel": "procedure" }, { "to": "hfea", "as": "One of the national registries feeding it, and one of only two in the world that publish clinic by clinic.", "rel": "contrast" }, { "to": "cdc-art-results", "as": "The American statutory register whose national totals reach the world report.", "rel": "dataset" }, { "to": "counting-patients", "as": "A world total assembled from voluntary returns on unlike definitions.", "rel": "story" }, { "to": "what-the-data-cannot-see", "as": "The destinations with no registry, which is most of the ones a fertility traveller is choosing between.", "rel": "story" } ], "links": [ { "label": "ICMART", "url": "https://www.icmartivf.org/" }, { "label": "Reports and publications", "url": "https://www.icmartivf.org/reports-publications/" } ], "sources": [ "s:icmart-about", "s:icmart-world-report-2017-2018" ], "provenance": { "default": { "tier": "cited", "source": "s:icmart-about" }, "fields": { "text.story": { "tier": "cited", "source": "s:icmart-world-report-2017-2018", "note": "the data flow and the tabulated-summary wording are from ICMART's own about page; the counts, the estimates and the quoted limitation are from the 2017-2018 world report, read in its abstract and method summary rather than the full text; the closing paragraph is marked inference" }, "facets": { "tier": "cited", "source": "s:icmart-about", "note": "founded is the 2003 California incorporation; international data collection began in 1989 and is stated in the prose. No headquarters is pinned: the committee works through regional representatives and this project found no office worth a point on a map" } } }, "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "The world registry of assisted reproduction: an independent non-profit that describes itself as having \"taken the leading role in the development, collection and dissemination of worldwide data on assisted reproductive…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "The European society it publishes alongside, and whose consortium supplies the European rows.", "rel": "org" }, { "to": "who", "type": "org", "name": "World Health Organization", "as": "The body it holds official relations with, and its co-author on the ART glossary.", "rel": "org" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment counted, cycle by cycle, in every national return it receives.", "rel": "procedure" }, { "to": "icsi", "type": "procedure", "name": "Intracytoplasmic sperm injection", "as": "Counted inside the same cycles, on definitions the glossary had to fix before anyone could add them up.", "rel": "procedure" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The cycles that cross a border, and that no national registry counts from both ends.", "rel": "procedure" }, { "to": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "One of the national registries feeding it, and one of only two in the world that publish clinic by clinic.", "rel": "contrast" }, { "to": "cdc-art-results", "type": "dataset", "name": "CDC assisted reproductive technology results", "as": "The American statutory register whose national totals reach the world report.", "rel": "dataset" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "A world total assembled from voluntary returns on unlike definitions.", "rel": "story" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "The destinations with no registry, which is most of the ones a fertility traveller is choosing between.", "rel": "story" } ], "source_list": [ { "id": "s:icmart-about", "kind": "org", "title": "About ICMART", "publisher": "International Committee for Monitoring Assisted Reproductive Technologies", "url": "https://www.icmartivf.org/about/", "accessed": "2026-09-16", "note": "data collection since 1989, incorporated in California as a 501(c)(3) in 2003, non-State actor in official relations with WHO, receives anonymised tabulated summaries from national and regional registries rather than clinic-level data" }, { "id": "s:icmart-world-report-2017-2018", "kind": "journal", "title": "International Committee for Monitoring Assisted Reproductive Technologies (ICMART): world report for cycles conducted in 2017-2018", "publisher": "Human Reproduction, Volume 40, Issue 6", "year": 2025, "url": "https://academic.oup.com/humrep/article-abstract/40/6/1110/8114747", "accessed": "2026-09-17", "note": "83 countries provided data (80 for 2017, 81 for 2018); 3,313 clinics reporting in 2017 and 3,254 in 2018; 2,913,498 reported cycles and 671,012 babies in 2017, 3,303,505 cycles and 728,383 babies in 2018; estimates including non-reporting centres of 3,107,188 cycles and 814,588 babies in 2017 and 3,568,635 and 870,814 in 2018. Read in the abstract and method summary, not the full text." } ], "tiers": { "text.what": { "tier": "cited", "source": "s:icmart-about" }, "text.story": { "tier": "cited", "source": "s:icmart-world-report-2017-2018", "note": "the data flow and the tabulated-summary wording are from ICMART's own about page; the counts, the estimates and the quoted limitation are from the 2017-2018 world report, read in its abstract and method summary rather than the full text; the closing paragraph is marked inference" }, "text.how": { "tier": "cited", "source": "s:icmart-about" }, "text.today": { "tier": "cited", "source": "s:icmart-about" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "The global registry body it feeds and publishes with.", "rel": "org" }, { "from": "who", "type": "org", "name": "World Health Organization", "as": "The fertility registry body it keeps in official relations, and with which it wrote the ART glossary.", "rel": "org" } ] }, { "schema": 1, "id": "imtj", "type": "org", "names": { "name": "International Medical Travel Journal", "aliases": [ "IMTJ" ], "said": "A trade publication, not a peer-reviewed journal, and the word journal in the title does a lot of work." }, "region": [ "global", "europe-west" ], "facets": { "kind": "trade-body", "iso2": "GB", "founded": 2007, "status": "unknown" }, "text": { "what": "A British trade publication covering cross-border care, established in 2007 and edited by Keith Pollard. It publishes a biweekly newsletter and news coverage, sells market reports, and runs an annual summit and the Medical Travel Awards. It was published by Intuition Communication of Berkhamsted, which LaingBuisson acquired.", "story": "The field has two houses that publish about itself, and this is the sceptical one. Its news coverage has spent years pulling apart the market-size claims the rest of the trade repeats, which makes it unusually useful and does not make it disinterested: it sells reports, sponsorship, conference places and award entries into the same industry it covers.\n\nThe awards are judged by a panel — reported as 21 medical travel experts chaired by the editor — and entrants pay to enter, which is the standard shape of a trade award. *Inference —* a trade award is evidence that a company entered a competition and a panel preferred its entry. It is not an inspection, it has no standard behind it, and it should never be counted alongside an accreditation.\n\nIts market reports are sold rather than published, so their methods sit behind a price. This record cannot say what is in them.\n\nThe ownership chain is documented. Intuition Communication, a Berkhamsted publisher, held the title from 2009; LaingBuisson announced the acquisition of Intuition on 1 March 2018, and Companies House records the renaming of company 04858023 from Intuition Communication Limited on 5 March 2018 and its dissolution on 14 March 2023, by which time the brand had moved to the parent. Who founded the journal in 2007 is not on the record anywhere this project could read.", "how": "Revenue comes from advertising, sponsorship, market report sales, the summit and the awards. Much of the news is free to read; the reports are not. IMTJ's own site refused every fetch from this project on 16 September 2026, so this record rests on the secondary source named in sources and the record is thinner than it should be.", "today": "As of 17 September 2026 the title looks dormant rather than active, and this record says so because the alternative is to repeat a claim the sources do not support. imtj.com answers automated requests with a Cloudflare challenge and its article URLs return 301 or 401 rather than pages; the LaingBuisson News category for IMTJ, captured on 10 September 2026, carries nothing newer than November 2023; awards.imtj.com no longer resolves; and summit.imtj.com redirects to a generic events homepage. Keith Pollard's own site describes him as editor in chief and adds that the journal's future \"is currently under review by LaingBuisson\" — wording already present in a September 2024 capture, so it dates the statement rather than the state. Whether the journal has formally ceased is not something this project could establish." }, "geo": { "lat": 51.76, "lon": -0.565, "precision": "city", "source": "s:imtj-wikipedia" }, "address": { "city": "Berkhamsted", "country": "GB" }, "kin": [ { "to": "keith-pollard", "as": "Its editor in chief, and the founder of the company that published it.", "rel": "person" }, { "to": "imtj-summit", "as": "The annual conference it runs, and part of how it is paid.", "rel": "event" }, { "to": "medical-tourism-association", "as": "The other house that publishes about this trade, from inside a membership body.", "rel": "contrast" }, { "to": "counting-patients", "as": "Where its long argument with the industry's headline numbers is set out.", "rel": "story" }, { "to": "medical-travel", "as": "The two words it put in its title, in preference to the other two.", "rel": "term" } ], "links": [ { "label": "IMTJ", "url": "https://www.imtj.com/" } ], "sources": [ "s:imtj-wikipedia", "s:imtj-about-2010-archive", "s:imtj-about-2021-archive", "s:laingbuisson-intuition-2018", "s:ch-laingbuisson-international", "s:keithpollard-about", "s:laingbuissonnews-imtj-archive" ], "provenance": { "default": { "tier": "cited", "source": "s:imtj-wikipedia" }, "fields": { "text.story": { "tier": "tradition", "note": "the publisher, the Berkhamsted base, the LaingBuisson acquisition and the 21-judge panel come from trade press this project read only in search summaries; the closing inference is marked inline" }, "geo": { "tier": "tradition", "note": "Berkhamsted was the publisher's base; city precision, not confirmed on a page read directly" } } }, "confidence": "low", "needs_verification": true, "updated": "2026-09-17", "blurb": "A British trade publication covering cross-border care, established in 2007 and edited by Keith Pollard.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "keith-pollard", "type": "person", "name": "Keith Pollard", "as": "Its editor in chief, and the founder of the company that published it.", "rel": "person" }, { "to": "imtj-summit", "type": "event", "name": "The IMTJ Medical Travel Summit and Awards", "as": "The annual conference it runs, and part of how it is paid.", "rel": "event" }, { "to": "medical-tourism-association", "type": "org", "name": "Medical Tourism Association", "as": "The other house that publishes about this trade, from inside a membership body.", "rel": "contrast" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Where its long argument with the industry's headline numbers is set out.", "rel": "story" }, { "to": "medical-travel", "type": "term", "name": "Medical travel", "as": "The two words it put in its title, in preference to the other two.", "rel": "term" } ], "source_list": [ { "id": "s:imtj-wikipedia", "kind": "wikipedia", "title": "International Medical Travel Journal", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/International_Medical_Travel_Journal", "accessed": "2026-09-16", "note": "established 2007, UK trade publication, biweekly newsletter, Keith Pollard as editor in chief, annual Medical Travel Awards; imtj.com refused every fetch on this date" }, { "id": "s:imtj-about-2010-archive", "kind": "web", "title": "About us — International Medical Travel Journal (Internet Archive snapshot, 11 January 2010)", "publisher": "IMTJ / Intuition Communication", "url": "https://web.archive.org/web/20100111234956/http://www.imtj.com/about-us/", "accessed": "2026-09-17", "note": "imtj.com answers automated requests with a Cloudflare challenge, so the publication's own pages are read here through the Internet Archive" }, { "id": "s:imtj-about-2021-archive", "kind": "web", "title": "About IMTJ, the International Medical Travel Journal (Internet Archive snapshot, 13 April 2021)", "publisher": "IMTJ / LaingBuisson", "url": "https://web.archive.org/web/20210413081607/https://www.imtj.com/about/", "accessed": "2026-09-17" }, { "id": "s:laingbuisson-intuition-2018", "kind": "web", "title": "LaingBuisson announces the acquisition of Intuition Communication, 1 March 2018 (Internet Archive snapshot, 28 September 2023)", "publisher": "LaingBuisson", "year": 2018, "url": "https://web.archive.org/web/20230928012944/https://www.laingbuisson.com/press-releases/laingbuisson-announces-acquisition-intuition-communication/", "accessed": "2026-09-17" }, { "id": "s:ch-laingbuisson-international", "kind": "dataset", "title": "LAINGBUISSON INTERNATIONAL LIMITED, company 04858023 — incorporation, previous names, dissolution", "publisher": "Companies House (United Kingdom)", "url": "https://find-and-update.company-information.service.gov.uk/company/04858023", "accessed": "2026-09-17" }, { "id": "s:keithpollard-about", "kind": "web", "title": "About Keith / Career history of Keith Pollard", "publisher": "keithpollard.com", "url": "https://keithpollard.com/about/", "accessed": "2026-09-17", "note": "self-reported; the same wording about the journal's future being under review was already on the page in a September 2024 snapshot" }, { "id": "s:laingbuissonnews-imtj-archive", "kind": "web", "title": "IMTJ news category (Internet Archive snapshot, 10 September 2026)", "publisher": "LaingBuisson News", "url": "https://web.archive.org/web/20260910213608/https://www.laingbuissonnews.com/category/imtj/", "accessed": "2026-09-17", "note": "the newest item on the page in a September 2026 capture is dated November 2023" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:imtj-wikipedia" }, "text.story": { "tier": "tradition", "note": "the publisher, the Berkhamsted base, the LaingBuisson acquisition and the 21-judge panel come from trade press this project read only in search summaries; the closing inference is marked inline" }, "text.how": { "tier": "cited", "source": "s:imtj-wikipedia" }, "text.today": { "tier": "cited", "source": "s:imtj-wikipedia" }, "geo": { "tier": "tradition", "note": "Berkhamsted was the publisher's base; city precision, not confirmed on a page read directly" }, "address": { "tier": "cited", "source": "s:imtj-wikipedia" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "medical-tourism-association", "type": "org", "name": "Medical Tourism Association", "as": "The other side of the trade's own publishing: a commercial journal rather than an association.", "rel": "contrast" }, { "from": "keith-pollard", "type": "person", "name": "Keith Pollard", "as": "The journal his company bought in 2009 and he still edits, and the record carrying its ownership chain.", "rel": "org" }, { "from": "imtj-summit", "type": "event", "name": "The IMTJ Medical Travel Summit and Awards", "as": "The publication that runs the summit and the awards.", "rel": "org" }, { "from": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The trade publisher that chose the other two words.", "rel": "org" }, { "from": "medical-travel", "type": "term", "name": "Medical travel", "as": "The trade publisher that took these two words as its title.", "rel": "org" }, { "from": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Runs a paid-entry trade award that is routinely counted beside an inspection.", "rel": "org" } ] }, { "schema": 1, "id": "isaps", "type": "org", "names": { "name": "International Society of Aesthetic Plastic Surgery", "aliases": [ "ISAPS" ], "said": "Every cosmetic-surgery count on this site that is not a hospital's own comes from the ISAPS survey. It is a survey of surgeons, extrapolated, and the report says so on page four." }, "region": [ "global" ], "facets": { "kind": "professional-society", "iso2": "US", "founded": 1970, "status": "open" }, "text": { "what": "The international professional society for board-certified aesthetic plastic surgeons, founded in 1970 with its charter signed at the United Nations in New York, registered at 19 Morgan Drive, Lebanon, New Hampshire, and reporting more than 6,000 members in 117 countries. It runs the annual Global Survey on aesthetic and cosmetic procedures, which is the only worldwide count of cosmetic work that exists, and therefore the source of nearly every national cosmetic figure in this directory.", "story": "The method is printed in the report, and reading it is the whole of the exercise.\n\nISAPS invited approximately 17,000 plastic surgeons from its own database to answer for 2024, and asked national societies to push their members towards it. \"Data from 2,975 plastic surgeons were submitted or provided for the 2024 statistics\" — up sharply from 1,600 respondents for 2023 — and 32 locations were reported individually, against 23 the year before. The society then projects: \"Final figures have been projected to reflect international statistics and are based exclusively on the estimated number of plastic surgeons actively practicing in each location and the respondent sample.\" The denominator in that sentence is itself partly modelled. The counts cover 98 per cent of an estimated 58,500 plastic surgeons worldwide, and where a national society gave no updated figure \"a simple regression model was used to estimate the number of plastic surgeons in that country based on its population size and Gross Domestic Product\". Outliers were adjusted to stop them distorting the averages the projections rest on, and the whole thing was compiled and tabulated by Industry Insights, Inc., an outside research firm in Columbus, Ohio.\n\n*Inference —* what that can support is a shape: which operations are common where, which way a national market is moving, roughly how large one country's aesthetic trade is against another's. What it cannot support is a count of operations. It cannot support a clean year-on-year comparison in a year when the response base nearly doubled — ISAPS says so itself, that the broader base \"has influenced some worldwide procedure totals\" and that new procedures on the form \"may affect comparability with totals of prior years\". And it cannot say anything at all about work done by someone who is not a board-certified plastic surgeon, which in the cosmetic trade sold across borders is a large share of it. No dentistry, no fertility, no orthopaedics, and no hair restoration performed by a technician.\n\nThe survey asks the travel question directly, and the answer is a pair of numbers rather than one. Surgeons report the share of their patients attending from other locations: worldwide the median was 5.0 per cent and the average 14.3 per cent for 2024. Colombia's surgeons reported a median of 20.0 per cent and an average of 30.0 per cent; Brazil's 5.0 and 8.2; the United States returned N/A, in the year it reported more aesthetic procedures than anywhere else. *Inference —* a median of 5 and an average of 14.3 in the same row is the signature of a trade where a handful of practices carry nearly all of the foreign patients and most practices see none.", "how": "An annual questionnaire, issued in English, Spanish, Chinese and Japanese, asking how many of each listed surgical and non-surgical procedure the surgeon performed in the year, plus demographic questions and the share of patients travelling in. Responses are edited, outliers adjusted, and results published only for locations with enough responses to be considered statistically valid. The report is a free PDF with worldwide rankings and per-location tables; ISAPS asks to be credited wherever the figures are quoted.", "today": "As of 17 September 2026 the published year is 2024 and the survey covering 2025 is closed and being analysed. For 2024 the society ranks eyelid surgery first worldwide at 2,115,360 procedures, liposuction second at 2,087,189, breast augmentation third at 1,658,615 and rhinoplasty fifth at 1,083,631. Botulinum toxin leads the non-surgical list at 7,887,955.", "notes": "Every ISAPS figure on this site is a projection from a survey of board-certified plastic surgeons, and the phrase is carried with the number wherever it appears." }, "geo": { "lat": 43.6423, "lon": -72.2518, "precision": "city", "source": "s:isaps-about" }, "address": { "street": "19 Morgan Drive", "city": "Lebanon", "area": "New Hampshire", "country": "US" }, "kin": [ { "to": "liposuction", "as": "Second on its worldwide surgical ranking for 2024, at 2,087,189 procedures.", "rel": "procedure" }, { "to": "breast-augmentation", "as": "Third on that ranking, and one of the operations its survey counts by country.", "rel": "procedure" }, { "to": "bbl", "as": "The operation its members answered a mortality survey about, which is where this directory's death rate for it comes from.", "rel": "procedure" }, { "to": "bbl-mortality", "as": "A risk measured the same way the counts are: by asking the society's own members.", "rel": "risk" }, { "to": "colombia", "as": "Where its respondents reported the highest share of patients attending from other locations, a median of 20 per cent.", "rel": "place" }, { "to": "brazil", "as": "The largest domestic aesthetic market in its 2024 count, and a small foreign share inside it.", "rel": "place" }, { "to": "turkiye", "as": "One of the 32 locations reported individually for 2024.", "rel": "place" }, { "to": "ishrs", "as": "The other society that counts a cosmetic trade by surveying its own members, and complains about the rest of it.", "rel": "contrast" }, { "to": "counting-patients", "as": "What a projection from 2,975 questionnaires can and cannot be asked to carry.", "rel": "story" }, { "to": "what-the-data-cannot-see", "as": "Everything cosmetic done by someone who is not a board-certified plastic surgeon.", "rel": "story" } ], "links": [ { "label": "ISAPS", "url": "https://www.isaps.org/" }, { "label": "Global Survey 2024 (PDF)", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf" } ], "sources": [ "s:isaps-about", "s:isaps-global-survey-2024" ], "provenance": { "default": { "tier": "cited", "source": "s:isaps-global-survey-2024" }, "fields": { "text.what": { "tier": "cited", "source": "s:isaps-about" }, "text.story": { "tier": "cited", "source": "s:isaps-global-survey-2024", "note": "every quoted sentence and every figure is read off the report's own method and ranking pages; the two paragraphs marked inference are this project's reading of what the method supports" }, "geo": { "tier": "inference", "source": "s:isaps-about", "note": "the registered office address is on the society's about page; city precision only" } } }, "confidence": "high", "needs_verification": false, "updated": "2026-09-17", "blurb": "The international professional society for board-certified aesthetic plastic surgeons, founded in 1970 with its charter signed at the United Nations in New York, registered at 19 Morgan Drive, Lebanon, New Hampshire…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "liposuction", "type": "procedure", "name": "Liposuction", "as": "Second on its worldwide surgical ranking for 2024, at 2,087,189 procedures.", "rel": "procedure" }, { "to": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "Third on that ranking, and one of the operations its survey counts by country.", "rel": "procedure" }, { "to": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "The operation its members answered a mortality survey about, which is where this directory's death rate for it comes from.", "rel": "procedure" }, { "to": "bbl-mortality", "type": "risk", "name": "Death from gluteal fat grafting", "as": "A risk measured the same way the counts are: by asking the society's own members.", "rel": "risk" }, { "to": "colombia", "type": "destination", "name": "Colombia", "as": "Where its respondents reported the highest share of patients attending from other locations, a median of 20 per cent.", "rel": "place" }, { "to": "brazil", "type": "destination", "name": "Brazil", "as": "The largest domestic aesthetic market in its 2024 count, and a small foreign share inside it.", "rel": "place" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "One of the 32 locations reported individually for 2024.", "rel": "place" }, { "to": "ishrs", "type": "org", "name": "International Society of Hair Restoration Surgery", "as": "The other society that counts a cosmetic trade by surveying its own members, and complains about the rest of it.", "rel": "contrast" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "What a projection from 2,975 questionnaires can and cannot be asked to carry.", "rel": "story" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "Everything cosmetic done by someone who is not a board-certified plastic surgeon.", "rel": "story" } ], "source_list": [ { "id": "s:isaps-about", "kind": "org", "title": "About ISAPS", "publisher": "International Society of Aesthetic Plastic Surgery", "url": "https://www.isaps.org/discover/about-isaps/", "accessed": "2026-09-16", "note": "founded 1970 with the charter signed at the United Nations in New York; registered office at 19 Morgan Drive, Lebanon, New Hampshire; more than 6,000 members in 117 countries" }, { "id": "s:isaps-global-survey-2024", "kind": "report", "title": "ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2024", "publisher": "International Society of Aesthetic Plastic Surgery, tabulated by Industry Insights Inc.", "url": "https://www.isaps.org/media/razfvmsk/isaps-global-survey-2024.pdf", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:isaps-about" }, "text.story": { "tier": "cited", "source": "s:isaps-global-survey-2024", "note": "every quoted sentence and every figure is read off the report's own method and ranking pages; the two paragraphs marked inference are this project's reading of what the method supports" }, "text.how": { "tier": "cited", "source": "s:isaps-global-survey-2024" }, "text.today": { "tier": "cited", "source": "s:isaps-global-survey-2024" }, "geo": { "tier": "inference", "source": "s:isaps-about", "note": "the registered office address is on the society's about page; city precision only" }, "address": { "tier": "cited", "source": "s:isaps-global-survey-2024" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "argentina", "type": "destination", "name": "Argentina", "as": "The society whose survey supplies the counts on this page.", "rel": "measured-by" }, { "from": "brazil", "type": "destination", "name": "Brazil", "as": "The society whose survey supplies the counts on this page.", "rel": "measured-by" }, { "from": "colombia", "type": "destination", "name": "Colombia", "as": "The society whose survey supplies every number on this page.", "rel": "measured-by" }, { "from": "panama", "type": "destination", "name": "Panama", "as": "The society whose survey supplies every number on this page.", "rel": "measured-by" }, { "from": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "One of the two societies whose members answered the mortality survey.", "rel": "org" }, { "from": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "The society whose global survey counts this operation across countries.", "rel": "org" }, { "from": "bbl-mortality", "type": "risk", "name": "Death from gluteal fat grafting", "as": "One of the societies whose members made up the surveyed population.", "rel": "org" }, { "from": "ishrs", "type": "org", "name": "International Society of Hair Restoration Surgery", "as": "The other society counting a cosmetic trade by surveying its own members.", "rel": "contrast" } ] }, { "schema": 1, "id": "ishrs", "type": "org", "names": { "name": "International Society of Hair Restoration Surgery", "aliases": [ "ISHRS" ], "said": "ISHRS is the complaint. Its census asks its own members what they see in their own cities, and its campaign has a name: Fight the FIGHT." }, "region": [ "global" ], "facets": { "kind": "professional-society", "iso2": "US", "founded": 1993, "status": "open" }, "text": { "what": "The international professional society for hair restoration surgeons, incorporated in 1993, run from Elgin, Illinois, and reporting 1,200 members across 80 countries. It publishes a Practice Census — a periodic questionnaire to its own members, from which it extrapolates worldwide procedure counts — and runs Fight the FIGHT, short for Fight the Fraudulent, Illicit, and Global Hair Transplants, which is the organised professional complaint about unlicensed hair-transplant work.", "story": "The census is the only number anyone has, and it is a number about the society's members.\n\nFrom the 2025 census release: 59 per cent of members reported black-market clinics operating in their own cities in 2024, against 51 per cent in 2021. Repair cases arising from a previous black-market transplant averaged 10 per cent of a member's caseload in 2024, against 6 per cent in 2021. The census was run by an outside firm, Relevant Research of Evanston, Illinois, from participating physicians only, with a margin of error the society gives as plus or minus 5.4 per cent at 95 per cent confidence. The 2022 census, on the same method, drew 197 responses from 822 valid invitations — a 24 per cent response rate — extrapolated 703,183 procedures worldwide for 2021, and stated in its own text that the true number performed worldwide is unknown.\n\n*Inference —* these are the society's claims, and this record reports them as such. A surgeon who repairs botched transplants sees botched transplants; a member answering about clinics in his own city is describing competitors. What the census measures is what a self-selected quarter of one society's membership reports, not what happened in the trade. It is still worth carrying, because there is no alternative: no state anywhere publishes a count of hair transplants performed, and none publishes a count of the ones that went wrong.\n\nThe complaint is a decade old and it named a country early. The society's release of 18 May 2016 warned that unqualified technicians were performing the surgery illegally, named Turkey through a surgeon practising in Istanbul, and reported Turkish technician groups working in Germany, the Netherlands and Belgium under cover of licensed doctors. Fight the FIGHT launched on 1 November 2019; its standing statement is that \"increasing numbers of unlicensed personnel worldwide are performing substantial medical aspects of hair restoration surgery\", and it names no country and gives no figures. Operation Restore, running since 2004, has delivered over $653,400 in free corrective surgery to people the society describes as victims of botched work, and World Hair Transplant Repair Day fell on 11 November 2025. ISHRS President Conradin von Albertini put the allegation this way: \"These fraudulent, illicit hair transplant clinics operate under the guise of an established medical practice, luring unsuspecting patients with false or misleading advertising, rock-bottom prices, and tempting travel packages.\"\n\nThe better corroboration is not the society's own. Türkiye's regulation on hair transplant units, in the Resmî Gazete of 6 May 2023, No. 32182, reserves the channel-opening stage of the operation to physicians holding the applicator certificate, forbids an assistant to work except under a certified physician, caps a certified physician at five rooms, and permits only one patient in a room at a time. *Inference —* a prohibition is written against a practice. The 2023 rules read as a list of what the society had been alleging since 2016, set out by the state where most of the alleged work is done, which is a stronger form of evidence than either a trade-press claim or a membership survey.", "how": "A membership society with an annual scientific meeting, a journal, position statements, and a census run for it by an outside research firm and published as a report and a press release. Fight the FIGHT is a standing public-awareness campaign rather than an enforcement mechanism: the society licenses nobody, inspects nobody and can strike nobody off. Its sanction is publication, and its repair arm is Operation Restore, which treats patients free.", "today": "As of 17 September 2026 the most recent census release is the 2025 one, reporting on 2024, and the Fight the FIGHT and consumer-alert pages carry dates through 30 January 2026.", "notes": "A society's survey of its own members is a survey of its own members. This record carries the figures with that attached, every time." }, "geo": { "lat": 42.0372, "lon": -88.2812, "precision": "city", "source": "s:ishrs-about" }, "address": { "street": "675 Tollgate Rd., Suite G", "city": "Elgin", "area": "Illinois", "country": "US", "postcode": "60123" }, "kin": [ { "to": "hair-transplant-fue", "as": "The operation, and the stage of it the society says a technician must not perform.", "rel": "procedure" }, { "to": "dhi-hair-transplant", "as": "A technique that makes the recipient site and places the graft in one movement, which is exactly the step the society's statements are about.", "rel": "procedure" }, { "to": "fue", "as": "The word, whose use in clinic advertising the society has tried to pin down.", "rel": "term" }, { "to": "turkiye", "as": "The country its 2016 release named, and the one that later wrote the same prohibitions into a regulation.", "rel": "place" }, { "to": "istanbul", "as": "The city named in its 2016 release, through a surgeon practising there.", "rel": "hub" }, { "to": "turkiye-hair-boom", "as": "The growth its warnings ran alongside, and predate by six years.", "rel": "event" }, { "to": "revision-at-home", "as": "The repair operation its census counts as a share of its members' caseload.", "rel": "risk" }, { "to": "advertising-rules", "as": "The rules on how this work may be sold, which the society's complaint is largely about.", "rel": "rule" }, { "to": "turkiye-health-services-directorate", "as": "The state body that wrote the 2023 hair transplant rules the society had been asking for.", "rel": "org" }, { "to": "isaps", "as": "The other society counting a cosmetic trade by surveying its own members.", "rel": "contrast" }, { "to": "counting-patients", "as": "A trade with no register, counted by asking the people who compete with it.", "rel": "story" } ], "links": [ { "label": "ISHRS", "url": "https://ishrs.org/" }, { "label": "Fight the FIGHT", "url": "https://ishrs.org/black-market/" }, { "label": "2025 census release", "url": "https://ishrs.org/fifth-hair-transplant-repair-day/" } ], "sources": [ "s:ishrs-about", "s:ishrs-2025-census-release", "s:ishrs-census-2022", "s:ishrs-black-market", "s:ishrs-consumer-alert", "s:ishrs-unlicensed-technicians", "s:ishrs-2016-buyer-beware", "s:rg-32182-2023-sac-ekimi" ], "provenance": { "default": { "tier": "cited", "source": "s:ishrs-about" }, "fields": { "text.story": { "tier": "cited", "source": "s:ishrs-2025-census-release", "note": "the 2024 and 2021 census figures and the von Albertini quotation are from the 2025 release, the response rate and the 703,183 extrapolation from the 2022 census report, the 2016 allegations from the buyer-beware release, the campaign dates and Operation Restore total from the black-market page, and the article-level reading of the 2023 Turkish regulation from the Resmî Gazete text; the two paragraphs marked inference are this project's" }, "text.how": { "tier": "inference", "note": "that the society has no licensing or disciplinary power over non-members is this project's reading of what its own pages describe" }, "geo": { "tier": "inference", "source": "s:ishrs-about", "note": "headquarters address from the society's about page; city precision only" } } }, "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "The international professional society for hair restoration surgeons, incorporated in 1993, run from Elgin, Illinois, and reporting 1,200 members across 80 countries.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The operation, and the stage of it the society says a technician must not perform.", "rel": "procedure" }, { "to": "dhi-hair-transplant", "type": "procedure", "name": "Direct hair implantation (DHI)", "as": "A technique that makes the recipient site and places the graft in one movement, which is exactly the step the society's statements are about.", "rel": "procedure" }, { "to": "fue", "type": "term", "name": "FUE", "as": "The word, whose use in clinic advertising the society has tried to pin down.", "rel": "term" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The country its 2016 release named, and the one that later wrote the same prohibitions into a regulation.", "rel": "place" }, { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "The city named in its 2016 release, through a surgeon practising there.", "rel": "hub" }, { "to": "turkiye-hair-boom", "type": "event", "name": "Türkiye's hair transplant boom", "as": "The growth its warnings ran alongside, and predate by six years.", "rel": "event" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The repair operation its census counts as a share of its members' caseload.", "rel": "risk" }, { "to": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "The rules on how this work may be sold, which the society's complaint is largely about.", "rel": "rule" }, { "to": "turkiye-health-services-directorate", "type": "org", "name": "Türkiye General Directorate of Health Services", "as": "The state body that wrote the 2023 hair transplant rules the society had been asking for.", "rel": "org" }, { "to": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "The other society counting a cosmetic trade by surveying its own members.", "rel": "contrast" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "A trade with no register, counted by asking the people who compete with it.", "rel": "story" } ], "source_list": [ { "id": "s:ishrs-about", "kind": "org", "title": "About the ISHRS", "publisher": "International Society of Hair Restoration Surgery", "url": "https://ishrs.org/about/", "accessed": "2026-09-17", "note": "'Since its incorporation in 1993'; 'an international, non-profit medical society'; 1,200 members representing 80 countries worldwide; headquarters at 675 Tollgate Rd., Suite G, Elgin, IL 60123 USA. A second page, ishrs.org/about-ishrs/, gives more than 1,100 members in 70 countries — the society publishes two counts." }, { "id": "s:ishrs-2025-census-release", "kind": "org", "title": "World Hair Transplant Repair Day press release, citing the ISHRS 2025 Practice Census", "publisher": "International Society of Hair Restoration Surgery", "year": 2025, "url": "https://ishrs.org/fifth-hair-transplant-repair-day/", "accessed": "2026-09-17", "note": "a professional society's survey of its own members, not a register" }, { "id": "s:ishrs-census-2022", "kind": "report", "title": "2022 Practice Census Results", "publisher": "International Society of Hair Restoration Surgery, prepared by Relevant Research, Inc.", "year": 2022, "url": "https://ishrs.org/wp-content/uploads/2022/04/Report-2022-ISHRS-Practice-Census_04-19-22-FINAL.pdf", "accessed": "2026-09-16", "note": "822 valid invitations, 197 responses, a 24 per cent response rate, an extrapolated 703,183 procedures worldwide in 2021, the sentence that the true number performed worldwide is unknown, 51.1 per cent reporting black-market clinics in their city, and a mean 6 per cent of cases as repairs of a previous black-market transplant" }, { "id": "s:ishrs-black-market", "kind": "org", "title": "Black Market hair restoration — the Fight the FIGHT campaign", "publisher": "International Society of Hair Restoration Surgery", "url": "https://ishrs.org/black-market/", "accessed": "2026-09-16", "note": "the society's standing warning that unlicensed personnel perform substantial medical parts of hair restoration surgery; campaign launched November 2019; Operation Restore repairs botched work" }, { "id": "s:ishrs-consumer-alert", "kind": "org", "title": "Consumer alert", "publisher": "International Society of Hair Restoration Surgery", "url": "https://ishrs.org/consumer-alert/", "accessed": "2026-09-17", "note": "page carries dates 18 January 2017 and 30 January 2026; 'increasing numbers of unlicensed personnel worldwide are performing substantial medical aspects of hair restoration surgery'; names no country and gives no figures" }, { "id": "s:ishrs-unlicensed-technicians", "kind": "org", "title": "Beware of Unlicensed Technicians Performing Hair Restoration Surgery", "publisher": "International Society of Hair Restoration Surgery", "url": "https://ishrs.org/beware-of-unlicensed-technicians-performing-hair-restoration-surgery/", "accessed": "2026-09-16", "note": "position statement dated 10 January 2024, updated from 18 September 2014" }, { "id": "s:ishrs-2016-buyer-beware", "kind": "org", "title": "Buyer Beware: Medical Tourism for Hair Transplants Can Have Costly Consequences", "publisher": "International Society of Hair Restoration Surgery", "year": 2016, "url": "https://ishrs.org/buyer-beware-medical-tourism-for-hair-transplants-can-have-costly-consequences/", "accessed": "2026-09-17" }, { "id": "s:rg-32182-2023-sac-ekimi", "kind": "web", "title": "Saç Ekimi Birimleri Hakkında Yönetmelik, Resmî Gazete 6 Mayıs 2023, Sayı 32182", "publisher": "T.C. Resmî Gazete", "year": 2023, "url": "https://www.resmigazete.gov.tr/eskiler/2023/05/20230506-11.htm", "accessed": "2026-09-17" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:ishrs-about" }, "text.story": { "tier": "cited", "source": "s:ishrs-2025-census-release", "note": "the 2024 and 2021 census figures and the von Albertini quotation are from the 2025 release, the response rate and the 703,183 extrapolation from the 2022 census report, the 2016 allegations from the buyer-beware release, the campaign dates and Operation Restore total from the black-market page, and the article-level reading of the 2023 Turkish regulation from the Resmî Gazete text; the two paragraphs marked inference are this project's" }, "text.how": { "tier": "inference", "note": "that the society has no licensing or disciplinary power over non-members is this project's reading of what its own pages describe" }, "text.today": { "tier": "cited", "source": "s:ishrs-about" }, "geo": { "tier": "inference", "source": "s:ishrs-about", "note": "headquarters address from the society's about page; city precision only" }, "address": { "tier": "cited", "source": "s:ishrs-about" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "istanbul", "type": "hub", "name": "Istanbul", "as": "The surgical society that has named this city in its warnings about unlicensed operators since 2016.", "rel": "org" }, { "from": "dhi-hair-transplant", "type": "procedure", "name": "Direct hair implantation (DHI)", "as": "The society whose statement on who may create recipient sites bears directly on a technique that makes the site and places the graft in one movement.", "rel": "org" }, { "from": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The society whose position statement names who should be cutting.", "rel": "org" }, { "from": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "The other society that counts a cosmetic trade by surveying its own members, and complains about the rest of it.", "rel": "contrast" }, { "from": "turkiye-health-services-directorate", "type": "org", "name": "Türkiye General Directorate of Health Services", "as": "The professional society whose allegations since 2016 the 2023 prohibitions read like a list of.", "rel": "org" }, { "from": "turkiye-hair-boom", "type": "event", "name": "Türkiye's hair transplant boom", "as": "The professional society whose alert about unlicensed operators predates the regulation by six years.", "rel": "org" } ] }, { "schema": 1, "id": "isqua-ieea", "type": "org", "names": { "name": "ISQua External Evaluation Association", "aliases": [ "ISQua EEA", "IEEA", "the accreditor of accreditors" ], "said": "The trade calls it the accreditor of accreditors, and that phrase does more work in marketing copy than in any contract." }, "region": [ "global", "europe-west" ], "facets": { "kind": "accreditor", "iso2": "IE", "founded": 2018, "status": "open" }, "text": { "what": "The body that assesses the bodies. Established by the International Society for Quality in Health Care in 2018 and trading from 2019, registered in Switzerland, it runs an International Accreditation Programme in four categories: health and social care standards, external evaluation organisations, surveyor training programmes, and quality and patient safety training programmes. It states plainly that it \"does not directly accredit health or social care services\".", "story": "Every other accreditor on this site is a private or public body selling an inspection to the organisation it inspects. The obvious question — who inspects the inspector — has exactly one industrial answer, and this is it.\n\nThe answer is smaller than it sounds. ISQua EEA does not audit a hospital and does not re-run an accreditor's surveys. It assesses whether a standards set, an evaluation organisation, or a surveyor training programme meets its own published principles, and grants an award for four years against annual progress reports. The applicant pays: a once-off Access Fee \"entitles an organisation to enter the International Accreditation Programme and to receive the full information pack\", banded by the World Bank income group of the country the applicant operates from — 1,716 to 2,946 euros for 2026.\n\n*Inference —* so the chain runs applicant pays accreditor, accreditor pays meta-accreditor, and nobody in the chain is paid by a patient. That is worth stating once, without indignation, because it is the shape of the whole field and most pages that cite these marks leave it out.", "how": "An organisation pays the Access Fee, receives the information pack, submits a self-assessment against the relevant ISQua EEA principles, and is reviewed by external surveyors. An award runs four years and requires an annual progress report with supporting evidence. Awards are dated on both ends, and accredited bodies publish the year range — AACI, for example, lists an organisational award for 2022 to 2026, a standards award for 2023 to 2027 and a surveyor training award for 2024 to 2028.", "today": "As of 16 September 2026 ISQua EEA holds awards over Temos, Global Healthcare Accreditation, AACI, NABH, CBAHI, the ACHS EQuIP standards and Thailand's Healthcare Accreditation Institute, among others. ISQua itself remains a separate Dublin-based not-for-profit, Irish registered charity number 20072445.", "notes": "Two countries sit on this record. The association is registered in Switzerland; the office the point is pinned on is ISQua's in Dublin, which is where the programme is run from. The country facet follows the point, so this record groups under Ireland on the maps and indexes." }, "geo": { "lat": 53.3498, "lon": -6.2603, "precision": "city", "source": "s:isqua-about" }, "address": { "city": "Dublin", "country": "IE" }, "kin": [ { "to": "jci", "as": "One of the accreditors whose standards it sits above, and the largest.", "rel": "accredits" }, { "to": "temos", "as": "Holds its award; the first German accreditor to take one.", "rel": "accredits" }, { "to": "gha", "as": "Holds its award over the Standards for Medical Travel 5.0.", "rel": "accredits" }, { "to": "aaci", "as": "Holds three of its awards, each with a published year range.", "rel": "accredits" }, { "to": "nabh", "as": "Holds its award over the Indian hospital standards.", "rel": "accredits" }, { "to": "the-accreditation-question", "as": "Where the chain of who pays whom is followed to the end.", "rel": "story" } ], "links": [ { "label": "International Accreditation Programme", "url": "https://ieea.ch/international-accreditation-programme/" }, { "label": "ISQua", "url": "https://isqua.org/" } ], "sources": [ "s:ieea-iap", "s:isqua-about" ], "provenance": { "default": { "tier": "cited", "source": "s:ieea-iap" }, "fields": { "text.story": { "tier": "cited", "source": "s:ieea-iap", "note": "third paragraph marked as this project's inference" }, "geo": { "tier": "cited", "source": "s:isqua-about", "note": "ISQua's Dublin base; ISQua EEA is registered in Switzerland and publishes no street address this project could read" } } }, "confidence": "high", "updated": "2026-09-16", "needs_verification": true, "blurb": "The body that assesses the bodies. Established by the International Society for Quality in Health Care in 2018 and trading from 2019, registered in Switzerland, it runs an International Accreditation Programme in four…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "One of the accreditors whose standards it sits above, and the largest.", "rel": "accredits" }, { "to": "temos", "type": "org", "name": "Temos International Healthcare Accreditation", "as": "Holds its award; the first German accreditor to take one.", "rel": "accredits" }, { "to": "gha", "type": "org", "name": "Global Healthcare Accreditation", "as": "Holds its award over the Standards for Medical Travel 5.0.", "rel": "accredits" }, { "to": "aaci", "type": "org", "name": "American Accreditation Commission International", "as": "Holds three of its awards, each with a published year range.", "rel": "accredits" }, { "to": "nabh", "type": "org", "name": "National Accreditation Board for Hospitals and Healthcare Providers", "as": "Holds its award over the Indian hospital standards.", "rel": "accredits" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Where the chain of who pays whom is followed to the end.", "rel": "story" } ], "source_list": [ { "id": "s:ieea-iap", "kind": "org", "title": "International Accreditation Programme", "publisher": "ISQua External Evaluation Association", "url": "https://ieea.ch/international-accreditation-programme/", "accessed": "2026-09-16", "note": "four assessment categories, the statement that ISQua EEA does not directly accredit health or social care services, the once-off Access Fee and the 2026 fee band" }, { "id": "s:isqua-about", "kind": "org", "title": "International Society for Quality in Health Care", "publisher": "ISQua", "url": "https://isqua.org/", "accessed": "2026-09-16", "note": "Dublin base, Irish registered charity number 20072445, and the statement that ISQua EEA was established by ISQua in 2018" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:ieea-iap" }, "text.story": { "tier": "cited", "source": "s:ieea-iap", "note": "third paragraph marked as this project's inference" }, "text.how": { "tier": "cited", "source": "s:ieea-iap" }, "text.today": { "tier": "cited", "source": "s:ieea-iap" }, "geo": { "tier": "cited", "source": "s:isqua-about", "note": "ISQua's Dublin base; ISQua EEA is registered in Switzerland and publishes no street address this project could read" }, "address": { "tier": "cited", "source": "s:ieea-iap" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "dubai", "type": "hub", "name": "Dubai", "as": "The body that accredits the standards a regulator writes, rather than the hospital.", "rel": "org" }, { "from": "aaci", "type": "org", "name": "American Accreditation Commission International", "as": "Holds three dated awards over this body, its standards and its surveyor training.", "rel": "accredited-by" }, { "from": "achsi", "type": "org", "name": "ACHS International", "as": "Holds the award over the EQuIP standards.", "rel": "accredited-by" }, { "from": "cbahi", "type": "org", "name": "Saudi Central Board for Accreditation of Healthcare Institutions", "as": "Holds the award over these standards.", "rel": "accredited-by" }, { "from": "gha", "type": "org", "name": "Global Healthcare Accreditation", "as": "Holds the award over its Standards for Medical Travel 5.0.", "rel": "accredited-by" }, { "from": "jci", "type": "org", "name": "Joint Commission International", "as": "The body that accredits accreditors, and the answer to who checks this one.", "rel": "accredited-by" }, { "from": "nabh", "type": "org", "name": "National Accreditation Board for Hospitals and Healthcare Providers", "as": "Holds the award over these standards.", "rel": "accredited-by" }, { "from": "temos", "type": "org", "name": "Temos International Healthcare Accreditation", "as": "The body holding an award over these standards.", "rel": "accredited-by" }, { "from": "thai-ha-institute", "type": "org", "name": "Healthcare Accreditation Institute", "as": "Holds the award over these standards.", "rel": "accredited-by" }, { "from": "jci-accredited-list", "type": "dataset", "name": "The JCI list of accredited organizations", "as": "The body that accredits the accreditors, and the answer to who audits this register.", "rel": "org" }, { "from": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "The body that assesses the bodies, and the only dated third-party check on a badge wall.", "rel": "org" } ] }, { "schema": 1, "id": "jci", "type": "org", "names": { "name": "Joint Commission International", "aliases": [ "JCI" ], "said": "Hospitals write JCI-accredited on the homepage and the brochure. Almost nobody writes the date the cycle ends." }, "region": [ "global" ], "facets": { "kind": "accreditor", "iso2": "US", "founded": 1998, "status": "open" }, "text": { "what": "The international arm of the Joint Commission, the body that accredits hospitals in the United States. Founded in 1998 and run through Joint Commission Resources, a not-for-profit private affiliate, it surveys hospitals, clinics and programmes outside the United States against its own standards and grants a three-year accreditation. It is the mark most often named when a hospital abroad advertises itself to a foreign patient.", "story": "The hospital applies. The hospital pays. JCI quotes an average of 46,000 US dollars a year to hold the accreditation, plus travel and other costs, and the fee is set from the services a hospital offers and its average daily census. That structure is not a scandal; it is how nearly every voluntary accreditation on earth works, and saying it out loud is the only way a reader can size what the mark means.\n\nThe survey is scheduled. JCI's own American surveys are unannounced; its international ones \"still take place at a time known in advance by the hospitals being surveyed, often after considerable preparation by those hospitals\". A reader who takes the mark as a snapshot of any ordinary Tuesday is reading it wrong.\n\n*Inference —* what the accreditation reliably certifies is that a named external body inspected named systems on a named date and found them conforming. It does not rank hospitals against each other, does not measure surgical outcomes, and does not survive the three years by itself. This directory therefore counts accreditations and never weighs them.", "how": "An organisation applies, signs a contract, pays a deposit against the survey fee, prepares, and is surveyed on an agreed date by a team of physicians, nurses and administrators working the tracer method — following real patients through real systems. Accreditation runs three years. The standards are published as manuals JCI sells; the directory of accredited organisations sits on JCI's own site. Reaccreditation is another survey and another fee.", "today": "As of 16 September 2026 JCI accredits organisations in more than 60 countries. Its own site refused every automated fetch on that date, so the figures here come from the secondary source named in sources, and the count is dated rather than current.", "notes": "An accreditation is a fact about an inspection somebody bought. It is not a quality score, and this site does not read it as one." }, "geo": { "lat": 41.8497, "lon": -87.9773, "precision": "city", "source": "s:jci-wikipedia" }, "address": { "city": "Oakbrook Terrace", "area": "Illinois", "country": "US" }, "kin": [ { "to": "isqua-ieea", "as": "The body that accredits accreditors, and the answer to who checks this one.", "rel": "accredited-by" }, { "to": "bumrungrad", "as": "Took this mark in 2002, early for Asia, and has renewed it five times.", "rel": "accredits" }, { "to": "jci-accredited-list", "as": "The published directory this site draws its accreditation counts from.", "rel": "measured-by" }, { "to": "the-accreditation-question", "as": "The argument over what a bought inspection proves, laid out at length.", "rel": "story" }, { "to": "temos", "as": "A competitor built for international patients rather than for hospitals in general.", "rel": "contrast" }, { "to": "gha", "as": "A competitor that certifies the travel pathway rather than the clinical unit.", "rel": "contrast" }, { "to": "thailand", "as": "The country whose hospitals hold more of these marks than any other in Southeast Asia.", "rel": "place" } ], "links": [ { "label": "Joint Commission International", "url": "https://www.jointcommissioninternational.org/" } ], "sources": [ "s:jci-wikipedia", "s:jci-accreditation" ], "provenance": { "default": { "tier": "cited", "source": "s:jci-wikipedia" }, "fields": { "text.story": { "tier": "cited", "source": "s:jci-wikipedia", "note": "the third paragraph is marked as this project's inference" }, "text.how": { "tier": "tradition", "note": "the general shape of a JCI survey cycle; the three-year interval and the public directory are cited" } } }, "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "The international arm of the Joint Commission, the body that accredits hospitals in the United States.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "isqua-ieea", "type": "org", "name": "ISQua External Evaluation Association", "as": "The body that accredits accreditors, and the answer to who checks this one.", "rel": "accredited-by" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Took this mark in 2002, early for Asia, and has renewed it five times.", "rel": "accredits" }, { "to": "jci-accredited-list", "type": "dataset", "name": "The JCI list of accredited organizations", "as": "The published directory this site draws its accreditation counts from.", "rel": "measured-by" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "The argument over what a bought inspection proves, laid out at length.", "rel": "story" }, { "to": "temos", "type": "org", "name": "Temos International Healthcare Accreditation", "as": "A competitor built for international patients rather than for hospitals in general.", "rel": "contrast" }, { "to": "gha", "type": "org", "name": "Global Healthcare Accreditation", "as": "A competitor that certifies the travel pathway rather than the clinical unit.", "rel": "contrast" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "The country whose hospitals hold more of these marks than any other in Southeast Asia.", "rel": "place" } ], "source_list": [ { "id": "s:jci-wikipedia", "kind": "wikipedia", "title": "Joint Commission International", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Joint_Commission_International", "accessed": "2026-09-16", "note": "used for the 1998 founding, the Joint Commission Resources affiliation, the quoted average annual fee and the announced-survey criticism; jointcommissioninternational.org redirected to jointcommission.org, which refused every fetch on this date" }, { "id": "s:jci-accreditation", "kind": "org", "title": "Joint Commission International — accreditation standards and accredited organizations", "publisher": "Joint Commission International", "url": "https://www.jointcommissioninternational.org/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:jci-wikipedia" }, "text.story": { "tier": "cited", "source": "s:jci-wikipedia", "note": "the third paragraph is marked as this project's inference" }, "text.how": { "tier": "tradition", "note": "the general shape of a JCI survey cycle; the three-year interval and the public directory are cited" }, "text.today": { "tier": "cited", "source": "s:jci-wikipedia" }, "geo": { "tier": "cited", "source": "s:jci-wikipedia" }, "address": { "tier": "cited", "source": "s:jci-wikipedia" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "costa-rica", "type": "destination", "name": "Costa Rica", "as": "The accreditor whose mark the San José hospitals hold.", "rel": "accredited-by" }, { "from": "amman", "type": "hub", "name": "Amman", "as": "The accreditor whose mark this city's flagship hospital carries, undated on the page read.", "rel": "accredited-by" }, { "from": "bogota", "type": "hub", "name": "Bogotá", "as": "Accredited the city's flagship hospital in 2010 and has renewed it five times since.", "rel": "accredited-by" }, { "from": "cancun", "type": "hub", "name": "Cancún", "as": "One of four schemes the city's main private hospital names on its own accreditations page.", "rel": "accredited-by" }, { "from": "panama-city", "type": "hub", "name": "Panama City", "as": "The mark the flagship hospital counts in fifths, without dating any of them.", "rel": "accredited-by" }, { "from": "san-jose-cr", "type": "hub", "name": "San José, Costa Rica", "as": "The mark the cluster's flagship hospital leads with.", "rel": "accredited-by" }, { "from": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "The accreditor whose mark seven of its hospitals hold.", "rel": "accredited-by" }, { "from": "albert-einstein-sao-paulo", "type": "facility", "name": "Hospital Israelita Albert Einstein", "as": "The first institution outside the United States it accredited, in 1999.", "rel": "accredited-by" }, { "from": "american-hospital-dubai", "type": "facility", "name": "American Hospital Dubai", "as": "Its accreditor, and the first award the body made in the Middle East.", "rel": "accredited-by" }, { "from": "anadolu-medical-center", "type": "facility", "name": "Anadolu Medical Center", "as": "The accreditor whose mark it has held since 2007, re-surveyed every three years to a seventh award.", "rel": "accredited-by" }, { "from": "apollo-chennai", "type": "facility", "name": "Apollo Hospitals, Greams Road, Chennai", "as": "An accreditor Apollo hospitals took early for India.", "rel": "accredited-by" }, { "from": "bangkok-hospital", "type": "facility", "name": "Bangkok Hospital", "as": "The international accreditor whose seal sits in its footer, undated.", "rel": "accredited-by" }, { "from": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "The accreditor whose mark it took in 2002, early for Asia.", "rel": "accredited-by" }, { "from": "clinica-biblica", "type": "facility", "name": "Hospital Clínica Bíblica", "as": "Its accreditor, shown as the gold seal on its own front page without a date.", "rel": "accredited-by" }, { "from": "fundacion-santa-fe", "type": "facility", "name": "Fundación Santa Fe de Bogotá", "as": "Its accreditor since 2010, in the academic medical centre category, renewed five times.", "rel": "accredited-by" }, { "from": "gleneagles-kl", "type": "facility", "name": "Gleneagles Hospital Kuala Lumpur", "as": "The international accreditor whose mark it holds alongside the Malaysian national one.", "rel": "accredited-by" }, { "from": "hospital-cima-san-jose", "type": "facility", "name": "Hospital CIMA San José", "as": "Its accreditor, undated in the sources read here.", "rel": "accredited-by" }, { "from": "king-hussein-cancer-center", "type": "facility", "name": "King Hussein Cancer Center", "as": "Its accreditor, in the disease-specific category rather than the hospital-wide one.", "rel": "accredited-by" }, { "from": "kokilaben", "type": "facility", "name": "Kokilaben Dhirubhai Ambani Hospital", "as": "One of four bodies whose marks it carries on its own front page.", "rel": "accredited-by" }, { "from": "liv-hospital", "type": "facility", "name": "Liv Hospital", "as": "Named on its site as its accreditor, without a year or a campus.", "rel": "accredited-by" }, { "from": "memorial-sisli", "type": "facility", "name": "Memorial Şişli Hospital", "as": "The accreditor whose mark it took first in the country and 21st in the world.", "rel": "accredited-by" }, { "from": "mount-elizabeth", "type": "facility", "name": "Mount Elizabeth Hospital", "as": "Named as its accreditor, undated in the source read here.", "rel": "accredited-by" }, { "from": "narayana-health", "type": "facility", "name": "Narayana Health", "as": "The accreditor whose mark two of its twenty-five hospitals hold.", "rel": "accredited-by" }, { "from": "raffles-hospital", "type": "facility", "name": "Raffles Hospital", "as": "Named as its accreditor, undated on the pages read here.", "rel": "accredited-by" }, { "from": "samitivej", "type": "facility", "name": "Samitivej Sukhumvit Hospital", "as": "The accreditor it names, without a year.", "rel": "accredited-by" }, { "from": "severance", "type": "facility", "name": "Severance Hospital", "as": "Its accreditor since 2007, the first award the body made in Korea.", "rel": "accredited-by" }, { "from": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "Certifies that a hospital runs a process; it is not a party to a consent.", "rel": "contrast" }, { "from": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "Accreditation is not a forum, and the accreditor is not a party.", "rel": "contrast" }, { "from": "malaysia-mhtc-licence", "type": "rule", "name": "Malaysia's healthcare travel registration", "as": "The accreditation the top membership tier is built on.", "rel": "accredited-by" }, { "from": "aaci", "type": "org", "name": "American Accreditation Commission International", "as": "The scheme it most often appears beside on a hospital's badge wall.", "rel": "contrast" }, { "from": "cbahi", "type": "org", "name": "Saudi Central Board for Accreditation of Healthcare Institutions", "as": "The voluntary international mark Saudi hospitals hold on top of this compulsory one.", "rel": "contrast" }, { "from": "dha-dubai", "type": "org", "name": "Dubai Health Authority", "as": "The voluntary mark Dubai's private hospitals buy on top of this compulsory licence.", "rel": "org" }, { "from": "dnv-healthcare", "type": "org", "name": "DNV Healthcare", "as": "The scheme it broke a near-monopoly on in the United States in 2008.", "rel": "contrast" }, { "from": "gha", "type": "org", "name": "Global Healthcare Accreditation", "as": "Surveys the ward where this scheme surveys the journey; the two are not substitutes.", "rel": "contrast" }, { "from": "isqua-ieea", "type": "org", "name": "ISQua External Evaluation Association", "as": "One of the accreditors whose standards it sits above, and the largest.", "rel": "accredits" }, { "from": "nabh", "type": "org", "name": "National Accreditation Board for Hospitals and Healthcare Providers", "as": "The international mark an Indian hospital holds alongside this one, for a different audience.", "rel": "contrast" }, { "from": "temos", "type": "org", "name": "Temos International Healthcare Accreditation", "as": "The larger competitor, built for hospitals rather than for international patients.", "rel": "contrast" }, { "from": "thai-ha-institute", "type": "org", "name": "Healthcare Accreditation Institute", "as": "The purchased international mark a Thai hospital holds for a different audience.", "rel": "contrast" }, { "from": "turkiye-health-services-directorate", "type": "org", "name": "Türkiye General Directorate of Health Services", "as": "A voluntary mark a hospital buys, against a compulsory state certificate it must hold to trade at all.", "rel": "contrast" }, { "from": "jci-accredited-list", "type": "dataset", "name": "The JCI list of accredited organizations", "as": "The body that keeps the list, sells the standards and takes the fee.", "rel": "org" }, { "from": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "The mark most often named, at a stated average of 46,000 dollars a year, surveyed on an agreed date.", "rel": "org" } ] }, { "schema": 1, "id": "khidi", "type": "org", "names": { "name": "Korea Health Industry Development Institute", "aliases": [ "KHIDI", "한국보건산업진흥원" ], "said": "KHIDI. It is the institute that both promotes the trade and counts it, which is worth knowing before reading the count." }, "region": [ "east-asia" ], "facets": { "kind": [ "ministry", "registry" ], "iso2": "KR", "status": "open" }, "text": { "what": "A government-affiliated institute under South Korea's Ministry of Health and Welfare. It develops the health industry, runs the Medical Korea programme, maintains the registration database of institutions permitted to attract foreign patients, and compiles the annual national statistics on foreign patients treated in Korea.", "story": "Korea did the thing almost no other destination did: it made attracting foreign patients a registered activity, and then counted the result at the level of the individual patient.\n\nA hospital or clinic that wants to solicit foreign patients registers. A facilitator that wants to broker them registers. Registration produces a list of who is in the trade, and it produces returns, and the returns produce a national figure that counts people rather than visits.\n\nThat is the difference this record exists to record. The 2024 report published by the Ministry of Health and Welfare with KHIDI counts 1,170,467 foreign patients from 202 countries, and it is stated as unique patients excluding repeat visits, with 999,642 of them treated in Seoul. *Inference —* a number built from a compulsory registration and a stated counting rule is a different class of evidence from a market-research total, and it is the reason a Korean figure can be carried on this site while most national totals cannot.", "how": "Institutions register with the ministry through the system KHIDI manages; registered hospitals and registered facilitators are listed. Registered institutions report their foreign patient activity, KHIDI analyses it annually, and the ministry publishes the result. The counting rule — patients, not visits — is stated in the reporting.", "today": "As of 16 September 2026 the most recent published year is 2024: 1,170,467 foreign patients from 202 countries, 85 per cent of them treated in Seoul, with national medical spending by those patients reported at 1.4 trillion won.", "notes": "This record carries the Korean figure because its counting rule is published. It does not follow that the same number is comparable with any other country's; almost no other country counts this way." }, "geo": { "lat": 36.48, "lon": 127.289, "precision": "city", "source": "s:khidi-medicalkorea" }, "address": { "city": "Cheongju", "area": "North Chungcheong", "country": "KR" }, "metrics": { "inbound_patients_year": 1170467, "note": "The 2024 national figure published by the Ministry of Health and Welfare with KHIDI. It counts unique foreign patients treated in Korea, excluding repeat visits, from 202 countries; 999,642 of them were treated in Seoul. It is a count of patients, not of people who travelled to Korea specifically for treatment — a resident foreigner treated in Korea is inside it.", "as_of": "2024", "source": "s:seoul-foreign-patients-2024", "url": "https://english.seoul.go.kr/seoul-draws-1m-international-medical-tourists-in-2024-with-%E2%82%A91-2t-in-medical-spending/" }, "kin": [ { "to": "south-korea", "as": "The country whose inbound patient count it compiles and publishes.", "rel": "place" }, { "to": "seoul", "as": "The city that takes 85 per cent of the patients in its own count.", "rel": "place" }, { "to": "korea-foreign-patient-registration", "as": "The registration rule that makes the count possible.", "rel": "governs" }, { "to": "counting-patients", "as": "The one national count on this site whose counting rule is published.", "rel": "story" }, { "to": "mhtc", "as": "Malaysia's equivalent agency, publishing a visit count rather than a patient count.", "rel": "contrast" }, { "to": "what-the-data-cannot-see", "as": "Even this count cannot separate a traveller from a resident foreigner.", "rel": "story" } ], "links": [ { "label": "About KHIDI — Medical Korea", "url": "http://www.medicalkorea.or.kr/en/aboutkhidi" } ], "sources": [ "s:khidi-medicalkorea", "s:seoul-foreign-patients-2024" ], "provenance": { "default": { "tier": "cited", "source": "s:khidi-medicalkorea" }, "fields": { "metrics": { "tier": "cited", "source": "s:seoul-foreign-patients-2024" }, "geo": { "tier": "inference", "note": "KHIDI's head office is at Osong in Cheongju; city precision only" } } }, "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "A government-affiliated institute under South Korea's Ministry of Health and Welfare.", "region_terms": [ { "key": "east-asia", "name": "East Asia", "note": "South Korea, Japan, Taiwan, China" } ], "kin_out": [ { "to": "south-korea", "type": "destination", "name": "South Korea", "as": "The country whose inbound patient count it compiles and publishes.", "rel": "place" }, { "to": "seoul", "type": "hub", "name": "Seoul", "as": "The city that takes 85 per cent of the patients in its own count.", "rel": "place" }, { "to": "korea-foreign-patient-registration", "type": "rule", "name": "Korea's foreign patient attraction registration", "as": "The registration rule that makes the count possible.", "rel": "governs" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "The one national count on this site whose counting rule is published.", "rel": "story" }, { "to": "mhtc", "type": "org", "name": "Malaysia Healthcare Travel Council", "as": "Malaysia's equivalent agency, publishing a visit count rather than a patient count.", "rel": "contrast" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "Even this count cannot separate a traveller from a resident foreigner.", "rel": "story" } ], "source_list": [ { "id": "s:khidi-medicalkorea", "kind": "org", "title": "About KHIDI — Medical Korea", "publisher": "Korea Health Industry Development Institute", "url": "http://www.medicalkorea.or.kr/en/aboutkhidi", "accessed": "2026-09-16", "note": "government-affiliated institution under the Ministry of Health and Welfare; the registration system, registered hospitals and registered facilitators" }, { "id": "s:seoul-foreign-patients-2024", "kind": "web", "title": "Seoul Draws 1M International Medical Tourists in 2024 with ₩1.2T in Medical Spending", "publisher": "Seoul Metropolitan Government", "year": 2026, "url": "https://english.seoul.go.kr/seoul-draws-1m-international-medical-tourists-in-2024-with-%E2%82%A91-2t-in-medical-spending/", "accessed": "2026-09-16", "note": "reports the MOHW and KHIDI 2024 count: 1,170,467 patients from 202 countries, 999,642 of them treated in Seoul" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:khidi-medicalkorea" }, "text.story": { "tier": "cited", "source": "s:khidi-medicalkorea" }, "text.how": { "tier": "cited", "source": "s:khidi-medicalkorea" }, "text.today": { "tier": "cited", "source": "s:khidi-medicalkorea" }, "geo": { "tier": "inference", "note": "KHIDI's head office is at Osong in Cheongju; city precision only" }, "address": { "tier": "cited", "source": "s:khidi-medicalkorea" }, "metrics": { "tier": "cited", "source": "s:seoul-foreign-patients-2024" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "south-korea", "type": "destination", "name": "South Korea", "as": "The institute that compiles the foreign-patient series for the health ministry.", "rel": "measured-by" }, { "from": "seoul", "type": "hub", "name": "Seoul", "as": "The state institute that keeps the foreign-patient count this record quotes.", "rel": "measured-by" }, { "from": "wooridul", "type": "facility", "name": "Wooridul Spine Hospital", "as": "The state body whose listing supplies every number on this record.", "rel": "measured-by" }, { "from": "korea-foreign-patient-registration", "type": "rule", "name": "Korea's foreign patient attraction registration", "as": "The institute that runs the register and publishes the count.", "rel": "org" }, { "from": "dha-dubai", "type": "org", "name": "Dubai Health Authority", "as": "The other agency that promotes and counts at once — and publishes its counting rule.", "rel": "contrast" }, { "from": "mhtc", "type": "org", "name": "Malaysia Healthcare Travel Council", "as": "Korea's equivalent state body, which publishes a patient count instead of a visit count.", "rel": "contrast" }, { "from": "counting-patients", "type": "story", "name": "Counting patients", "as": "The institute that compiles the Korean returns and states the count excludes repeat visits.", "rel": "org" } ] }, { "schema": 1, "id": "medical-tourism-association", "type": "org", "names": { "name": "Medical Tourism Association", "aliases": [ "MTA" ], "said": "A membership organisation. Governments, hospitals and insurers pay to belong, and it publishes an index of destinations." }, "region": [ "global", "north-america" ], "facets": { "kind": "trade-body", "iso2": "US", "founded": 2007, "status": "open" }, "text": { "what": "A non-profit membership organisation founded in 2007 and run from West Palm Beach, Florida, serving the industry that sells cross-border care: healthcare providers, referral organisations, insurers and governments. It runs conferences, training and certification, works with destinations on their national marketing, and is associated with the Medical Tourism Index.", "story": "A trade association exists to advance its members' interests, and this one says so: its stated goal is making it easier for stakeholders to connect and do business, and it names the destination brands it has helped launch — South Korea, Dubai, Washington DC, the State of Florida, Abu Dhabi. Those are clients. Reading its published material without that fact in view is reading a brochure as a survey.\n\nThe Medical Tourism Index is the output most often cited as though it were an independent ranking. Its method is published in outline: three editions to date, the most recent covering 46 destinations, built from 41 criteria across three dimensions and from a national survey of 3,030 Americans. It is credited to Renée-Marie Stephano, who co-founded this association, with Marc Fetscherin of Rollins College, and published through the International Healthcare Research Center.\n\nSo the index measures what a sample of Americans believed about 46 destinations. It does not measure outcomes, prices, complication rates or how many people went. *Inference —* an index of perception, published by people commercially engaged in the field it ranks, is a legitimate object as long as it is labelled as what it is. This directory reports the method and does not repeat the ranking as a finding, and does not carry the association's market-size figures at all.", "how": "Members pay dues. The association sells conference places, sponsorship, training and certification, and consults to governments on destination branding. Global Healthcare Accreditation is its named strategic partner for training, accreditation and certification.", "today": "As of 16 September 2026 the most recent Medical Tourism Index edition is 2020-21, covering 46 destinations. The 2014-15 edition covered 25 and the 2016-17 edition 41.", "notes": "This record names the method where the method is published and says where it is not. It takes no view on whether the rankings are right." }, "geo": { "lat": 26.7153, "lon": -80.0534, "precision": "city", "source": "s:mta-about" }, "address": { "city": "West Palm Beach", "area": "Florida", "country": "US" }, "kin": [ { "to": "gha", "as": "The accreditation body it names as its strategic partner, founded by its co-founder.", "rel": "org" }, { "to": "imtj", "as": "The other side of the trade's own publishing: a commercial journal rather than an association.", "rel": "contrast" }, { "to": "medical-tourism", "as": "The word it put in its own name, and the fight over that word.", "rel": "term" }, { "to": "counting-patients", "as": "Where the industry's market-size figures are traced back to their sources.", "rel": "story" }, { "to": "keith-pollard", "as": "The trade's other long-standing publisher, and a frequent critic of its numbers.", "rel": "person" }, { "to": "uae", "as": "One of the destinations whose national brand it names as its own work.", "rel": "place" } ], "links": [ { "label": "Medical Tourism Association", "url": "https://www.medicaltourismassociation.com/" }, { "label": "Medical Tourism Index", "url": "https://www.medicaltourism.com/mti/home" } ], "sources": [ "s:mta-about", "s:mti-home" ], "provenance": { "default": { "tier": "cited", "source": "s:mta-about" }, "fields": { "text.story": { "tier": "cited", "source": "s:mti-home", "note": "the closing paragraph is marked as this project's inference" } } }, "confidence": "high", "updated": "2026-09-16", "blurb": "A non-profit membership organisation founded in 2007 and run from West Palm Beach, Florida, serving the industry that sells cross-border care: healthcare providers, referral organisations, insurers and governments.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "gha", "type": "org", "name": "Global Healthcare Accreditation", "as": "The accreditation body it names as its strategic partner, founded by its co-founder.", "rel": "org" }, { "to": "imtj", "type": "org", "name": "International Medical Travel Journal", "as": "The other side of the trade's own publishing: a commercial journal rather than an association.", "rel": "contrast" }, { "to": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The word it put in its own name, and the fight over that word.", "rel": "term" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Where the industry's market-size figures are traced back to their sources.", "rel": "story" }, { "to": "keith-pollard", "type": "person", "name": "Keith Pollard", "as": "The trade's other long-standing publisher, and a frequent critic of its numbers.", "rel": "person" }, { "to": "uae", "type": "destination", "name": "United Arab Emirates", "as": "One of the destinations whose national brand it names as its own work.", "rel": "place" } ], "source_list": [ { "id": "s:mta-about", "kind": "org", "title": "About MTA", "publisher": "Medical Tourism Association", "url": "https://www.medicaltourismassociation.com/about-us", "accessed": "2026-09-16", "note": "founded 2007, non-profit, West Palm Beach, Florida; describes government, provider and insurer members" }, { "id": "s:mti-home", "kind": "web", "title": "The Medical Tourism Index 2020-21", "publisher": "International Healthcare Research Center", "url": "https://www.medicaltourism.com/mti/home", "accessed": "2026-09-16", "note": "authorship, the three editions and their destination counts, the three dimensions and 41 criteria, and the survey of 3,030 Americans" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:mta-about" }, "text.story": { "tier": "cited", "source": "s:mti-home", "note": "the closing paragraph is marked as this project's inference" }, "text.how": { "tier": "cited", "source": "s:mta-about" }, "text.today": { "tier": "cited", "source": "s:mta-about" }, "geo": { "tier": "cited", "source": "s:mta-about" }, "address": { "tier": "cited", "source": "s:mta-about" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "A trade body whose logo appears where a licence does not exist.", "rel": "org" }, { "from": "gha", "type": "org", "name": "Global Healthcare Accreditation", "as": "The trade body it names as its strategic partner, and whose co-founder founded it.", "rel": "org" }, { "from": "imtj", "type": "org", "name": "International Medical Travel Journal", "as": "The other house that publishes about this trade, from inside a membership body.", "rel": "contrast" }, { "from": "promed", "type": "org", "name": "PROMED", "as": "The same form of body one scale up: members pay, the body promotes.", "rel": "contrast" }, { "from": "imtj-summit", "type": "event", "name": "The IMTJ Medical Travel Summit and Awards", "as": "The other house that convenes this industry, with its own conference and its own index.", "rel": "contrast" }, { "from": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The trade body that put this word in its own name in 2007.", "rel": "org" } ] }, { "schema": 1, "id": "mhtc", "type": "org", "names": { "name": "Malaysia Healthcare Travel Council", "aliases": [ "MHTC" ], "said": "A government agency that markets. Hospitals are licensed by the Ministry of Health; MHTC lists them." }, "region": [ "southeast-asia" ], "facets": { "kind": "ministry", "iso2": "MY", "founded": 2005, "status": "open" }, "text": { "what": "A Malaysian government agency set up in 2005 and incorporated as an independent entity in 2011 to promote and coordinate the country's healthcare travel trade. It sits under the Ministry of Health, moved to the Ministry of Finance in 2018, and works as the promoting and facilitating arm of the health ministry rather than as a licensing authority.", "story": "Malaysia built a state marketing body before most of its competitors did, and the structure is the interesting part. MHTC does not license a hospital — the Ministry of Health does that under the private healthcare legislation. MHTC admits hospitals to a membership list and promotes them, which means its list is a marketing roster with an entry requirement, not a register of who may lawfully operate.\n\n*Inference —* that distinction decides what a reader can do with the list. Absence from it does not make a hospital unlicensed. Presence on it does not add a licence. It says a hospital chose to join a promotional scheme and met its terms.\n\nThe agency publishes arrival and revenue figures for the trade, and those numbers travel widely. *Trade practice —* national healthcare-travel counts of this kind generally derive from hospital returns of foreign patient episodes, which count visits by non-residents rather than people who came for treatment, and include expatriates and visitors who fell ill. This directory does not carry the headline totals as facts about how many people travelled to Malaysia for care.", "how": "A hospital or clinic applies for MHTC membership, meets the entry criteria, and is listed and promoted. MHTC runs concierge desks, publishes destination material, and reports the sector's numbers to government. Its own site returned a server error to every fetch from this project on 16 September 2026, so this record rests on the secondary source named in sources.", "today": "As of 16 September 2026 the agency's own site could not be read by this project. The most recent figure this record could source is 2019, when Malaysia is reported to have received over 1.2 million healthcare travellers — a count of episodes reported by facilities, not of individuals who travelled for treatment." }, "geo": { "lat": 3.139, "lon": 101.6869, "precision": "city", "source": "s:mhtc-wikipedia" }, "address": { "city": "Kuala Lumpur", "country": "MY" }, "kin": [ { "to": "malaysia", "as": "The country whose inbound trade it markets and reports on.", "rel": "place" }, { "to": "malaysia-mhtc-licence", "as": "The rule record for what membership is and is not; licensing sits with the health ministry.", "rel": "governs" }, { "to": "gleneagles-kl", "as": "One of the private hospitals on its member roster.", "rel": "org" }, { "to": "island-hospital-penang", "as": "The Penang hospital the agency's Indonesian corridor is built around.", "rel": "org" }, { "to": "counting-patients", "as": "Where a national healthcare-traveller total is taken apart.", "rel": "story" }, { "to": "khidi", "as": "Korea's equivalent state body, which publishes a patient count instead of a visit count.", "rel": "contrast" } ], "links": [ { "label": "Malaysia Healthcare Travel Council", "url": "https://www.mhtc.org.my/" } ], "sources": [ "s:mhtc-wikipedia" ], "provenance": { "default": { "tier": "cited", "source": "s:mhtc-wikipedia" }, "fields": { "text.story": { "tier": "tradition", "note": "the second paragraph is this project's inference; the third is the trade's general practice on national counts, marked inline" }, "geo": { "tier": "inference", "note": "MHTC operates from Kuala Lumpur; city precision only" } } }, "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "A Malaysian government agency set up in 2005 and incorporated as an independent entity in 2011 to promote and coordinate the country's healthcare travel trade.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "malaysia", "type": "destination", "name": "Malaysia", "as": "The country whose inbound trade it markets and reports on.", "rel": "place" }, { "to": "malaysia-mhtc-licence", "type": "rule", "name": "Malaysia's healthcare travel registration", "as": "The rule record for what membership is and is not; licensing sits with the health ministry.", "rel": "governs" }, { "to": "gleneagles-kl", "type": "facility", "name": "Gleneagles Hospital Kuala Lumpur", "as": "One of the private hospitals on its member roster.", "rel": "org" }, { "to": "island-hospital-penang", "type": "facility", "name": "Island Hospital", "as": "The Penang hospital the agency's Indonesian corridor is built around.", "rel": "org" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Where a national healthcare-traveller total is taken apart.", "rel": "story" }, { "to": "khidi", "type": "org", "name": "Korea Health Industry Development Institute", "as": "Korea's equivalent state body, which publishes a patient count instead of a visit count.", "rel": "contrast" } ], "source_list": [ { "id": "s:mhtc-wikipedia", "kind": "wikipedia", "title": "Malaysia Healthcare Travel Council", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Malaysia_Healthcare_Travel_Council", "accessed": "2026-09-16", "note": "set up 2005, incorporated as an independent entity 2011, moved from the Ministry of Health to the Ministry of Finance in 2018, and the 2019 arrivals figure; mhtc.org.my returned HTTP 500 on this date" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:mhtc-wikipedia" }, "text.story": { "tier": "tradition", "note": "the second paragraph is this project's inference; the third is the trade's general practice on national counts, marked inline" }, "text.how": { "tier": "cited", "source": "s:mhtc-wikipedia" }, "text.today": { "tier": "cited", "source": "s:mhtc-wikipedia" }, "geo": { "tier": "inference", "note": "MHTC operates from Kuala Lumpur; city precision only" }, "address": { "tier": "cited", "source": "s:mhtc-wikipedia" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "malaysia", "type": "destination", "name": "Malaysia", "as": "The council inside the health ministry that publishes this country's traveller count.", "rel": "measured-by" }, { "from": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "The state council that licenses and lists the hospitals here, and keeps the count.", "rel": "governed-by" }, { "from": "penang", "type": "hub", "name": "Penang", "as": "The state council that lists these hospitals and publishes the counts.", "rel": "governed-by" }, { "from": "gleneagles-kl", "type": "facility", "name": "Gleneagles Hospital Kuala Lumpur", "as": "The government agency that lists and promotes Malaysia's inbound hospitals.", "rel": "org" }, { "from": "island-hospital-penang", "type": "facility", "name": "Island Hospital", "as": "The government agency that named it a flagship hospital in 2025.", "rel": "accredited-by" }, { "from": "prince-court", "type": "facility", "name": "Prince Court Medical Centre", "as": "The Malaysian government agency that lists and promotes hospitals taking foreign patients.", "rel": "org" }, { "from": "malaysia-mhtc-licence", "type": "rule", "name": "Malaysia's healthcare travel registration", "as": "The council that runs the membership half.", "rel": "org" }, { "from": "dha-dubai", "type": "org", "name": "Dubai Health Authority", "as": "Malaysia's equivalent, publishing a visit count rather than a patient count.", "rel": "contrast" }, { "from": "khidi", "type": "org", "name": "Korea Health Industry Development Institute", "as": "Malaysia's equivalent agency, publishing a visit count rather than a patient count.", "rel": "contrast" }, { "from": "counting-patients", "type": "story", "name": "Counting patients", "as": "The council whose membership list is a marketing roster rather than a register of who may operate.", "rel": "org" } ] }, { "schema": 1, "id": "nabh", "type": "org", "names": { "name": "National Accreditation Board for Hospitals and Healthcare Providers", "aliases": [ "NABH" ], "said": "In India a hospital says NABH the way a hospital in Bangkok says JCI, and the two are not the same object." }, "region": [ "south-asia", "global" ], "facets": { "kind": "accreditor", "iso2": "IN", "founded": 2005, "status": "open" }, "text": { "what": "India's hospital accreditation board, set up in 2005 as a constituent board of the Quality Council of India. It accredits hospitals, small healthcare organisations, eye care centres, blood banks, clinics, AYUSH hospitals, ethics committees and laboratories, and its accreditation is reassessed every two years rather than every three.", "story": "NABH matters to cross-border care for a reason that has nothing to do with quality: it is the gate. Indian government schemes and insurer empanelment — CGHS, ECHS — run through NABH status, so accreditation in India is tied to being paid domestically in a way that a voluntary international mark is not.\n\nThat changes the incentive. A hospital chasing JCI is chasing a foreign patient's confidence. A hospital chasing NABH is chasing both that and a domestic reimbursement channel, and the second is the larger sum for almost every hospital in the country.\n\n*Inference —* a foreign reader comparing an Indian hospital's NABH mark with a Thai hospital's JCI mark is comparing two different instruments. One is a national scheme with money attached; the other is an international product. Counting them as equivalent badges flattens the difference.", "how": "The hospital applies to NABH, pays, is assessed, and is reassessed every two years. The standards are published, currently in their fifth edition, and the accredited organisations are searchable on NABH's own site. The standards themselves hold an ISQua EEA award.", "today": "As of 16 September 2026 NABH's homepage claims more than 30,000 accreditations and certifications across all its programmes — a count of certificates across every scheme it runs, not of accredited hospitals. The hospital figure most often cited is 1,299." }, "geo": { "lat": 28.6139, "lon": 77.209, "precision": "city", "source": "s:nabh-home" }, "address": { "city": "New Delhi", "country": "IN" }, "recognitions": [ { "by": "isqua-eea", "what": "ISQua EEA accreditation of the NABH hospital standards", "year": null, "valid_until": null, "source": "s:nabh-wikipedia", "url": "https://nabh.co/", "note": "award year not established from the pages read for this record" } ], "kin": [ { "to": "india", "as": "The country whose hospitals this scheme gates, for domestic payment as much as for foreign patients.", "rel": "place" }, { "to": "apollo-chennai", "as": "One of the private hospitals whose badge wall carries this mark.", "rel": "accredits" }, { "to": "fortis-gurgaon", "as": "Another, in the Delhi cluster.", "rel": "accredits" }, { "to": "jci", "as": "The international mark an Indian hospital holds alongside this one, for a different audience.", "rel": "contrast" }, { "to": "isqua-ieea", "as": "Holds the award over these standards.", "rel": "accredited-by" }, { "to": "india-e-medical-visa", "as": "The other Indian instrument a foreign patient meets before arrival.", "rel": "governed-by" } ], "links": [ { "label": "NABH", "url": "https://nabh.co/" } ], "sources": [ "s:nabh-home", "s:nabh-wikipedia" ], "provenance": { "default": { "tier": "cited", "source": "s:nabh-wikipedia" }, "fields": { "text.story": { "tier": "cited", "source": "s:nabh-home", "note": "the empanelment link is from NABH's own programme list; the closing paragraph is marked as inference" }, "geo": { "tier": "inference", "note": "NABH operates from the Quality Council of India offices in New Delhi; city precision only" } } }, "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "India's hospital accreditation board, set up in 2005 as a constituent board of the Quality Council of India.", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" }, { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "india", "type": "destination", "name": "India", "as": "The country whose hospitals this scheme gates, for domestic payment as much as for foreign patients.", "rel": "place" }, { "to": "apollo-chennai", "type": "facility", "name": "Apollo Hospitals, Greams Road, Chennai", "as": "One of the private hospitals whose badge wall carries this mark.", "rel": "accredits" }, { "to": "fortis-gurgaon", "type": "facility", "name": "Fortis Memorial Research Institute, Gurugram", "as": "Another, in the Delhi cluster.", "rel": "accredits" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The international mark an Indian hospital holds alongside this one, for a different audience.", "rel": "contrast" }, { "to": "isqua-ieea", "type": "org", "name": "ISQua External Evaluation Association", "as": "Holds the award over these standards.", "rel": "accredited-by" }, { "to": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The other Indian instrument a foreign patient meets before arrival.", "rel": "governed-by" } ], "source_list": [ { "id": "s:nabh-home", "kind": "web", "title": "National Accreditation Board for Hospitals & Healthcare Providers", "publisher": "NABH", "url": "https://nabh.co/", "accessed": "2026-09-16", "note": "the programme list, the Find an Accredited Healthcare Organisation search, and the headline figure of more than 30,000 accreditations and certifications" }, { "id": "s:nabh-wikipedia", "kind": "wikipedia", "title": "National Accreditation Board for Hospitals & Healthcare Providers", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/National_Accreditation_Board_for_Hospitals_%26_Healthcare_Providers", "accessed": "2026-09-16", "note": "2005 establishment under the Quality Council of India, the two-year reassessment interval, and the count of accredited hospitals" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:nabh-wikipedia" }, "text.story": { "tier": "cited", "source": "s:nabh-home", "note": "the empanelment link is from NABH's own programme list; the closing paragraph is marked as inference" }, "text.how": { "tier": "cited", "source": "s:nabh-wikipedia" }, "text.today": { "tier": "cited", "source": "s:nabh-wikipedia" }, "geo": { "tier": "inference", "note": "NABH operates from the Quality Council of India offices in New Delhi; city precision only" }, "address": { "tier": "cited", "source": "s:nabh-wikipedia" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [ { "key": "isqua-eea", "label": "ISQua External Evaluation Association", "what": "ISQua EEA accreditation of the NABH hospital standards", "url": "https://nabh.co/", "kind": "meta", "year": null, "valid_until": null, "source": "s:nabh-wikipedia" } ], "acclaim": 1, "kin_in": [ { "from": "india", "type": "destination", "name": "India", "as": "The national accreditor, holding more than 1,299 hospitals as of 2026.", "rel": "accredited-by" }, { "from": "apollo-chennai", "type": "facility", "name": "Apollo Hospitals, Greams Road, Chennai", "as": "The Indian national board whose standard the group holds.", "rel": "accredited-by" }, { "from": "fortis-gurgaon", "type": "facility", "name": "Fortis Memorial Research Institute, Gurugram", "as": "The Indian national board; this record holds no dated grant for this hospital.", "rel": "accredited-by" }, { "from": "kokilaben", "type": "facility", "name": "Kokilaben Dhirubhai Ambani Hospital", "as": "The Indian national board, inspecting against a domestic standard rather than an international one.", "rel": "accredited-by" }, { "from": "achsi", "type": "org", "name": "ACHS International", "as": "The Indian equivalent: a domestic scheme that also sells abroad.", "rel": "contrast" }, { "from": "isqua-ieea", "type": "org", "name": "ISQua External Evaluation Association", "as": "Holds its award over the Indian hospital standards.", "rel": "accredits" }, { "from": "thai-ha-institute", "type": "org", "name": "Healthcare Accreditation Institute", "as": "India's equivalent domestic board.", "rel": "contrast" }, { "from": "prathap-reddy", "type": "person", "name": "Prathap C. Reddy", "as": "The Indian accreditation system his group's hospitals are counted in.", "rel": "org" }, { "from": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "A national scheme with domestic reimbursement attached, reassessed every two years.", "rel": "org" } ] }, { "schema": 1, "id": "oecd", "type": "org", "names": { "name": "Organisation for Economic Co-operation and Development", "aliases": [ "OECD", "OCDE" ], "said": "The rich-country statistics club. It is the only body that has seriously tried to measure this trade, and it said the numbers are small." }, "region": [ "global", "europe-west" ], "facets": { "kind": "ngo", "founded": 1961, "status": "open" }, "text": { "what": "An intergovernmental organisation of 38 member countries, founded in 1961 as successor to the Organisation for European Economic Co-operation of 1948, headquartered at the Château de la Muette in Paris. It publishes OECD Health Statistics, the comparative health database behind most cross-country health charts, including waiting times — the queue that sends a large share of Europe's patients abroad.", "story": "In June 2011 the OECD published the one serious attempt to put trade in health services on a statistical footing: a final report, funded by the European Commission's health directorate, on improving estimates of exports and imports of health services under the System of Health Accounts framework. Its findings are the most useful thing on this site about the size of the field.\n\nIt found the data patchy and the reason structural. \"The traditional data sources used in the estimation of imports and exports (i.e. in the Balance of Payments) become less and less adequate.\" Residency rules cut across the question — a foreign patient may keep non-resident status past a year, a retiree abroad technically leaves the resident population while staying insured at home. Third-party payment complicates it further. And several of the things cross-border patients most often buy sit on or outside the boundary of health care as the accounts define it: \"Many other services linked to 'health travel' are on the borderline or outside of the definition of health care (e.g. cosmetic surgery, patient transport abroad, etc)\".\n\nThe size finding is the one worth carrying: \"for the vast majority of countries the level of trade in health care remains marginal – typically accounting for 0.0 to 1.0% of total health spending, even if this is still likely to be an underestimate\". That is a dated figure from a named report with a stated method and a stated limit — which is more than any market-research total on this subject offers.", "how": "Member countries report health accounts to a shared framework jointly maintained by the OECD, Eurostat and WHO. OECD Health Statistics assembles them into comparable series. The 2011 project produced supplementary trade tables; reporting against them is voluntary and, at the time of the report, thin.", "today": "As of 16 September 2026 the OECD Health Statistics landing page refused an automated fetch from this project, so this record's account of what the collection contains rests on the 2011 report and on the existing source entry." }, "geo": { "lat": 48.8656, "lon": 2.2705, "precision": "street", "source": "s:oecd-wikipedia" }, "address": { "street": "2 rue André Pascal", "city": "Paris", "country": "FR", "postcode": "75016" }, "kin": [ { "to": "oecd-waiting-times", "as": "The series behind the queue at home, which is half of why anyone travels.", "rel": "measures" }, { "to": "eurostat", "as": "The partner that runs the same accounting framework for Europe, and excludes exports from it.", "rel": "org" }, { "to": "who", "as": "The third partner in the System of Health Accounts.", "rel": "org" }, { "to": "is-it-cheaper", "as": "Where the 0.0 to 1.0 per cent finding is set against the market-size claims.", "rel": "story" }, { "to": "counting-patients", "as": "The residency and boundary problems this report names, one layer up.", "rel": "story" }, { "to": "eu-directive-2011-24", "as": "The instrument adopted the same year, whose reporting produces the other European numbers.", "rel": "governs" } ], "links": [ { "label": "OECD Health Statistics", "url": "https://www.oecd.org/en/data/datasets/oecd-health-statistics.html" }, { "label": "Improving estimates of exports and imports of health services (2011)", "url": "https://www.oecd.org/content/dam/oecd/en/topics/policy-issue-focus/sha-guidelines/49011758.pdf" } ], "sources": [ "s:oecd-trade-health-2011", "s:oecd-wikipedia", "s:oecd-health-statistics" ], "provenance": { "default": { "tier": "cited", "source": "s:oecd-trade-health-2011" }, "fields": { "text.story": { "tier": "cited", "source": "s:oecd-trade-health-2011", "note": "every quoted sentence was read in the report itself" } } }, "confidence": "high", "updated": "2026-09-16", "blurb": "An intergovernmental organisation of 38 member countries, founded in 1961 as successor to the Organisation for European Economic Co-operation of 1948, headquartered at the Château de la Muette in Paris.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The series behind the queue at home, which is half of why anyone travels.", "rel": "measures" }, { "to": "eurostat", "type": "org", "name": "Eurostat", "as": "The partner that runs the same accounting framework for Europe, and excludes exports from it.", "rel": "org" }, { "to": "who", "type": "org", "name": "World Health Organization", "as": "The third partner in the System of Health Accounts.", "rel": "org" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "Where the 0.0 to 1.0 per cent finding is set against the market-size claims.", "rel": "story" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "The residency and boundary problems this report names, one layer up.", "rel": "story" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The instrument adopted the same year, whose reporting produces the other European numbers.", "rel": "governs" } ], "source_list": [ { "id": "s:oecd-trade-health-2011", "kind": "paper", "title": "Improving estimates of exports and imports of health services and goods under the SHA framework — final report", "publisher": "OECD, funded by DG SANCO of the European Commission", "year": 2011, "url": "https://www.oecd.org/content/dam/oecd/en/topics/policy-issue-focus/sha-guidelines/49011758.pdf", "accessed": "2026-09-16", "note": "June 2011; states that trade in health care is typically 0.0 to 1.0% of total health spending for the vast majority of countries, that balance-of-payments sources have proved mostly inadequate, and that cosmetic surgery and patient transport sit on or outside the boundary of health care" }, { "id": "s:oecd-wikipedia", "kind": "wikipedia", "title": "OECD", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/OECD", "accessed": "2026-09-16", "note": "founded 1961 as successor to the OEEC of 1948, 38 member countries, headquarters at the Château de la Muette in Paris" }, { "id": "s:oecd-health-statistics", "kind": "dataset", "title": "OECD Health Statistics", "publisher": "Organisation for Economic Co-operation and Development", "url": "https://www.oecd.org/en/data/datasets/oecd-health-statistics.html", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:oecd-trade-health-2011" }, "text.story": { "tier": "cited", "source": "s:oecd-trade-health-2011", "note": "every quoted sentence was read in the report itself" }, "text.how": { "tier": "cited", "source": "s:oecd-trade-health-2011" }, "text.today": { "tier": "cited", "source": "s:oecd-trade-health-2011" }, "geo": { "tier": "cited", "source": "s:oecd-trade-health-2011" }, "address": { "tier": "cited", "source": "s:oecd-trade-health-2011" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "eurostat", "type": "org", "name": "Eurostat", "as": "Co-author of the accounting framework whose exclusion rule this record turns on.", "rel": "org" }, { "from": "who", "type": "org", "name": "World Health Organization", "as": "The other body with comparable cross-country health figures, and the only one that has tried to measure the trade itself.", "rel": "contrast" }, { "from": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The publisher, and the same body that measured how little of this trade the health accounts can see.", "rel": "org" }, { "from": "world-bank-out-of-pocket", "type": "dataset", "name": "Out-of-pocket share of health spending", "as": "Whose 2011 report measured what this indicator cannot: the trade across the border.", "rel": "org" } ] }, { "schema": 1, "id": "promed", "type": "org", "names": { "name": "PROMED", "aliases": [ "Council for the International Promotion of Costa Rica Medicine", "Consejo para la Promoción Internacional de la Medicina de Costa Rica" ], "said": "PROMED now sits inside the Cámara Costarricense de la Salud, and promedcostarica.org redirects there." }, "region": [ "central-america" ], "facets": { "kind": "trade-body", "iso2": "CR", "status": "open" }, "text": { "what": "Costa Rica's membership body for providers serving international patients, now run within the Cámara Costarricense de la Salud, the country's health chamber. Its members include hospitals, medical and dental clinics and spas, and affiliated businesses — recovery retreats, hotels, transport, travel facilitators, insurers, law firms, marketing agencies and consultants. It issues a Seal of Quality to members.", "story": "PROMED is a trade association, not a regulator, and the membership list shows it: a law firm and a hotel sit in the same scheme as a hospital. That mix is the point of a destination promotion body and it is also the reason its seal answers a different question from an accreditation.\n\n*Inference —* a seal issued by a body whose members pay it, to members who are also its constituency, is a membership badge with conditions attached. It may carry real entry requirements. It is not an external inspection of a clinical service, and a reader who takes it as one has substituted one kind of evidence for another.\n\nCosta Rica's clinical licensing sits elsewhere, with the Ministry of Health and the professional colleges, and a dentist practising in San José is licensed by a body that has nothing to do with this council.", "how": "A provider joins, pays dues, and meets the scheme's terms to carry the Seal of Quality. The chamber runs a directory of members. The pages read for this record do not state the founding year, the dues, the seal's criteria or its renewal interval.", "today": "As of 16 September 2026 promedcostarica.org redirects to the Cámara Costarricense de la Salud, which describes PROMED's membership categories and the Seal of Quality on its English page." }, "geo": { "lat": 9.9281, "lon": -84.0907, "precision": "city", "source": "s:promed-salud-cr" }, "address": { "city": "San José", "country": "CR" }, "kin": [ { "to": "costa-rica", "as": "The destination this council exists to promote.", "rel": "place" }, { "to": "san-jose-cr", "as": "The hub its member hospitals and dental clinics cluster in.", "rel": "place" }, { "to": "clinica-biblica", "as": "One of the hospitals the scheme is built around.", "rel": "org" }, { "to": "medical-tourism-association", "as": "The same form of body one scale up: members pay, the body promotes.", "rel": "contrast" }, { "to": "dental-implant", "as": "The work that brings most of Costa Rica's international patients in.", "rel": "procedure" }, { "to": "choosing-a-facilitator", "as": "The step where a membership seal is often read as an inspection.", "rel": "step" } ], "links": [ { "label": "PROMED, via the Cámara Costarricense de la Salud", "url": "https://salud.co.cr/english/" } ], "sources": [ "s:promed-salud-cr" ], "provenance": { "default": { "tier": "cited", "source": "s:promed-salud-cr" }, "fields": { "text.story": { "tier": "cited", "source": "s:promed-salud-cr", "note": "the second paragraph is this project's inference; the third is general knowledge of Costa Rican licensing and is not sourced on this disk" }, "geo": { "tier": "inference", "note": "San José, city precision" } } }, "confidence": "low", "needs_verification": true, "updated": "2026-09-16", "blurb": "Costa Rica's membership body for providers serving international patients, now run within the Cámara Costarricense de la Salud, the country's health chamber.", "region_terms": [ { "key": "central-america", "name": "Central America", "note": "Costa Rica, Panama, Guatemala, Belize" } ], "kin_out": [ { "to": "costa-rica", "type": "destination", "name": "Costa Rica", "as": "The destination this council exists to promote.", "rel": "place" }, { "to": "san-jose-cr", "type": "hub", "name": "San José, Costa Rica", "as": "The hub its member hospitals and dental clinics cluster in.", "rel": "place" }, { "to": "clinica-biblica", "type": "facility", "name": "Hospital Clínica Bíblica", "as": "One of the hospitals the scheme is built around.", "rel": "org" }, { "to": "medical-tourism-association", "type": "org", "name": "Medical Tourism Association", "as": "The same form of body one scale up: members pay, the body promotes.", "rel": "contrast" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "The work that brings most of Costa Rica's international patients in.", "rel": "procedure" }, { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "The step where a membership seal is often read as an inspection.", "rel": "step" } ], "source_list": [ { "id": "s:promed-salud-cr", "kind": "web", "title": "PROMED — English", "publisher": "Cámara Costarricense de la Salud", "url": "https://salud.co.cr/english/", "accessed": "2026-09-16", "note": "promedcostarica.org now redirects here; membership categories and the Seal of Quality are described on this page" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:promed-salud-cr" }, "text.story": { "tier": "cited", "source": "s:promed-salud-cr", "note": "the second paragraph is this project's inference; the third is general knowledge of Costa Rican licensing and is not sourced on this disk" }, "text.how": { "tier": "cited", "source": "s:promed-salud-cr" }, "text.today": { "tier": "cited", "source": "s:promed-salud-cr" }, "geo": { "tier": "inference", "note": "San José, city precision" }, "address": { "tier": "cited", "source": "s:promed-salud-cr" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "costa-rica", "type": "destination", "name": "Costa Rica", "as": "The national council that certifies providers here, and the reason this country organised before its neighbours.", "rel": "org" }, { "from": "san-jose-cr", "type": "hub", "name": "San José, Costa Rica", "as": "The national council that certifies providers here for international patients.", "rel": "accredits" }, { "from": "clinica-biblica", "type": "facility", "name": "Hospital Clínica Bíblica", "as": "The national certification council a Costa Rican provider joins to sell to foreign patients.", "rel": "accredited-by" }, { "from": "hospital-cima-san-jose", "type": "facility", "name": "Hospital CIMA San José", "as": "The national council a Costa Rican provider joins to sell abroad.", "rel": "accredited-by" }, { "from": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "A membership seal from a body its members pay, in a scheme that also admits hotels.", "rel": "org" } ] }, { "schema": 1, "id": "temos", "type": "org", "names": { "name": "Temos International Healthcare Accreditation", "aliases": [ "Temos", "Temos International GmbH" ], "said": "Temos International GmbH — a limited company, not a society, and the legal form is on the page." }, "region": [ "global", "europe-west" ], "facets": { "kind": "accreditor", "iso2": "DE", "founded": 2010, "status": "open" }, "text": { "what": "A German accreditation company founded in 2010 and run from Bergisch Gladbach, near Cologne. It accredits in six programmes — medical care, dental care, eye care, reproductive care, rehabilitation care, and medical travel coordinators — and is built around facilities that treat patients from abroad rather than around hospitals in general.", "story": "Temos grew out of aeromedical and expatriate care work and kept that shape: the standards ask about the international patient's passage through a facility, not only about the clinical unit. The medical travel coordinator programme accredits the broker, which almost no other scheme does.\n\nThe fee structure is published, which is rarer than it should be. Fees scale with the level of care and the bed count, are quoted over three years with a first and a second annual fee, and cover \"all professional services… but do not include travel and accommodation costs for the Temos assessors\". A small clinic in a country an assessor must fly to therefore pays a different real price from a large one next door to the office, and the difference is on the applicant.\n\n*Inference —* the three-year fee schedule implies a three-year cycle with annual maintenance, the same shape as JCI. Temos does not state the validity period on the pages read for this record, so the cycle length here is read off the fee table and not off a claim.", "how": "An applicant enquires, receives a quotation against its care level and bed count, self-assesses, and is audited on site by Temos assessors whose travel it pays for on top of the fee. The list of accredited partners is public, on a separate Temos-run register. ISQua EEA holds an award over the Temos standards, including the dental set.", "today": "As of 16 September 2026 Temos operates from the Bergisch Gladbach office with regional offices it describes as spanning six continents, and publishes its accredited partners as a searchable list." }, "geo": { "lat": 50.9925, "lon": 7.1298, "precision": "street", "source": "s:temos-company" }, "address": { "street": "Friedrich-Ebert-Straße 75, Campus 1", "city": "Bergisch Gladbach", "country": "DE", "postcode": "51429" }, "recognitions": [ { "by": "isqua-eea", "what": "ISQua EEA accreditation of the Temos standards, the first German accreditation body to hold it", "year": null, "valid_until": null, "source": "s:temos-company", "url": "https://ieea.ch/international-accreditation-programme/", "note": "the year of first award is not stated on the pages read for this record" } ], "kin": [ { "to": "jci", "as": "The larger competitor, built for hospitals rather than for international patients.", "rel": "contrast" }, { "to": "gha", "as": "The nearest competitor by purpose: both certify the journey rather than the ward.", "rel": "contrast" }, { "to": "isqua-ieea", "as": "The body holding an award over these standards.", "rel": "accredited-by" }, { "to": "facilitator", "as": "The trade this scheme is unusual in accrediting at all.", "rel": "term" }, { "to": "choosing-a-facilitator", "as": "The step of the journey where a broker's accreditation is the only external mark on offer.", "rel": "step" }, { "to": "ivf", "as": "One of the treatments its reproductive care programme covers.", "rel": "procedure" } ], "links": [ { "label": "Temos International GmbH", "url": "https://temos-worldwide.com/" }, { "label": "Accredited partners", "url": "https://temos-accreditation.com/AccreditedPartners/List.aspx" } ], "sources": [ "s:temos-company", "s:temos-medical-care" ], "provenance": { "default": { "tier": "cited", "source": "s:temos-company" }, "fields": { "text.story": { "tier": "cited", "source": "s:temos-medical-care", "note": "the cycle length in the third paragraph is inferred from the published fee table and marked as such" } } }, "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "A German accreditation company founded in 2010 and run from Bergisch Gladbach, near Cologne.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The larger competitor, built for hospitals rather than for international patients.", "rel": "contrast" }, { "to": "gha", "type": "org", "name": "Global Healthcare Accreditation", "as": "The nearest competitor by purpose: both certify the journey rather than the ward.", "rel": "contrast" }, { "to": "isqua-ieea", "type": "org", "name": "ISQua External Evaluation Association", "as": "The body holding an award over these standards.", "rel": "accredited-by" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The trade this scheme is unusual in accrediting at all.", "rel": "term" }, { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "The step of the journey where a broker's accreditation is the only external mark on offer.", "rel": "step" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "One of the treatments its reproductive care programme covers.", "rel": "procedure" } ], "source_list": [ { "id": "s:temos-company", "kind": "web", "title": "Company — Temos International GmbH", "publisher": "Temos International GmbH", "url": "https://temos-worldwide.com/about-us/company/", "accessed": "2026-09-16", "note": "founded 2010, registered address in Bergisch Gladbach, the six programmes, and the public Accredited Partners list" }, { "id": "s:temos-medical-care", "kind": "web", "title": "International Hospital Accreditation — Medical Care", "publisher": "Temos International GmbH", "url": "https://temos-worldwide.com/accreditation-programs/medical-care/", "accessed": "2026-09-16", "note": "fees by level of care and bed count, three-year fee schedule with first and second annual fees, assessor travel and accommodation excluded" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:temos-company" }, "text.story": { "tier": "cited", "source": "s:temos-medical-care", "note": "the cycle length in the third paragraph is inferred from the published fee table and marked as such" }, "text.how": { "tier": "cited", "source": "s:temos-company" }, "text.today": { "tier": "cited", "source": "s:temos-company" }, "geo": { "tier": "cited", "source": "s:temos-company" }, "address": { "tier": "cited", "source": "s:temos-company" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [ { "key": "isqua-eea", "label": "ISQua External Evaluation Association", "what": "ISQua EEA accreditation of the Temos standards, the first German accreditation body to hold it", "url": "https://ieea.ch/international-accreditation-programme/", "kind": "meta", "year": null, "valid_until": null, "source": "s:temos-company" } ], "acclaim": 1, "kin_in": [ { "from": "gha", "type": "org", "name": "Global Healthcare Accreditation", "as": "The other scheme built around the international patient rather than the hospital.", "rel": "contrast" }, { "from": "isqua-ieea", "type": "org", "name": "ISQua External Evaluation Association", "as": "Holds its award; the first German accreditor to take one.", "rel": "accredits" }, { "from": "jci", "type": "org", "name": "Joint Commission International", "as": "A competitor built for international patients rather than for hospitals in general.", "rel": "contrast" }, { "from": "facilitator", "type": "term", "name": "Facilitator", "as": "One of the few accreditors that certifies this trade at all.", "rel": "org" }, { "from": "jci-accredited-list", "type": "dataset", "name": "The JCI list of accredited organizations", "as": "A rival register, built for facilities treating international patients.", "rel": "org" }, { "from": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Publishes its fee table, and puts the assessors' travel on the applicant.", "rel": "org" } ] }, { "schema": 1, "id": "thai-ha-institute", "type": "org", "names": { "name": "Healthcare Accreditation Institute", "aliases": [ "HAI", "HA Thailand", "สถาบันรับรองคุณภาพสถานพยาบาล", "สรพ." ], "said": "Thai hospitals say HA. It is the domestic mark, and it sits beside JCI on the same wall in Bangkok." }, "region": [ "southeast-asia" ], "facets": { "kind": "accreditor", "iso2": "TH", "founded": 2009, "status": "open" }, "text": { "what": "Thailand's national hospital accreditation body, a public organisation established by the Royal Decree on the Establishment of the Healthcare Accreditation Institute, B.E. 2552 (2009), with a second edition of the decree in B.E. 2562 (2019). It sets the HA standards, assesses hospitals against them, and publishes the certificate status of accredited facilities. Its motto is \"Accreditation is an Educational Process\".", "story": "The Thai scheme is a public organisation — a Thai legal form that is neither a ministry department nor a private company — and that matters when the mark is read next to the imported one.\n\nA large Bangkok private hospital typically holds both HA and JCI. The first is a domestic standard, administered by a body the state created by decree, covering hospitals across the country including the public ones. The second is an American product bought by hospitals selling to foreigners. *Inference —* a badge wall showing both is showing two different relationships, and counting them as two accreditations obscures that one is nearly universal among Thai hospitals of any size and the other is a purchase aimed outward.\n\nThe standards themselves hold an ISQua EEA award, so the Thai scheme sits in the same external chain as the international ones.", "how": "A hospital enters the HA process, which the institute frames as developmental rather than purely inspectional, is assessed, and is certified. Certificate status is published on the institute's own site. The pages read for this record do not state the cycle length or the fee.", "today": "As of 16 September 2026 the institute publishes hospital certificate status through its own site and remains the national accreditation body for Thai hospitals." }, "geo": { "lat": 13.859, "lon": 100.525, "precision": "city", "source": "s:ha-thailand-home" }, "address": { "city": "Nonthaburi", "country": "TH" }, "recognitions": [ { "by": "isqua-eea", "what": "ISQua EEA accreditation, listed by ISQua EEA among its accredited organisations", "year": null, "valid_until": null, "source": "s:ha-thailand-home", "url": "https://ieea.ch/organisation/the-healthcare-accreditation-institute-public-organization-thailand/", "note": "the award term is not stated on the pages read for this record" } ], "kin": [ { "to": "thailand", "as": "The country whose hospitals this is the national standard for, public and private alike.", "rel": "place" }, { "to": "bumrungrad", "as": "One of the private hospitals holding this mark alongside the imported one.", "rel": "accredits" }, { "to": "jci", "as": "The purchased international mark a Thai hospital holds for a different audience.", "rel": "contrast" }, { "to": "nabh", "as": "India's equivalent domestic board.", "rel": "contrast" }, { "to": "isqua-ieea", "as": "Holds the award over these standards.", "rel": "accredited-by" }, { "to": "the-accreditation-question", "as": "Where a domestic standard and an exported one are separated.", "rel": "story" } ], "links": [ { "label": "Healthcare Accreditation Institute", "url": "https://www.ha.or.th/EN/Home" } ], "sources": [ "s:ha-thailand-home" ], "provenance": { "default": { "tier": "cited", "source": "s:ha-thailand-home" }, "fields": { "text.story": { "tier": "cited", "source": "s:ha-thailand-home", "note": "the comparison in the second paragraph is marked as this project's inference" }, "geo": { "tier": "inference", "note": "the institute sits in the health ministry campus area in Nonthaburi; city precision only" } } }, "confidence": "medium", "needs_verification": true, "updated": "2026-09-16", "blurb": "Thailand's national hospital accreditation body, a public organisation established by the Royal Decree on the Establishment of the Healthcare Accreditation Institute, B.E.", "region_terms": [ { "key": "southeast-asia", "name": "Southeast Asia", "note": "Thailand, Malaysia, Singapore, Vietnam, the Philippines, Indonesia" } ], "kin_out": [ { "to": "thailand", "type": "destination", "name": "Thailand", "as": "The country whose hospitals this is the national standard for, public and private alike.", "rel": "place" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "One of the private hospitals holding this mark alongside the imported one.", "rel": "accredits" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The purchased international mark a Thai hospital holds for a different audience.", "rel": "contrast" }, { "to": "nabh", "type": "org", "name": "National Accreditation Board for Hospitals and Healthcare Providers", "as": "India's equivalent domestic board.", "rel": "contrast" }, { "to": "isqua-ieea", "type": "org", "name": "ISQua External Evaluation Association", "as": "Holds the award over these standards.", "rel": "accredited-by" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Where a domestic standard and an exported one are separated.", "rel": "story" } ], "source_list": [ { "id": "s:ha-thailand-home", "kind": "org", "title": "The Healthcare Accreditation Institute (Public Organization)", "publisher": "Healthcare Accreditation Institute, Thailand", "url": "https://www.ha.or.th/EN/Home", "accessed": "2026-09-16", "note": "public-organisation status under the Royal Decree establishing the HAI, B.E. 2552 (2009), and the public Certificate Status pages" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:ha-thailand-home" }, "text.story": { "tier": "cited", "source": "s:ha-thailand-home", "note": "the comparison in the second paragraph is marked as this project's inference" }, "text.how": { "tier": "cited", "source": "s:ha-thailand-home" }, "text.today": { "tier": "cited", "source": "s:ha-thailand-home" }, "geo": { "tier": "inference", "note": "the institute sits in the health ministry campus area in Nonthaburi; city precision only" }, "address": { "tier": "cited", "source": "s:ha-thailand-home" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [ { "key": "isqua-eea", "label": "ISQua External Evaluation Association", "what": "ISQua EEA accreditation, listed by ISQua EEA among its accredited organisations", "url": "https://ieea.ch/organisation/the-healthcare-accreditation-institute-public-organization-thailand/", "kind": "meta", "year": null, "valid_until": null, "source": "s:ha-thailand-home" } ], "acclaim": 1, "kin_in": [ { "from": "bangkok-hospital", "type": "facility", "name": "Bangkok Hospital", "as": "The Thai national accreditor whose advanced standard the hospital states for 2026.", "rel": "accredited-by" }, { "from": "achsi", "type": "org", "name": "ACHS International", "as": "The Thai equivalent, run by a public organisation rather than a subsidiary.", "rel": "contrast" } ] }, { "schema": 1, "id": "turkiye-health-services-directorate", "type": "org", "names": { "name": "Türkiye General Directorate of Health Services", "aliases": [ "Sağlık Hizmetleri Genel Müdürlüğü", "SHGM", "Sağlık Turizmi Daire Başkanlığı", "Health Tourism Department" ], "said": "SHGM. Inside it sits the Sağlık Turizmi Daire Başkanlığı, and inside that sit four PDFs that decide whether a clinic may lawfully treat a foreign patient at all." }, "region": [ "west-asia" ], "facets": { "kind": [ "ministry", "regulator" ], "iso2": "TR", "status": "open" }, "text": { "what": "The General Directorate of Health Services inside Türkiye's Ministry of Health, and its Health Tourism Department, which issues the authorisation certificate a facility must hold before it may treat an international patient. The instrument is the Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik, published in the Resmî Gazete on 26 April 2025, No. 32882, whose MADDE 17 repeals the regulation of 13 July 2017 that most secondary writing still cites. The directorate licenses the facility; USHAŞ, the ministry's own international health services company, licenses the intermediary.", "story": "What this body publishes is a list, and the list is the rarest thing in this directory.\n\nFour of them, in fact, all stamped 20 August 2026: 542 hospitals, 135 medical centres, 2,468 private physician offices and 1,581 other facilities. That is 4,726, a sum made here — the ministry prints no total. It publishes no count of authorised intermediaries anywhere that could be read.\n\nThe certificate carries obligations a patient would recognise. It cannot be transferred (MADDE 5(5)) and a separate one is needed for each branch (5(4)). Complication insurance is compulsory for anything done in an operating-theatre setting, with a deadline of 31 December 2025 (6(1)(c)). Accreditation by TÜSKA is required for hospitals, medical centres, medical laboratories and dialysis centres by 31 December 2026 (6(1)(b)). A holder may not buy intermediary services from an unlicensed party (6(1)(e)). Complications and medical malpractice sit expressly inside the holder's responsibility (6(3)) — a sentence with no counterpart in most of the world. The facility must run an international unit with a documented foreign-language speaker (MADDE 7) and register on the HealthTürkiye portal (8(4)); pricing is set by the ministry (11(1)). USHAŞ evaluates performance annually, with a three-month and then a six-month suspension and cancellation after a failed second control evaluation (MADDE 9), and a certificate lapses after a year of inactivity, with no new one for a year after that (MADDE 16).\n\nHair restoration got its own instrument. The Saç Ekimi Birimleri Hakkında Yönetmelik, Resmî Gazete of 6 May 2023, No. 32182, reserves the channel-opening stage to physicians holding the applicator certificate, lets assistants work only under a certified physician, caps one certified physician at five rooms, and allows one patient per room at a time. Every case is logged with technique, graft count, region, the names of the team, and photographs before and at 72 hours — with one carve-out: the six-month photograph is not required for a patient who came in under the international health tourism rules. The unit register is public. Breach draws a fine of 1 to 3 per cent of the previous month's gross service revenue, and on persistence the activity certificate is cancelled with no re-issue; inspection runs at least annually and unscheduled on complaint.\n\n*Inference —* the register answers one question well and no other. It says whether a named facility holds the certificate on a given date. It rates nobody, publishes no outcome, and counts no operation. Set against most destinations in this directory that is still exceptional, because most publish no list at all: a reader can check a Turkish clinic's standing and cannot check a Mexican one's.\n\nThe national figure for the trade is not this directorate's either. It comes from the Turkish Statistical Institute's survey of departing visitors' stated purpose of visit, republished by USHAŞ with an income series attached: 1,398,580 for 2025, of which 250,401 were Turkish citizens resident abroad. *Inference —* a licensing register and a border survey measure two different things, and neither of them measures an operation.", "how": "A facility applies, is assessed against the conditions in MADDE 6, and is issued a certificate per branch that it cannot transfer. The ministry republishes the authorised lists as PDFs, which are the register: a facility not on them is not authorised, whatever its own site says. USHAŞ runs the annual performance evaluation and holds the suspension power; it also licenses the intermediaries, a function moved to it from the travel-agency system by the 2025 regulation. Hair transplant units are inspected at least once a year and on complaint.", "today": "As of 17 September 2026 the instrument in force is the 2025 regulation; the authorised-facility lists are stamped 20 August 2026; the complication-insurance deadline of 31 December 2025 has passed and the TÜSKA accreditation deadline of 31 December 2026 has not.", "notes": "The repealed 2017 regulation stays in this project's source register, marked repealed, because a great deal of writing published since still cites it." }, "geo": { "lat": 39.9334, "lon": 32.8597, "precision": "city", "source": "s:tr-shgm" }, "address": { "street": "Üniversiteler Mahallesi, Şehit Mehmet Bayraktar Caddesi No 3", "city": "Ankara", "area": "Çankaya", "country": "TR" }, "kin": [ { "to": "turkiye", "as": "The country whose international patient trade it licenses, facility by facility.", "rel": "place" }, { "to": "turkiye-health-tourism-authorisation", "as": "The certificate it issues, withdraws and publishes the register of.", "rel": "rule" }, { "to": "istanbul", "as": "Where most of the certificate holders selling to foreign patients are.", "rel": "hub" }, { "to": "hair-transplant-fue", "as": "The operation given its own regulation in 2023, down to who may open the channels.", "rel": "procedure" }, { "to": "turkiye-hair-boom", "as": "The growth these rules were written against.", "rel": "event" }, { "to": "ishrs", "as": "The professional society whose allegations since 2016 the 2023 prohibitions read like a list of.", "rel": "org" }, { "to": "jci", "as": "A voluntary mark a hospital buys, against a compulsory state certificate it must hold to trade at all.", "rel": "contrast" }, { "to": "facilitator", "as": "The intermediary this regime licenses separately, through USHAŞ rather than through the directorate.", "rel": "term" }, { "to": "acibadem", "as": "One of the hospital groups whose international business this certificate governs.", "rel": "facility" }, { "to": "counting-patients", "as": "A register of who may treat, beside a border survey of who said they came for treatment.", "rel": "story" } ], "links": [ { "label": "Sağlık Hizmetleri Genel Müdürlüğü", "url": "https://shgm.saglik.gov.tr/" }, { "label": "Authorised health facilities (four lists)", "url": "https://shgmturizmdb.saglik.gov.tr/TR-67458/bakanligimizca-yetkilendirilmis-saglik-tesisleri-icin-tiklayiniz.html" }, { "label": "Yönetmelik, Resmî Gazete 26 April 2025, No. 32882", "url": "https://www.resmigazete.gov.tr/eskiler/2025/04/20250426-2.htm" } ], "sources": [ "s:tr-shgm", "s:rg-32882-2025", "s:shgm-yetkili-tesisler", "s:rg-32182-2023-sac-ekimi", "s:tr-authorised-providers", "s:rg-saglik-turizmi-2017", "s:ushas-saglik-turizmi-verileri", "s:tuik-turizm-2025" ], "provenance": { "default": { "tier": "cited", "source": "s:rg-32882-2025" }, "fields": { "text.story": { "tier": "cited", "source": "s:shgm-yetkili-tesisler", "note": "the facility counts are the last sequence number in each of the ministry's four published lists, stamped 20 August 2026, and the total of 4,726 is a sum made here; the article numbers are read in the Resmî Gazete texts of 26 April 2025 and 6 May 2023; the 2025 visitor figure is the TurkStat departing-visitors table republished by USHAŞ; the two paragraphs marked inference are this project's reading" }, "geo": { "tier": "inference", "source": "s:tr-shgm", "note": "the directorate's street address is on its own site at Bilkent in Çankaya; only the city is pinned here" } } }, "confidence": "high", "needs_verification": false, "updated": "2026-09-17", "blurb": "The General Directorate of Health Services inside Türkiye's Ministry of Health, and its Health Tourism Department, which issues the authorisation certificate a facility must hold before it may treat an international…", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The country whose international patient trade it licenses, facility by facility.", "rel": "place" }, { "to": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The certificate it issues, withdraws and publishes the register of.", "rel": "rule" }, { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "Where most of the certificate holders selling to foreign patients are.", "rel": "hub" }, { "to": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The operation given its own regulation in 2023, down to who may open the channels.", "rel": "procedure" }, { "to": "turkiye-hair-boom", "type": "event", "name": "Türkiye's hair transplant boom", "as": "The growth these rules were written against.", "rel": "event" }, { "to": "ishrs", "type": "org", "name": "International Society of Hair Restoration Surgery", "as": "The professional society whose allegations since 2016 the 2023 prohibitions read like a list of.", "rel": "org" }, { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "A voluntary mark a hospital buys, against a compulsory state certificate it must hold to trade at all.", "rel": "contrast" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The intermediary this regime licenses separately, through USHAŞ rather than through the directorate.", "rel": "term" }, { "to": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "One of the hospital groups whose international business this certificate governs.", "rel": "facility" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "A register of who may treat, beside a border survey of who said they came for treatment.", "rel": "story" } ], "source_list": [ { "id": "s:tr-shgm", "kind": "org", "title": "Sağlık Hizmetleri Genel Müdürlüğü", "publisher": "Türkiye Ministry of Health", "url": "https://shgm.saglik.gov.tr/", "accessed": "2026-09-16", "note": "departments including the Health Tourism Department and the Quality and Accreditation Department; address at Üniversiteler Mahallesi, Şehit Mehmet Bayraktar Caddesi No 3, Çankaya, Ankara" }, { "id": "s:rg-32882-2025", "kind": "web", "title": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik, Resmî Gazete 26 Nisan 2025, Sayı 32882", "publisher": "T.C. Resmî Gazete", "year": 2025, "url": "https://www.resmigazete.gov.tr/eskiler/2025/04/20250426-2.htm", "accessed": "2026-09-17", "note": "MADDE 17 repeals the 13/7/2017 regulation (RG 30123) that most secondary writing still cites" }, { "id": "s:shgm-yetkili-tesisler", "kind": "org", "title": "Bakanlığımızca Yetkilendirilmiş Sağlık Tesisleri — the four published lists of authorised facilities", "publisher": "T.C. Sağlık Bakanlığı, Sağlık Turizmi Daire Başkanlığı", "url": "https://shgmturizmdb.saglik.gov.tr/TR-67458/bakanligimizca-yetkilendirilmis-saglik-tesisleri-icin-tiklayiniz.html", "accessed": "2026-09-17", "note": "lists stamped 20 August 2026; the Ministry prints no total, so the counts here are the last sequence number in each list" }, { "id": "s:rg-32182-2023-sac-ekimi", "kind": "web", "title": "Saç Ekimi Birimleri Hakkında Yönetmelik, Resmî Gazete 6 Mayıs 2023, Sayı 32182", "publisher": "T.C. Resmî Gazete", "year": 2023, "url": "https://www.resmigazete.gov.tr/eskiler/2023/05/20230506-11.htm", "accessed": "2026-09-17" }, { "id": "s:tr-authorised-providers", "kind": "web", "title": "Healthcare Providers Authorized by the Ministry", "publisher": "Türkiye Ministry of Health, Health Services General Directorate, Health Tourism Department", "url": "https://saglikturizmi.saglik.gov.tr/EN,69063/healthcare-providers-authorized-by-the-ministry.html", "accessed": "2026-09-16", "note": "separate downloadable lists for hospitals, medical centres, private practices, other providers and authorised facilitators; page dated 20 August 2026" }, { "id": "s:rg-saglik-turizmi-2017", "kind": "web", "title": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik", "publisher": "Resmî Gazete, Republic of Türkiye (Ministry of Health)", "url": "https://www.resmigazete.gov.tr/eskiler/2017/07/20170713-3.htm", "accessed": "2026-09-16", "note": "Resmî Gazete 13 July 2017, No. 30123. Read in Turkish off the Resmî Gazete page. Article 5(1) makes an international health tourism authorisation certificate (yetki belgesi) compulsory for both the health facility and the intermediary; the Ministry halts the activity of anyone without one. Transitional Article 1 gave those already trading one year to comply. Article 16: in force on publication. REPEALED: MADDE 17 of the regulation of 26 April 2025 (Resmî Gazete 32882) revokes this one. Cite it for what the regime was, not for what it is." }, { "id": "s:ushas-saglik-turizmi-verileri", "kind": "gov", "title": "Sağlık Turizmi Verileri (health tourism data by year)", "publisher": "USHAŞ — Uluslararası Sağlık Hizmetleri A.Ş., the Turkish Ministry of Health's international health services company", "url": "https://ushas.gov.tr/saglik-turizmi-verileri/", "accessed": "2026-09-16", "note": "USHAŞ publishes the series it attributes to TÜİK, the Turkish statistical institute: visitors and revenue by year — 2019 756,926 and USD 1.459bn; 2020 435,691; 2021 729,592; 2022 1,381,807; 2023 1,538,643; 2024 1,506,442; 2025 1,398,580 and USD 3,022,452 thousand; first half of 2026 563,327 and USD 1.580bn. The unit is a visitor arriving with a health purpose, not an operation." }, { "id": "s:tuik-turizm-2025", "kind": "dataset", "title": "Turizm İstatistikleri, IV. Çeyrek: Ekim-Aralık ve Yıllık, 2025 (Sayı 54158) — table: Departing Visitors by Purpose of Visit, 2012–2026", "publisher": "Türkiye İstatistik Kurumu (TurkStat)", "year": 2026, "url": "https://veriportali.tuik.gov.tr/Bulten/Index?p=Turizm-Istatistikleri-IV.-Ceyrek:-Ekim-Aralik-ve-Yillik,-2025-54158", "accessed": "2026-09-17", "note": "the health figure appears only in the attached statistical table, not in the bulletin text; its own footer names the source as the TurkStat Departing Visitors Survey — a border exit survey of stated purpose, not a count of patients treated" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:rg-32882-2025" }, "text.story": { "tier": "cited", "source": "s:shgm-yetkili-tesisler", "note": "the facility counts are the last sequence number in each of the ministry's four published lists, stamped 20 August 2026, and the total of 4,726 is a sum made here; the article numbers are read in the Resmî Gazete texts of 26 April 2025 and 6 May 2023; the 2025 visitor figure is the TurkStat departing-visitors table republished by USHAŞ; the two paragraphs marked inference are this project's reading" }, "text.how": { "tier": "cited", "source": "s:rg-32882-2025" }, "text.today": { "tier": "cited", "source": "s:rg-32882-2025" }, "geo": { "tier": "inference", "source": "s:tr-shgm", "note": "the directorate's street address is on its own site at Bilkent in Çankaya; only the city is pinned here" }, "address": { "tier": "cited", "source": "s:rg-32882-2025" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "turkiye", "type": "destination", "name": "Türkiye", "as": "The directorate inside the Ministry that issues and withdraws that certificate.", "rel": "org" }, { "from": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The directorate that issues the certificate and publishes the register.", "rel": "org" }, { "from": "ishrs", "type": "org", "name": "International Society of Hair Restoration Surgery", "as": "The state body that wrote the 2023 hair transplant rules the society had been asking for.", "rel": "org" } ] }, { "schema": 1, "id": "who", "type": "org", "names": { "name": "World Health Organization", "aliases": [ "WHO", "OMS" ], "said": "The intergovernmental agency, not a non-governmental one — it is the member states, meeting." }, "region": [ "global", "europe-west" ], "facets": { "kind": "ngo", "founded": 1948, "status": "open" }, "text": { "what": "The United Nations health agency, established on 7 April 1948 and based in Geneva. Its governing body, the World Health Assembly, is made up of 193 member states. It publishes the Global Health Observatory, the data platform this site draws national health indicators from, and it maintains the health expenditure database the World Bank republishes.", "story": "WHO is on this list for what it does not collect. Its indicators come from member states — routine health information systems, civil registration, surveys, facility assessments — and a member state reports what it counts. Almost none of them count foreign patients as a category.\n\nSo the agency that holds the most complete picture of world health holds close to nothing on the flow this site is about. The health expenditure database behind the World Bank series measures what residents consume, which by construction excludes what a country earns treating other countries' residents. *Inference —* an export trade in surgery can be a real industry in a country and still leave no trace in any WHO series, and that absence is a fact about the data, not about the trade.\n\nWhere WHO has acted on cross-border care it has been through ethics and standards rather than statistics: the Guiding Principles on human cell, tissue and organ transplantation, and the official relations it maintains with the fertility registry body ICMART.", "how": "Member states report to WHO on agreed instruments and schedules. The Global Health Observatory republishes the results as indicators with country, year and value, reachable through an OData interface. The reporting year differs by country, which is why every value on this site carries its own year.", "today": "As of 16 September 2026 the Global Health Observatory remains the source behind several indicators this site charts, and none of them counts a patient who crossed a border for treatment." }, "geo": { "lat": 46.2325, "lon": 6.14, "precision": "street", "source": "s:who-wikipedia" }, "address": { "street": "Avenue Appia 20", "city": "Geneva", "country": "CH", "postcode": "1211" }, "kin": [ { "to": "who-global-health-observatory", "as": "The data platform it publishes, and what that platform does and does not count.", "rel": "measures" }, { "to": "world-bank-health-spending", "as": "The series the World Bank republishes from WHO's health expenditure database.", "rel": "measures" }, { "to": "icmart", "as": "The fertility registry body it keeps in official relations, and with which it wrote the ART glossary.", "rel": "org" }, { "to": "declaration-of-istanbul-group", "as": "The professional body whose declaration WHO's transplant principles sit beside.", "rel": "org" }, { "to": "what-the-data-cannot-see", "as": "Where the gap between world health data and cross-border care is the subject.", "rel": "story" }, { "to": "oecd", "as": "The other body with comparable cross-country health figures, and the only one that has tried to measure the trade itself.", "rel": "contrast" } ], "links": [ { "label": "World Health Organization", "url": "https://www.who.int/" }, { "label": "Global Health Observatory", "url": "https://www.who.int/data/gho" } ], "sources": [ "s:who-wikipedia", "s:who-gho" ], "provenance": { "default": { "tier": "cited", "source": "s:who-wikipedia" }, "fields": { "text.story": { "tier": "cited", "source": "s:who-gho", "note": "the second paragraph's conclusion is marked as this project's inference; the Guiding Principles are named from general knowledge and are not sourced on this disk" } } }, "confidence": "high", "updated": "2026-09-16", "blurb": "The United Nations health agency, established on 7 April 1948 and based in Geneva. Its governing body, the World Health Assembly, is made up of 193 member states.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "who-global-health-observatory", "type": "dataset", "name": "WHO Global Health Observatory", "as": "The data platform it publishes, and what that platform does and does not count.", "rel": "measures" }, { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "The series the World Bank republishes from WHO's health expenditure database.", "rel": "measures" }, { "to": "icmart", "type": "org", "name": "International Committee for Monitoring Assisted Reproductive Technologies", "as": "The fertility registry body it keeps in official relations, and with which it wrote the ART glossary.", "rel": "org" }, { "to": "declaration-of-istanbul-group", "type": "org", "name": "Declaration of Istanbul Custodian Group", "as": "The professional body whose declaration WHO's transplant principles sit beside.", "rel": "org" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "Where the gap between world health data and cross-border care is the subject.", "rel": "story" }, { "to": "oecd", "type": "org", "name": "Organisation for Economic Co-operation and Development", "as": "The other body with comparable cross-country health figures, and the only one that has tried to measure the trade itself.", "rel": "contrast" } ], "source_list": [ { "id": "s:who-wikipedia", "kind": "wikipedia", "title": "World Health Organization", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/World_Health_Organization", "accessed": "2026-09-16", "note": "established 7 April 1948, Geneva headquarters, World Health Assembly of 193 member states" }, { "id": "s:who-gho", "kind": "dataset", "title": "Global Health Observatory", "publisher": "World Health Organization", "url": "https://www.who.int/data/gho", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:who-wikipedia" }, "text.story": { "tier": "cited", "source": "s:who-gho", "note": "the second paragraph's conclusion is marked as this project's inference; the Guiding Principles are named from general knowledge and are not sourced on this disk" }, "text.how": { "tier": "cited", "source": "s:who-wikipedia" }, "text.today": { "tier": "cited", "source": "s:who-wikipedia" }, "geo": { "tier": "cited", "source": "s:who-wikipedia" }, "address": { "tier": "cited", "source": "s:who-wikipedia" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "israel", "type": "destination", "name": "Israel", "as": "The body that counts the permit approvals this page reports.", "rel": "measures" }, { "from": "bone-marrow-transplant", "type": "procedure", "name": "Bone marrow transplant", "as": "Sets the framework under which donated cells and tissues move between countries.", "rel": "org" }, { "from": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "Guiding Principle 5, endorsed by the World Health Assembly in 2010, is the rule the statutes are written against.", "rel": "org" }, { "from": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "Guiding Principle 5, endorsed by the World Health Assembly in 2010, is the rule the national statutes are written against.", "rel": "org" }, { "from": "antimicrobial-resistance", "type": "risk", "name": "Antimicrobial resistance acquired abroad", "as": "Publishes the global surveillance this sits inside.", "rel": "org" }, { "from": "blood-supply-safety", "type": "risk", "name": "Blood supply safety", "as": "Runs the Global Database on Blood Safety, which is the only source for any of this.", "rel": "measured-by" }, { "from": "candida-auris", "type": "risk", "name": "Candida auris", "as": "Lists this organism among its fungal priority pathogens.", "rel": "org" }, { "from": "counterfeit-medicines", "type": "risk", "name": "Substandard and falsified medicines", "as": "Publishes the only figure this record carries.", "rel": "measured-by" }, { "from": "abortion-travel-law", "type": "rule", "name": "Travelling for a termination", "as": "The body whose database is the comparative reading behind most of these rows.", "rel": "org" }, { "from": "transplant-prohibition", "type": "rule", "name": "Buying an organ, and being transplanted abroad", "as": "The body whose Guiding Principles the World Health Assembly endorsed in 2010.", "rel": "org" }, { "from": "declaration-of-istanbul-group", "type": "org", "name": "Declaration of Istanbul Custodian Group", "as": "The intergovernmental body whose transplant guiding principles this text sits beside.", "rel": "org" }, { "from": "icmart", "type": "org", "name": "International Committee for Monitoring Assisted Reproductive Technologies", "as": "The body it holds official relations with, and its co-author on the ART glossary.", "rel": "org" }, { "from": "oecd", "type": "org", "name": "Organisation for Economic Co-operation and Development", "as": "The third partner in the System of Health Accounts.", "rel": "org" }, { "from": "covid-shutdown-2020", "type": "event", "name": "The 2020 shutdown", "as": "Whose director-general used the word on 11 March 2020.", "rel": "org" }, { "from": "istanbul-declaration-2008", "type": "event", "name": "The Declaration of Istanbul, 2008", "as": "Whose guiding principles on transplantation the declaration sits beside, and whose 10% estimate it cited from a personal communication.", "rel": "org" }, { "from": "who-global-health-observatory", "type": "dataset", "name": "WHO Global Health Observatory", "as": "The publisher, in its own record.", "rel": "org" } ] }, { "schema": 1, "id": "devi-shetty", "type": "person", "names": { "name": "Devi Prasad Shetty", "aliases": [ "Devi Shetty", "Dr Devi Prasad Shetty" ], "said": "A cardiac surgeon who argues about cost the way an industrial engineer does, and who says so in public more often than most surgeons say anything." }, "region": [ "south-asia", "caribbean" ], "facets": { "role": [ "surgeon", "founder" ], "iso2": "IN" }, "text": { "what": "Cardiac surgeon, and founder and chairman of Narayana Health, the Bengaluru hospital group built on operating volume and low unit cost. The Indian Institute of Technology Kanpur's own convocation profile states it plainly: \"Dr Devi Prasad Shetty is the Founder and Chairman of Narayana Health.\" He is the person most often quoted on the proposition that heart surgery gets cheaper by being done more often, which is the argument underneath a large part of this directory.", "story": "The peer-reviewed profile of him in Cureus in 2024 gives the life: born on 8 May 1953 in Kinnigoli, Karnataka; MBBS from Kasturba Medical College, Mangalore, in 1979; cardiothoracic training at Guy's Hospital in London. IIT Kanpur's profile instead records an MBBS from the University of Mysore in 1978 and a master's in surgery there in 1982, with a fellowship of the Royal College of Surgeons of England in 2009. The institutions are reconcilable — the Mangalore college was affiliated to that university — and the years are not; both are reported here and neither is preferred.\n\nNarayana Hrudayalaya was founded in 2000. The Cureus profile describes the cardiac hospital as one of the largest in the world with a thousand beds, performing more than thirty major heart operations a day. The same paper records Yeshasvini, the farmers' insurance scheme he built with the Karnataka state government, launched in 2003 \"at a nominal premium of 5-7 Indian Rupees\" a month — a domestic financing experiment that has nothing to do with foreign patients and explains more about the group's economics than the export trade does.\n\nHealth City Cayman Islands, a member of the Narayana network, opened in 2014, and states on its own pages that it is \"the first hospital in the Caribbean and one of only six organisations globally to receive the prestigious Joint Commission International (JCI) Enterprise Accreditation\". *Inference —* an Indian group building a hospital an hour from Miami is the clearest single statement in this field about where the customers are; the hospital's own page does not put it that way, and no quotation from him saying so was found for this record.\n\nThe Government of India conferred the Padma Shri in 2004 and the Padma Bhushan in 2012, as recorded in the Cureus profile.", "notes": "The career operation total widely attached to him traces to a magazine article and was not verified in a first-party or peer-reviewed source; it is not carried here." }, "kin": [ { "to": "narayana-health", "as": "The group he founded, and the record carrying its volume argument and its 2013 bypass figure.", "rel": "facility" }, { "to": "bengaluru", "as": "Where the first hospital was built, on the southern edge of the city.", "rel": "hub" }, { "to": "cabg", "as": "The operation his cost argument was made about.", "rel": "procedure" }, { "to": "india", "as": "The country whose low-cost cardiac surgery he is the public face of.", "rel": "destination" }, { "to": "prathap-reddy", "as": "The earlier founder, who made the corporate hospital a category before this argument could be made inside one.", "rel": "contrast" }, { "to": "is-it-cheaper", "as": "Volume against price, which is his claim and this site's question.", "rel": "story" } ], "links": [ { "label": "IIT Kanpur — convocation profile", "url": "https://www.iitk.ac.in/doaa/convocation/data/Profile-Dr.-Devi-Prasad-Shetty.pdf" }, { "label": "Cureus 2024 profile", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11530259/" } ], "sources": [ "s:iitk-shetty-profile", "s:cureus-devi-shetty", "s:hcci-about-archived", "s:wp-devi-shetty", "s:wp-narayana-health-2" ], "provenance": { "default": { "tier": "cited", "source": "s:iitk-shetty-profile" }, "fields": { "text.story": { "tier": "cited", "source": "s:cureus-devi-shetty", "note": "the biography, the founding year, the bed and throughput figures, the Yeshasvini premium and the two Padma years are from the Cureus profile; the qualification conflict is between that paper and the IIT Kanpur profile; the Cayman sentence is quoted from an archived capture of the hospital's own page and the paragraph's closing reading is marked inference" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-17", "blurb": "Cardiac surgeon, and founder and chairman of Narayana Health, the Bengaluru hospital group built on operating volume and low unit cost.", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" }, { "key": "caribbean", "name": "The Caribbean", "note": "the Dominican Republic, Cuba, Barbados, the Caymans" } ], "kin_out": [ { "to": "narayana-health", "type": "facility", "name": "Narayana Health", "as": "The group he founded, and the record carrying its volume argument and its 2013 bypass figure.", "rel": "facility" }, { "to": "bengaluru", "type": "hub", "name": "Bengaluru", "as": "Where the first hospital was built, on the southern edge of the city.", "rel": "hub" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The operation his cost argument was made about.", "rel": "procedure" }, { "to": "india", "type": "destination", "name": "India", "as": "The country whose low-cost cardiac surgery he is the public face of.", "rel": "destination" }, { "to": "prathap-reddy", "type": "person", "name": "Prathap C. Reddy", "as": "The earlier founder, who made the corporate hospital a category before this argument could be made inside one.", "rel": "contrast" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "Volume against price, which is his claim and this site's question.", "rel": "story" } ], "source_list": [ { "id": "s:iitk-shetty-profile", "kind": "web", "title": "Profile — Dr Devi Prasad Shetty (convocation)", "publisher": "Indian Institute of Technology Kanpur, Dean of Academic Affairs", "url": "https://www.iitk.ac.in/doaa/convocation/data/Profile-Dr.-Devi-Prasad-Shetty.pdf", "accessed": "2026-09-17", "note": "'Dr Devi Prasad Shetty is the Founder and Chairman of Narayana Health'; MBBS University of Mysore 1978, MS 1982, FRCS England 2009; the Yeshaswini scheme with the Government of Karnataka; awards listed without years" }, { "id": "s:cureus-devi-shetty", "kind": "journal", "title": "Dr. Devi Prasad Shetty: The Visionary Cardiothoracic Surgeon Who Championed Affordable Healthcare", "publisher": "Cureus, 2024;16(10):e70683", "url": "https://doi.org/10.7759/cureus.70683", "accessed": "2026-09-16", "note": "Jayakumar D, Bansal A, Albano JE, Mirhan JLG. Open access, CC BY 4.0; full text at Europe PMC, PMC11530259" }, { "id": "s:hcci-about-archived", "kind": "web", "title": "About Us — Health City Cayman Islands (archived capture, 13 December 2025)", "publisher": "Health City Cayman Islands, via the Internet Archive", "url": "http://web.archive.org/web/20251213104822/https://healthcitycaymanislands.com/about-us/", "accessed": "2026-09-17", "note": "the hospital opened in 2014 and describes itself as a member of the Narayana Health network and 'the first hospital in the Caribbean and one of only six organisations globally to receive the prestigious Joint Commission International (JCI) Enterprise Accreditation'; the live site refuses automated requests and the Internet Archive could not be reached from this machine, so this entry rests on a capture read during research rather than on a fetch made for the record" }, { "id": "s:wp-devi-shetty", "kind": "web", "title": "Devi Shetty", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Devi_Shetty", "accessed": "2026-09-16", "note": "carries the Bloomberg 2013 bypass figure of 95,000 rupees and the Cleveland Clinic comparison" }, { "id": "s:wp-narayana-health-2", "kind": "wikipedia", "title": "Narayana Health", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Narayana_Health", "license": "CC BY-SA 4.0", "accessed": "2026-09-17" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:iitk-shetty-profile" }, "text.story": { "tier": "cited", "source": "s:cureus-devi-shetty", "note": "the biography, the founding year, the bed and throughput figures, the Yeshasvini premium and the two Padma years are from the Cureus profile; the qualification conflict is between that paper and the IIT Kanpur profile; the Cayman sentence is quoted from an archived capture of the hospital's own page and the paragraph's closing reading is marked inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "bengaluru", "type": "hub", "name": "Bengaluru", "as": "The cardiac surgeon who put a 280-bed heart hospital at the edge of this city in 2000.", "rel": "person" }, { "from": "narayana-health", "type": "facility", "name": "Narayana Health", "as": "Its founder and the author of the volume argument.", "rel": "person" }, { "from": "prathap-reddy", "type": "person", "name": "Prathap C. Reddy", "as": "The other founder-surgeon in Indian corporate medicine, working the volume end of the same market.", "rel": "contrast" } ] }, { "schema": 1, "id": "john-connell", "type": "person", "names": { "name": "John Connell", "aliases": [ "J. Connell" ], "said": "The geographer who got here first. His 2006 paper is the most cited single article in the field, and it read the trade as a story about globalisation rather than about hospitals." }, "region": [ "oceania", "global" ], "facets": { "role": "researcher", "iso2": "AU" }, "text": { "what": "Honorary Professor in the Faculty of Science at the University of Sydney, attached to the School of Geosciences, and the author of the first widely read academic treatment of cross-border care. His own university profile describes him as \"a social geographer with a longstanding interest in migration and development issues in the island Pacific, notably in Bougainville and Tuvalu\".", "story": "The article is Connell J, \"Medical tourism: Sea, sun, sand and … surgery\", Tourism Management 2006;27(6):1093–1100. It arrived before the market-research reports, before the accreditation business had scaled, and before any government had written a health-travel licensing regime, and it treated the subject as a geographer treats a labour flow: who moves, in which direction, and what that reveals about the systems they are moving between.\n\nThe book followed. The Wellcome Collection catalogues \"Medical tourism\", John Connell, CABI, Wallingford, 2011, 209 pages, ISBN 9781845936600; Open Library records the same title reissued by CABI in 2013 under ISBN 9781780643694. Retail listings dating the book to 2010 are common, and the library record is the one carried here.\n\n*Inference —* his framing is why this directory is organised the way it is. A person travelling for an operation is a migration event with a medical reason attached, and the useful questions about it — who can afford to move, which countries export and which import, what the movement does to the health system left behind — are the questions a geographer asks, not the questions a brochure answers.", "notes": "English Wikipedia gives a birth year of 1946, uncited, on an article carrying a neutrality banner; it is not asserted here. His university profile's own title is Honorary Professor, not the \"Professor of Human Geography\" that appears on his book jackets." }, "kin": [ { "to": "medical-tourism", "as": "The word in his title, used academically before the trade contested it.", "rel": "term" }, { "to": "who-travels", "as": "The question his 2006 paper set, and the one this site keeps returning to.", "rel": "story" }, { "to": "patient-mobility", "as": "The other word for the same movement, preferred by the people who regulate it.", "rel": "term" }, { "to": "australia", "as": "Where he writes from, and a country that both sends and receives patients.", "rel": "destination" }, { "to": "leigh-turner", "as": "The bioethicist working the same subject from the direction of what is being sold.", "rel": "contrast" }, { "to": "counting-patients", "as": "The problem his book named twenty years before the market reports learned to state it.", "rel": "story" } ], "links": [ { "label": "University of Sydney profile", "url": "https://profiles.sydney.edu.au/john.connell" }, { "label": "Medical tourism: Sea, sun, sand and … surgery (2006)", "url": "https://doi.org/10.1016/j.tourman.2005.11.005" }, { "label": "Wellcome Collection — Medical tourism, CABI 2011", "url": "https://wellcomecollection.org/works/v9j3qseb" } ], "sources": [ "s:sydney-connell-profile", "s:connell-2006", "s:wellcome-connell-2011", "s:openlibrary-connell-medical-tourism", "s:wp-john-connell" ], "provenance": { "default": { "tier": "cited", "source": "s:sydney-connell-profile" }, "fields": { "text.what": { "tier": "cited", "source": "s:sydney-connell-profile", "note": "title, faculty, school and the quoted biography line were read on the university's own profile in a browser on 2026-09-17; the page does not render to a plain fetch" }, "text.story": { "tier": "cited", "source": "s:wellcome-connell-2011", "note": "the 2006 citation was confirmed through Crossref; the book's date and ISBN are from the Wellcome Collection record; the closing paragraph is marked inference" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "Honorary Professor in the Faculty of Science at the University of Sydney, attached to the School of Geosciences, and the author of the first widely read academic treatment of cross-border care.", "region_terms": [ { "key": "oceania", "name": "Oceania", "note": "Australia, New Zealand, the Pacific" }, { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The word in his title, used academically before the trade contested it.", "rel": "term" }, { "to": "who-travels", "type": "story", "name": "Who travels", "as": "The question his 2006 paper set, and the one this site keeps returning to.", "rel": "story" }, { "to": "patient-mobility", "type": "term", "name": "Patient mobility", "as": "The other word for the same movement, preferred by the people who regulate it.", "rel": "term" }, { "to": "australia", "type": "destination", "name": "Australia", "as": "Where he writes from, and a country that both sends and receives patients.", "rel": "destination" }, { "to": "leigh-turner", "type": "person", "name": "Leigh Turner", "as": "The bioethicist working the same subject from the direction of what is being sold.", "rel": "contrast" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "The problem his book named twenty years before the market reports learned to state it.", "rel": "story" } ], "source_list": [ { "id": "s:sydney-connell-profile", "kind": "web", "title": "John Connell — academic profile", "publisher": "The University of Sydney", "url": "https://profiles.sydney.edu.au/john.connell", "accessed": "2026-09-17", "note": "read in a browser because the page renders only with script: 'PROFESSOR / John Connell / Honorary Professor / Faculty of Science', School of Geosciences and the Sydney Southeast Asia Centre, with the biography line describing him as a social geographer" }, { "id": "s:connell-2006", "kind": "journal", "title": "Medical tourism: Sea, sun, sand and … surgery", "publisher": "Tourism Management, 2006;27(6):1093–1100", "url": "https://doi.org/10.1016/j.tourman.2005.11.005", "accessed": "2026-09-16", "note": "Connell J. Citation confirmed through the Crossref API" }, { "id": "s:wellcome-connell-2011", "kind": "catalogue", "title": "Medical tourism — John Connell, CABI, 2011 (ISBN 9781845936600)", "publisher": "Wellcome Collection catalogue", "url": "https://wellcomecollection.org/works/v9j3qseb", "accessed": "2026-09-17", "note": "Wallingford, Oxfordshire, 2011, xii, 209 pp.; retail listings dating the book to 2010 are common and the library record is preferred here" }, { "id": "s:openlibrary-connell-medical-tourism", "kind": "catalogue", "title": "Medical tourism — John Connell, CABI, 2010 (ISBN 9781845936600)", "publisher": "Open Library", "url": "https://openlibrary.org/works/OL15571593W", "accessed": "2026-09-16", "note": "a second CABI title under the same name is catalogued at 2013, ISBN 9781780643694" }, { "id": "s:wp-john-connell", "kind": "web", "title": "John Connell (geographer)", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/John_Connell_(geographer)", "accessed": "2026-09-16", "note": "born 1946; joined the University of Sydney in 1977 as a lecturer in geography and retired as Professor; Member of the Order of Australia 2021" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:sydney-connell-profile", "note": "title, faculty, school and the quoted biography line were read on the university's own profile in a browser on 2026-09-17; the page does not render to a plain fetch" }, "text.story": { "tier": "cited", "source": "s:wellcome-connell-2011", "note": "the 2006 citation was confirmed through Crossref; the book's date and ISBN are from the Wellcome Collection record; the closing paragraph is marked inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [] }, { "schema": 1, "id": "josef-woodman", "type": "person", "names": { "name": "Josef Woodman", "aliases": [ "Josef Woodman, Patients Beyond Borders" ], "said": "Styled in his own publisher's releases as CEO of Patients Beyond Borders — a consumer guidebook that is also a business selling services to the hospitals it covers." }, "region": [ "north-america", "global" ], "facets": { "role": "journalist", "iso2": "US" }, "text": { "what": "Author of \"Patients Beyond Borders: Everybody's Guide to Affordable, World-Class Medical Tourism\", the consumer guidebook that introduced most English-speaking readers to this subject. Open Library records the first edition on 12 March 2007, published by Healthy Travel Media. A press release from that publisher on 21 January 2020 announcing the fourth edition describes him as \"CEO of Patients Beyond Borders\", covering \"800 medical centers and clinics in 70 countries\".", "story": "The guidebook did something no register did: it listed hospitals abroad by procedure, with prices and with what to ask, for a reader with no clinical training. For fifteen years it was the most widely read single object in this field, and the vocabulary it used — package, facilitator, accreditation — is the vocabulary the trade still uses with patients.\n\nThe same 2020 release also shows the field's characteristic arithmetic in its natural habitat. It states that \"the international medical travel market is expanding at 15-18% annually\" and that \"more than two million US patients will cross borders for medical care\" that year. Neither figure carries a method, a denominator or a source in the release, and this site does not repeat either as a fact.\n\n*Inference —* a guidebook with an audience is also a business, and whose money it takes matters to how it should be read. This record does not have first-party access to how that business worked at its height: patientsbeyondborders.com's own about and services pages are gone from the live site, and the archived copies could not be retrieved from this machine.\n\nWhat can be read today is the ending. As of 17 September 2026 patientsbeyondborders.com carries no author name and no book, and directs the reader elsewhere: \"If you are a patient seeking assistance with medical travel, please visit Medical Departures, or contact info@medicaldepartures.com.\" The most-read consumer guide in this trade now forwards its readers to a booking platform.", "notes": "No birth year is published in any source read for this record, and none is asserted." }, "kin": [ { "to": "facilitator", "as": "The trade his guidebook taught a generation of readers to use, and to check.", "rel": "term" }, { "to": "package-price", "as": "The unit his book listed hospitals in.", "rel": "term" }, { "to": "choosing-a-facilitator", "as": "The step of the journey his guide was written for.", "rel": "pathway" }, { "to": "medical-tourism", "as": "The word in his title, and the fight over it.", "rel": "term" }, { "to": "counting-patients", "as": "Where the two-million figure in his publisher's release is taken apart.", "rel": "story" }, { "to": "leigh-turner", "as": "The academic reading of the same industry, from outside it.", "rel": "contrast" } ], "links": [ { "label": "Open Library — Patients Beyond Borders", "url": "https://openlibrary.org/works/OL9228481W" }, { "label": "Healthy Travel Media announces fourth edition (21 January 2020)", "url": "https://www.newswise.com/articles/healthy-travel-media-announces-fourth-edition-of-patients-beyond-borders" }, { "label": "patientsbeyondborders.com", "url": "https://www.patientsbeyondborders.com/" } ], "sources": [ "s:openlibrary-pbb", "s:newswise-pbb-2020", "s:pbb-homepage-2026" ], "provenance": { "default": { "tier": "cited", "source": "s:newswise-pbb-2020" }, "fields": { "text.story": { "tier": "cited", "source": "s:newswise-pbb-2020", "note": "the quoted market claims are from the publisher's own release; the third paragraph is marked inference; the closing quotation was read on the live site on 2026-09-17" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-17", "blurb": "Author of \"Patients Beyond Borders: Everybody's Guide to Affordable, World-Class Medical Tourism\", the consumer guidebook that introduced most English-speaking readers to this subject.", "region_terms": [ { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" }, { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The trade his guidebook taught a generation of readers to use, and to check.", "rel": "term" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The unit his book listed hospitals in.", "rel": "term" }, { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "The step of the journey his guide was written for.", "rel": "pathway" }, { "to": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The word in his title, and the fight over it.", "rel": "term" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Where the two-million figure in his publisher's release is taken apart.", "rel": "story" }, { "to": "leigh-turner", "type": "person", "name": "Leigh Turner", "as": "The academic reading of the same industry, from outside it.", "rel": "contrast" } ], "source_list": [ { "id": "s:openlibrary-pbb", "kind": "catalogue", "title": "Patients Beyond Borders — Josef Woodman, Healthy Travel Media", "publisher": "Open Library", "url": "https://openlibrary.org/works/OL9228481W", "accessed": "2026-09-16", "note": "first publication year 2007; the author record /authors/OL3288597A carries thirteen works" }, { "id": "s:newswise-pbb-2020", "kind": "article", "title": "Healthy Travel Media announces fourth edition of Patients Beyond Borders", "publisher": "Newswise (press release from Healthy Travel Media), 21 January 2020", "url": "https://www.newswise.com/articles/healthy-travel-media-announces-fourth-edition-of-patients-beyond-borders", "accessed": "2026-09-17", "note": "describes Josef Woodman as 'CEO of Patients Beyond Borders'; names Healthy Travel Media as publisher and Calvander Communications as parent; the fourth edition covers '800 medical centers and clinics in 70 countries'; carries the claims that the market is 'expanding at 15-18% annually' and that 'more than two million US patients will cross borders for medical care' in 2020, neither with a method" }, { "id": "s:pbb-homepage-2026", "kind": "web", "title": "patientsbeyondborders.com homepage", "publisher": "Patients Beyond Borders", "url": "https://www.patientsbeyondborders.com/", "accessed": "2026-09-17", "note": "as read on this date the site names no author and no book and states: 'If you are a patient seeking assistance with medical travel, please visit Medical Departures, or contact info@medicaldepartures.com.' The /about and /services paths return 404" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:newswise-pbb-2020" }, "text.story": { "tier": "cited", "source": "s:newswise-pbb-2020", "note": "the quoted market claims are from the publisher's own release; the third paragraph is marked inference; the closing quotation was read on the live site on 2026-09-17" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "monterrey", "type": "hub", "name": "Monterrey", "as": "Wrote the only city edition of his guidebook devoted to a Latin American hub, and it was this one.", "rel": "person" }, { "from": "keith-pollard", "type": "person", "name": "Keith Pollard", "as": "The other figure who built a business explaining this trade to patients, from the consumer-guide side rather than the trade-press one.", "rel": "contrast" }, { "from": "leigh-turner", "type": "person", "name": "Leigh Turner", "as": "The consumer-guide reading of the same industry, from inside it.", "rel": "contrast" } ] }, { "schema": 1, "id": "keith-pollard", "type": "person", "names": { "name": "Keith Pollard", "aliases": [ "Keith Lindsay Pollard" ], "said": "The publisher who ended up as the field's principal sceptic about its own numbers, while selling reports, sponsorship and award entries into it." }, "region": [ "europe-west", "global" ], "facets": { "role": [ "journalist" ], "iso2": "GB" }, "text": { "what": "British healthcare publisher, consultant and editor. He founded and ran Intuition Communication, a web publishing business whose sites sold information about private treatment to UK and overseas patients, and which bought the International Medical Travel Journal in 2009. He is the journal's editor in chief and chairs the judging panel of its Medical Travel Awards. Everything this record states about his career comes from his own site or from the UK companies registry, and it says which.", "story": "The registry gives the frame. Company 04858023 was incorporated on 6 August 2003 as Trekwell Ltd, took the name Intuition Communication Limited on 22 August 2003, and Keith Lindsay Pollard is recorded as a director from incorporation until his resignation on 28 February 2018. LaingBuisson announced the acquisition of Intuition on 1 March 2018; the company was renamed LaingBuisson International Limited on 5 March 2018, renamed again to Healthcare Business Intelligence Limited that June, back the following year, and dissolved on 14 March 2023. He is recorded as a director of it again from 25 April 2019.\n\nHis own account fills in what a registry cannot. He describes himself as CEO of Intuition, a business established in 2003 running Private Healthcare UK, HarleyStreet.com, Treatment Abroad and Cancer Advice, which launched an Arabic-language portal for Middle Eastern patients in 2010 and acquired IMTJ in 2009 — not 2007, which is the year the journal itself was established, and the two dates are easily run together. He names a past role as Executive Chairman of LaingBuisson International, without dating it, and current roles as a senior healthcare consultant to LaingBuisson, an independent consultant through his own company, and subject matter expert on medical travel for the Trojena development at NEOM in Saudi Arabia.\n\nThe awards are where the roles meet. The awards site's last published state describes them as \"judged by an independent panel of medical travel experts, chaired by IMTJ Editor-in-Chief, Keith Pollard\". *Inference —* a panel chaired by the editor of the paper that runs the competition and takes the entry fees is independent of the entrants, which is not the same as independent. This directory counts a trade award as evidence that a company entered and a panel preferred its entry, and never alongside an accreditation.\n\nOn the same page he adds the sentence this record turns on. His site says he is editor in chief of IMTJ \"although the journal's future is currently under review by LaingBuisson\" — wording already present in a September 2024 capture. It therefore dates the statement rather than the state: what can be said is that the review was being described in those terms two years ago, not that it is still under way, and not that the journal has stopped.", "notes": "His birth year is not asserted here. Where date-of-birth detail is published about a company officer, this project leaves it there. No month-level dating is carried for the CEO or Executive Chairman titles either, because neither his site nor the registry gives one for the title — the registry's dates are for the directorship, which is what the record names." }, "kin": [ { "to": "imtj", "as": "The journal his company bought in 2009 and he still edits, and the record carrying its ownership chain.", "rel": "org" }, { "to": "imtj-summit", "as": "The meeting and the awards his publication ran, with him in the chair of the panel.", "rel": "event" }, { "to": "counting-patients", "as": "His paper's long argument with the industry's headline figures is the best-known part of his editing.", "rel": "story" }, { "to": "the-accreditation-question", "as": "Where a trade award chaired by an editor and an inspection paid for by a hospital are told apart.", "rel": "story" }, { "to": "josef-woodman", "as": "The other figure who built a business explaining this trade to patients, from the consumer-guide side rather than the trade-press one.", "rel": "contrast" }, { "to": "medical-travel", "as": "The two words his journal put in its title, and the ones he uses.", "rel": "term" }, { "to": "facilitator", "as": "The trade his sites sold to and his awards judged.", "rel": "term" }, { "to": "united-kingdom", "as": "Where the publishing business was registered, and where its sites sold private treatment at home as well as abroad.", "rel": "destination" } ], "links": [ { "label": "About Keith — keithpollard.com", "url": "https://keithpollard.com/about/" }, { "label": "Companies House: company 04858023", "url": "https://find-and-update.company-information.service.gov.uk/company/04858023" }, { "label": "Officers of company 04858023", "url": "https://find-and-update.company-information.service.gov.uk/company/04858023/officers" } ], "sources": [ "s:keithpollard-about", "s:ch-laingbuisson-international", "s:ch-04858023-officers", "s:laingbuisson-intuition-2018", "s:imtj-awards-2024-archive", "s:imtj-wikipedia" ], "provenance": { "default": { "tier": "cited", "source": "s:keithpollard-about" }, "fields": { "text.story": { "tier": "cited", "source": "s:ch-04858023-officers", "note": "the company names, dates and directorships are the registry's, read 17 September 2026; the career descriptions and the sentence about the journal's future are his own site's, self-reported; the awards panel wording is quoted from the September 2024 capture of the awards site; the stretch marked *Inference —* is this project's reading" }, "text.what": { "tier": "cited", "source": "s:keithpollard-about", "note": "self-reported, and the record says so on the page" } } }, "confidence": "medium", "needs_verification": true, "updated": "2026-09-17", "blurb": "British healthcare publisher, consultant and editor. He founded and ran Intuition Communication, a web publishing business whose sites sold information about private treatment to UK and overseas patients, and which…", "region_terms": [ { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" }, { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "imtj", "type": "org", "name": "International Medical Travel Journal", "as": "The journal his company bought in 2009 and he still edits, and the record carrying its ownership chain.", "rel": "org" }, { "to": "imtj-summit", "type": "event", "name": "The IMTJ Medical Travel Summit and Awards", "as": "The meeting and the awards his publication ran, with him in the chair of the panel.", "rel": "event" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "His paper's long argument with the industry's headline figures is the best-known part of his editing.", "rel": "story" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Where a trade award chaired by an editor and an inspection paid for by a hospital are told apart.", "rel": "story" }, { "to": "josef-woodman", "type": "person", "name": "Josef Woodman", "as": "The other figure who built a business explaining this trade to patients, from the consumer-guide side rather than the trade-press one.", "rel": "contrast" }, { "to": "medical-travel", "type": "term", "name": "Medical travel", "as": "The two words his journal put in its title, and the ones he uses.", "rel": "term" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The trade his sites sold to and his awards judged.", "rel": "term" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Where the publishing business was registered, and where its sites sold private treatment at home as well as abroad.", "rel": "destination" } ], "source_list": [ { "id": "s:keithpollard-about", "kind": "web", "title": "About Keith / Career history of Keith Pollard", "publisher": "keithpollard.com", "url": "https://keithpollard.com/about/", "accessed": "2026-09-17", "note": "self-reported; the same wording about the journal's future being under review was already on the page in a September 2024 snapshot" }, { "id": "s:ch-laingbuisson-international", "kind": "dataset", "title": "LAINGBUISSON INTERNATIONAL LIMITED, company 04858023 — incorporation, previous names, dissolution", "publisher": "Companies House (United Kingdom)", "url": "https://find-and-update.company-information.service.gov.uk/company/04858023", "accessed": "2026-09-17" }, { "id": "s:ch-04858023-officers", "kind": "dataset", "title": "Officers of company 04858023 (Intuition Communication Limited, later LaingBuisson International Limited)", "publisher": "Companies House (United Kingdom)", "url": "https://find-and-update.company-information.service.gov.uk/company/04858023/officers", "accessed": "2026-09-17", "note": "the registry's officer list. Keith Lindsay Pollard is recorded as a director appointed 6 August 2003 and resigned 28 February 2018, and again as a director appointed 25 April 2019. The company was incorporated 6 August 2003 as Trekwell Ltd, named Intuition Communication Limited from 22 August 2003 to 5 March 2018, LaingBuisson International Limited from 5 March 2018, Healthcare Business Intelligence Limited from 26 June 2018 to 13 May 2019, and dissolved 14 March 2023. Officer dates of birth are published there and are deliberately not carried in this directory" }, { "id": "s:laingbuisson-intuition-2018", "kind": "web", "title": "LaingBuisson announces the acquisition of Intuition Communication, 1 March 2018 (Internet Archive snapshot, 28 September 2023)", "publisher": "LaingBuisson", "year": 2018, "url": "https://web.archive.org/web/20230928012944/https://www.laingbuisson.com/press-releases/laingbuisson-announces-acquisition-intuition-communication/", "accessed": "2026-09-17" }, { "id": "s:imtj-awards-2024-archive", "kind": "web", "title": "The IMTJ Medical Travel Awards (Internet Archive snapshot, 17 September 2024) — carries the 2022 cancellation notice", "publisher": "LaingBuisson", "url": "https://web.archive.org/web/20240917050124/https://awards.imtj.com/", "accessed": "2026-09-17", "note": "awards.imtj.com no longer resolves; this snapshot is the last published state" }, { "id": "s:imtj-wikipedia", "kind": "wikipedia", "title": "International Medical Travel Journal", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/International_Medical_Travel_Journal", "accessed": "2026-09-16", "note": "established 2007, UK trade publication, biweekly newsletter, Keith Pollard as editor in chief, annual Medical Travel Awards; imtj.com refused every fetch on this date" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:keithpollard-about", "note": "self-reported, and the record says so on the page" }, "text.story": { "tier": "cited", "source": "s:ch-04858023-officers", "note": "the company names, dates and directorships are the registry's, read 17 September 2026; the career descriptions and the sentence about the journal's future are his own site's, self-reported; the awards panel wording is quoted from the September 2024 capture of the awards site; the stretch marked *Inference —* is this project's reading" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "imtj", "type": "org", "name": "International Medical Travel Journal", "as": "Its editor in chief, and the founder of the company that published it.", "rel": "person" }, { "from": "medical-tourism-association", "type": "org", "name": "Medical Tourism Association", "as": "The trade's other long-standing publisher, and a frequent critic of its numbers.", "rel": "person" }, { "from": "imtj-summit", "type": "event", "name": "The IMTJ Medical Travel Summit and Awards", "as": "Its editor, and the chair of the awards panel.", "rel": "person" } ] }, { "schema": 1, "id": "leigh-turner", "type": "person", "names": { "name": "Leigh Turner", "aliases": [ "Leigh G. Turner" ], "said": "The bioethicist who counts the clinics. His method in the stem cell work is to enumerate what is being sold, which is why the numbers survive argument." }, "region": [ "north-america", "global" ], "facets": { "role": [ "ethicist", "researcher" ], "iso2": "US" }, "text": { "what": "Professor in the Department of Health, Society, & Behavior at the University of California, Irvine, and Director of the UC Irvine Center for Health Ethics. His faculty page states that his \"primary research program addresses ethical, legal, social, and public health issues related to stem cells and regenerative medicine\". He has published on cross-border care since 2010 and is the principal source of counts for the American market in unapproved cell products.", "story": "The work that matters most here is arithmetic. With Paul Knoepfler in Cell Stem Cell in 2016 he enumerated the businesses selling stem cell interventions directly to American consumers. Five years later he published the recount: \"In March 2021, 1,480 U.S. businesses operating 2,754 clinics were found selling purported stem cell treatments for various indications\" — \"more than four times as many businesses than were identified 5 years ago\", selling products \"that are not FDA-approved and lack convincing evidence of safety and efficacy\".\n\n*Inference —* that finding cuts across this subject's usual framing. Unproven cell treatment is written about as something patients fly abroad for; the count says the largest market for it is inside the country most of those patients live in.\n\nHis earlier cross-border papers took the industry's intermediaries as the object rather than the hospitals: accreditation and regulatory oversight of medical travel companies in the International Journal for Quality in Health Care in 2011, and the Canadian companies marketing medical travel in Globalization and Health in 2012, which examined what those companies actually told prospective patients.\n\nBefore Irvine he was at the University of Minnesota's Center for Bioethics and School of Public Health, at McGill's Biomedical Ethics Unit as a William Dawson Scholar, at the University of Toronto Joint Centre for Bioethics, and a research associate at the Hastings Center.", "notes": "No birth year is published in the sources read for this record. \"Medical tourism: assessing the evidence on treatment abroad\" is by Lunt and Carrera and is sometimes misattributed to him; it is not his." }, "kin": [ { "to": "stem-cell-unproven", "as": "The trade he counted, and the record carrying his 2021 figures.", "rel": "procedure" }, { "to": "unproven-stem-cell", "as": "The risk record, where his enumeration sets the scale.", "rel": "risk" }, { "to": "stem-cell-regulation", "as": "The rules his counts are measured against, country by country.", "rel": "rule" }, { "to": "facilitator", "as": "The intermediary his 2011 and 2012 papers made the object of study.", "rel": "term" }, { "to": "the-accreditation-question", "as": "His 2011 paper on oversight of medical travel companies sits at the centre of it.", "rel": "story" }, { "to": "united-states", "as": "The country his counts are of, and the one usually described as a source of patients rather than a market.", "rel": "destination" }, { "to": "josef-woodman", "as": "The consumer-guide reading of the same industry, from inside it.", "rel": "contrast" } ], "links": [ { "label": "UC Irvine faculty profile", "url": "https://publichealth.uci.edu/faculty/turner-leigh/" }, { "label": "The American stem cell sell in 2021 (Cell Stem Cell)", "url": "https://doi.org/10.1016/j.stem.2021.10.008" }, { "label": "Selling stem cells in the USA (Cell Stem Cell, 2016)", "url": "https://doi.org/10.1016/j.stem.2016.06.007" } ], "sources": [ "s:uci-leigh-turner", "s:turner-2021-stem-cell-sell", "s:turner-knoepfler-2016", "s:turner-2011-intqhc", "s:turner-2012-globalization-health" ], "provenance": { "default": { "tier": "cited", "source": "s:uci-leigh-turner" }, "fields": { "text.story": { "tier": "cited", "source": "s:turner-2021-stem-cell-sell", "note": "the 2021 counts are quoted from the paper's abstract; the citations for the 2011 and 2012 papers were confirmed through Crossref on 2026-09-17" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "Professor in the Department of Health, Society, & Behavior at the University of California, Irvine, and Director of the UC Irvine Center for Health Ethics.", "region_terms": [ { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" }, { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "stem-cell-unproven", "type": "procedure", "name": "Unapproved stem cell treatment", "as": "The trade he counted, and the record carrying his 2021 figures.", "rel": "procedure" }, { "to": "unproven-stem-cell", "type": "risk", "name": "Unproven stem cell treatment", "as": "The risk record, where his enumeration sets the scale.", "rel": "risk" }, { "to": "stem-cell-regulation", "type": "rule", "name": "Regulating cell and tissue therapies", "as": "The rules his counts are measured against, country by country.", "rel": "rule" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The intermediary his 2011 and 2012 papers made the object of study.", "rel": "term" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "His 2011 paper on oversight of medical travel companies sits at the centre of it.", "rel": "story" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The country his counts are of, and the one usually described as a source of patients rather than a market.", "rel": "destination" }, { "to": "josef-woodman", "type": "person", "name": "Josef Woodman", "as": "The consumer-guide reading of the same industry, from inside it.", "rel": "contrast" } ], "source_list": [ { "id": "s:uci-leigh-turner", "kind": "web", "title": "Leigh Turner — faculty profile", "publisher": "University of California, Irvine, Joe C. Wen School of Population and Public Health", "url": "https://publichealth.uci.edu/faculty/turner-leigh/", "accessed": "2026-09-16", "note": "Professor, Department of Health, Society & Behavior; Director, UC Irvine Center for Health Ethics; research on stem cell and regenerative medicine marketing and on health-related travel" }, { "id": "s:turner-2021-stem-cell-sell", "kind": "paper", "title": "The American stem cell sell in 2021: U.S. businesses selling unlicensed and unproven stem cell interventions", "publisher": "Cell Stem Cell 2021;28(11):1891-1895 (Turner L), doi:10.1016/j.stem.2021.10.008", "url": "https://doi.org/10.1016/j.stem.2021.10.008", "accessed": "2026-09-17", "note": "abstract read through Europe PMC: 'In March 2021, 1,480 U.S. businesses operating 2,754 clinics were found selling purported stem cell treatments for various indications'; citation confirmed through Crossref" }, { "id": "s:turner-knoepfler-2016", "kind": "paper", "title": "Selling Stem Cells in the USA: Assessing the Direct-to-Consumer Industry", "publisher": "Cell Stem Cell 2016;19(2):154-157 (Turner L, Knoepfler P)", "url": "https://pubmed.ncbi.nlm.nih.gov/27374789/", "accessed": "2026-09-16" }, { "id": "s:turner-2011-intqhc", "kind": "paper", "title": "Quality in health care and globalization of health services: accreditation and regulatory oversight of medical tourism companies", "publisher": "International Journal for Quality in Health Care 2011;23(1):1-7 (Turner L), doi:10.1093/intqhc/mzq078", "url": "https://doi.org/10.1093/intqhc/mzq078", "accessed": "2026-09-17", "note": "citation confirmed through the Crossref API; the publisher's page refuses automated requests" }, { "id": "s:turner-2012-globalization-health", "kind": "paper", "title": "Beyond 'medical tourism': Canadian companies marketing medical travel", "publisher": "Globalization and Health 2012;8:16 (Turner L), doi:10.1186/1744-8603-8-16", "url": "https://doi.org/10.1186/1744-8603-8-16", "accessed": "2026-09-17", "note": "citation confirmed through the Crossref API; open access" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:uci-leigh-turner" }, "text.story": { "tier": "cited", "source": "s:turner-2021-stem-cell-sell", "note": "the 2021 counts are quoted from the paper's abstract; the citations for the 2011 and 2012 papers were confirmed through Crossref on 2026-09-17" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "john-connell", "type": "person", "name": "John Connell", "as": "The bioethicist working the same subject from the direction of what is being sold.", "rel": "contrast" }, { "from": "josef-woodman", "type": "person", "name": "Josef Woodman", "as": "The academic reading of the same industry, from outside it.", "rel": "contrast" } ] }, { "schema": 1, "id": "prathap-reddy", "type": "person", "names": { "name": "Prathap C. Reddy", "aliases": [ "Dr Prathap Chandra Reddy", "Prathap Chandra Reddy" ], "said": "Apollo's own pages call him Founder, Chairman, and in Indian health writing he is the man who made a private hospital a legitimate thing for a middle-class family to enter." }, "region": [ "south-asia" ], "facets": { "role": [ "founder", "physician" ], "iso2": "IN" }, "text": { "what": "The cardiologist who founded Apollo Hospitals, the first corporate hospital chain in India, and who is named on the group's own leadership page as Founder and Chairman. Apollo opened in Chennai in 1983 with 150 beds. The chain that grew from it is the single largest supplier of hospital care to foreign patients in South Asia, and the reason this directory has an India section at all.", "story": "The training came first and the business followed from it. Apollo's own account has him taking his medical degree at Stanley Medical College in Chennai, training as a cardiologist in the United Kingdom and the United States, and holding a fellowship at Massachusetts General Hospital in Boston before returning to India.\n\nWhat he built was not a hospital but a category. Before 1983 Indian private medicine was the nursing home and the consulting room; a corporate hospital raising capital, buying imported equipment and charging fees was new, and contested. The export trade in surgery came later and followed the same structure — an international patient office, a quoted package, a visa letter.\n\nHonours date the recognition: the Government of India conferred the Padma Bhushan in 1991 and the Padma Vibhushan, its second highest civilian award, in March 2010.\n\n*Inference —* a founder's record is the place where a hospital group's own claims about itself should be read most carefully. Apollo's leadership page states that the group has grown to \"over 10,000 beds across 76+ hospitals, 7,000+ pharmacies, 2,500+ clinics and diagnostic centers\" and that it has been \"honoured by the trust of over 200 million individuals who came from 150 countries\". Those are the group's own figures, undated on the page, and no register was read against them for this record.", "notes": "English Wikipedia gives his date of birth as 5 February 1933, citing an Apollo press release that no longer resolves. No first-party page read for this record states a birth year, and none is asserted here." }, "kin": [ { "to": "apollo-chennai", "as": "The hospital he opened in 1983, and the one Apollo still treats as its origin.", "rel": "facility" }, { "to": "india", "as": "The country whose private hospital sector his group defined the shape of.", "rel": "destination" }, { "to": "chennai", "as": "Where it started, and still a hub in this directory.", "rel": "hub" }, { "to": "devi-shetty", "as": "The other founder-surgeon in Indian corporate medicine, working the volume end of the same market.", "rel": "contrast" }, { "to": "nabh", "as": "The Indian accreditation system his group's hospitals are counted in.", "rel": "org" }, { "to": "cabg", "as": "The cardiac work the group was built around and still sells abroad.", "rel": "procedure" } ], "links": [ { "label": "Apollo Hospitals — leadership", "url": "https://www.apollohospitals.com/about-us/leadership" }, { "label": "Apollo Clinic — our chairman's profile", "url": "https://www.apolloclinic.com/for-patients/services/vaccinations/adult/our-chairmans-profile" } ], "sources": [ "s:apollo-leadership", "s:apolloclinic-chairman", "s:wp-apollo-hospitals" ], "provenance": { "default": { "tier": "cited", "source": "s:apollo-leadership" }, "fields": { "text.story": { "tier": "cited", "source": "s:apolloclinic-chairman", "note": "the training, the 1983 opening and the two Padma years are from Apollo's own chairman profile; the closing paragraph is marked inference and quotes the group's own undated figures" }, "text.notes": { "tier": "inference", "note": "the Wikipedia birth date and the dead citation behind it were checked on 2026-09-17" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-17", "blurb": "The cardiologist who founded Apollo Hospitals, the first corporate hospital chain in India, and who is named on the group's own leadership page as Founder and Chairman. Apollo opened in Chennai in 1983 with 150 beds.", "region_terms": [ { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" } ], "kin_out": [ { "to": "apollo-chennai", "type": "facility", "name": "Apollo Hospitals, Greams Road, Chennai", "as": "The hospital he opened in 1983, and the one Apollo still treats as its origin.", "rel": "facility" }, { "to": "india", "type": "destination", "name": "India", "as": "The country whose private hospital sector his group defined the shape of.", "rel": "destination" }, { "to": "chennai", "type": "hub", "name": "Chennai", "as": "Where it started, and still a hub in this directory.", "rel": "hub" }, { "to": "devi-shetty", "type": "person", "name": "Devi Prasad Shetty", "as": "The other founder-surgeon in Indian corporate medicine, working the volume end of the same market.", "rel": "contrast" }, { "to": "nabh", "type": "org", "name": "National Accreditation Board for Hospitals and Healthcare Providers", "as": "The Indian accreditation system his group's hospitals are counted in.", "rel": "org" }, { "to": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "The cardiac work the group was built around and still sells abroad.", "rel": "procedure" } ], "source_list": [ { "id": "s:apollo-leadership", "kind": "web", "title": "Our Leadership", "publisher": "Apollo Hospitals Enterprise Limited", "url": "https://www.apollohospitals.com/about-us/leadership", "accessed": "2026-09-16", "note": "names Dr Prathap C. Reddy as Founder, Chairman and states that he established Apollo Hospitals in 1983; the same page carries the group's own counts of hospitals, beds, doctors and accreditations" }, { "id": "s:apolloclinic-chairman", "kind": "web", "title": "Our Chairman's Profile — Dr Prathap C Reddy", "publisher": "Apollo Clinic (Apollo Hospitals Group)", "url": "https://www.apolloclinic.com/for-patients/services/vaccinations/adult/our-chairmans-profile", "accessed": "2026-09-17", "note": "medical degree at Stanley Medical College, Chennai; cardiology training in the UK and USA; fellowship at Massachusetts General Hospital, Boston; Apollo set up in Chennai in 1983 as a 150-bed hospital; Padma Bhushan 1991; Padma Vibhushan March 2010" }, { "id": "s:wp-apollo-hospitals", "kind": "wikipedia", "title": "Apollo Hospitals", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Apollo_Hospitals", "license": "CC BY-SA 4.0", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:apollo-leadership" }, "text.story": { "tier": "cited", "source": "s:apolloclinic-chairman", "note": "the training, the 1983 opening and the two Padma years are from Apollo's own chairman profile; the closing paragraph is marked inference and quotes the group's own undated figures" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "chennai", "type": "hub", "name": "Chennai", "as": "The cardiologist who opened the first hospital here and set the pattern.", "rel": "person" }, { "from": "apollo-chennai", "type": "facility", "name": "Apollo Hospitals, Greams Road, Chennai", "as": "Its founder, who opened it in 1983 as the first corporate hospital in the country.", "rel": "person" }, { "from": "devi-shetty", "type": "person", "name": "Devi Prasad Shetty", "as": "The earlier founder, who made the corporate hospital a category before this argument could be made inside one.", "rel": "contrast" } ] }, { "schema": 1, "id": "covid-shutdown-2020", "type": "event", "names": { "name": "The 2020 shutdown", "aliases": [ "COVID-19 pandemic, 2020", "the year the borders closed" ], "said": "In this trade 2020 is the year every arrival number goes to the floor, and the year most published series in this directory stop." }, "region": [ "global" ], "facets": { "kind": "turning-point", "when": 2020, "status": "one-off" }, "text": { "what": "The year cross-border care stopped. On 11 March 2020 the Director-General of the World Health Organization told a media briefing in Geneva: \"We have therefore made the assessment that COVID-19 can be characterized as a pandemic.\" Borders closed, airlines grounded, and hospitals cancelled the planned operations that are this directory's entire subject.", "story": "Travel first. UN Tourism's assessment of the year, published on 28 January 2021, recorded \"1 billion fewer international arrivals in 2020 than in the previous year\", international arrivals dropping by 74%, an estimated loss of USD 1.3 trillion in export revenues, and between 100 and 120 million direct tourism jobs at risk. By region: Asia and the Pacific down 84%, the Middle East and Africa 75% each, Europe 70%, the Americas 69%.\n\nThen the operating lists. The CovidSurg Collaborative's modelling, published in BJS in 2020, projected that \"28 404 603 operations would be cancelled or postponed during the peak 12 weeks\" of disruption — 2,367,050 a week, a global cancellation rate of 72.3%, taking in 81.7% of operations for benign conditions, 37.7% of cancer operations and 25.4% of elective caesarean sections. It is a projection from a survey of surgeons fed through a model, not a tally of cancelled operations, and it should never be quoted as a count.\n\nA destination gives the shape on the ground. Türkiye's official health-tourism series — published by USHAŞ from Turkish Statistical Institute figures, which come from a survey of departing visitors' stated purpose rather than from any hospital's records — counts 756,926 in 2019 and 435,691 in 2020, a fall of about 42%, then 729,592 in 2021 and 1,381,807 in 2022, nearly double the last year before the closure.\n\n*Inference —* the year did two lasting things to this subject's evidence. It put a hole in every series that a chart now has to draw across, and for many countries in the World Bank's arrivals table 2020 remains the most recent year with a value, so a map of the latest available data is a map of the shutdown. And it taught the trade that a patient who cannot fly is a patient who waits: the queues the pandemic built are part of why the demand came back larger than it left." }, "geo": { "lat": 46.2333, "lon": 6.05, "precision": "city", "source": "s:who-pandemic-remarks-2020" }, "address": { "city": "Geneva", "country": "CH" }, "kin": [ { "to": "world-bank-tourism-arrivals", "as": "The series where 2020 is still the most recent year for 132 of 223 codes.", "rel": "dataset" }, { "to": "turkiye", "as": "435,691 visitors gave health as their purpose in 2020, against 756,926 in 2019 — and 1,381,807 by 2022.", "rel": "destination" }, { "to": "oecd-waiting-times", "as": "Where the backlog the cancellations built shows up, in the countries that measure it.", "rel": "dataset" }, { "to": "turkiye-hair-boom", "as": "The recovery that followed, in one procedure and one country.", "rel": "event" }, { "to": "knee-replacement", "as": "The kind of planned operation the cancellation modelling was about.", "rel": "procedure" }, { "to": "counting-patients", "as": "A hole in every series at once, and what charts do to cover it.", "rel": "story" }, { "to": "who", "as": "Whose director-general used the word on 11 March 2020.", "rel": "org" } ], "links": [ { "label": "WHO Director-General's opening remarks, 11 March 2020", "url": "https://www.who.int/news-room/speeches/item/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020" }, { "label": "UN Tourism — 2020, the worst year in tourism history", "url": "https://www.untourism.int/news/2020-worst-year-in-tourism-history-with-1-billion-fewer-international-arrivals" }, { "label": "CovidSurg Collaborative, BJS 2020", "url": "https://doi.org/10.1002/bjs.11746" } ], "sources": [ "s:who-pandemic-remarks-2020", "s:unwto-2020-arrivals", "s:covidsurg-bjs-2020", "s:ushas-saglik-turizmi-verileri", "s:tuik-turizm-2025" ], "provenance": { "default": { "tier": "cited", "source": "s:who-pandemic-remarks-2020" }, "fields": { "text.story": { "tier": "cited", "source": "s:unwto-2020-arrivals", "note": "each figure was read on the page named in sources; the closing paragraph is marked inference" }, "geo": { "tier": "inference", "note": "Geneva, where the briefing was given; the event itself belongs to no one place" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "The year cross-border care stopped. On 11 March 2020 the Director-General of the World Health Organization told a media briefing in Geneva: \"We have therefore made the assessment that COVID-19 can be characterized as a…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "world-bank-tourism-arrivals", "type": "dataset", "name": "International arrivals", "as": "The series where 2020 is still the most recent year for 132 of 223 codes.", "rel": "dataset" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "435,691 visitors gave health as their purpose in 2020, against 756,926 in 2019 — and 1,381,807 by 2022.", "rel": "destination" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "Where the backlog the cancellations built shows up, in the countries that measure it.", "rel": "dataset" }, { "to": "turkiye-hair-boom", "type": "event", "name": "Türkiye's hair transplant boom", "as": "The recovery that followed, in one procedure and one country.", "rel": "event" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The kind of planned operation the cancellation modelling was about.", "rel": "procedure" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "A hole in every series at once, and what charts do to cover it.", "rel": "story" }, { "to": "who", "type": "org", "name": "World Health Organization", "as": "Whose director-general used the word on 11 March 2020.", "rel": "org" } ], "source_list": [ { "id": "s:who-pandemic-remarks-2020", "kind": "web", "title": "WHO Director-General's opening remarks at the media briefing on COVID-19 — 11 March 2020", "publisher": "World Health Organization", "url": "https://www.who.int/news-room/speeches/item/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020", "accessed": "2026-09-17", "note": "'We have therefore made the assessment that COVID-19 can be characterized as a pandemic.'" }, { "id": "s:unwto-2020-arrivals", "kind": "org", "title": "2020: worst year in tourism history with 1 billion fewer international arrivals", "publisher": "UN Tourism (World Tourism Organization), 28 January 2021", "url": "https://www.untourism.int/news/2020-worst-year-in-tourism-history-with-1-billion-fewer-international-arrivals", "accessed": "2026-09-17", "note": "arrivals down 74% in 2020, 1 billion fewer than 2019, an estimated USD 1.3 trillion in lost export revenues, 100-120 million direct tourism jobs at risk; Asia-Pacific -84%, Middle East and Africa -75%, Europe -70%, Americas -69%" }, { "id": "s:covidsurg-bjs-2020", "kind": "paper", "title": "Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans", "publisher": "British Journal of Surgery 2020;107(11):1440-1449 (COVIDSurg Collaborative), doi:10.1002/bjs.11746", "url": "https://academic.oup.com/bjs/article/107/11/1440/6139510", "accessed": "2026-09-17", "note": "a projection, not a count: 28,404,603 operations cancelled or postponed over 12 peak weeks, 2,367,050 a week, a 72.3% cancellation rate, 81.7% of benign-condition operations, 37.7% of cancer operations, 25.4% of elective caesarean sections; built from a global expert response study fed through a model" }, { "id": "s:ushas-saglik-turizmi-verileri", "kind": "gov", "title": "Sağlık Turizmi Verileri (health tourism data by year)", "publisher": "USHAŞ — Uluslararası Sağlık Hizmetleri A.Ş., the Turkish Ministry of Health's international health services company", "url": "https://ushas.gov.tr/saglik-turizmi-verileri/", "accessed": "2026-09-16", "note": "USHAŞ publishes the series it attributes to TÜİK, the Turkish statistical institute: visitors and revenue by year — 2019 756,926 and USD 1.459bn; 2020 435,691; 2021 729,592; 2022 1,381,807; 2023 1,538,643; 2024 1,506,442; 2025 1,398,580 and USD 3,022,452 thousand; first half of 2026 563,327 and USD 1.580bn. The unit is a visitor arriving with a health purpose, not an operation." }, { "id": "s:tuik-turizm-2025", "kind": "dataset", "title": "Turizm İstatistikleri, IV. Çeyrek: Ekim-Aralık ve Yıllık, 2025 (Sayı 54158) — table: Departing Visitors by Purpose of Visit, 2012–2026", "publisher": "Türkiye İstatistik Kurumu (TurkStat)", "year": 2026, "url": "https://veriportali.tuik.gov.tr/Bulten/Index?p=Turizm-Istatistikleri-IV.-Ceyrek:-Ekim-Aralik-ve-Yillik,-2025-54158", "accessed": "2026-09-17", "note": "the health figure appears only in the attached statistical table, not in the bulletin text; its own footer names the source as the TurkStat Departing Visitors Survey — a border exit survey of stated purpose, not a count of patients treated" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:who-pandemic-remarks-2020" }, "text.story": { "tier": "cited", "source": "s:unwto-2020-arrivals", "note": "each figure was read on the page named in sources; the closing paragraph is marked inference" }, "geo": { "tier": "inference", "note": "Geneva, where the briefing was given; the event itself belongs to no one place" }, "address": { "tier": "cited", "source": "s:who-pandemic-remarks-2020" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "turkiye-hair-boom", "type": "event", "name": "Türkiye's hair transplant boom", "as": "The collapse this recovery followed, and doubled.", "rel": "event" } ] }, { "schema": 1, "id": "directive-2011-24-adopted", "type": "event", "names": { "name": "Directive 2011/24/EU adopted, 9 March 2011", "aliases": [ "cross-border healthcare directive", "patients' rights directive" ], "said": "Brussels calls it the patients' rights directive. What it actually did was put a price ceiling on a right that the Court of Justice had already granted case by case." }, "region": [ "global", "europe-west", "europe-central", "europe-south", "europe-north", "europe-east" ], "facets": { "kind": "ruling", "when": 2011, "status": "in-force" }, "text": { "what": "The European Parliament and the Council adopted Directive 2011/24/EU on the application of patients' rights in cross-border healthcare on 9 March 2011, signed at Strasbourg by J. Buzek for the Parliament and E. Győri for the Council. It was published in the Official Journal on 4 April 2011 at L 88/45, entered into force twenty days later, and Member States had to transpose it \"by 25 October 2013\". It is the only instrument in this directory that gives a patient a general right to be treated in another country and have the bill sent home.", "story": "The rule is in Article 7(1): \"the Member State of affiliation shall ensure the costs incurred by an insured person who receives cross-border healthcare are reimbursed, if the healthcare in question is among the benefits to which the insured person is entitled in the Member State of affiliation.\" Then Article 7(4) fixes the ceiling — costs are reimbursed \"up to the level of costs that would have been assumed by the Member State of affiliation, had this healthcare been provided in its territory without exceeding the actual costs of healthcare received.\"\n\nRead together, those two sentences describe the whole bargain. A patient may go; the home system pays what it would have paid at home; the patient carries the difference, and pays first. A right to travel is not a right to a free operation.\n\nGovernments kept one lever. Article 8 allows a prior authorisation system, restricted \"to what is necessary and proportionate\", and limits it to care that \"involves overnight hospital accommodation of the patient in question for at least one night\", \"requires use of highly specialised and cost-intensive medical infrastructure or medical equipment\", or presents a particular patient-safety risk. Article 8(5) then closes the obvious loophole: authorisation may not be refused when the treatment cannot be provided at home \"within a time limit which is medically justifiable\". The queue is written into the law.\n\nArticle 6 requires every Member State to run a national contact point, which is how a patient is supposed to find out any of this.\n\n*Inference —* the directive is also the only place in this subject where a state agreed, in advance and in writing, to pay for a citizen's treatment abroad. Everything else in this directory is paid out of pocket.", "today": "The Commission's report for reference year 2022 shows what the instrument produces in practice: 23 countries reported 547,890 reimbursement requests for care that needed no prior authorisation, of which France's 300,254 and Germany's 160,647 are 84%, against 14,176 from Poland, 1,841 from Ireland, 440 from Czechia and nine from Spain. Total reimbursed was EUR 86,462,491. For care that did need prior authorisation there were 4,552 requests and EUR 7,708,041.", "notes": "One instrument, one date, one jurisdiction — the directive binds the EU Member States and, through the EEA agreement and national implementations, extends unevenly beyond them. Nothing here is legal advice, and the per-country reading sits on the rule record rather than in this event." }, "geo": { "lat": 48.5839, "lon": 7.7455, "precision": "city", "source": "s:eurlex-2011-24-oj" }, "address": { "city": "Strasbourg", "country": "FR" }, "kin": [ { "to": "eu-directive-2011-24", "as": "The rule record: what it says, country by country, and what it does not cover.", "rel": "rule" }, { "to": "s2-route", "as": "The older route it sits beside, under the social security regulation, which pays the treating country's tariff instead.", "rel": "rule" }, { "to": "eu-national-contact-points", "as": "The offices Article 6 created, and the thin place where a patient meets the law.", "rel": "org" }, { "to": "oecd-waiting-times", "as": "The queue Article 8(5) turns into an entitlement, measured where anybody measures it.", "rel": "dataset" }, { "to": "patient-mobility", "as": "The word Brussels uses for this, and why it is not the word the trade uses.", "rel": "term" }, { "to": "prior-authorisation", "as": "The permission Article 8 lets a state require, and the conditions it may require it under.", "rel": "term" }, { "to": "is-it-cheaper", "as": "A reimbursement at the home tariff changes the arithmetic that every other page here does out of pocket.", "rel": "story" } ], "links": [ { "label": "Directive 2011/24/EU on EUR-Lex", "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A32011L0024" }, { "label": "Official Journal text, L 88/45", "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32011L0024" }, { "label": "Procedure file 2008/0142/COD", "url": "https://eur-lex.europa.eu/procedure/EN/2008_142" } ], "sources": [ "s:eurlex-2011-24-oj", "s:eu-directive-2011-24", "s:dir-2011-24-chapter-ii", "s:ec-crossborder-2022" ], "provenance": { "default": { "tier": "cited", "source": "s:eurlex-2011-24-oj" }, "fields": { "text.story": { "tier": "cited", "source": "s:eurlex-2011-24-oj", "note": "every quoted passage was read in the Official Journal text; the closing paragraph is marked inference" }, "text.today": { "tier": "cited", "source": "s:ec-crossborder-2022" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "The European Parliament and the Council adopted Directive 2011/24/EU on the application of patients' rights in cross-border healthcare on 9 March 2011, signed at Strasbourg by J. Buzek for the Parliament and E.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" }, { "key": "europe-central", "name": "Central Europe", "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia" }, { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" }, { "key": "europe-north", "name": "Northern Europe", "note": "the Nordics and the Baltics" }, { "key": "europe-east", "name": "Eastern Europe", "note": "Romania, Bulgaria, Serbia, Ukraine, Moldova, Albania, North Macedonia" } ], "kin_out": [ { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The rule record: what it says, country by country, and what it does not cover.", "rel": "rule" }, { "to": "s2-route", "type": "rule", "name": "The S2 route", "as": "The older route it sits beside, under the social security regulation, which pays the treating country's tariff instead.", "rel": "rule" }, { "to": "eu-national-contact-points", "type": "org", "name": "EU National Contact Points for cross-border healthcare", "as": "The offices Article 6 created, and the thin place where a patient meets the law.", "rel": "org" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The queue Article 8(5) turns into an entitlement, measured where anybody measures it.", "rel": "dataset" }, { "to": "patient-mobility", "type": "term", "name": "Patient mobility", "as": "The word Brussels uses for this, and why it is not the word the trade uses.", "rel": "term" }, { "to": "prior-authorisation", "type": "term", "name": "Prior authorisation", "as": "The permission Article 8 lets a state require, and the conditions it may require it under.", "rel": "term" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "A reimbursement at the home tariff changes the arithmetic that every other page here does out of pocket.", "rel": "story" } ], "source_list": [ { "id": "s:eurlex-2011-24-oj", "kind": "law", "title": "Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients' rights in cross-border healthcare — Official Journal text", "publisher": "Official Journal of the European Union, L 88/45, 4.4.2011", "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32011L0024", "accessed": "2026-09-17", "note": "read in the OJ PDF: Article 7(1) and 7(4) on reimbursement up to the home level, Article 8(1)(2)(5) on prior authorisation and the medically justifiable time limit, Article 6 on national contact points, Article 21 transposition by 25 October 2013, Article 22 entry into force on the 20th day after publication, signed at Strasbourg 9 March 2011 by J. BUZEK and GYORI E." }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:dir-2011-24-chapter-ii", "kind": "law", "title": "Directive 2011/24/EU, Chapter II — responsibilities of the Member State of treatment and of affiliation, Articles 4 to 6", "publisher": "legislation.gov.uk, retained text of Directive 2011/24/EU", "url": "https://www.legislation.gov.uk/cy/eudr/2011/24/chapter/II/data.htm?view=plain", "accessed": "2026-09-16", "note": "read for Art 4(2)(b) invoices and prices, 4(2)(c) complaints and redress, 4(2)(d) professional liability insurance, 4(2)(f) copy of the medical record, 5(d) access to records, and Art 6 national contact points" }, { "id": "s:ec-crossborder-2022", "kind": "report", "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU — reference year 2022", "publisher": "European Commission, DG Health and Food Safety, Unit B.3; written by PredictBy Research and Consulting and Baltic Media; Publications Office of the European Union", "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf", "license": "CC BY 4.0", "accessed": "2026-09-16", "note": "final version January 2024, ISBN 978-92-68-14858-7. 23 countries reported 547,890 reimbursement requests for care not needing prior authorisation in 2022, of which France 300,254 and Germany 160,647 are 84%; Poland 14,176, Slovakia 13,904, Ireland 1,841, Romania 889, Czechia 440, Croatia 192, Lithuania 131, Greece 56, Cyprus 44, Portugal 27 (all refused), Spain 9. Total reimbursed EUR 86,462,491. For care needing prior authorisation, 4,552 requests and EUR 7,708,041. Belgium and Hungary could not report; Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway run no prior-authorisation system; only Denmark and Romania have a mechanism to limit inflow." } ], "tiers": { "text.what": { "tier": "cited", "source": "s:eurlex-2011-24-oj" }, "text.story": { "tier": "cited", "source": "s:eurlex-2011-24-oj", "note": "every quoted passage was read in the Official Journal text; the closing paragraph is marked inference" }, "text.today": { "tier": "cited", "source": "s:ec-crossborder-2022" }, "geo": { "tier": "cited", "source": "s:eurlex-2011-24-oj" }, "address": { "tier": "cited", "source": "s:eurlex-2011-24-oj" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The year this was passed, and the litigation behind it.", "rel": "event" } ] }, { "schema": 1, "id": "dominican-republic-ntm-outbreak", "type": "event", "names": { "name": "The Dominican mycobacterial outbreaks, 2013–14 and 2017", "aliases": [ "NTM surgical site infections, Dominican Republic", "M. abscessus cosmetic surgery cluster" ], "said": "Infectious disease physicians in New York called it before anyone else did, because the patients kept arriving at their clinics with the same wound and the same boarding pass." }, "region": [ "caribbean", "north-america" ], "facets": { "kind": "outbreak", "when": 2017, "iso2": "DO", "status": "one-off" }, "text": { "what": "Two multi-state clusters of rapidly growing nontuberculous mycobacteria — environmental bacteria that infect surgical wounds and take months of antibiotics to clear — in United States residents who had cosmetic surgery in the Dominican Republic. The CDC published the first in MMWR in March 2014 and the second in March 2018. They are the longest published outbreak record attached to any destination in this directory.", "story": "The first cluster: \"As of February 21, 2014, a total of 19 cases were identified from five states (New York, 11; Massachusetts, three; Connecticut, two; Maryland, two; and Pennsylvania, one).\" Sixteen were confirmed and three probable. Twelve of the 19 had been operated on at one clinic and seven at seven other Dominican clinics. The commonest operations were liposuction at 74%, abdominoplasty at 58% and breast implantation at 32%. Fourteen were admitted to hospital in the United States and needed repeated corrective surgery and long courses of antibiotics. Of the 16 confirmed, 13 were Mycobacterium abscessus and two M. fortuitum.\n\nThe second, three years later, was larger. By 8 November 2017 the CDC had been notified of 52 patients from nine states; 38, or 73%, met the confirmed case definition — \"A diagnosed SSI and laboratory evidence confirming the presence of NTM in a U.S. resident who underwent a cosmetic surgery procedure in the Dominican Republic since January 1, 2017.\" All the confirmed patients were women, operated on between 4 January and 14 July 2017. They named 14 surgeons at seven surgical centres, and 26 of the 32 with information available — 81% — had been operated on at one centre, CIPLA, which closed temporarily on 8 July 2017. Fourteen of 15 with information needed further surgery after returning home. One patient died.\n\n*Inference —* the shape of both is a practice rather than a person. Rapidly growing mycobacteria live in water and in solutions; a cluster that concentrates in one building and then appears in six others is describing something done in theatres across a city. Neither report reached a denominator — nobody published how many patients travelled for cosmetic surgery to the country in either period — so no rate can be computed from 19 cases or from 38, and this record computes none.", "today": "Both CDC reports stand unrevised, at eight and twelve years old. No later Dominican inspection register was read for this record, and no denominator has been published since." }, "geo": { "lat": 18.4861, "lon": -69.9312, "precision": "city", "source": "s:mmwr-ntm-dominican-2018" }, "address": { "city": "Santo Domingo", "country": "DO" }, "kin": [ { "to": "dominican-republic", "as": "The country page, where these two clusters sit beside the trade that produced them.", "rel": "destination" }, { "to": "nontuberculous-mycobacteria", "as": "The organism, and why water and solutions are where it comes from.", "rel": "risk" }, { "to": "surgical-site-infection", "as": "What 38 confirmed patients flew home with in 2017.", "rel": "risk" }, { "to": "mexico-fungal-meningitis-2023", "as": "The later outbreak traced to clinics abroad, fungal rather than bacterial, and found the same way.", "rel": "event" }, { "to": "liposuction", "as": "The commonest operation in the 2013–14 cluster, at 74% of cases.", "rel": "procedure" }, { "to": "bbl", "as": "The body operation the Dominican trade is now known for.", "rel": "procedure" }, { "to": "revision-at-home", "as": "Fourteen of 19 admitted in the United States in the first cluster; 14 of 15 needing further surgery in the second.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Both outbreaks were found by doctors at home, weeks after discharge abroad.", "rel": "risk" }, { "to": "counting-patients", "as": "Two outbreak counts with no denominator between them.", "rel": "story" } ], "links": [ { "label": "MMWR 2018 — NTM infections after plastic surgery, Dominican Republic 2017", "url": "https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a5.htm" }, { "label": "MMWR 2014 — rapidly growing NTM wound infections, March 2013–February 2014", "url": "https://www.cdc.gov/Mmwr/preview/mmwrhtml/mm6309a5.htm" } ], "sources": [ "s:mmwr-ntm-dominican-2018", "s:mmwr-ntm-dominican-2014", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited", "source": "s:mmwr-ntm-dominican-2018" }, "fields": { "text.story": { "tier": "cited", "source": "s:mmwr-ntm-dominican-2014", "note": "the first paragraph is read off the 2014 MMWR and the second off the 2018 MMWR; the closing paragraph is marked inference" }, "geo": { "tier": "inference", "note": "Santo Domingo, where the named centres sit; neither report gives an address" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "Two multi-state clusters of rapidly growing nontuberculous mycobacteria — environmental bacteria that infect surgical wounds and take months of antibiotics to clear — in United States residents who had cosmetic surgery…", "region_terms": [ { "key": "caribbean", "name": "The Caribbean", "note": "the Dominican Republic, Cuba, Barbados, the Caymans" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "dominican-republic", "type": "destination", "name": "Dominican Republic", "as": "The country page, where these two clusters sit beside the trade that produced them.", "rel": "destination" }, { "to": "nontuberculous-mycobacteria", "type": "risk", "name": "Nontuberculous mycobacteria", "as": "The organism, and why water and solutions are where it comes from.", "rel": "risk" }, { "to": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "What 38 confirmed patients flew home with in 2017.", "rel": "risk" }, { "to": "mexico-fungal-meningitis-2023", "type": "event", "name": "The Matamoros fungal meningitis outbreak, 2023", "as": "The later outbreak traced to clinics abroad, fungal rather than bacterial, and found the same way.", "rel": "event" }, { "to": "liposuction", "type": "procedure", "name": "Liposuction", "as": "The commonest operation in the 2013–14 cluster, at 74% of cases.", "rel": "procedure" }, { "to": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "The body operation the Dominican trade is now known for.", "rel": "procedure" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Fourteen of 19 admitted in the United States in the first cluster; 14 of 15 needing further surgery in the second.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Both outbreaks were found by doctors at home, weeks after discharge abroad.", "rel": "risk" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Two outbreak counts with no denominator between them.", "rel": "story" } ], "source_list": [ { "id": "s:mmwr-ntm-dominican-2018", "kind": "journal", "title": "Notes from the Field: Nontuberculous Mycobacteria Infections in U.S. Medical Tourists Associated with Plastic Surgery — Dominican Republic, 2017", "publisher": "MMWR Morbidity and Mortality Weekly Report 2018;67(12):369-370, 30 March 2018", "url": "https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a5.htm", "accessed": "2026-09-16" }, { "id": "s:mmwr-ntm-dominican-2014", "kind": "journal", "title": "Notes from the Field: Rapidly Growing Nontuberculous Mycobacterium Wound Infections Among Medical Tourists Undergoing Cosmetic Surgeries in the Dominican Republic — Multiple States, March 2013–February 2014", "publisher": "MMWR Morbidity and Mortality Weekly Report 2014;63(9), 7 March 2014", "url": "https://www.cdc.gov/Mmwr/preview/mmwrhtml/mm6309a5.htm", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:mmwr-ntm-dominican-2018" }, "text.story": { "tier": "cited", "source": "s:mmwr-ntm-dominican-2014", "note": "the first paragraph is read off the 2014 MMWR and the second off the 2018 MMWR; the closing paragraph is marked inference" }, "text.today": { "tier": "cited", "source": "s:mmwr-ntm-dominican-2018" }, "geo": { "tier": "inference", "note": "Santo Domingo, where the named centres sit; neither report gives an address" }, "address": { "tier": "cited", "source": "s:mmwr-ntm-dominican-2018" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "dominican-republic", "type": "destination", "name": "Dominican Republic", "as": "The two clusters, in their own record.", "rel": "event" }, { "from": "santo-domingo", "type": "hub", "name": "Santo Domingo", "as": "The 2017 cluster: 52 patients, nine states, one clinic temporarily closed, three genetic clusters and no single culprit.", "rel": "event" }, { "from": "when-it-goes-wrong", "type": "pathway", "name": "When it goes wrong", "as": "The same, in another destination and another organism.", "rel": "event" }, { "from": "nontuberculous-mycobacteria", "type": "risk", "name": "Nontuberculous mycobacteria", "as": "The investigations themselves, with their clinics and dates.", "rel": "event" }, { "from": "mexico-fungal-meningitis-2023", "type": "event", "name": "The Matamoros fungal meningitis outbreak, 2023", "as": "The other multi-state outbreak traced to clinics abroad, five years earlier and bacterial rather than fungal.", "rel": "event" } ] }, { "schema": 1, "id": "imtj-summit", "type": "event", "names": { "name": "The IMTJ Medical Travel Summit and Awards", "aliases": [ "IMTJ Summit", "Medical Travel Awards" ], "said": "The trade's own annual meeting, run by the trade paper that covers it, with an awards dinner attached." }, "region": [ "global", "europe-west" ], "facets": { "kind": "conference", "founded": 2015, "iso2": "GB", "status": "suspended", "when": 2019 }, "text": { "what": "The trade's own annual gathering, run by the publisher of the International Medical Travel Journal alongside an awards ceremony. Five editions ran between 2015 and 2019 — Athens, Croatia, Madrid, London, then Berlin on 1 to 3 December 2019. The sixth was postponed in 2020 and this project could find no evidence that it ever ran.", "story": "The summit and the awards were one weekend. The awards began first, in Dubai on 5 March 2014, created by Intuition Communication and judged by a panel chaired by the journal's editor in chief. The summit followed, and by 2019 it was running co-located with the awards, a marketplace and Temos's own meeting.\n\nThen it stopped. The 2020 edition was postponed with a notice promising a virtual conference early in 2021 and a face-to-face one in Madrid that autumn; what ran instead was a five-hour online forum and awards on 23 September 2020. The awards site's last published state, captured in September 2024, still carried the 2022 cancellation: the publisher had taken the decision not to run the awards that year and would \"make decisions around the next Awards and Summit accordingly\".\n\n*Inference —* the negative evidence is about as strong as negative evidence gets. The summit subdomain has no successful capture after 16 March 2021 and now redirects to a generic events homepage; the awards subdomain has stopped resolving; and a four-thousand-URL listing of the events site holds no IMTJ event page after 2020. A single third-party listing for a September 2022 Madrid summit exists and could not be verified from any source belonging to the organiser, so it is not carried as a fact here.", "today": "As of 17 September 2026 no next edition is announced anywhere this project could read, and the two domains that used to announce one are gone or redirected. The field's own annual meeting stopping is a fact about the field worth carrying, which is why this record exists at all.", "notes": "The year on this record is 2007, the year the publication was established. It is not the year of the first summit, which is not sourced here." }, "kin": [ { "to": "imtj", "as": "The publication that runs the summit and the awards.", "rel": "org" }, { "to": "keith-pollard", "as": "Its editor, and the chair of the awards panel.", "rel": "person" }, { "to": "medical-tourism-association", "as": "The other house that convenes this industry, with its own conference and its own index.", "rel": "contrast" }, { "to": "the-accreditation-question", "as": "Where a trade award and an inspection are told apart.", "rel": "story" }, { "to": "facilitator", "as": "The trade this meeting is largely for.", "rel": "term" }, { "to": "counting-patients", "as": "Where many of the field's circulating numbers are first said out loud.", "rel": "story" } ], "links": [ { "label": "IMTJ", "url": "https://www.imtj.com/" } ], "sources": [ "s:imtj-wikipedia", "s:imtj-summit-2019-archive", "s:imtj-summit-2021-archive", "s:imtj-awards-2024-archive", "s:globalhtc-imtj-awards" ], "provenance": { "default": { "tier": "cited", "source": "s:imtj-summit-2019-archive" }, "fields": { "text.story": { "tier": "cited", "source": "s:imtj-wikipedia", "note": "the second paragraph's reading of what a trade award evidences is marked as this project's inference" }, "text.today": { "tier": "inference", "note": "the security challenge on imtj.com was observed from this machine on 2026-09-17" } } }, "needs_verification": false, "confidence": "medium", "updated": "2026-09-17", "blurb": "The trade's own annual gathering, run by the publisher of the International Medical Travel Journal alongside an awards ceremony.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "imtj", "type": "org", "name": "International Medical Travel Journal", "as": "The publication that runs the summit and the awards.", "rel": "org" }, { "to": "keith-pollard", "type": "person", "name": "Keith Pollard", "as": "Its editor, and the chair of the awards panel.", "rel": "person" }, { "to": "medical-tourism-association", "type": "org", "name": "Medical Tourism Association", "as": "The other house that convenes this industry, with its own conference and its own index.", "rel": "contrast" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "Where a trade award and an inspection are told apart.", "rel": "story" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The trade this meeting is largely for.", "rel": "term" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Where many of the field's circulating numbers are first said out loud.", "rel": "story" } ], "source_list": [ { "id": "s:imtj-wikipedia", "kind": "wikipedia", "title": "International Medical Travel Journal", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/International_Medical_Travel_Journal", "accessed": "2026-09-16", "note": "established 2007, UK trade publication, biweekly newsletter, Keith Pollard as editor in chief, annual Medical Travel Awards; imtj.com refused every fetch on this date" }, { "id": "s:imtj-summit-2019-archive", "kind": "web", "title": "IMTJ Medical Travel Summit 2019, Berlin (Internet Archive snapshot, 23 August 2019)", "publisher": "IMTJ", "year": 2019, "url": "https://web.archive.org/web/20190823071607/https://summit.imtj.com/", "accessed": "2026-09-17" }, { "id": "s:imtj-summit-2021-archive", "kind": "web", "title": "IMTJ Medical Travel Summit — postponement notice (Internet Archive snapshot, 16 March 2021)", "publisher": "IMTJ / LaingBuisson", "year": 2021, "url": "https://web.archive.org/web/20210316102011/https://summit.imtj.com/", "accessed": "2026-09-17" }, { "id": "s:imtj-awards-2024-archive", "kind": "web", "title": "The IMTJ Medical Travel Awards (Internet Archive snapshot, 17 September 2024) — carries the 2022 cancellation notice", "publisher": "LaingBuisson", "url": "https://web.archive.org/web/20240917050124/https://awards.imtj.com/", "accessed": "2026-09-17", "note": "awards.imtj.com no longer resolves; this snapshot is the last published state" }, { "id": "s:globalhtc-imtj-awards", "kind": "org", "title": "IMTJ Medical Travel Awards — the 2014 inaugural announcement", "publisher": "Global Healthcare Travel Council", "year": 2014, "url": "https://globalhtc.org/imtj-medical-travel-awards/", "accessed": "2026-09-17" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:imtj-summit-2019-archive" }, "text.story": { "tier": "cited", "source": "s:imtj-wikipedia", "note": "the second paragraph's reading of what a trade award evidences is marked as this project's inference" }, "text.today": { "tier": "inference", "note": "the security challenge on imtj.com was observed from this machine on 2026-09-17" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "imtj", "type": "org", "name": "International Medical Travel Journal", "as": "The annual conference it runs, and part of how it is paid.", "rel": "event" }, { "from": "keith-pollard", "type": "person", "name": "Keith Pollard", "as": "The meeting and the awards his publication ran, with him in the chair of the panel.", "rel": "event" } ] }, { "schema": 1, "id": "istanbul-declaration-2008", "type": "event", "names": { "name": "The Declaration of Istanbul, 2008", "aliases": [ "Declaration of Istanbul on Organ Trafficking and Transplant Tourism" ], "said": "Transplant surgeons say Istanbul and mean the document, not the city. It is the one place in this subject where a profession wrote down which journeys it would refuse to be part of." }, "region": [ "global", "west-asia" ], "facets": { "kind": "turning-point", "when": 2008, "iso2": "TR", "status": "in-force" }, "text": { "what": "A consensus statement agreed at an international summit in Istanbul in 2008, convened by The Transplantation Society and the International Society of Nephrology, which defined organ trafficking, transplant commercialism and transplant tourism and called for the first two to be prohibited. It is the reason those three phrases have fixed meanings, and the reason one kind of cross-border medical travel is treated by the profession as categorically different from the rest.", "story": "The summit ran in Istanbul from 30 April 2008. \"None of the 152 participants from 78 countries was polled with respect to his or her opinion, practice, or philosophy before selection. The declaration was agreed by consensus among the summit's participants.\" The Lancet Comment announcing it dates the meeting 30 April to 1 May; the Declaration's own preamble runs it to 2 May.\n\nThe definitions are the working part. \"Transplant commercialism is a policy or practice in which an organ is treated as a commodity, including by being bought or sold or used for material gain.\" And the one that draws the line through this whole directory: \"Travel for transplantation is the movement of organs, donors, recipients, or transplant professionals across jurisdictional borders for transplantation purposes. Travel for transplantation becomes transplant tourism if it involves organ trafficking and/or transplant commercialism or if the resources (organs, professionals, and transplant centres) devoted to providing transplants to patients from outside a country undermine the country's ability to provide transplant services for its own population.\"\n\nRead that carefully. Crossing a border for a transplant is not condemned. What is condemned is buying an organ, and drawing down a poorer country's transplant capacity to serve visitors. The declaration then demanded prohibitions extending to \"all types of advertising (electronic and print), soliciting, or brokering for the purpose of transplant commercialism\".\n\nThe scale claim in the same Comment shows what the field had to work with. \"WHO has estimated that about 10% of organ transplants around the world involve these unacceptable activities\" — attributed in the text to a personal communication from a named WHO officer, not to a published series. Beside it sits a harder figure: \"by 2006, two-thirds of the 2000 kidney transplants in Pakistan were for foreign recipients\".\n\nA revised edition was presented in Madrid on 1 July 2018, after a consultation earlier that year. It drops transplant commercialism as a separate defined term, takes its trafficking definitions from the Council of Europe convention and the United Nations protocol, and rewrites the tourism clause around non-resident patients: \"Travel for transplantation becomes transplant tourism, and thus unethical, if it involves trafficking in persons for the purpose of organ removal or trafficking in human organs, or if the resources (organs, professionals and transplant centres) devoted to providing transplants to non-resident patients undermine the country's ability to provide transplant services for its own population.\"", "today": "The Declaration of Istanbul Custodian Group, formed by the two founding societies in 2010, maintains the text and the endorsement list. Its endorsements page states \"the complete list of 173 endorsing organizations\", while another page on the same site still says more than 135 — a discrepancy this record reports rather than resolves.", "notes": "This is a professional declaration, not law. It binds nobody by itself; its force comes from the societies, journals and ministries that adopted it, and from the national statutes written afterwards." }, "geo": { "lat": 41.0082, "lon": 28.9784, "precision": "city", "source": "s:doi-2008-lancet" }, "address": { "city": "Istanbul", "country": "TR" }, "kin": [ { "to": "declaration-of-istanbul-group", "as": "The custodians, who keep the text and the endorsement list.", "rel": "org" }, { "to": "transplant-prohibition", "as": "The rules countries wrote afterwards, jurisdiction by jurisdiction.", "rel": "rule" }, { "to": "kidney-transplant", "as": "The operation the declaration was written about.", "rel": "procedure" }, { "to": "liver-transplant", "as": "The other organ trade the declaration covers.", "rel": "procedure" }, { "to": "transplant-harm", "as": "What happens to the seller, which is the half of this trade that leaves no patient record.", "rel": "risk" }, { "to": "who", "as": "Whose guiding principles on transplantation the declaration sits beside, and whose 10% estimate it cited from a personal communication.", "rel": "org" }, { "to": "istanbul", "as": "The city that gave the document its name, and a hub in this directory for entirely different reasons.", "rel": "hub" }, { "to": "medical-tourism", "as": "The contested word — here attached, by a profession, to a specific practice it wanted stopped.", "rel": "term" } ], "links": [ { "label": "Declaration of Istanbul (Lancet Comment, 2008)", "url": "https://www.declarationofistanbul.org/images/Policy_Documents/Declaration%20of%20Istanbul_2008.pdf" }, { "label": "The Declaration — 2018 edition", "url": "https://www.declarationofistanbul.org/the-declaration" }, { "label": "Endorsements", "url": "https://www.declarationofistanbul.org/endorsements" } ], "sources": [ "s:doi-2008-lancet", "s:doi-2018-edition", "s:doi-endorsements", "s:declaration-of-istanbul", "s:dicg-about" ], "provenance": { "default": { "tier": "cited", "source": "s:doi-2008-lancet" }, "fields": { "text.story": { "tier": "cited", "source": "s:doi-2008-lancet", "note": "every quoted passage was read in the 2008 Lancet Comment, except the 2018 definition, which is from the custodian group's own page" }, "text.today": { "tier": "cited", "source": "s:doi-endorsements" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "A consensus statement agreed at an international summit in Istanbul in 2008, convened by The Transplantation Society and the International Society of Nephrology, which defined organ trafficking, transplant commercialism…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" } ], "kin_out": [ { "to": "declaration-of-istanbul-group", "type": "org", "name": "Declaration of Istanbul Custodian Group", "as": "The custodians, who keep the text and the endorsement list.", "rel": "org" }, { "to": "transplant-prohibition", "type": "rule", "name": "Buying an organ, and being transplanted abroad", "as": "The rules countries wrote afterwards, jurisdiction by jurisdiction.", "rel": "rule" }, { "to": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "The operation the declaration was written about.", "rel": "procedure" }, { "to": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "The other organ trade the declaration covers.", "rel": "procedure" }, { "to": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "What happens to the seller, which is the half of this trade that leaves no patient record.", "rel": "risk" }, { "to": "who", "type": "org", "name": "World Health Organization", "as": "Whose guiding principles on transplantation the declaration sits beside, and whose 10% estimate it cited from a personal communication.", "rel": "org" }, { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "The city that gave the document its name, and a hub in this directory for entirely different reasons.", "rel": "hub" }, { "to": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The contested word — here attached, by a profession, to a specific practice it wanted stopped.", "rel": "term" } ], "source_list": [ { "id": "s:doi-2008-lancet", "kind": "journal", "title": "Organ trafficking and transplant tourism and commercialism: the Declaration of Istanbul", "publisher": "The Lancet 2008;372(9632):5-6 (Comment), doi:10.1016/S0140-6736(08)60967-8", "url": "https://www.declarationofistanbul.org/images/Policy_Documents/Declaration%20of%20Istanbul_2008.pdf", "accessed": "2026-09-17", "note": "read in full from the custodian group's PDF: the summit ran in Istanbul 'from April 30 to May 1, 2008', convened by The Transplantation Society and the International Society of Nephrology; 152 participants from 78 countries; the panel carries the 2008 definitions of organ trafficking, transplant commercialism and travel for transplantation/transplant tourism; also the WHO 10% estimate attributed to a personal communication, and two-thirds of Pakistan's 2,000 kidney transplants going to foreign recipients by 2006" }, { "id": "s:doi-2018-edition", "kind": "org", "title": "The Declaration — 2018 edition", "publisher": "Declaration of Istanbul Custodian Group", "url": "https://www.declarationofistanbul.org/the-declaration", "accessed": "2026-09-17", "note": "the 2018 edition was presented in Madrid on 1 July 2018 during the TTS congress, after a public consultation; carries the revised transplant tourism definition built on non-resident patients" }, { "id": "s:doi-endorsements", "kind": "org", "title": "Endorsements", "publisher": "Declaration of Istanbul Custodian Group", "url": "https://www.declarationofistanbul.org/endorsements", "accessed": "2026-09-17", "note": "'Click to view the complete list of 173 endorsing organizations'; other pages on the same site still say more than 135 and more than 80" }, { "id": "s:declaration-of-istanbul", "kind": "org", "title": "The Declaration of Istanbul on Organ Trafficking and Transplant Tourism (2018 edition)", "publisher": "Declaration of Istanbul Custodian Group", "url": "https://www.declarationofistanbul.org/", "accessed": "2026-09-16" }, { "id": "s:dicg-about", "kind": "org", "title": "Declaration of Istanbul Custodian Group", "publisher": "Declaration of Istanbul Custodian Group", "url": "https://www.declarationofistanbul.org/", "accessed": "2026-09-16", "note": "Custodian Group formed 2010, sponsored by The Transplantation Society and the International Society of Nephrology, endorsed by more than 80 professional organisations, 2018 edition of the Declaration" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:doi-2008-lancet" }, "text.story": { "tier": "cited", "source": "s:doi-2008-lancet", "note": "every quoted passage was read in the 2008 Lancet Comment, except the 2018 definition, which is from the custodian group's own page" }, "text.today": { "tier": "cited", "source": "s:doi-endorsements" }, "geo": { "tier": "cited", "source": "s:doi-2008-lancet" }, "address": { "tier": "cited", "source": "s:doi-2008-lancet" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "china", "type": "destination", "name": "China", "as": "The declaration written partly with this country's transplant practice in view.", "rel": "event" }, { "from": "kidney-transplant", "type": "procedure", "name": "Kidney transplant", "as": "The Istanbul summit of April 2008, where the definitions on this page were agreed.", "rel": "event" }, { "from": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "The April 2008 summit where the definitions on this page were agreed.", "rel": "event" }, { "from": "transplant-harm", "type": "risk", "name": "Transplant harm", "as": "The year the field drew the line it still uses.", "rel": "event" }, { "from": "transplant-prohibition", "type": "rule", "name": "Buying an organ, and being transplanted abroad", "as": "The year the norm was written down.", "rel": "event" }, { "from": "declaration-of-istanbul-group", "type": "org", "name": "Declaration of Istanbul Custodian Group", "as": "The summit and text this group was formed to keep.", "rel": "event" } ] }, { "schema": 1, "id": "mexico-fungal-meningitis-2023", "type": "event", "names": { "name": "The Matamoros fungal meningitis outbreak, 2023", "aliases": [ "Fusarium solani meningitis outbreak", "Matamoros epidural outbreak" ], "said": "In the clinics it was an epidural for a cosmetic operation. In the case notes it is fungal meningitis after epidural anaesthesia, and the fungus is one nobody expected to find in a spine." }, "region": [ "mexico", "north-america" ], "facets": { "kind": "outbreak", "when": 2023, "iso2": "MX", "status": "one-off" }, "text": { "what": "An outbreak of fungal meningitis among people — almost all of them residents of the United States — who had procedures under epidural anaesthesia at two clinics in Matamoros, Tamaulipas, in the first five months of 2023. Both clinics, River Side Surgical Center and Clinica K-3, were closed on 13 May 2023. By 31 August 2023 the CDC's tally stood at 10 confirmed cases, 14 probable, nine suspected, 151 persons under investigation, and 12 deaths.", "story": "The exposure was defined by a date range and a room, not by an operation: \"Anyone who had procedures under epidural anaesthesia in these clinics from January 1 to May 13, 2023, is at risk for fungal meningitis.\" Most of the operations were cosmetic. The route of infection ran through the anaesthesia rather than the surgery, which is why patients who had entirely different procedures shared the same exposure.\n\nThree United States laboratories and the Mexican national laboratory detected fungal signals consistent with the Fusarium solani species complex in patients' cerebrospinal fluid, and a highly resistant strain of Fusarium solani was isolated from one patient. Fusarium is a mould of soil and water; meningitis caused by it is rare, hard to treat and treated with drugs that many strains resist.\n\nThe tracing shows what a cross-border outbreak costs in time. The Mexican Ministry of Health gave the CDC a list of United States residents who had procedures at the two clinics in the exposure window, and the CDC recorded the list's limits plainly: \"Some of the listed contact information is incorrect or incomplete and some at-risk persons have been identified who were not on the list.\" Health departments in several states then worked the list by telephone to reach people who felt well and tell them to have a lumbar puncture.\n\n*Inference —* the counts are counts of people found, and there is no denominator. Nobody published how many patients were anaesthetised in those two clinics in those nineteen weeks, so no rate can be computed from twelve deaths, and this record does not compute one. What the numbers do support is the ratio inside them: on 31 August 2023 the persons under investigation outnumbered the confirmed cases fifteen to one.", "today": "The CDC page is archived and was last updated on 27 October 2023. Both clinics remained closed from 13 May 2023; this record carries no later Mexican regulatory finding, because none was read for it." }, "geo": { "lat": 25.8797, "lon": -97.5042, "precision": "city", "source": "s:cdc-meningitis-matamoros" }, "address": { "city": "Matamoros", "area": "Tamaulipas", "country": "MX" }, "kin": [ { "to": "mexico", "as": "The country page where this outbreak sits alongside the border dental trade and the Tijuana bariatric trade.", "rel": "destination" }, { "to": "fungal-meningitis", "as": "The risk record: what it is, how it is found, and who treats it.", "rel": "risk" }, { "to": "dominican-republic-ntm-outbreak", "as": "The other multi-state outbreak traced to clinics abroad, five years earlier and bacterial rather than fungal.", "rel": "event" }, { "to": "anaesthetic-risk-unscreened", "as": "The exposure here was the anaesthesia, not the operation.", "rel": "risk" }, { "to": "follow-up-gap", "as": "Patients were traced by telephone from a list, weeks after they had flown home.", "rel": "risk" }, { "to": "revision-at-home", "as": "Every counted case was managed by a hospital in the patient's own country.", "rel": "risk" }, { "to": "counting-patients", "as": "Twelve deaths with no denominator is the shape of almost every number in this field.", "rel": "story" } ], "links": [ { "label": "CDC — fungal meningitis outbreak associated with procedures under epidural anesthesia in Matamoros", "url": "https://archive.cdc.gov/www_cdc_gov/hai/outbreaks/meningitis-epidural-anesthesia.html" } ], "sources": [ "s:cdc-meningitis-matamoros", "s:cdc-yellowbook-medical-tourism" ], "provenance": { "default": { "tier": "cited", "source": "s:cdc-meningitis-matamoros" }, "fields": { "text.story": { "tier": "cited", "source": "s:cdc-meningitis-matamoros", "note": "every quoted sentence was read on the archived CDC page; the closing paragraph is marked inference" }, "geo": { "tier": "inference", "note": "the city of Matamoros, not either clinic's address, which the CDC page does not give" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "An outbreak of fungal meningitis among people — almost all of them residents of the United States — who had procedures under epidural anaesthesia at two clinics in Matamoros, Tamaulipas, in the first five months of…", "region_terms": [ { "key": "mexico", "name": "Mexico", "note": "its own entry because the border towns are a category of their own" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "mexico", "type": "destination", "name": "Mexico", "as": "The country page where this outbreak sits alongside the border dental trade and the Tijuana bariatric trade.", "rel": "destination" }, { "to": "fungal-meningitis", "type": "risk", "name": "Fungal meningitis after epidural anaesthesia", "as": "The risk record: what it is, how it is found, and who treats it.", "rel": "risk" }, { "to": "dominican-republic-ntm-outbreak", "type": "event", "name": "The Dominican mycobacterial outbreaks, 2013–14 and 2017", "as": "The other multi-state outbreak traced to clinics abroad, five years earlier and bacterial rather than fungal.", "rel": "event" }, { "to": "anaesthetic-risk-unscreened", "type": "risk", "name": "Fitness for anaesthesia, assessed on arrival", "as": "The exposure here was the anaesthesia, not the operation.", "rel": "risk" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "Patients were traced by telephone from a list, weeks after they had flown home.", "rel": "risk" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "Every counted case was managed by a hospital in the patient's own country.", "rel": "risk" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Twelve deaths with no denominator is the shape of almost every number in this field.", "rel": "story" } ], "source_list": [ { "id": "s:cdc-meningitis-matamoros", "kind": "web", "title": "Fungal Meningitis Outbreak Associated with Procedures Performed under Epidural Anesthesia in Matamoros, Mexico", "publisher": "US Centers for Disease Control and Prevention (archived page, last updated 27 October 2023)", "url": "https://archive.cdc.gov/www_cdc_gov/hai/outbreaks/meningitis-epidural-anesthesia.html", "accessed": "2026-09-16" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:cdc-meningitis-matamoros" }, "text.story": { "tier": "cited", "source": "s:cdc-meningitis-matamoros", "note": "every quoted sentence was read on the archived CDC page; the closing paragraph is marked inference" }, "text.today": { "tier": "cited", "source": "s:cdc-meningitis-matamoros" }, "geo": { "tier": "inference", "note": "the city of Matamoros, not either clinic's address, which the CDC page does not give" }, "address": { "tier": "cited", "source": "s:cdc-meningitis-matamoros" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "mexico", "type": "destination", "name": "Mexico", "as": "The Matamoros outbreak, in its own record.", "rel": "event" }, { "from": "when-it-goes-wrong", "type": "pathway", "name": "When it goes wrong", "as": "An outbreak that made a scatter of cases countable.", "rel": "event" }, { "from": "fungal-meningitis", "type": "risk", "name": "Fungal meningitis after epidural anaesthesia", "as": "The outbreak itself, with its dates and its two addresses.", "rel": "event" }, { "from": "dominican-republic-ntm-outbreak", "type": "event", "name": "The Dominican mycobacterial outbreaks, 2013–14 and 2017", "as": "The later outbreak traced to clinics abroad, fungal rather than bacterial, and found the same way.", "rel": "event" } ] }, { "schema": 1, "id": "ndm-1-2010", "type": "event", "names": { "name": "NDM-1, 2010", "aliases": [ "New Delhi metallo-beta-lactamase-1", "the Lancet Infectious Diseases NDM-1 paper" ], "said": "Microbiologists say NDM-1 and mean a gene. India's health ministry heard a city named in it, and the argument that followed was about both at once." }, "region": [ "global", "south-asia", "europe-west" ], "facets": { "kind": "turning-point", "when": 2010, "status": "one-off" }, "text": { "what": "A study published online in August 2010 in The Lancet Infectious Diseases describing the spread of NDM-1 — New Delhi metallo-beta-lactamase-1, an enzyme that destroys carbapenems, the antibiotics kept for infections nothing else will treat — across India, Pakistan and the United Kingdom, and linking several British cases to hospital treatment taken while travelling. It is the moment antimicrobial resistance entered this subject, and the moment the subject acquired a naming dispute.", "story": "The counts are narrow and stated: \"We identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other sites in India and Pakistan.\" On the travel link: \"At least 17 patients had a history of travelling to India or Pakistan within 1 year, and 14 of them had been admitted to a hospital in these countries.\" The admissions were for many things — \"renal or bone marrow transplantation, dialysis, cerebral infarction, chronic obstructive pulmonary disease, pregnancy, burns, road traffic accidents, and cosmetic surgery\" — and the authors noted that \"several of the UK source patients had undergone elective, including cosmetic, surgery while visiting India or Pakistan\".\n\nThe paper did not stop at description. \"It is disturbing, in context, to read calls in the popular press for UK patients to opt for corrective surgery in India with the aim of saving the NHS money.\" That sentence, in a laboratory paper about a plasmid, is what made this an event in the history of medical travel rather than in the history of microbiology.\n\nThe objection came within days. India's health ministry said it would \"strongly refute the naming of the enzyme … and also refute that hospitals in India are not safe for treatment including medical tourism\", and that \"to link this with the safety of surgery in hospitals in India and citing isolated examples to show that … India is not a safe place to visit, is wrong\". V M Katoch, director general of the Indian Council of Medical Research, said: \"When you link it to our antibiotics policy … say it is dangerous to get operated on in India and that you will get more infections, that is totally irrational.\" Members of parliament called the study a commercial attack on India's hospital export trade. The funding line — \"Our work was funded by EU grant LSHM-CT-2005-018705 and Wellcome Trust grant 084627/Z/08\", with pharmaceutical interests declared by two authors — was cited as evidence of motive.\n\nIn Delhi in January 2011 the editor of The Lancet, Richard Horton, said of the name: \"It was an error of judgement. We didn't think of its implications for which I sincerely apologise\", adding that it had unnecessarily stigmatised a single country and city. He did not withdraw the science. Indian authors later argued in print for a descriptive name instead, on the ground that organisms and genes should not be named after cities, countries or races.\n\n*Inference —* the two claims never actually met. That a mobile carbapenemase was widespread in South Asia and reached Britain in patients who had been in hospital there is a laboratory finding, tested by other laboratories since. That naming it after a capital city was a choice with consequences for a country's hospitals is a claim about scientific practice. Both can hold. This record reports both and settles neither." }, "kin": [ { "to": "antimicrobial-resistance", "as": "The risk this paper put at the centre of the subject.", "rel": "risk" }, { "to": "india", "as": "The country named in the gene and in the argument that followed.", "rel": "destination" }, { "to": "united-kingdom", "as": "Where the 37 UK isolates were found, and where the travel histories were taken.", "rel": "destination" }, { "to": "surgical-site-infection", "as": "The route most of these organisms take into a patient.", "rel": "risk" }, { "to": "medical-tourism", "as": "The word the ministry used in its reply, and the fight over it in miniature.", "rel": "term" }, { "to": "dialysis-holiday", "as": "One of the treatments named among the admissions in the paper.", "rel": "procedure" }, { "to": "counting-patients", "as": "Seventeen travel histories carried a global argument for a decade.", "rel": "story" } ], "links": [ { "label": "Kumarasamy et al., Lancet Infect Dis 2010 (full text)", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2933358/" }, { "label": "India rejects superbug claims (Al Jazeera, 13 August 2010)", "url": "https://www.aljazeera.com/news/2010/8/13/india-rejects-superbug-claims" }, { "label": "Lancet editor on the naming (AFP, January 2011)", "url": "https://medicalxpress.com/news/2011-01-delhi-superbug-unfairly-editor.html" } ], "sources": [ "s:kumarasamy-ndm1-2010", "s:kumarasamy-ndm1-pmc", "s:aljazeera-ndm1-india-2010", "s:afp-horton-ndm1-2011", "s:mohapatra-ndm1-2013" ], "provenance": { "default": { "tier": "cited", "source": "s:kumarasamy-ndm1-pmc" }, "fields": { "text.story": { "tier": "cited", "source": "s:kumarasamy-ndm1-pmc", "note": "the study's figures and sentences are from the paper's full text; the ministry and ICMR quotations from the Al Jazeera report; the editor's words from the AFP report; the closing paragraph is marked inference" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "A study published online in August 2010 in The Lancet Infectious Diseases describing the spread of NDM-1 — New Delhi metallo-beta-lactamase-1, an enzyme that destroys carbapenems, the antibiotics kept for infections…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "south-asia", "name": "South Asia", "note": "India, Pakistan, Bangladesh, Sri Lanka, Nepal" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "antimicrobial-resistance", "type": "risk", "name": "Antimicrobial resistance acquired abroad", "as": "The risk this paper put at the centre of the subject.", "rel": "risk" }, { "to": "india", "type": "destination", "name": "India", "as": "The country named in the gene and in the argument that followed.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Where the 37 UK isolates were found, and where the travel histories were taken.", "rel": "destination" }, { "to": "surgical-site-infection", "type": "risk", "name": "Surgical site infection", "as": "The route most of these organisms take into a patient.", "rel": "risk" }, { "to": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The word the ministry used in its reply, and the fight over it in miniature.", "rel": "term" }, { "to": "dialysis-holiday", "type": "procedure", "name": "Dialysis away from home", "as": "One of the treatments named among the admissions in the paper.", "rel": "procedure" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Seventeen travel histories carried a global argument for a decade.", "rel": "story" } ], "source_list": [ { "id": "s:kumarasamy-ndm1-2010", "kind": "paper", "title": "Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study", "publisher": "The Lancet Infectious Diseases 2010;10(9):597-602 (Kumarasamy KK, Toleman MA, Walsh TR, et al.)", "url": "https://pubmed.ncbi.nlm.nih.gov/20705517/", "accessed": "2026-09-16" }, { "id": "s:kumarasamy-ndm1-pmc", "kind": "paper", "title": "Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study — full text", "publisher": "Lancet Infectious Diseases 2010;10(9):597-602, via PubMed Central PMC2933358", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2933358/", "accessed": "2026-09-17", "note": "read for the isolate counts (44 Chennai, 26 Haryana, 37 UK, 73 other sites), the 17 travel histories and 14 hospital admissions, the list of reasons for admission, the sentence on elective and cosmetic surgery, the interpretation sentence on calls in the popular press, and the funding statement" }, { "id": "s:aljazeera-ndm1-india-2010", "kind": "article", "title": "India rejects superbug claims", "publisher": "Al Jazeera, 13 August 2010", "url": "https://www.aljazeera.com/news/2010/8/13/india-rejects-superbug-claims", "accessed": "2026-09-17", "note": "carries the Indian health ministry statement refuting the naming of the enzyme and the safety claim, and V M Katoch of the Indian Council of Medical Research" }, { "id": "s:afp-horton-ndm1-2011", "kind": "article", "title": "'New Delhi' superbug unfairly named, admits editor", "publisher": "Agence France-Presse, via Medical Xpress, January 2011", "url": "https://medicalxpress.com/news/2011-01-delhi-superbug-unfairly-editor.html", "accessed": "2026-09-17", "note": "Richard Horton in Delhi: 'It was an error of judgement. We didn't think of its implications for which I sincerely apologise'; he said the name had unnecessarily stigmatised a single country and city, while standing by the study" }, { "id": "s:mohapatra-ndm1-2013", "kind": "journal", "title": "Metallo-beta-lactamase 1 — why blame New Delhi & India?", "publisher": "Indian Journal of Medical Research 2013;137(1):213-215 (Mohapatra PR)", "url": "https://ijmr.org.in/metallo-lactamase-1-why-blame-new-delhi-india/", "accessed": "2026-09-17", "note": "'It is strongly felt that the organisms should not be named after cities, countries and races. The nomenclature should be based on their scientific characteristics.'" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:kumarasamy-ndm1-pmc" }, "text.story": { "tier": "cited", "source": "s:kumarasamy-ndm1-pmc", "note": "the study's figures and sentences are from the paper's full text; the ministry and ICMR quotations from the Al Jazeera report; the editor's words from the AFP report; the closing paragraph is marked inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "india", "type": "destination", "name": "India", "as": "The 2010 resistance-gene naming row, argued over this country's name and over surgery abroad.", "rel": "event" }, { "from": "antimicrobial-resistance", "type": "risk", "name": "Antimicrobial resistance acquired abroad", "as": "The paper that put hospital travel and resistance in the same sentence, and the argument that followed it.", "rel": "event" } ] }, { "schema": 1, "id": "turkiye-hair-boom", "type": "event", "names": { "name": "Türkiye's hair transplant boom", "aliases": [ "Istanbul hair clinics", "saç ekimi turizmi" ], "said": "Istanbul calls it saç ekimi. The trade sells it as a package with a hotel and a driver, and the bandaged forehead on the airport bus is the one visible sign of medical travel anywhere in the world." }, "region": [ "west-asia", "europe-south" ], "facets": { "kind": "turning-point", "when": 2022, "iso2": "TR", "status": "open" }, "text": { "what": "The growth of hair restoration surgery sold to foreign buyers in Türkiye, mostly in Istanbul, into the most visible single procedure in cross-border care. The event is dated here at 2022, the year the country's official health-travel count first passed 1.38 million, against 756,926 in 2019. No official series counts hair transplants separately, and this record carries no procedure-level total.", "story": "The numbers that exist are these. USHAŞ, the Ministry of Health's international health services company, publishes a health-tourism series taken from Turkish Statistical Institute figures: 756,926 in 2019, 435,691 in 2020, 729,592 in 2021, 1,381,807 in 2022, 1,538,643 in 2023, 1,506,442 in 2024 and 1,398,580 in 2025, with revenue rising from USD 1.46 billion in 2019 to about USD 3.0 billion from 2023 onwards. The underlying count comes from a survey of departing visitors' stated purpose of visit — a border survey, not a patient register — so it counts nobody's operation and nobody's clinic.\n\n*Inference —* every per-procedure figure in circulation for this trade is an estimate somebody sold. This record carries none of them, and the absence is the finding: a sector large enough to have its own regulation has no published count of its own operations.\n\nWhat there is instead is the regulation, and it is unusually specific. The Saç Ekimi Birimleri Hakkında Yönetmelik of 6 May 2023 reserves the channel-opening stage of the operation to physicians holding the applicator certificate, forbids more than one patient in a room at a time, and caps a certified physician at five rooms. Rules are written against practices; a rule about how many patients may be in a room at once describes a room with several in it.\n\nThe professional objection ran ahead of the regulation and is worldwide rather than Turkish. The International Society of Hair Restoration Surgery's consumer alert, first issued in January 2017 and still carried in 2026, says that \"increasing numbers of unlicensed personnel worldwide are performing substantial medical aspects of hair restoration surgery and, in doing so, are putting patients at risk\", and that \"when doctors advertise their credentials and then delegate the surgery to unlicensed personnel, patients are being misled and placed at risk\". The page names no country and gives no figures, and this record does not supply either on its behalf." }, "geo": { "lat": 41.0082, "lon": 28.9784, "precision": "city", "source": "s:ushas-saglik-turizmi-verileri" }, "address": { "city": "Istanbul", "country": "TR" }, "kin": [ { "to": "turkiye", "as": "The country page, where the official series and the licensing regime are set out.", "rel": "destination" }, { "to": "istanbul", "as": "Where most of the clinics are, and where the packages start at the airport.", "rel": "hub" }, { "to": "hair-transplant-fue", "as": "The operation being sold, and the stage of it the 2023 regulation reserves to a physician.", "rel": "procedure" }, { "to": "dhi-hair-transplant", "as": "The branded variant the clinics price above it.", "rel": "procedure" }, { "to": "turkiye-health-tourism-authorisation", "as": "The certificate a facility or intermediary must hold to sell any of this lawfully.", "rel": "rule" }, { "to": "ishrs", "as": "The professional society whose alert about unlicensed operators predates the regulation by six years.", "rel": "org" }, { "to": "covid-shutdown-2020", "as": "The collapse this recovery followed, and doubled.", "rel": "event" }, { "to": "counting-patients", "as": "A sector with its own regulation and no published count of its own operations.", "rel": "story" } ], "links": [ { "label": "USHAŞ — health tourism data", "url": "https://www.ushas.gov.tr/en/saglik-turizmi-verileri/" }, { "label": "Saç Ekimi Birimleri Hakkında Yönetmelik (Resmî Gazete, 6 May 2023, No. 32182)", "url": "https://www.resmigazete.gov.tr/eskiler/2023/05/20230506-11.htm" }, { "label": "ISHRS consumer alert", "url": "https://ishrs.org/consumer-alert/" } ], "sources": [ "s:ushas-saglik-turizmi-verileri", "s:tuik-turizm-2025", "s:rg-32182-2023-sac-ekimi", "s:ishrs-consumer-alert", "s:haider-2025-hair-transplant-tourism" ], "provenance": { "default": { "tier": "cited", "source": "s:ushas-saglik-turizmi-verileri" }, "fields": { "text.story": { "tier": "cited", "source": "s:ushas-saglik-turizmi-verileri", "note": "the series was read on the USHAŞ page on 2026-09-17 and the ISHRS wording on its own alert; the 2023 hair-transplant regulation is cited to the Resmî Gazete entry; the second paragraph is marked inference" }, "facets.when": { "tier": "inference", "note": "2022 is the first year the official series passes 1.38 million; no procedure-level series exists to date the boom more precisely" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-17", "blurb": "The growth of hair restoration surgery sold to foreign buyers in Türkiye, mostly in Istanbul, into the most visible single procedure in cross-border care.", "region_terms": [ { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" }, { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" } ], "kin_out": [ { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The country page, where the official series and the licensing regime are set out.", "rel": "destination" }, { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "Where most of the clinics are, and where the packages start at the airport.", "rel": "hub" }, { "to": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The operation being sold, and the stage of it the 2023 regulation reserves to a physician.", "rel": "procedure" }, { "to": "dhi-hair-transplant", "type": "procedure", "name": "Direct hair implantation (DHI)", "as": "The branded variant the clinics price above it.", "rel": "procedure" }, { "to": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The certificate a facility or intermediary must hold to sell any of this lawfully.", "rel": "rule" }, { "to": "ishrs", "type": "org", "name": "International Society of Hair Restoration Surgery", "as": "The professional society whose alert about unlicensed operators predates the regulation by six years.", "rel": "org" }, { "to": "covid-shutdown-2020", "type": "event", "name": "The 2020 shutdown", "as": "The collapse this recovery followed, and doubled.", "rel": "event" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "A sector with its own regulation and no published count of its own operations.", "rel": "story" } ], "source_list": [ { "id": "s:ushas-saglik-turizmi-verileri", "kind": "gov", "title": "Sağlık Turizmi Verileri (health tourism data by year)", "publisher": "USHAŞ — Uluslararası Sağlık Hizmetleri A.Ş., the Turkish Ministry of Health's international health services company", "url": "https://ushas.gov.tr/saglik-turizmi-verileri/", "accessed": "2026-09-16", "note": "USHAŞ publishes the series it attributes to TÜİK, the Turkish statistical institute: visitors and revenue by year — 2019 756,926 and USD 1.459bn; 2020 435,691; 2021 729,592; 2022 1,381,807; 2023 1,538,643; 2024 1,506,442; 2025 1,398,580 and USD 3,022,452 thousand; first half of 2026 563,327 and USD 1.580bn. The unit is a visitor arriving with a health purpose, not an operation." }, { "id": "s:tuik-turizm-2025", "kind": "dataset", "title": "Turizm İstatistikleri, IV. Çeyrek: Ekim-Aralık ve Yıllık, 2025 (Sayı 54158) — table: Departing Visitors by Purpose of Visit, 2012–2026", "publisher": "Türkiye İstatistik Kurumu (TurkStat)", "year": 2026, "url": "https://veriportali.tuik.gov.tr/Bulten/Index?p=Turizm-Istatistikleri-IV.-Ceyrek:-Ekim-Aralik-ve-Yillik,-2025-54158", "accessed": "2026-09-17", "note": "the health figure appears only in the attached statistical table, not in the bulletin text; its own footer names the source as the TurkStat Departing Visitors Survey — a border exit survey of stated purpose, not a count of patients treated" }, { "id": "s:rg-32182-2023-sac-ekimi", "kind": "web", "title": "Saç Ekimi Birimleri Hakkında Yönetmelik, Resmî Gazete 6 Mayıs 2023, Sayı 32182", "publisher": "T.C. Resmî Gazete", "year": 2023, "url": "https://www.resmigazete.gov.tr/eskiler/2023/05/20230506-11.htm", "accessed": "2026-09-17" }, { "id": "s:ishrs-consumer-alert", "kind": "org", "title": "Consumer alert", "publisher": "International Society of Hair Restoration Surgery", "url": "https://ishrs.org/consumer-alert/", "accessed": "2026-09-17", "note": "page carries dates 18 January 2017 and 30 January 2026; 'increasing numbers of unlicensed personnel worldwide are performing substantial medical aspects of hair restoration surgery'; names no country and gives no figures" }, { "id": "s:haider-2025-hair-transplant-tourism", "kind": "article", "title": "The Allures and the Alarms of the Hair Transplant Tourism Industry", "author": "Haider SA, Hasanzade S, Borna S, et al.", "publisher": "Aesthetic Plastic Surgery 2025;49(17):4745–4753", "year": 2025, "url": "https://pubmed.ncbi.nlm.nih.gov/40660034/", "accessed": "2026-09-17", "note": "a narrative review; its widely repeated billion-dollar figure traces to a 2015 magazine article, and the review's own words for the sector are a data black hole" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:ushas-saglik-turizmi-verileri" }, "text.story": { "tier": "cited", "source": "s:ushas-saglik-turizmi-verileri", "note": "the series was read on the USHAŞ page on 2026-09-17 and the ISHRS wording on its own alert; the 2023 hair-transplant regulation is cited to the Resmî Gazete entry; the second paragraph is marked inference" }, "geo": { "tier": "cited", "source": "s:ushas-saglik-turizmi-verileri" }, "address": { "tier": "cited", "source": "s:ushas-saglik-turizmi-verileri" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "turkiye", "type": "destination", "name": "Türkiye", "as": "The years the hair trade scaled, and the regulation that followed it.", "rel": "event" }, { "from": "istanbul", "type": "hub", "name": "Istanbul", "as": "The years this belt became the thing Istanbul is known for.", "rel": "event" }, { "from": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The years the corridor formed.", "rel": "event" }, { "from": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The years the volume arrived.", "rel": "event" }, { "from": "ishrs", "type": "org", "name": "International Society of Hair Restoration Surgery", "as": "The growth its warnings ran alongside, and predate by six years.", "rel": "event" }, { "from": "turkiye-health-services-directorate", "type": "org", "name": "Türkiye General Directorate of Health Services", "as": "The growth these rules were written against.", "rel": "event" }, { "from": "covid-shutdown-2020", "type": "event", "name": "The 2020 shutdown", "as": "The recovery that followed, in one procedure and one country.", "rel": "event" } ] }, { "id": "asa-grade", "names": { "name": "ASA grade", "aliases": [ "ASA physical status", "ASA class", "ASA PS classification" ], "said": "Anaesthetists say ASA 1 through 6, with an E for emergency. Nobody says it to a patient, and it decides whether the patient is operated on that morning." }, "etymology": { "root": "An initialism of the American Society of Anesthesiologists, on a Greek stem: anaesthesia is 1721, \"loss of feeling\", from medical Latin and Greek anaisthesia, want of feeling, from an-, without, plus aisthesis, feeling; the sense of a procedure preventing pain in surgery is attested from 1846. The scale itself has a date rather than a root — introduced in 1941 to give perioperative clinicians a standard way to record a patient's other illnesses, and last amended on 13 December 2020 from a table approved on 15 October 2014.", "first_attested": "1941 for the classification; 1721 for anaesthesia", "tier": "cited", "source": "s:statpearls-asa-physical-status", "note": "The grade describes the patient, not the operation. It is assigned by an anaesthetist who has met the patient, usually on the day." }, "text": { "what": "A six-point scale describing how well a patient is before an operation, from ASA I, healthy, to ASA VI, declared brain-dead with organs being removed for donation, with an E appended where the surgery is an emergency. It is the shorthand every anaesthetic record in the world carries.", "story": "The scale ranges from a healthy patient through mild systemic disease, severe systemic disease, severe systemic disease that is a constant threat to life, and a moribund patient not expected to survive without the operation, to the brain-dead donor. It was introduced in 1941 and has been revised repeatedly since; the current table was approved on 15 October 2014 and last amended on 13 December 2020.\n\n*Inference —* the grade is where a remote quotation and a real patient meet. A package price, a stated length of stay and a fitness-to-fly date all assume a low grade. The grade is assigned face to face, after the history, usually on the morning of surgery, by a doctor who has not seen the quotation. A patient graded higher than the package assumed is the commonest way a fixed price stops being fixed.", "how": "Three things follow from the grade: whether the operation proceeds as planned, whether it needs a higher level of monitoring or a bed in intensive care, and how long the patient stays. Intensive care sits outside almost every published package.", "today": "As of 17 September 2026 no record on this site carries an ASA grade as a fact about a procedure, because the grade belongs to a patient and not to an operation. It appears here as the variable every package price assumes away." }, "kin": [ { "to": "anaesthetic-risk-unscreened", "as": "The risk this scale exists to measure, and what happens when nobody applies it before the flight.", "rel": "risk" }, { "to": "arrival-and-consent", "as": "The step where the grade is actually assigned.", "rel": "step" }, { "to": "package-price", "as": "The price that assumes a low grade without saying so.", "rel": "term" }, { "to": "day-case", "as": "The category a grade can move a patient out of.", "rel": "term" }, { "to": "length-of-stay", "as": "The number the grade changes first.", "rel": "term" } ], "sources": [ "s:statpearls-asa-physical-status", "s:etymonline-anesthesia" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "A" }, "blurb": "A six-point scale describing how well a patient is before an operation, from ASA I, healthy, to ASA VI, declared brain-dead with organs being removed for donation, with an E appended where the surgery is an emergency.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "anaesthetic-risk-unscreened", "type": "risk", "name": "Fitness for anaesthesia, assessed on arrival", "as": "The risk this scale exists to measure, and what happens when nobody applies it before the flight.", "rel": "risk" }, { "to": "arrival-and-consent", "type": "pathway", "name": "Arrival and consent", "as": "The step where the grade is actually assigned.", "rel": "step" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The price that assumes a low grade without saying so.", "rel": "term" }, { "to": "day-case", "type": "term", "name": "Day case", "as": "The category a grade can move a patient out of.", "rel": "term" }, { "to": "length-of-stay", "type": "term", "name": "Length of stay", "as": "The number the grade changes first.", "rel": "term" } ], "source_list": [ { "id": "s:statpearls-asa-physical-status", "kind": "reference", "title": "American Society of Anesthesiologists Physical Status Classification System — StatPearls, last updated 11 February 2025", "publisher": "Hendrix JM, Garmon EH. StatPearls Publishing, NCBI Bookshelf NBK441940", "url": "https://www.ncbi.nlm.nih.gov/books/NBK441940/", "accessed": "2026-09-17", "note": "used because the ASA's own statement page now redirects to a journal host that refuses automated access. Carries the 1941 introduction, the House of Delegates approval of 15 October 2014 and the amendment of 13 December 2020, the six ordinal classes plus the E designation, and the meta-analytic sensitivity, specificity and area under the curve for predicting postoperative mortality" }, { "id": "s:etymonline-anesthesia", "kind": "dictionary", "title": "anesthesia (n.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/anesthesia", "accessed": "2026-09-17", "note": "1721, from Greek anaisthesia; the surgical sense from 1846" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "anaesthetic-risk-unscreened", "type": "risk", "name": "Fitness for anaesthesia, assessed on arrival", "as": "The word for the score this whole exposure turns on.", "rel": "term" }, { "from": "day-case", "type": "term", "name": "Day case", "as": "The assessment that decides whether a case stays a day case.", "rel": "term" } ] }, { "id": "bundled-payment", "names": { "name": "Bundled payment", "aliases": [ "episode payment", "episode-based payment", "global payment" ], "said": "Payers say bundle and mean an episode across several providers. Hospitals selling abroad say package and mean one seller's own list. The words are cousins and the objects are not the same." }, "region": [ "global", "north-america" ], "etymology": { "root": "bundle is early 14c., a bound collection of things, from Middle Dutch bondel, a diminutive of bond, from binden, to bind, on the Germanic root meaning to bind; with payment, from pay, c. 1200, from Old French paier and Latin pacare, to appease or satisfy. The word says what the payment does: it ties services that were billed separately into one thing that cannot be unpicked.", "first_attested": "early 14c. for bundle; 2013 for the American programmes that made it a payment form", "tier": "cited", "source": "s:etymonline-bundle", "note": "A bundle is defined by a window as much as by a list. Change the number of days after discharge and you have changed what the payment covers." }, "text": { "what": "One payment covering everything a patient needs for a defined episode — the admission, the surgeon, the rehabilitation, the readmission if it happens — across every provider involved, for a fixed number of days after discharge. Providers who spend less than the target keep the difference; those who spend more absorb it.", "story": "The American programmes are where the shape can be read, because each one published its own window. Under Bundled Payments for Care Improvement, whose first awardees began in April 2013 and whose later models began that October, Model 1 defined the episode as \"the inpatient stay in the acute care hospital\" and Model 2 as the inpatient stay \"plus the post-acute care and all related services up to 90 days post-hospital discharge\". BPCI Advanced, from 1 October 2018, defined it as \"the Anchor Stay plus 90 days beginning the day of discharge or the Anchor Procedure plus 90 days beginning on the day of completion of the outpatient procedure\". Comprehensive Care for Joint Replacement ran from 1 April 2016 to 31 December 2024 on a 90-day episode. The Transforming Episode Accountability Model, mandatory for selected hospitals, runs from 1 January 2026 to 31 December 2030 across five surgical categories — and its episode is shorter: \"Each episode will end 30 days after the individual leaves the hospital.\"\n\n*Inference —* the window is the whole design. A 90-day bundle makes the readmission the payer's problem and the hospital's risk; a 30-day bundle moves the same complication outside the payment. Nothing about the clinical course changed between the two models.", "how": "A bundle is an arrangement between a payer and providers, not a price offered to a patient. Its exclusions are published separately from its definition, in technical lists of clinical episode exclusions rather than on the face of the model. Nothing in it crosses a border: a patient treated abroad is outside every episode any of these programmes defines.", "today": "As of 17 September 2026 no record on this site carries a bundled payment as a price. The term appears here because it is the payer-side relative of the package a foreign hospital sells, and the comparison between them is the clearest way to see what a package leaves out." }, "kin": [ { "to": "package-price", "as": "The seller's version of the same idea, with no payer and no published window.", "rel": "contrast" }, { "to": "drg", "as": "The unit bundles were built on top of, and the admission they extend past.", "rel": "origin" }, { "to": "case-rate", "as": "The narrower form: one provider, one encounter, one negotiated price.", "rel": "term" }, { "to": "knee-replacement", "as": "The operation these programmes were built around, at home and abroad alike.", "rel": "procedure" }, { "to": "united-states", "as": "Where the episode payment was designed, and the market whose patients travel out of it.", "rel": "destination" }, { "to": "follow-up-gap", "as": "What a 90-day episode covers at home and nobody covers abroad.", "rel": "risk" } ], "sources": [ "s:etymonline-bundle", "s:etymonline-pay", "s:cms-bpci", "s:cms-bpci-advanced", "s:cms-cjr", "s:cms-team-model" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "updated": "2026-09-17", "facets": { "letter": "B" }, "blurb": "One payment covering everything a patient needs for a defined episode — the admission, the surgeon, the rehabilitation, the readmission if it happens — across every provider involved, for a fixed number of days after…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "package-price", "type": "term", "name": "Package price", "as": "The seller's version of the same idea, with no payer and no published window.", "rel": "contrast" }, { "to": "drg", "type": "term", "name": "DRG", "as": "The unit bundles were built on top of, and the admission they extend past.", "rel": "origin" }, { "to": "case-rate", "type": "term", "name": "Case rate", "as": "The narrower form: one provider, one encounter, one negotiated price.", "rel": "term" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The operation these programmes were built around, at home and abroad alike.", "rel": "procedure" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "Where the episode payment was designed, and the market whose patients travel out of it.", "rel": "destination" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "What a 90-day episode covers at home and nobody covers abroad.", "rel": "risk" } ], "source_list": [ { "id": "s:etymonline-bundle", "kind": "dictionary", "title": "bundle (n.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/bundle", "accessed": "2026-09-17", "note": "early 14c., from Middle Dutch bondel" }, { "id": "s:etymonline-pay", "kind": "dictionary", "title": "pay (v.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/pay", "accessed": "2026-09-17", "note": "c. 1200, from Latin pacare" }, { "id": "s:cms-bpci", "kind": "gov", "title": "Bundled Payments for Care Improvement (BPCI) Initiative", "publisher": "CMS Innovation Center", "url": "https://www.cms.gov/priorities/innovation/innovation-models/bundled-payments", "accessed": "2026-09-17", "note": "Model 1 awardees from April 2013, Models 2, 3 and 4 from October 2013; carries each model's episode definition" }, { "id": "s:cms-bpci-advanced", "kind": "gov", "title": "BPCI Advanced", "publisher": "CMS Innovation Center", "url": "https://www.cms.gov/priorities/innovation/innovation-models/bpci-advanced", "accessed": "2026-09-17", "note": "first cohort from 1 October 2018; episode is the anchor stay or procedure plus 90 days" }, { "id": "s:cms-cjr", "kind": "gov", "title": "Comprehensive Care for Joint Replacement Model", "publisher": "CMS Innovation Center", "url": "https://www.cms.gov/priorities/innovation/innovation-models/cjr", "accessed": "2026-09-17", "note": "performance period 1 April 2016 to 31 December 2024; 90-day episode" }, { "id": "s:cms-team-model", "kind": "gov", "title": "Transforming Episode Accountability Model (TEAM)", "publisher": "CMS Innovation Center", "url": "https://www.cms.gov/priorities/innovation/innovation-models/team-model", "accessed": "2026-09-17", "note": "mandatory for selected hospitals, 1 January 2026 to 31 December 2030, five surgical categories, 30-day episode" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "case-rate", "type": "term", "name": "Case rate", "as": "The stretched version, across providers and a window of days.", "rel": "contrast" }, { "from": "drg", "type": "term", "name": "DRG", "as": "What comes after the DRG, when the payer buys the whole episode instead of the admission.", "rel": "descendant" }, { "from": "package-price", "type": "term", "name": "Package price", "as": "The payer's version of the same idea: one price for an episode, set by an insurer instead of by a seller.", "rel": "contrast" } ] }, { "id": "case-rate", "names": { "name": "Case rate", "aliases": [ "flat rate per case", "per-case payment", "global fee" ], "said": "Contracting departments say case rate. It is the plainest of the four money words on this site and the least defined by anybody outside a contract." }, "region": [ "global", "north-america" ], "etymology": { "root": "case is early 13c., \"what befalls one; state of affairs\", from Old French cas and Latin casus, literally \"a falling\"; medicine took it for an instance of a disease in the late 14c. rate is early 15c., \"estimated value or worth, proportional estimation according to some standard\", from Old French rate and Medieval Latin rata pars, a fixed amount, from Latin rata, fixed or settled, the feminine past participle of reri, to reckon. A case rate is therefore a settled reckoning on an instance of illness, which is exactly what it is.", "first_attested": "early 13c. for case; early 15c. for rate; this project could not date the contracting phrase", "tier": "cited", "source": "s:etymonline-case", "note": "A DRG is a case rate that has been classified. A plain case rate is one price for one named procedure, with no grouping for severity, and the risk of a sicker patient sits with whoever accepted it." }, "text": { "what": "One flat amount for one case, agreed in advance. A trade description puts it at its bluntest: under a case rate \"providers receive a flat reimbursement rate for every patient visit, no matter what service they provide\". Acuity has no bearing on the payment, which is the point and also the problem.", "story": "The form sits between two better-documented ones. A DRG is a case rate that has been sorted into hundreds of clinically defined groups with weights drawn from average costs, so a complicated case is paid more than a simple one. A bundled payment is a case rate stretched across several providers and a stated number of days. A plain contracted case rate has neither: one price, one procedure, one provider.\n\n*Inference —* that is why the case rate is the form a foreign hospital's price page most resembles. A published package for a named operation, with no severity adjustment and no episode window, is a case rate offered to the public instead of negotiated with a payer — and the risk it carries is the same risk, moved onto whoever accepted the price.", "how": "Two questions decide whether a case rate holds: what happens to a case that turns out to be more complicated than the rate assumed, and who decided it was more complicated. On a payer contract the answer is in a severity or outlier clause. On a hospital's package page abroad the answer is usually the eligibility list — the conditions under which the published price stops applying.", "today": "As of 17 September 2026 this site records prices in the form the seller published them. Where a figure is a payer's negotiated rate rather than a price a patient can pay, it is recorded as a tariff and named as one." }, "kin": [ { "to": "drg", "as": "The classified version, with several hundred groups and weights behind it.", "rel": "descendant" }, { "to": "bundled-payment", "as": "The stretched version, across providers and a window of days.", "rel": "contrast" }, { "to": "package-price", "as": "What a case rate looks like when it is offered to the public instead of negotiated.", "rel": "term" }, { "to": "tariff", "as": "The schedule a case rate sits in.", "rel": "term" }, { "to": "getting-a-quote", "as": "The step where a flat figure is handed over without its severity clause.", "rel": "step" } ], "sources": [ "s:etymonline-case", "s:etymonline-rate", "s:jucm-case-rate-2017" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "the definition is quoted; the comparison between the three forms is this project's" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "medium", "schema": 1, "type": "term", "updated": "2026-09-17", "facets": { "letter": "C" }, "blurb": "One flat amount for one case, agreed in advance. A trade description puts it at its bluntest: under a case rate \"providers receive a flat reimbursement rate for every patient visit, no matter what service they provide\".", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "drg", "type": "term", "name": "DRG", "as": "The classified version, with several hundred groups and weights behind it.", "rel": "descendant" }, { "to": "bundled-payment", "type": "term", "name": "Bundled payment", "as": "The stretched version, across providers and a window of days.", "rel": "contrast" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "What a case rate looks like when it is offered to the public instead of negotiated.", "rel": "term" }, { "to": "tariff", "type": "term", "name": "Tariff", "as": "The schedule a case rate sits in.", "rel": "term" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step where a flat figure is handed over without its severity clause.", "rel": "step" } ], "source_list": [ { "id": "s:etymonline-case", "kind": "dictionary", "title": "case (n.1) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/case", "accessed": "2026-09-17", "note": "early 13c., from Latin casus; medical sense late 14c." }, { "id": "s:etymonline-rate", "kind": "dictionary", "title": "rate (n.1) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/rate", "accessed": "2026-09-17", "note": "early 15c., from Medieval Latin rata pars, from Latin reri, to reckon" }, { "id": "s:jucm-case-rate-2017", "kind": "web", "title": "Understanding Case-Rate Reimbursement", "publisher": "Journal of Urgent Care Medicine, 1 December 2017", "url": "https://www.jucm.com/understanding-case-rate-reimbursement/", "accessed": "2026-09-17", "note": "a trade journal definition; no standards body publishes one" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "the definition is quoted; the comparison between the three forms is this project's" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "bundled-payment", "type": "term", "name": "Bundled payment", "as": "The narrower form: one provider, one encounter, one negotiated price.", "rel": "term" }, { "from": "drg", "type": "term", "name": "DRG", "as": "The same idea unclassified: one negotiated price for one procedure, with no severity grouping.", "rel": "contrast" }, { "from": "package-price", "type": "term", "name": "Package price", "as": "The trade term for the flat fee a package is built out of.", "rel": "term" }, { "from": "tariff", "type": "term", "name": "Tariff", "as": "The same idea sold privately: one agreed amount for one episode.", "rel": "term" } ] }, { "id": "circumvention-travel", "names": { "name": "Circumvention travel", "aliases": [ "circumvention tourism", "circumvention medical tourism", "travel to evade a prohibition" ], "said": "The legal literature says circumvention tourism, after the paper that named it, and this site writes circumvention travel under its own rule. No other user of the second form was found for this record." }, "etymology": { "root": "circumvent is mid-15c., \"surround by hostile stratagem\", from Latin circumventus, past participle of circumvenire, to get around, be around or encircle, from circum, around, plus venire, to come; the noun circumvention is early 15c., an act of outwitting. The word says the law was gone around rather than broken, and that distinction is the whole of the category.", "first_attested": "mid-15c. for the verb; 2012 for the legal category", "tier": "cited", "source": "s:etymonline-circumvent", "note": "I. Glenn Cohen wrote circumvention tourism and, in the same abstract, circumvention medical tourism. The form used on this site is this site's, imposed by its own banned-word rule, and is not offered as anyone else's usage." }, "text": { "what": "Travelling to a country where a treatment is lawful in order to have it, because it is prohibited at home. The treatment is legal where it happens. Whether the traveller's own state reaches the conduct is a separate question, and mostly it does not.", "story": "I. Glenn Cohen named the category in the Cornell Law Review in 2012, at volume 97, pages 1309 to 1398. His own definition: travel \"for services that are legal in the patient's destination country but illegal in the patient's home country—that is, travel to circumvent domestic prohibitions on accessing certain medical services\". The four worked examples in that paper are female genital cutting, abortion, the use of reproductive technology, and assisted suicide. His 2014 book put the same problem inside a wider account of law and ethics, and the argument is still live: the Journal of Law, Medicine and Ethics ran an exchange on it in 2022 between Joshua Shaw and Jeremy Snyder.\n\n*Inference —* a category defined by a legal difference behaves unlike the rest of this subject. A price gap narrows when a currency moves; a prohibition does not. The traffic is steady, it points one way, and it stops the day the law at home changes — which is why these journeys cluster on borders rather than on airline routes.", "how": "Three questions decide what a journey of this kind exposes a traveller to, and each pair of countries answers them differently: whether the home state criminalises the act when its own nationals commit it abroad, whether a status created abroad — a parentage order, a certificate — is recognised at home, and whether a professional at home may lawfully provide the follow-up. None of the three is answered by the destination's law, which is the law the patient will have read.", "today": "As of 17 September 2026 the rule records on this site carry these questions country by country, each row naming one instrument and one date. This record names a category. It gives no legal advice and tells no reader what to do." }, "kin": [ { "to": "reproductive-exile", "as": "The same journeys named from the traveller's side rather than the law's.", "rel": "contrast" }, { "to": "surrogacy", "as": "The clearest case: lawful in one country, void or criminal in the next.", "rel": "procedure" }, { "to": "abortion-travel-law", "as": "The rule record that maps this category across borders.", "rel": "rule" }, { "to": "assisted-dying-law", "as": "Where the prohibition falls on whoever assists rather than on the patient.", "rel": "rule" }, { "to": "pgt", "as": "A test that moves country when the permitted indications differ rather than when the price does.", "rel": "procedure" }, { "to": "medical-tourism", "as": "The wider contested name, and the page where the argument over it is held.", "rel": "term" } ], "sources": [ "s:etymonline-circumvent", "s:cohen-circumvention-2012", "s:cohen-patients-with-passports-2014", "s:jlme-circumvention-2022" ], "provenance": { "default": { "tier": "cited" }, "fields": { "etymology": { "tier": "cited", "note": "no attested user of the -travel form was found; the note says so" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "C" }, "blurb": "Travelling to a country where a treatment is lawful in order to have it, because it is prohibited at home. The treatment is legal where it happens.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The same journeys named from the traveller's side rather than the law's.", "rel": "contrast" }, { "to": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "The clearest case: lawful in one country, void or criminal in the next.", "rel": "procedure" }, { "to": "abortion-travel-law", "type": "rule", "name": "Travelling for a termination", "as": "The rule record that maps this category across borders.", "rel": "rule" }, { "to": "assisted-dying-law", "type": "rule", "name": "Assisted dying, and who may cross a border for it", "as": "Where the prohibition falls on whoever assists rather than on the patient.", "rel": "rule" }, { "to": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "A test that moves country when the permitted indications differ rather than when the price does.", "rel": "procedure" }, { "to": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The wider contested name, and the page where the argument over it is held.", "rel": "term" } ], "source_list": [ { "id": "s:etymonline-circumvent", "kind": "dictionary", "title": "circumvent (v.), circumvention (n.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/circumvent", "accessed": "2026-09-17", "note": "mid-15c. and early 15c., from Latin circumvenire" }, { "id": "s:cohen-circumvention-2012", "kind": "paper", "title": "Circumvention Tourism", "publisher": "Cornell Law Review 97(6):1309 (Cohen IG)", "url": "https://scholarship.law.cornell.edu/clr/vol97/iss6/1", "accessed": "2026-09-16" }, { "id": "s:cohen-patients-with-passports-2014", "kind": "book", "title": "Patients with Passports: Medical Tourism, Law, and Ethics", "publisher": "Oxford University Press, 2014 (Cohen IG), ISBN 9780199975099", "url": "https://openlibrary.org/works/OL21085324W", "accessed": "2026-09-16" }, { "id": "s:jlme-circumvention-2022", "kind": "paper", "title": "The Flaw in Formalist Accounts of Circumvention Tourism, and Revisiting the Ethics of Circumvention Tourism", "publisher": "Shaw J, pp. 551-562; Snyder JC, pp. 563-565. Journal of Law, Medicine and Ethics 2022;50(3)", "url": "https://doi.org/10.1017/jme.2022.93", "accessed": "2026-09-17", "note": "metadata confirmed through Crossref; the articles themselves were not read" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited", "note": "no attested user of the -travel form was found; the note says so" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "cuba", "type": "destination", "name": "Cuba", "as": "The word for travelling because a rule at home forbids it — here the rule points the other way, at entry rather than at treatment.", "rel": "term" }, { "from": "georgia", "type": "destination", "name": "Georgia", "as": "The word for most of why anyone flies here.", "rel": "term" }, { "from": "nicosia", "type": "hub", "name": "Nicosia", "as": "What a journey across a line like this one is usually called.", "rel": "term" }, { "from": "warsaw", "type": "hub", "name": "Warsaw", "as": "The word for the outward half of this city's traffic.", "rel": "term" }, { "from": "abortion-care", "type": "procedure", "name": "Abortion", "as": "The name for crossing a border to do lawfully what home law forbids.", "rel": "term" }, { "from": "assisted-dying", "type": "procedure", "name": "Assisted dying", "as": "The word for crossing a border to do lawfully what cannot be done at home.", "rel": "term" }, { "from": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "What this traffic is called when the reason for it is a prohibition at home.", "rel": "term" }, { "from": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "What the law-driven half of this traffic is called in the literature.", "rel": "term" }, { "from": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "Why this test moves country when the permitted indications differ, rather than when the price does.", "rel": "term" }, { "from": "sperm-donation", "type": "procedure", "name": "Sperm donation", "as": "What the traffic is called where the reason to move is a prohibition on who may be treated.", "rel": "term" }, { "from": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "The name for crossing a border to do what home law forbids.", "rel": "term" }, { "from": "vaginoplasty", "type": "procedure", "name": "Vaginoplasty", "as": "The word for crossing a border to obtain what home law or a home waiting list withholds.", "rel": "term" }, { "from": "abortion-travel-law", "type": "rule", "name": "Travelling for a termination", "as": "The category this is the oldest example of.", "rel": "term" }, { "from": "assisted-dying-law", "type": "rule", "name": "Assisted dying, and who may cross a border for it", "as": "The category this sits in.", "rel": "term" }, { "from": "gender-affirming-care-access", "type": "rule", "name": "Access to gender-affirming care", "as": "The category this sits in.", "rel": "term" }, { "from": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "The wider category this sits in.", "rel": "term" }, { "from": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The part of the traffic a prohibition at home explains, named separately in the legal literature.", "rel": "term" }, { "from": "medical-visa", "type": "term", "name": "Medical visa", "as": "Why a visa that records the purpose of a journey matters where the treatment is lawful there and not at home.", "rel": "term" }, { "from": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The same journeys named from the law's side rather than the patient's.", "rel": "contrast" }, { "from": "circumvention", "type": "story", "name": "Circumvention", "as": "The word, its root, and the paper that named the category in 2012.", "rel": "term" }, { "from": "the-word-itself", "type": "story", "name": "The word itself", "as": "A name for a legal difference rather than for a motive.", "rel": "term" } ] }, { "id": "co-payment", "names": { "name": "Co-payment", "aliases": [ "copay", "copayment", "patient contribution", "user charge" ], "said": "American plans say copay. European systems say patient contribution or user charge. All three name the same thing: the part the patient pays on a bill somebody else is also paying." }, "etymology": { "root": "co-, the Latin prefix com-, with or together, on payment — behind which sits pay, c. 1200, from Old French paier, from Latin pacare, to please, pacify or satisfy, from pax, peace. To pay was first to appease a creditor; the sense of giving what is due for goods or services follows in the early 13th century. A co-payment is two parties appeasing one bill.", "first_attested": "c. 1200 for pay; this project could not date the insurance compound from a dictionary", "tier": "cited", "source": "s:etymonline-pay", "note": "A co-payment is a fixed amount. Coinsurance is a percentage. A deductible is an amount paid before cover begins at all. Trade writing uses the three interchangeably and they behave very differently on a large bill." }, "text": { "what": "A fixed sum the patient pays for a covered service while the payer pays the rest. The US federal glossary puts it plainly: \"A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible.\" The word only means anything where somebody else is paying the remainder.", "story": "Set against its two neighbours the word becomes readable. Coinsurance is \"The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible\" — on a $100 allowed amount at 20%, the patient pays $20. A deductible is paid first and in full. A fixed co-payment is predictable and a percentage is not, and on an operation rather than an office visit the difference is the whole argument.\n\n*Inference —* the word is a poor fit for cross-border care and is used there anyway. A co-payment presupposes a payer with a schedule. A patient paying a foreign hospital has no payer and no schedule, so the correct word for what they hand over is not a co-payment but the whole price.", "how": "Three things decide what a co-payment costs over a year: whether it is a flat sum or a percentage, whether it counts towards an annual cap, and whether the service is in the payer's network at all. The third question answers itself for a hospital in another country.", "today": "As of 17 September 2026 no record on this site carries a co-payment figure as a price. Where a state's user charge is the whole of what a patient pays — the English dental bands, for instance — the amount is recorded as a tariff and named as one." }, "kin": [ { "to": "out-of-pocket", "as": "The wider category this sits inside, and the only part of it a payer has agreed to in advance.", "rel": "term" }, { "to": "tariff", "as": "The schedule a co-payment is calculated against.", "rel": "term" }, { "to": "prior-authorisation", "as": "The gate that has to be passed before a co-payment is the only thing owed.", "rel": "term" }, { "to": "dental-implant", "as": "A treatment where the patient contribution at home is what makes the fare abroad arithmetic.", "rel": "procedure" }, { "to": "reading-the-exclusions", "as": "The step where the difference between a fixed sum and a percentage is discovered.", "rel": "step" } ], "sources": [ "s:etymonline-pay", "s:healthcare-gov-copayment", "s:healthcare-gov-coinsurance", "s:nhs-dental-charges" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "C" }, "blurb": "A fixed sum the patient pays for a covered service while the payer pays the rest.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "out-of-pocket", "type": "term", "name": "Out-of-pocket", "as": "The wider category this sits inside, and the only part of it a payer has agreed to in advance.", "rel": "term" }, { "to": "tariff", "type": "term", "name": "Tariff", "as": "The schedule a co-payment is calculated against.", "rel": "term" }, { "to": "prior-authorisation", "type": "term", "name": "Prior authorisation", "as": "The gate that has to be passed before a co-payment is the only thing owed.", "rel": "term" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "A treatment where the patient contribution at home is what makes the fare abroad arithmetic.", "rel": "procedure" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step where the difference between a fixed sum and a percentage is discovered.", "rel": "step" } ], "source_list": [ { "id": "s:etymonline-pay", "kind": "dictionary", "title": "pay (v.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/pay", "accessed": "2026-09-17", "note": "c. 1200, from Latin pacare" }, { "id": "s:healthcare-gov-copayment", "kind": "gov", "title": "Copayment — glossary", "publisher": "HealthCare.gov, US Centers for Medicare & Medicaid Services", "url": "https://www.healthcare.gov/glossary/co-payment/", "accessed": "2026-09-17" }, { "id": "s:healthcare-gov-coinsurance", "kind": "gov", "title": "Coinsurance — glossary", "publisher": "HealthCare.gov, US Centers for Medicare & Medicaid Services", "url": "https://www.healthcare.gov/glossary/co-insurance/", "accessed": "2026-09-17" }, { "id": "s:nhs-dental-charges", "kind": "gov", "title": "Understanding NHS dental charges — bands 1, 2 and 3", "publisher": "NHS (England)", "url": "https://www.nhs.uk/nhs-services/dentists/dental-costs/understanding-nhs-dental-charges/", "accessed": "2026-09-16", "note": "band amounts read on the accessed date; the page does not state the date the amounts took effect" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "What a patient still pays under either route.", "rel": "term" }, { "from": "s2-route", "type": "rule", "name": "The S2 route", "as": "What survives the certificate.", "rel": "term" }, { "from": "out-of-pocket", "type": "term", "name": "Out-of-pocket", "as": "The share a payer fixes in advance, and the only part of out-of-pocket spending anybody plans for.", "rel": "term" }, { "from": "prior-authorisation", "type": "term", "name": "Prior authorisation", "as": "What remains owed once the gate has been passed.", "rel": "term" } ] }, { "id": "cycle", "names": { "name": "Cycle", "aliases": [ "IVF cycle", "treatment cycle", "started cycle", "fresh cycle", "stimulated cycle" ], "said": "Clinics sell a cycle. Registers count a cycle. The two words mark different points on the same treatment, and the gap between them is where success rates are made." }, "etymology": { "root": "Late 14c., from Old French cicle and Late Latin cyclus, from Greek kyklos, a circle or wheel, and so a circular motion or a round of events; the sense \"single complete period in a cycle\" is dated to 1821. Medicine borrowed the word for the menstrual round, and assisted reproduction borrowed it again for one stimulated round of it.", "first_attested": "late 14c. for the noun; 1821 for a single complete period", "tier": "cited", "source": "s:etymonline-cycle", "note": "A cycle can mean a cycle started, a cycle that reached egg collection, a fresh transfer, or a fresh course plus every frozen transfer that follows. A price and a success rate quoted against different senses cannot be compared." }, "text": { "what": "One round of stimulation, egg collection, fertilisation and transfer. It is the unit fertility treatment is sold in and the unit registers count in, and neither party has to say which of the four senses of the word they are using.", "story": "The denominator is the argument. The HFEA's preliminary figure for 2023 gives a 25% birth rate per embryo transferred for fresh transfers using a patient's own eggs — not per cycle started, and not per patient. The US register counts from a different starting line: the CDC's 2022 national rows give 49.7% of intended egg retrievals ending in a live birth for patients under 35 and 7.7% for patients over 40, against 49.1% and 25.4% of transfers. Over 40 the per-transfer figure is more than three times the per-retrieval figure, because every cycle that never reached a transfer has dropped out of the denominator.\n\nThe same word does the same work on a price list. Reprofit's self-payer list valid from 1 January 2026 prices an IVF cycle with own eggs at 3,245 euro, excluding screening tests, freezing and general anaesthetic for the egg collection; its Optimal line at 4,985 euro puts those four items back in. Its native cycle, at 1,100 euro, has no stimulation at all, so it is a cycle in the register's sense and one egg at most in the patient's. Stimulation medication appears in no inclusion line on that five-page list.\n\n*Inference —* a cycle is therefore not a unit of treatment. It is a unit of accounting, and each party chooses the edge of it that suits the number they are publishing.", "how": "Three edges have to be named before two cycle figures can be set side by side: where counting starts — at the drugs, at the collection or at the transfer; what happens to a cycle that is abandoned, which is usually charged at a reduced rate rather than refunded; and whether frozen transfers from the same collection are inside the cycle or sold again.", "today": "As of 17 September 2026 the two largest public registers in this field, the HFEA and the CDC, publish rates against different denominators and say so. Clinic pages rarely say so." }, "kin": [ { "to": "ivf", "as": "The treatment this word is the unit of.", "rel": "procedure" }, { "to": "package-price", "as": "The form a cycle price takes, and the inclusion list that decides what a cycle is.", "rel": "term" }, { "to": "reproductive-exile", "as": "The word for why a patient buys this cycle in another country.", "rel": "term" }, { "to": "eshre", "as": "The society whose European registry counts these cycles across countries.", "rel": "org" }, { "to": "egg-freezing", "as": "Where the cycle ends at collection and the storage bill begins.", "rel": "procedure" }, { "to": "getting-a-quote", "as": "The step where a per-cycle figure is first quoted, usually without its denominator.", "rel": "step" } ], "sources": [ "s:etymonline-cycle", "s:hfea-2023-trends", "s:cdc-art-2022-summary", "s:reprofit-pricelist-2026" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "C" }, "blurb": "One round of stimulation, egg collection, fertilisation and transfer.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment this word is the unit of.", "rel": "procedure" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The form a cycle price takes, and the inclusion list that decides what a cycle is.", "rel": "term" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The word for why a patient buys this cycle in another country.", "rel": "term" }, { "to": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "The society whose European registry counts these cycles across countries.", "rel": "org" }, { "to": "egg-freezing", "type": "procedure", "name": "Egg freezing", "as": "Where the cycle ends at collection and the storage bill begins.", "rel": "procedure" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step where a per-cycle figure is first quoted, usually without its denominator.", "rel": "step" } ], "source_list": [ { "id": "s:etymonline-cycle", "kind": "dictionary", "title": "cycle (n.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/cycle", "accessed": "2026-09-17", "note": "late 14c., from Greek kyklos" }, { "id": "s:hfea-2023-trends", "kind": "org", "title": "Fertility treatment 2023: trends and figures", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2023-trends-and-figures/", "accessed": "2026-09-16", "note": "the UK regulator's annual register report; birth rates marked preliminary and not yet validated" }, { "id": "s:cdc-art-2022-summary", "kind": "dataset", "title": "2022 Final Assisted Reproductive Technology (ART) Summary", "publisher": "US Centers for Disease Control and Prevention", "url": "https://data.cdc.gov/Assisted-Reproductive-Technology-ART-/2022-Final-Assisted-Reproductive-Technology-ART-Su/9tjt-seye", "accessed": "2026-09-16", "note": "clinic-level and national rows; the national rows carry locationabbr NA. Queried through the Socrata endpoint https://data.cdc.gov/resource/9tjt-seye.json" }, { "id": "s:reprofit-pricelist-2026", "kind": "web", "title": "Pricelist — Assisted Reproduction, valid from 01.01.2026 (document 0331.26ENG)", "publisher": "Reprofit International s.r.o., Brno", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "accessed": "2026-09-16", "note": "the clinic's own self-payer price list, five pages, each line naming its inclusions and its exclusions" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The unit this treatment is sold and counted in, and the reason two prices are not comparable.", "rel": "term" }, { "from": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The unit these journeys are counted and sold in.", "rel": "term" } ] }, { "id": "day-case", "names": { "name": "Day case", "aliases": [ "day surgery", "ambulatory surgery", "same-day surgery", "outpatient surgery", "day-care discharge" ], "said": "British hospitals say day case. American ones say ambulatory or outpatient. Statisticians say day-care discharge, and count it separately or not at all." }, "etymology": { "root": "case is early 13c., \"what befalls one; state of affairs\", from Old French cas and Latin casus, a chance or mishap, literally \"a falling\", from the root meaning to fall; medicine took it for \"an instance of a disease\" in the late 14c. A day case is an instance of disease that begins and ends inside one day — an administrative boundary wearing a clinical word.", "first_attested": "late 14c. for the medical sense of case", "tier": "cited", "source": "s:etymonline-case", "note": "The category is defined by intention. A patient admitted as a day case who stays the night is reclassified, not merely charged extra." }, "text": { "what": "Treatment that occupies a hospital bed for part of a day and no night. The OECD's definition is procedural: \"A day-care discharge is the release of a patient who was formally admitted in a hospital for receiving planned medical and paramedical services, and who was discharged on the same day.\" Formal admission is the part people miss — a day case is an admission, not a clinic visit.", "story": "The category is built on an intention, and the statistics say what happens when the intention fails. The OECD excludes day cases from its average length of stay altogether, and counts among inpatient discharges \"[p]atients admitted as day-care patients but who have been retained overnight due to complication\". One unplanned night moves the episode into a different category of the national statistics.\n\n*Tradition holds —* the trade traces its founding to James Nicoll at the Glasgow Royal Hospital for Sick Children, who reported a large series of children's operations done without an overnight stay in the British Medical Journal in 1909, and argued that keeping such cases in beds wasted the hospital's resources. This project has not read the original paper and carries neither the case count nor the exact citation.\n\n*Inference —* the same reclassification is what a day-case price does not cover. A quoted day-case fee is the price of the intended pathway. The bed the patient did not plan to use is billed on the ward's terms, and it is the first line on almost every exclusion list.", "how": "Three conditions keep a case in the category: an operation short enough to recover from by evening, an anaesthetic light enough to leave, and somebody at the other end. For a patient in a foreign city the third condition is a hotel room and a companion, which is where the day case and the escort burden meet.", "today": "As of 17 September 2026 the procedure records on this site state the nights a seller's package names, and note where a procedure is ordinarily a day case at home and is sold abroad with a ward night attached." }, "kin": [ { "to": "length-of-stay", "as": "The count this category is excluded from, and rejoins the moment a night is added.", "rel": "contrast" }, { "to": "knee-arthroscopy", "as": "An operation that is usually this at home and is sold abroad with a night in it.", "rel": "procedure" }, { "to": "package-price", "as": "The price that assumes the intended pathway held.", "rel": "term" }, { "to": "the-companion", "as": "The person a day case requires and a foreign trip may not have.", "rel": "step" }, { "to": "asa-grade", "as": "The assessment that decides whether a case stays a day case.", "rel": "term" } ], "sources": [ "s:etymonline-case", "s:oecd-alos-metadata-2025" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "the Nicoll paragraph is marked as the trade's account; the paper was not read for this record" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "D" }, "blurb": "Treatment that occupies a hospital bed for part of a day and no night.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "length-of-stay", "type": "term", "name": "Length of stay", "as": "The count this category is excluded from, and rejoins the moment a night is added.", "rel": "contrast" }, { "to": "knee-arthroscopy", "type": "procedure", "name": "Knee arthroscopy", "as": "An operation that is usually this at home and is sold abroad with a night in it.", "rel": "procedure" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The price that assumes the intended pathway held.", "rel": "term" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "The person a day case requires and a foreign trip may not have.", "rel": "step" }, { "to": "asa-grade", "type": "term", "name": "ASA grade", "as": "The assessment that decides whether a case stays a day case.", "rel": "term" } ], "source_list": [ { "id": "s:etymonline-case", "kind": "dictionary", "title": "case (n.1) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/case", "accessed": "2026-09-17", "note": "early 13c., from Latin casus; medical sense late 14c." }, { "id": "s:oecd-alos-metadata-2025", "kind": "dataset", "title": "Hospital discharges and average length of stay by diagnostic categories — definitions, sources and methods", "publisher": "OECD Health Statistics 2025", "url": "https://stats.oecd.org/wbos/fileview2.aspx?IDFile=1aac08d9-99d5-4b52-9aa8-bbc8da33454b", "accessed": "2026-09-17", "note": "ALOS is bed-days divided by discharges, counted as date of discharge minus date of admission; day cases are excluded, and a day-care patient retained overnight because of a complication is counted as an inpatient discharge" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "the Nicoll paragraph is marked as the trade's account; the paper was not read for this record" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "knee-arthroscopy", "type": "procedure", "name": "Knee arthroscopy", "as": "What this operation usually is, and what a one-night package quietly is not.", "rel": "term" }, { "from": "alone-after-discharge", "type": "risk", "name": "Discharged alone", "as": "The category built on somebody being at the other end by evening.", "rel": "term" }, { "from": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "The category that assumes somebody is there by evening; abroad, that somebody flew in.", "rel": "term" }, { "from": "asa-grade", "type": "term", "name": "ASA grade", "as": "The category a grade can move a patient out of.", "rel": "term" }, { "from": "length-of-stay", "type": "term", "name": "Length of stay", "as": "The stay of zero nights, and the category a package can quietly leave.", "rel": "contrast" } ] }, { "id": "drg", "names": { "name": "DRG", "aliases": [ "diagnosis-related group", "diagnosis related group", "case mix group", "G-DRG", "Fallpauschale" ], "said": "American hospitals say DRG. German ones say Fallpauschale, a flat rate per case. Irish patients travelling abroad are refunded against one and are rarely told the word." }, "region": [ "global", "north-america", "europe-west" ], "etymology": { "root": "Not a word with a root but a label with a date. Diagnosis is 1680s in English, medical Latin from Greek diagnosis, \"a discerning, distinguishing\", from diagignoskein, to know thoroughly or know apart. Related and group are ordinary English doing classification work. The scheme itself was published by Fetter, Shin, Freeman, Averill and Thompson as \"Case mix definition by diagnosis-related groups\" in Medical Care in February 1980, and the United States wrote it into statute three years later.", "first_attested": "1980 for the published classification; 20 April 1983 for the statute", "tier": "cited", "source": "s:fetter-drg-1980", "note": "A DRG turned a hospital bill from a list of items into one price per case. Everything the case did not need became profit, and everything it needed beyond the price became loss." }, "text": { "what": "A bucket. Every inpatient stay is sorted at discharge into one group by diagnosis, procedures and complications, each group carries a weight, and the weight times a base rate is what the hospital is paid — the same amount whether the stay ran short or long. It is the unit most national hospital tariffs in the world are now built from.", "story": "The American statute is the moment the idea became money. The Social Security Amendments of 1983, Public Law 98-21, approved on 20 April 1983 at 97 Stat. 65, carries Title VI, \"Prospective Payments for Medicare\", and section 601 pays for inpatient hospital services on prospective rates. It did not switch over in a day: for discharges \"on or after October 1, 1983, and before October 1, 1984, the 'target percentage' is 75 percent and the 'DRG percentage' is 25 percent\", moving to half and half, then a quarter and three quarters, across three years.\n\nCMS states the mechanism in one line: \"Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG\", with an extra payment for outlier cases \"designed to protect the hospital from large financial losses due to unusually expensive cases\".\n\nWhat the rate does not buy is written into the regulations. Physician services paid on a fee schedule are excluded from inpatient hospital services under 42 CFR 409.10(b)(3), so the doctor bills separately. Organ acquisition costs, nurse-anaesthetist costs and approved education costs are paid on a reasonable cost basis outside the rate under 42 CFR 412.2(e). Transfers are paid differently again under 42 CFR 412.4.\n\nGermany adopted the same machinery on a different schedule: section 17b of the Krankenhausfinanzierungsgesetz requires a flat-rate, performance-based payment system for general hospital services, applied voluntarily from 2003 and compulsorily for somatic hospitals from 2004.", "how": "For a patient crossing a border the DRG is most often met as a refund. Ireland's Health Service Executive publishes a DRG guide for its cross-border schemes: I04B, knee replacement, is priced at 16,505 euro, \"Includes: Unilateral Knee Replacement with bone graft to Tibia / Fibula, Unilateral Patella Resurfacing. Excludes: Bilateral Knee Replacement, Revision of Knee Replacement\". The footnote states that the price is for an inlier stay — one falling between the published low and high boundaries — and that a stay above the high boundary earns a per-diem addition. The scheme itself \"does not cover other costs such as travel, accommodation or translation costs\", and the patient pays the foreign hospital first.", "today": "As of 17 September 2026 a DRG on this site is always named as a payer's unit, never as a price a patient is charged. Where a state refunds a traveller against one, the record names the code, the amount and the date." }, "kin": [ { "to": "tariff", "as": "The schedule a DRG is the unit of.", "rel": "term" }, { "to": "case-rate", "as": "The same idea unclassified: one negotiated price for one procedure, with no severity grouping.", "rel": "contrast" }, { "to": "bundled-payment", "as": "What comes after the DRG, when the payer buys the whole episode instead of the admission.", "rel": "descendant" }, { "to": "length-of-stay", "as": "The number a case rate made expensive, and the reason stays shortened everywhere it arrived.", "rel": "term" }, { "to": "germany", "as": "Where a foreign self-payer is billed against this schedule with a surcharge.", "rel": "destination" }, { "to": "eu-directive-2011-24", "as": "The route under which a European patient is refunded at a home-state DRG rather than the foreign invoice.", "rel": "rule" } ], "sources": [ "s:etymonline-diagnosis", "s:fetter-drg-1980", "s:pl-98-21-statute", "s:cms-acute-inpatient-pps", "s:cfr-409-10", "s:cfr-412-2", "s:cfr-412-4", "s:khg-17b", "s:bmg-fallpauschalen", "s:hse-cbd-niphs-drg-guide", "s:hse-niphs-claim" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "updated": "2026-09-17", "facets": { "letter": "D" }, "blurb": "A bucket. Every inpatient stay is sorted at discharge into one group by diagnosis, procedures and complications, each group carries a weight, and the weight times a base rate is what the hospital is paid — the same…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "tariff", "type": "term", "name": "Tariff", "as": "The schedule a DRG is the unit of.", "rel": "term" }, { "to": "case-rate", "type": "term", "name": "Case rate", "as": "The same idea unclassified: one negotiated price for one procedure, with no severity grouping.", "rel": "contrast" }, { "to": "bundled-payment", "type": "term", "name": "Bundled payment", "as": "What comes after the DRG, when the payer buys the whole episode instead of the admission.", "rel": "descendant" }, { "to": "length-of-stay", "type": "term", "name": "Length of stay", "as": "The number a case rate made expensive, and the reason stays shortened everywhere it arrived.", "rel": "term" }, { "to": "germany", "type": "destination", "name": "Germany", "as": "Where a foreign self-payer is billed against this schedule with a surcharge.", "rel": "destination" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The route under which a European patient is refunded at a home-state DRG rather than the foreign invoice.", "rel": "rule" } ], "source_list": [ { "id": "s:etymonline-diagnosis", "kind": "dictionary", "title": "diagnosis (n.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/diagnosis", "accessed": "2026-09-17", "note": "1680s, from Greek diagnosis" }, { "id": "s:fetter-drg-1980", "kind": "paper", "title": "Case mix definition by diagnosis-related groups", "publisher": "Fetter RB, Shin Y, Freeman JL, Averill RF, Thompson JD. Medical Care 1980 Feb;18(2 Suppl):iii, 1-53", "url": "https://pubmed.ncbi.nlm.nih.gov/7188781/", "accessed": "2026-09-17", "note": "citation verified through the NCBI esummary API on 17 September 2026 (PMID 7188781); the Yale origin story of the late 1960s is widely repeated and was not confirmed against a primary source for this record" }, { "id": "s:pl-98-21-statute", "kind": "statute", "title": "Social Security Amendments of 1983, Public Law 98-21, 97 Stat. 65, approved 20 April 1983 — Title VI, Prospective Payments for Medicare, section 601", "publisher": "United States Statutes at Large, via govinfo", "url": "https://www.govinfo.gov/content/pkg/STATUTE-97/pdf/STATUTE-97-Pg65.pdf", "accessed": "2026-09-17", "note": "carries the three-year phase-in: 75 per cent target and 25 per cent DRG for discharges on or after 1 October 1983" }, { "id": "s:cms-acute-inpatient-pps", "kind": "gov", "title": "Acute Inpatient PPS", "publisher": "US Centers for Medicare & Medicaid Services", "url": "https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps", "accessed": "2026-09-17" }, { "id": "s:cfr-409-10", "kind": "statute", "title": "42 CFR § 409.10 — Included services (inpatient hospital services)", "publisher": "Legal Information Institute, Cornell Law School", "url": "https://www.law.cornell.edu/cfr/text/42/409.10", "accessed": "2026-09-17", "note": "paragraph (b)(3) excludes physician services paid on a fee schedule basis" }, { "id": "s:cfr-412-2", "kind": "statute", "title": "42 CFR § 412.2 — Basis of payment", "publisher": "Legal Information Institute, Cornell Law School", "url": "https://www.law.cornell.edu/cfr/text/42/412.2", "accessed": "2026-09-17", "note": "paragraph (e) names the costs excluded from the prospective payment amounts and paid on a reasonable cost basis" }, { "id": "s:cfr-412-4", "kind": "statute", "title": "42 CFR § 412.4 — Discharges and transfers", "publisher": "Legal Information Institute, Cornell Law School", "url": "https://www.law.cornell.edu/cfr/text/42/412.4", "accessed": "2026-09-17" }, { "id": "s:khg-17b", "kind": "statute", "title": "Krankenhausfinanzierungsgesetz § 17b — Einführung eines pauschalierenden Entgeltsystems für DRG-Krankenhäuser", "publisher": "Bundesministerium der Justiz, gesetze-im-internet.de", "url": "https://www.gesetze-im-internet.de/khg/__17b.html", "accessed": "2026-09-17" }, { "id": "s:bmg-fallpauschalen", "kind": "gov", "title": "Fallpauschalen", "publisher": "Bundesministerium für Gesundheit", "url": "https://www.bundesgesundheitsministerium.de/service/begriffe-von-a-z/f/fallpauschalen", "accessed": "2026-09-17", "note": "DRG billing voluntary for hospitals in 2003 and compulsory for somatic hospitals from 2004; convergence 2005-2009; a state-uniform base rate from 1 January 2010" }, { "id": "s:hse-cbd-niphs-drg-guide", "kind": "gov", "title": "CBD / NIPHS Most Common Procedures DRG Guide", "publisher": "Health Service Executive (Ireland)", "url": "https://assets.hse.ie/media/documents/CBD-NIPHS-Most-Common-Procedures-DRG-Guide.pdf", "accessed": "2026-09-16", "note": "the tariff behind both the Cross Border Directive scheme and the Northern Ireland Planned Healthcare Scheme. Cataract procedures map to DRG C16Z LENS INTERVENTIONS at a day-case price of EUR 1,171, covering phacoemulsification or other extraction of the crystalline lens and capsulotomy; colonoscopy G48B EUR 1,001; gastroscopy G47C EUR 726. Same figure as the HSE's 2024 activity-based-funding day-case price list." }, { "id": "s:hse-niphs-claim", "kind": "gov", "title": "Northern Ireland Planned Healthcare Scheme — how much you can claim", "publisher": "Health Service Executive (Ireland)", "url": "https://www2.hse.ie/services/schemes-allowances/niphs/how-much-you-can-claim/", "accessed": "2026-09-16", "note": "the HSE repays the lesser of what the patient paid in Northern Ireland and the price of the same care in the Irish public system, using diagnosis-related group codes; the maximum for an outpatient appointment is EUR 194 from 1 May 2023, EUR 178 for claims between 1 March 2021 and 30 April 2023. The patient pays first." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "cited" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "germany", "type": "destination", "name": "Germany", "as": "The case-rate schedule a German hospital bills a foreign patient against.", "rel": "term" }, { "from": "ireland", "type": "destination", "name": "Ireland", "as": "The code that fixes what a patient gets back, and the reason a quote abroad has to be read against a category rather than a bill.", "rel": "term" }, { "from": "bundled-payment", "type": "term", "name": "Bundled payment", "as": "The unit bundles were built on top of, and the admission they extend past.", "rel": "origin" }, { "from": "case-rate", "type": "term", "name": "Case rate", "as": "The classified version, with several hundred groups and weights behind it.", "rel": "descendant" }, { "from": "length-of-stay", "type": "term", "name": "Length of stay", "as": "The payment unit that made short stays profitable and long ones a loss.", "rel": "term" }, { "from": "tariff", "type": "term", "name": "Tariff", "as": "The case-based unit most modern hospital tariffs are built on.", "rel": "term" } ] }, { "id": "facilitator", "names": { "name": "Facilitator", "aliases": [ "broker", "medical travel agency", "intermediary", "patient coordinator", "medical travel agent" ], "said": "The trade says facilitator. The research literature says broker. Türkiye's regulation says intermediary institution, and means a licensed travel agency." }, "etymology": { "root": "facilitate, 1610s, \"make easy, render less difficult\", from French faciliter, from the stem of Latin facilis, easy to do, from facere, to do or make — so a facilitator is one who makes a thing easy. The Online Etymology Dictionary carries no separate entry for the agent noun; it hangs off the verb.", "first_attested": "1610s for the verb; this project could not date the trade sense from a dictionary", "tier": "cited", "source": "s:etymonline-facilitate", "note": "The word names a service and asserts no qualification. Nothing in it says who pays the facilitator, and the answer is usually the hospital." }, "text": { "what": "The commercial party between a patient and a hospital abroad. It gathers records, produces a quote, books the surgeon, often books the flight and the hotel, and meets the patient at the airport. In most countries the job needs no licence, and the word carries no qualification with it.", "story": "The most-cited empirical work on these firms counted what they publish. Penney and colleagues examined 17 English-language Canadian broker websites in the summer of 2010: 47% made no mention of risks, two of the seventeen displayed certified accreditation, 35.3% displayed a membership logo instead, and 52.9% promised follow-up care. One site stated it had \"no ongoing involvement in the doctor-patient relationship\". The authors concluded that brokers \"currently lack a common standard of care and accreditation\".\n\nTwo states have written the role into law rather than leaving it to the word. Türkiye's regulation of 13 July 2017 defines an international health tourism intermediary and requires it to be an authorised travel agency, so in Antalya the invoice is frequently written by the agency and not by the hospital. Israel's Medical Tourism Law, 5778-2018, in force from 29 January 2019, put agents on a Ministry of Health register and bound the hospitals that use them.\n\n*Trade practice —* the arrangement the word conceals is the money. The facilitator is typically paid by the hospital on commission, which means the party choosing the surgeon is paid by the surgeon's employer. The facilitator sites this project has read do not state it.", "how": "Where no licence exists, the word is the only credential on offer, and it is self-applied. What distinguishes one firm from another is contractual rather than lexical: which legal entity signs, where it is registered, who pays it, which country's law the contract names, and what it undertakes if a complication occurs.", "today": "As of 17 September 2026 no national licensing regime aimed at medical travel facilitators as such turned up anywhere this project could read. Where a regime exists it licenses the intermediary as a travel agency, as in Türkiye, or registers the agent, as in Israel." }, "kin": [ { "to": "choosing-a-facilitator", "as": "The step where this word is chosen from, and what a reader can check about it.", "rel": "step" }, { "to": "deposit-and-refund", "as": "The risk that follows from an unlicensed party holding the money.", "rel": "risk" }, { "to": "package-price", "as": "What a facilitator sells: a single number assembled out of other people's services.", "rel": "term" }, { "to": "temos", "as": "One of the few accreditors that certifies this trade at all.", "rel": "org" }, { "to": "defiant", "as": "A named firm doing this job, described in the same voice as any other.", "rel": "org" }, { "to": "medical-travel", "as": "The wider name for the traffic these firms sit inside.", "rel": "term" } ], "sources": [ "s:etymonline-facilitate", "s:penney-broker-websites", "s:rg-saglik-turizmi-2017", "s:loc-israel-medical-tourism-law" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "the commission arrangement is marked as the trade's account, not a sourced fact" }, "text.how": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "F" }, "blurb": "The commercial party between a patient and a hospital abroad. It gathers records, produces a quote, books the surgeon, often books the flight and the hotel, and meets the patient at the airport.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "The step where this word is chosen from, and what a reader can check about it.", "rel": "step" }, { "to": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "The risk that follows from an unlicensed party holding the money.", "rel": "risk" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "What a facilitator sells: a single number assembled out of other people's services.", "rel": "term" }, { "to": "temos", "type": "org", "name": "Temos International Healthcare Accreditation", "as": "One of the few accreditors that certifies this trade at all.", "rel": "org" }, { "to": "defiant", "type": "org", "name": "Defiant", "as": "A named firm doing this job, described in the same voice as any other.", "rel": "org" }, { "to": "medical-travel", "type": "term", "name": "Medical travel", "as": "The wider name for the traffic these firms sit inside.", "rel": "term" } ], "source_list": [ { "id": "s:etymonline-facilitate", "kind": "dictionary", "title": "facilitate (v.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/facilitate", "accessed": "2026-09-17", "note": "1610s" }, { "id": "s:penney-broker-websites", "kind": "paper", "title": "Risk communication and informed consent in the medical tourism industry: a thematic content analysis of Canadian broker websites", "publisher": "Penney K, Snyder J, Crooks VA, Johnston R. BMC Medical Ethics 2011;12:17", "url": "https://bmcmedethics.biomedcentral.com/articles/10.1186/1472-6939-12-17", "accessed": "2026-09-16", "note": "17 English-language Canadian broker sites, summer 2010" }, { "id": "s:rg-saglik-turizmi-2017", "kind": "web", "title": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik", "publisher": "Resmî Gazete, Republic of Türkiye (Ministry of Health)", "url": "https://www.resmigazete.gov.tr/eskiler/2017/07/20170713-3.htm", "accessed": "2026-09-16", "note": "Resmî Gazete 13 July 2017, No. 30123. Read in Turkish off the Resmî Gazete page. Article 5(1) makes an international health tourism authorisation certificate (yetki belgesi) compulsory for both the health facility and the intermediary; the Ministry halts the activity of anyone without one. Transitional Article 1 gave those already trading one year to comply. Article 16: in force on publication. REPEALED: MADDE 17 of the regulation of 26 April 2025 (Resmî Gazete 32882) revokes this one. Cite it for what the regime was, not for what it is." }, { "id": "s:loc-israel-medical-tourism-law", "kind": "law", "title": "Israel: Knesset Passes Medical Tourism Legislation", "publisher": "Library of Congress, Global Legal Monitor", "url": "https://www.loc.gov/item/global-legal-monitor/2018-09-25/israel-knesset-passes-medical-tourism-legislation/", "accessed": "2026-09-16", "note": "names the instrument as the Medical Tourism Law, 5778-2018, passed 18 July 2018. The page would not open for this project on the access date — a bot check stood in front of it — so the provisions here were taken from the Israeli Ministry of Health's own summary and flagged for verification against the statute." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "the commission arrangement is marked as the trade's account, not a sourced fact" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "iran", "type": "destination", "name": "Iran", "as": "The broker who books the visa, the hotel and the surgeon as one price — and who handles the cash.", "rel": "term" }, { "from": "israel", "type": "destination", "name": "Israel", "as": "The role this country put on a public register in 2019.", "rel": "term" }, { "from": "kenya", "type": "destination", "name": "Kenya", "as": "The middle layer that starts most of these referrals.", "rel": "term" }, { "from": "morocco", "type": "destination", "name": "Morocco", "as": "The middle layer most European bookings here pass through.", "rel": "term" }, { "from": "philippines", "type": "destination", "name": "Philippines", "as": "The layer that stayed thin here because the patients were already family.", "rel": "term" }, { "from": "poland", "type": "destination", "name": "Poland", "as": "The agent between a British patient and a Kraków chair, paid by the clinic.", "rel": "term" }, { "from": "vietnam", "type": "destination", "name": "Vietnam", "as": "The broker layer between a dental clinic here and a patient abroad.", "rel": "term" }, { "from": "antalya", "type": "hub", "name": "Antalya", "as": "In this city the facilitator is a licensed travel agency, and the law says so.", "rel": "term" }, { "from": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "The word, and the argument about what the job is.", "rel": "term" }, { "from": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "The party that often holds the money without performing the treatment.", "rel": "term" }, { "from": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "The company whose staff member often does the interpreting, and whose invoice it appears on.", "rel": "term" }, { "from": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "The party most of these instruments reach least.", "rel": "term" }, { "from": "korea-foreign-patient-registration", "type": "rule", "name": "Korea's foreign patient attraction registration", "as": "The role this Act bonds, capitalises and keeps onshore.", "rel": "term" }, { "from": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The role this regulation turns into a licensed travel agency.", "rel": "term" }, { "from": "defiant", "type": "org", "name": "Defiant", "as": "The trade word for what this company is.", "rel": "term" }, { "from": "temos", "type": "org", "name": "Temos International Healthcare Accreditation", "as": "The trade this scheme is unusual in accrediting at all.", "rel": "term" }, { "from": "turkiye-health-services-directorate", "type": "org", "name": "Türkiye General Directorate of Health Services", "as": "The intermediary this regime licenses separately, through USHAŞ rather than through the directorate.", "rel": "term" }, { "from": "josef-woodman", "type": "person", "name": "Josef Woodman", "as": "The trade his guidebook taught a generation of readers to use, and to check.", "rel": "term" }, { "from": "keith-pollard", "type": "person", "name": "Keith Pollard", "as": "The trade his sites sold to and his awards judged.", "rel": "term" }, { "from": "leigh-turner", "type": "person", "name": "Leigh Turner", "as": "The intermediary his 2011 and 2012 papers made the object of study.", "rel": "term" }, { "from": "imtj-summit", "type": "event", "name": "The IMTJ Medical Travel Summit and Awards", "as": "The trade this meeting is largely for.", "rel": "term" }, { "from": "informed-consent", "type": "term", "name": "Informed consent", "as": "The party whose website is not part of the consent, whatever it said.", "rel": "term" }, { "from": "medical-travel", "type": "term", "name": "Medical travel", "as": "The commercial layer that grew up inside this traffic.", "rel": "term" } ] }, { "id": "fue", "names": { "name": "FUE", "aliases": [ "follicular unit excision", "follicular unit extraction", "FUE hair transplant" ], "said": "Clinics still say extraction. The society that certifies the surgeons changed the E to excision in 2018, and the change was about what kind of act it is." }, "etymology": { "root": "An initialism, and the interesting part is the middle letter. The technique was published as follicular unit extraction by Rassman, Bernstein and colleagues in Dermatologic Surgery in August 2002. In 2018 the International Society of Hair Restoration Surgery renamed it: \"the International Society of Hair Restoration Surgery formally changed FUE terminology from Follicular Unit 'Extraction' to Follicular Unit 'Excision' in order to more accurately define FUE as a surgical procedure. Excision is the combination of 'incision' followed by 'extraction.'\"", "first_attested": "2002, Dermatologic Surgery 28(8):720-728; renamed in 2018", "tier": "cited", "source": "s:ishrs-fue-terminology-2019", "note": "Extraction sounds like pulling something out. Excision says a cut was made. The society changed the word because the second is what happens." }, "text": { "what": "Harvesting hair by cutting individual follicular units out of the donor area one at a time through small circular punches, rather than taking a strip of scalp and dissecting it. No ward, no general anaesthetic, no implant: the cost is almost entirely staff time, which is why the trade relocated to where staff time is cheaper.", "story": "The renaming is the record of an argument about what the operation is. A society that certifies surgeons has an interest in the answer, and it said so in terms: excision is incision followed by extraction, and incision is surgery. The same society names the practice that follows from treating it as anything less — \"the problematic rise today of unlicensed technicians (the so-called black market)\" performing the harvesting.\n\n*Inference —* the pricing unit and the labour question are the same question. FUE is sold per graft, so the count is the price, and the count is produced by however many pairs of hands the clinic puts on the case. A technique whose cost is staff time and whose price is a unit count has both its incentives pointing the same way.", "how": "Punches run from 0.7 to 1.2 mm, manual, motorised or robotic. Grafts are counted out of the donor area and placed into incisions in the recipient area, in a session running most of a day. The donor area does not regenerate: overharvesting it, or going outside the safe zone, is described by the society as \"an uncorrectable problem\".", "today": "As of 17 September 2026 clinic pages in this trade use extraction and excision interchangeably, eight years after the society changed the term. This site records the price and the unit the seller used, and does not convert between clinics." }, "kin": [ { "to": "graft", "as": "The unit this technique is sold in, and the one whose definition decides the count.", "rel": "term" }, { "to": "hair-transplant-fue", "as": "The operation these three letters name.", "rel": "procedure" }, { "to": "dhi-hair-transplant", "as": "The branded variant sold beside it, with an implanter pen instead of forceps.", "rel": "contrast" }, { "to": "istanbul", "as": "The city that made this technique a commodity.", "rel": "hub" }, { "to": "revision", "as": "What follows an overharvested donor area, and what cannot be undone.", "rel": "term" } ], "sources": [ "s:ishrs-fue-terminology-2019", "s:rassman-fue-2002", "s:ishrs-fue-what-is-it" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "F" }, "blurb": "Harvesting hair by cutting individual follicular units out of the donor area one at a time through small circular punches, rather than taking a strip of scalp and dissecting it.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "graft", "type": "term", "name": "Graft", "as": "The unit this technique is sold in, and the one whose definition decides the count.", "rel": "term" }, { "to": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The operation these three letters name.", "rel": "procedure" }, { "to": "dhi-hair-transplant", "type": "procedure", "name": "Direct hair implantation (DHI)", "as": "The branded variant sold beside it, with an implanter pen instead of forceps.", "rel": "contrast" }, { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "The city that made this technique a commodity.", "rel": "hub" }, { "to": "revision", "type": "term", "name": "Revision", "as": "What follows an overharvested donor area, and what cannot be undone.", "rel": "term" } ], "source_list": [ { "id": "s:ishrs-fue-terminology-2019", "kind": "org", "title": "A 2019 Guide to Currently Accepted FUE and Implanter Terminology", "publisher": "International Society of Hair Restoration Surgery; dated 15 July 2019, editor Robert H. True", "url": "https://ishrs.org/wp-content/uploads/2019/08/July-15-2019-FUE-Terminology.pdf", "accessed": "2026-09-17", "note": "carries the Headington definition of the follicular unit, the 2018 renaming of FUE from extraction to excision, and the CFGE and CFGA measures" }, { "id": "s:rassman-fue-2002", "kind": "paper", "title": "Follicular unit extraction: minimally invasive surgery for hair transplantation", "publisher": "Rassman WR, Bernstein RM, McClellan R, Jones R, Worton E, Uyttendaele H. Dermatologic Surgery 2002 Aug;28(8):720-8", "url": "https://pubmed.ncbi.nlm.nih.gov/12174065/", "accessed": "2026-09-17", "note": "citation verified through the NCBI esummary API on 17 September 2026 (PMID 12174065)" }, { "id": "s:ishrs-fue-what-is-it", "kind": "org", "title": "FUE — what is it?", "publisher": "International Society of Hair Restoration Surgery", "url": "https://ishrs.org/fue-what-is-it/", "accessed": "2026-09-17", "note": "follicular units of 1 to 4 hairs, punches 0.7 to 1.2 mm, overharvesting as an uncorrectable problem, and the society's black-market warning" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "cited" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The three letters, and what the society that certifies the surgeons renamed them.", "rel": "term" }, { "from": "ishrs", "type": "org", "name": "International Society of Hair Restoration Surgery", "as": "The word, whose use in clinic advertising the society has tried to pin down.", "rel": "term" }, { "from": "graft", "type": "term", "name": "Graft", "as": "The technique sold by the graft, which is why the unit matters at all.", "rel": "term" } ] }, { "id": "graft", "names": { "name": "Graft", "aliases": [ "follicular unit", "FU", "hair graft" ], "said": "A hair clinic's graft is a follicular unit of one to four hairs. A surgeon's graft is transplanted tissue. The same word prices two different things." }, "etymology": { "root": "Late 15c., an alteration of Middle English graff, from Old French graife, \"grafting knife, carving tool; stylus, pen\", from Latin graphium, stylus, from Greek grapheion, stylus, from graphein, to write. The shoot inserted into another plant was pencil-shaped like a stylus, and took the stylus's name. The surgical sense of the verb follows in 1868 and of the noun in 1871. The corruption sense — graft as bribery, American English from about 1859 — is a separate word and unrelated.", "first_attested": "late 15c. for the horticultural noun; 1868 and 1871 for the surgical senses", "tier": "cited", "source": "s:etymonline-graft", "note": "In hair restoration a graft is one follicular unit, not one hair. A price per graft is a price per cluster." }, "text": { "what": "In the older surgical sense, tissue moved from one place to another and expected to take. In the hair trade — where most of this subject's graft prices come from — a graft is one follicular unit: a naturally occurring cluster of one to four hairs with its sebaceous lobules and arrector pili muscle. The unit was described histologically before it was ever sold.", "story": "Headington described the follicular unit in the Archives of Dermatology in April 1984, and the International Society of Hair Restoration Surgery quotes him in its own terminology standard: \"The follicular unit (FU) of the adult human scalp usually consists of two to four terminal follicles and one or rarely two vellus follicles, the associated sebaceous lobules, and the insertions of the arrector pili muscles of the terminal follicles.\" The society's patient page puts the same thing in trade terms: clinics remove \"natural clusters of hairs grouped in 1-4 hairs each\", with punches \"from 0.7 to 1.2 mm in size\".\n\nThat range of one to four is the whole problem with the unit as a price. The society's 2019 terminology document defines two further measures, Calculated Follicles per Graft Expected and Calculated Follicles per Graft Achieved, which exist because a graft count on its own does not say how many follicles were moved.\n\n*Inference —* the arithmetic follows from the definition. A donor area yielding three-hair units can be dissected into single-hair grafts, and the same hair then sells as three times the number. Nothing on a quotation states the follicles-per-graft figure, so two clinics quoting 4,000 grafts may be quoting hair counts that differ by a factor of two or more.", "how": "Two numbers make a graft quote readable and neither is usually published: hairs per graft, and where on the donor area the grafts came from. The society names overharvesting the donor area, or harvesting outside the safe zone, as \"an uncorrectable problem\", and it names \"the problematic rise today of unlicensed technicians (the so-called black market)\" as the risk attached to volume work.", "today": "As of 17 September 2026 every hair price on this site is recorded with the unit the seller used — per graft, per session or per package — because the three cannot be converted into one another." }, "kin": [ { "to": "fue", "as": "The technique sold by the graft, which is why the unit matters at all.", "rel": "term" }, { "to": "hair-transplant-fue", "as": "The operation this unit prices.", "rel": "procedure" }, { "to": "dhi-hair-transplant", "as": "The other technique sold in the same unit, whose prices state it no more clearly.", "rel": "procedure" }, { "to": "istanbul", "as": "Where most of the world's graft prices are quoted.", "rel": "hub" }, { "to": "package-price", "as": "The form that removes the unit altogether by selling a session instead.", "rel": "term" } ], "sources": [ "s:etymonline-graft", "s:headington-1984", "s:ishrs-fue-terminology-2019", "s:ishrs-fue-what-is-it" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "G" }, "blurb": "In the older surgical sense, tissue moved from one place to another and expected to take.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "fue", "type": "term", "name": "FUE", "as": "The technique sold by the graft, which is why the unit matters at all.", "rel": "term" }, { "to": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The operation this unit prices.", "rel": "procedure" }, { "to": "dhi-hair-transplant", "type": "procedure", "name": "Direct hair implantation (DHI)", "as": "The other technique sold in the same unit, whose prices state it no more clearly.", "rel": "procedure" }, { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "Where most of the world's graft prices are quoted.", "rel": "hub" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The form that removes the unit altogether by selling a session instead.", "rel": "term" } ], "source_list": [ { "id": "s:etymonline-graft", "kind": "dictionary", "title": "graft (n.1), graft (v.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/graft", "accessed": "2026-09-17", "note": "late 15c.; surgical sense 1871" }, { "id": "s:headington-1984", "kind": "paper", "title": "Transverse microscopic anatomy of the human scalp. A basis for a morphometric approach to disorders of the hair follicle", "publisher": "Headington JT. Archives of Dermatology 1984 Apr;120(4):449-56", "url": "https://pubmed.ncbi.nlm.nih.gov/6703750/", "accessed": "2026-09-17", "note": "citation verified through the NCBI esummary API on 17 September 2026 (PMID 6703750); the definition of the follicular unit is quoted here from the ISHRS terminology document, which reproduces it" }, { "id": "s:ishrs-fue-terminology-2019", "kind": "org", "title": "A 2019 Guide to Currently Accepted FUE and Implanter Terminology", "publisher": "International Society of Hair Restoration Surgery; dated 15 July 2019, editor Robert H. True", "url": "https://ishrs.org/wp-content/uploads/2019/08/July-15-2019-FUE-Terminology.pdf", "accessed": "2026-09-17", "note": "carries the Headington definition of the follicular unit, the 2018 renaming of FUE from extraction to excision, and the CFGE and CFGA measures" }, { "id": "s:ishrs-fue-what-is-it", "kind": "org", "title": "FUE — what is it?", "publisher": "International Society of Hair Restoration Surgery", "url": "https://ishrs.org/fue-what-is-it/", "accessed": "2026-09-17", "note": "follicular units of 1 to 4 hairs, punches 0.7 to 1.2 mm, overharvesting as an uncorrectable problem, and the society's black-market warning" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "cited" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "The other trade unit whose count decides a price, in a different trade.", "rel": "contrast" }, { "from": "dhi-hair-transplant", "type": "procedure", "name": "Direct hair implantation (DHI)", "as": "The unit both techniques are sold in, and which neither of these two prices states.", "rel": "term" }, { "from": "hair-transplant-fue", "type": "procedure", "name": "Follicular unit extraction", "as": "The unit this operation is priced in, and the one that is routinely inflated.", "rel": "term" }, { "from": "fue", "type": "term", "name": "FUE", "as": "The unit this technique is sold in, and the one whose definition decides the count.", "rel": "term" } ] }, { "id": "health-tourism", "names": { "name": "Health tourism", "aliases": [ "sağlık turizmi", "thermal tourism", "spa tourism", "curative tourism" ], "said": "Türkiye's ministry says uluslararası sağlık turizmi and means a legal category. European usage means the cure resort as much as the operating theatre." }, "region": [ "global", "west-asia", "europe-central", "europe-south" ], "etymology": { "root": "The older half of this compound comes from the spring, not the hospital. Spa is 1620s in English, from the town of Spa in eastern Belgium, known since the 14th century for its mineral springs, from Walloon espa, a spring or fountain; the sense of a commercial establishment offering health and beauty treatments arrives only by 1960. Beside it sit balneal, 1640s, from Latin balneum and Greek balaneion, a warm bath, and the German Kur, attested since the 16th century and borrowed from Latin cura, care. Health itself is Old English hælþ, wholeness, an abstract noun formed on whole rather than on heal. The category was about water long before it was about surgery, and the statistics still are.", "first_attested": "1620s for spa, 1640s for balneal, 1811 for tourism; the compound is commoner than the medical one in English books until 2005", "tier": "cited", "source": "s:etymonline-spa", "note": "Where a national figure is very large, this is usually the word behind it. A total built on this category is not a count of operations." }, "text": { "what": "The wider administrative category: travel for treatment, for a cure, for thermal and spa stays, and for the care of travellers who fall ill while abroad. States use it because it matches the ministries that share the file, and because it is the category their statistics can actually fill.", "story": "Türkiye writes it into law and defines it twice. The regulation published in the Resmî Gazete of 13 July 2017, number 30123, is the Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik — on international health tourism, and on the health of the visitor. Its Article 4 defines international health tourism as every health service, and the support services around it, received by people who come to the country temporarily for health purposes and are either not citizens or citizens resident abroad; and it defines the second head separately, as care for foreigners already in the country for any reason who fall suddenly ill or need emergency treatment. One category is the journey's purpose, the other is its accident.\n\nArticle 2 defines the category by subtraction, and that is the part worth reading. The regulation expressly excludes patients covered by social security arrangements and bilateral treaties, refugees, asylum seekers, stateless people, victims of trafficking, students, foreigners of Turkish descent, and patients brought by the state development agency. What is left after every entitlement-based route has been removed is what the word means there.\n\n*Inference —* the breadth is what makes national totals under this word unusable as counts of surgery. A country treating many visitors for minor illness, many for dental work and a few for cardiac surgery publishes one number, and the number is dominated by the cheapest category inside it.", "how": "Two sub-categories do most of the work in European usage: curative or medical travel, meaning treatment; and thermal or wellness travel, meaning the stay itself. A record on this site names which of the two a figure came from where the source says so, and says where it does not.", "today": "As of 17 September 2026 the destination records on this site carry inbound figures only with the publisher, the definition and the year attached. Where the only available figure is a health tourism total, the record says that is what it is. Whether Türkiye's 2017 regulation has since been replaced was not checked for this record." }, "kin": [ { "to": "medical-tourism", "as": "The narrower and more contested word inside this one.", "rel": "contrast" }, { "to": "wellness-travel", "as": "The other half of this category, and the half that inflates its totals.", "rel": "term" }, { "to": "turkiye", "as": "The state that made this category its unit of regulation.", "rel": "destination" }, { "to": "turkiye-health-tourism-authorisation", "as": "The certificate the category requires, on its own instrument.", "rel": "rule" }, { "to": "panchakarma", "as": "A course of treatment that sits inside this word and outside the medical one.", "rel": "procedure" }, { "to": "counting-patients", "as": "Where the arithmetic of these categories is taken apart.", "rel": "story" } ], "sources": [ "s:etymonline-spa", "s:etymonline-balneal", "s:etymonline-health", "s:wiktionary-de-kur", "s:rg-saglik-turizmi-2017", "s:ngram-naming", "s:ushas-saglik-turizmi-verileri" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "needs_verification": true, "schema": 1, "type": "term", "updated": "2026-09-17", "facets": { "letter": "H" }, "blurb": "The wider administrative category: travel for treatment, for a cure, for thermal and spa stays, and for the care of travellers who fall ill while abroad.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "west-asia", "name": "West Asia", "note": "Türkiye, Jordan, Israel, Lebanon, Iran, the Gulf" }, { "key": "europe-central", "name": "Central Europe", "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia" }, { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" } ], "kin_out": [ { "to": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The narrower and more contested word inside this one.", "rel": "contrast" }, { "to": "wellness-travel", "type": "term", "name": "Wellness travel", "as": "The other half of this category, and the half that inflates its totals.", "rel": "term" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The state that made this category its unit of regulation.", "rel": "destination" }, { "to": "turkiye-health-tourism-authorisation", "type": "rule", "name": "Türkiye's international health tourism authorisation certificate", "as": "The certificate the category requires, on its own instrument.", "rel": "rule" }, { "to": "panchakarma", "type": "procedure", "name": "Panchakarma", "as": "A course of treatment that sits inside this word and outside the medical one.", "rel": "procedure" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Where the arithmetic of these categories is taken apart.", "rel": "story" } ], "source_list": [ { "id": "s:etymonline-spa", "kind": "dictionary", "title": "spa (n.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/spa", "accessed": "2026-09-17", "note": "1620s, from the town of Spa in eastern Belgium, from Walloon espa, a spring" }, { "id": "s:etymonline-balneal", "kind": "dictionary", "title": "balneal (adj.), balneography — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/balneal", "accessed": "2026-09-17", "note": "1640s, from Latin balneum and Greek balaneion, a warm bath" }, { "id": "s:etymonline-health", "kind": "dictionary", "title": "health (n.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/health", "accessed": "2026-09-17", "note": "Old English haelth, wholeness; an abstract noun on whole, not on heal" }, { "id": "s:wiktionary-de-kur", "kind": "dictionary", "title": "Kur", "publisher": "Wiktionary (German edition)", "url": "https://de.wiktionary.org/wiki/Kur", "accessed": "2026-09-17", "note": "attested since the 16th century, borrowed from Latin cura, care; compounds Badekur, Trinkkur, Wasserkur, Luftkur" }, { "id": "s:rg-saglik-turizmi-2017", "kind": "web", "title": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik", "publisher": "Resmî Gazete, Republic of Türkiye (Ministry of Health)", "url": "https://www.resmigazete.gov.tr/eskiler/2017/07/20170713-3.htm", "accessed": "2026-09-16", "note": "Resmî Gazete 13 July 2017, No. 30123. Read in Turkish off the Resmî Gazete page. Article 5(1) makes an international health tourism authorisation certificate (yetki belgesi) compulsory for both the health facility and the intermediary; the Ministry halts the activity of anyone without one. Transitional Article 1 gave those already trading one year to comply. Article 16: in force on publication. REPEALED: MADDE 17 of the regulation of 26 April 2025 (Resmî Gazete 32882) revokes this one. Cite it for what the regime was, not for what it is." }, { "id": "s:ngram-naming", "kind": "dataset", "title": "Relative frequency of medical tourism, health tourism, medical travel and wellness tourism in the Google Books English 2019 corpus", "publisher": "Google Books Ngram Viewer", "url": "https://books.google.com/ngrams/json?content=medical+tourism,health+tourism&year_start=1970&year_end=2019&corpus=en-2019&smoothing=0", "accessed": "2026-09-17", "note": "queried directly against the JSON endpoint, smoothing 0. The crossover year is 2005. Pre-1980 non-zero values in this corpus are OCR noise and are not read as attestations" }, { "id": "s:ushas-saglik-turizmi-verileri", "kind": "gov", "title": "Sağlık Turizmi Verileri (health tourism data by year)", "publisher": "USHAŞ — Uluslararası Sağlık Hizmetleri A.Ş., the Turkish Ministry of Health's international health services company", "url": "https://ushas.gov.tr/saglik-turizmi-verileri/", "accessed": "2026-09-16", "note": "USHAŞ publishes the series it attributes to TÜİK, the Turkish statistical institute: visitors and revenue by year — 2019 756,926 and USD 1.459bn; 2020 435,691; 2021 729,592; 2022 1,381,807; 2023 1,538,643; 2024 1,506,442; 2025 1,398,580 and USD 3,022,452 thousand; first half of 2026 563,327 and USD 1.580bn. The unit is a visitor arriving with a health purpose, not an operation." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "panchakarma", "type": "procedure", "name": "Panchakarma", "as": "The wider word under which spa and cure stays are counted.", "rel": "term" }, { "from": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The older and wider administrative word, commoner in English books until 2005.", "rel": "contrast" }, { "from": "wellness-travel", "type": "term", "name": "Wellness travel", "as": "The administrative word that counts this category and surgery in one total.", "rel": "whole" }, { "from": "the-word-itself", "type": "story", "name": "The word itself", "as": "The widest category, and the one usually sitting behind a very large national figure.", "rel": "term" } ] }, { "id": "informed-consent", "names": { "name": "Informed consent", "aliases": [ "consent", "valid consent", "consent to treatment" ], "said": "Lawyers call it a doctrine. Hospitals call it a form. The two are not the same object, and abroad it is usually the form that arrives." }, "etymology": { "root": "consent, c. 1300, \"approval, voluntary acceptance of what is done or proposed\", from Old French consentir and Latin consentire, to agree or accord, literally to feel together, from com-, with, plus sentire, to feel. The qualifier is American and legal: the phrase informed consent is generally traced to Salgo v. Leland Stanford Jr. University Board of Trustees, 154 Cal. App. 2d 560, 317 P.2d 170, decided by the California Court of Appeal on 22 October 1957.", "first_attested": "c. 1300 for consent; 1957 for the phrase in an American decision", "tier": "cited", "source": "s:etymonline-consent", "note": "Feeling together is a high bar. A signature is not evidence that it happened." }, "text": { "what": "A patient's agreement to a procedure, given after being told what it involves, what it risks and what the alternatives are. It is a doctrine about a conversation, evidenced by a document, and the document travels much better than the conversation does.", "story": "The principle is older than the phrase. In Schloendorff v. Society of the New York Hospital, 211 N.Y. 125, decided on 14 April 1914, Cardozo put it as a right: every adult of sound mind decides what is done with their own body, and a surgeon operating without consent commits an assault. Research ethics reached the same place from the other direction — the Nuremberg Code of 1947 opens \"The voluntary consent of the human subject is absolutely essential\", and the World Medical Association's Declaration of Helsinki, adopted in June 1964 and amended as recently as 2024, carries it into research practice.\n\nWhat happens to the doctrine across a language barrier has been measured, in a country with interpreters on site. Schenker and colleagues found that charts of English-speaking patients at a US hospital with on-site professional interpreter services were more likely than those of patients with limited English to carry full documentation of informed consent: 53% against 28%.\n\n*Inference —* that is the floor, not the ceiling. It is what a consent process looks like where interpreters are employed, the patient can complain to a regulator, and a lawyer can be found locally. A consent signed on arrival, in a second language, hours before surgery, has none of those three.", "how": "Three things make a consent process readable from outside: whether the conversation happened before the flight or after it, whether it happened in a language the patient reads, and who was in the room when the alternatives were discussed. What a broker's website said months earlier is marketing, and is not part of it.", "today": "As of 17 September 2026 the only systematic evidence on this in the cross-border trade is content analysis of what intermediaries publish, not observation of consent conversations. Nobody audits the conversation." }, "kin": [ { "to": "arrival-and-consent", "as": "The step where the form is signed, usually the day before surgery.", "rel": "step" }, { "to": "language-consent", "as": "The risk this doctrine runs into across a language barrier.", "rel": "risk" }, { "to": "second-opinion", "as": "What the alternatives half of the doctrine actually requires.", "rel": "step" }, { "to": "getting-your-records", "as": "The file without which a receiving surgeon is consenting a patient blind.", "rel": "step" }, { "to": "malpractice-recourse", "as": "What a defective consent is worth in a forum the patient cannot reach.", "rel": "risk" }, { "to": "facilitator", "as": "The party whose website is not part of the consent, whatever it said.", "rel": "term" } ], "sources": [ "s:etymonline-consent", "s:salgo-1957", "s:schloendorff-1914", "s:nuremberg-code-bmj", "s:wma-helsinki", "s:schenker-consent-language", "s:penney-broker-consent-2011" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "I" }, "blurb": "A patient's agreement to a procedure, given after being told what it involves, what it risks and what the alternatives are.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "arrival-and-consent", "type": "pathway", "name": "Arrival and consent", "as": "The step where the form is signed, usually the day before surgery.", "rel": "step" }, { "to": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "The risk this doctrine runs into across a language barrier.", "rel": "risk" }, { "to": "second-opinion", "type": "pathway", "name": "The second opinion", "as": "What the alternatives half of the doctrine actually requires.", "rel": "step" }, { "to": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "The file without which a receiving surgeon is consenting a patient blind.", "rel": "step" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "What a defective consent is worth in a forum the patient cannot reach.", "rel": "risk" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The party whose website is not part of the consent, whatever it said.", "rel": "term" } ], "source_list": [ { "id": "s:etymonline-consent", "kind": "dictionary", "title": "consent (n.), consent (v.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/consent", "accessed": "2026-09-17", "note": "c. 1300, from Latin consentire" }, { "id": "s:salgo-1957", "kind": "law", "title": "Salgo v. Leland Stanford Jr. University Board of Trustees, 154 Cal. App. 2d 560, 317 P.2d 170 (Cal. Ct. App., 22 October 1957)", "publisher": "CourtListener, Free Law Project", "url": "https://www.courtlistener.com/opinion/2619445/salgo-v-leland-stanford-jr-university-board-of-trustees/", "accessed": "2026-09-17", "note": "case name, citations, court and filing date verified through the CourtListener search API on 17 September 2026; the opinion text itself was not read for this record" }, { "id": "s:schloendorff-1914", "kind": "law", "title": "Schloendorff v. Society of the New York Hospital, 211 N.Y. 125, 105 N.E. 92 (N.Y. Court of Appeals, 14 April 1914)", "publisher": "CourtListener, Free Law Project", "url": "https://www.courtlistener.com/opinion/3599100/schloendorff-v-society-of-the-new-york-hospital/", "accessed": "2026-09-17", "note": "citations, court and date verified through the CourtListener search API on 17 September 2026" }, { "id": "s:nuremberg-code-bmj", "kind": "web", "title": "The Nuremberg Code (1947)", "publisher": "reprinted in the BMJ, No 7070, Volume 313, page 1448, 7 December 1996", "url": "https://media.tghn.org/medialibrary/2011/04/BMJ_No_7070_Volume_313_The_Nuremberg_Code.pdf", "accessed": "2026-09-17", "note": "Principle 1 opens: The voluntary consent of the human subject is absolutely essential" }, { "id": "s:wma-helsinki", "kind": "org", "title": "WMA Declaration of Helsinki — Ethical Principles for Medical Research Involving Human Subjects", "publisher": "World Medical Association", "url": "https://www.wma.net/policies-post/wma-declaration-of-helsinki/", "accessed": "2026-09-17", "note": "adopted June 1964 at the 18th WMA General Assembly, Helsinki; most recently amended at the 75th General Assembly, Helsinki, 2024" }, { "id": "s:schenker-consent-language", "kind": "paper", "title": "The impact of language barriers on documentation of informed consent at a hospital with on-site interpreter services", "publisher": "Schenker Y, Wang F, Selig SJ, Ng R, Fernandez A. Journal of General Internal Medicine 2007;22(Suppl 2):294–9", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2078548/", "accessed": "2026-09-16", "note": "74 matched pairs, lumbar puncture, thoracentesis and paracentesis, one US public teaching hospital, January 2004 to January 2006" }, { "id": "s:penney-broker-consent-2011", "kind": "paper", "title": "Risk communication and informed consent in the medical tourism industry: a thematic content analysis of Canadian broker websites", "publisher": "BMC Medical Ethics 2011;12:17 (Penney K, Snyder J, Crooks VA, Johnston R)", "url": "https://pubmed.ncbi.nlm.nih.gov/21943392/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "assisted-dying", "type": "procedure", "name": "Assisted dying", "as": "The requirement that the person act for themselves at the end is a consent rule before it is a clinical one.", "rel": "term" }, { "from": "facelift", "type": "procedure", "name": "Facelift", "as": "The facial nerve is the risk that consent conversations turn on, and language is part of that conversation.", "rel": "term" }, { "from": "arrival-and-consent", "type": "pathway", "name": "Arrival and consent", "as": "The doctrine, and what it assumes about a shared language.", "rel": "term" }, { "from": "getting-your-records", "type": "pathway", "name": "Getting your records out", "as": "What the receiving surgeon is consenting the patient to without the file.", "rel": "term" }, { "from": "second-opinion", "type": "pathway", "name": "The second opinion", "as": "What a diagnosis reviewed once cannot fully support.", "rel": "term" }, { "from": "language-consent", "type": "risk", "name": "Consent taken across a language barrier", "as": "The word, and the doctrine behind the form being signed.", "rel": "term" }, { "from": "stem-cell-regulation", "type": "rule", "name": "Regulating cell and tissue therapies", "as": "What a patient is consenting to when the product class is unsettled.", "rel": "term" } ] }, { "id": "length-of-stay", "names": { "name": "Length of stay", "aliases": [ "LOS", "ward nights", "inpatient days", "bed days" ], "said": "Hospitals abroad quote nights. Statisticians count days. A package that says three nights is describing a plan, not a measurement." }, "etymology": { "root": "A compound of two plain words doing accounting work. Stay as a noun is 1520s, \"continuance in a place; stationary position\", from the verb, mid-15c., from Old French estai-, stem of estare, to stay or stand, from Latin stare, to stand or remain standing. Length is the quality of being long. Nothing in the phrase is medical; it names a duration somebody is paying for.", "first_attested": "1520s for the noun stay", "tier": "cited", "source": "s:etymonline-stay", "note": "Nights and days are not the same count everywhere, so the rule has to be named. The OECD counts a stay as the date of discharge minus the date of admission, which makes it a count of nights: admitted on the 25th and discharged on the 26th is one." }, "text": { "what": "How long a patient occupies a hospital bed. On a price page it is a number of nights the seller has budgeted for; in a health statistic it is a measured average across discharges. The first is a forecast and the second is a result, and the word does not distinguish them.", "story": "On a package the number is a boundary. Bumrungrad's knee package names three nights in the surgical ward and excludes \"nights beyond 3, and any ICU\"; its hip package names four. Both figures are what the hospital has priced, not what a given knee will need. A fourth night is not a complication in the clinical sense and is still a bill.\n\nThe statistical version counts something else. The OECD calculates average length of stay by dividing bed-days by discharges, counting a stay as \"the date of discharge minus the date of admission\", and excludes day cases from the measure entirely — while counting as inpatient discharges \"[p]atients admitted as day-care patients but who have been retained overnight due to complication\". The unplanned night is exactly the event that moves an episode from one category to the other.\n\n*Trade practice —* the trade quotes the stay twice over and means different things each time: nights in the ward, and then days in the country before the surgeon will sign a fitness-to-fly note. The second number is longer than the first, and it is the one that sets the hotel bill, the companion's leave and the changeable fare.\n\n*Inference —* a short published stay is also a selling point, which gives the number a direction. Nothing on a package page is audited against what the ward recorded.", "how": "Three questions make a stay figure readable: whether the quoted number is nights or days and under whose rule; what a night past the package costs and whether that rate is published; and whether intensive care sits inside the count or outside it, which it usually does.", "today": "As of 17 September 2026 the stay figures on this site's procedure records are read off sellers' package pages and are labelled as such. National averages on the OECD definition measure discharges rather than packages, and the two cannot be substituted for one another." }, "kin": [ { "to": "in-hospital", "as": "The step this number is the length of.", "rel": "step" }, { "to": "day-case", "as": "The stay of zero nights, and the category a package can quietly leave.", "rel": "contrast" }, { "to": "package-price", "as": "Where the nights are fixed, and where the night after them is priced.", "rel": "term" }, { "to": "drg", "as": "The payment unit that made short stays profitable and long ones a loss.", "rel": "term" }, { "to": "knee-replacement", "as": "The operation whose three-night package this record reads.", "rel": "procedure" }, { "to": "flying-after-surgery", "as": "The second, longer stay: days in the country before a seat is allowed.", "rel": "risk" } ], "sources": [ "s:etymonline-stay", "s:bumrungrad-joint04", "s:bumrungrad-joint08", "s:oecd-alos-metadata-2025" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "the package figures are cited; the marked stretches are the trade's account and this project's reasoning" }, "text.how": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "L" }, "blurb": "How long a patient occupies a hospital bed. On a price page it is a number of nights the seller has budgeted for; in a health statistic it is a measured average across discharges.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "in-hospital", "type": "pathway", "name": "In hospital", "as": "The step this number is the length of.", "rel": "step" }, { "to": "day-case", "type": "term", "name": "Day case", "as": "The stay of zero nights, and the category a package can quietly leave.", "rel": "contrast" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "Where the nights are fixed, and where the night after them is priced.", "rel": "term" }, { "to": "drg", "type": "term", "name": "DRG", "as": "The payment unit that made short stays profitable and long ones a loss.", "rel": "term" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The operation whose three-night package this record reads.", "rel": "procedure" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The second, longer stay: days in the country before a seat is allowed.", "rel": "risk" } ], "source_list": [ { "id": "s:etymonline-stay", "kind": "dictionary", "title": "stay (v.1), stay (n.3) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/stay", "accessed": "2026-09-17", "note": "mid-15c. / 1520s" }, { "id": "s:bumrungrad-joint04", "kind": "web", "title": "Total Knee Replacement Surgery (Exclude implant) — package JOINT04", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery", "accessed": "2026-09-16", "note": "read off the hospital's own package page; price stated valid until 31 December 2026" }, { "id": "s:bumrungrad-joint08", "kind": "web", "title": "Total Hip Replacement Surgery (Exclude implant) — package JOINT08", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/total-hip-replacement-surgery", "accessed": "2026-09-16", "note": "425,200 THB, four nights, implant excluded; price stated valid until 31 December 2026" }, { "id": "s:oecd-alos-metadata-2025", "kind": "dataset", "title": "Hospital discharges and average length of stay by diagnostic categories — definitions, sources and methods", "publisher": "OECD Health Statistics 2025", "url": "https://stats.oecd.org/wbos/fileview2.aspx?IDFile=1aac08d9-99d5-4b52-9aa8-bbc8da33454b", "accessed": "2026-09-17", "note": "ALOS is bed-days divided by discharges, counted as date of discharge minus date of admission; day cases are excluded, and a day-care patient retained overnight because of a complication is counted as an inpatient discharge" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "the package figures are cited; the marked stretches are the trade's account and this project's reasoning" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "panchakarma", "type": "procedure", "name": "Panchakarma", "as": "Here the stay is the product, not a consequence of the procedure.", "rel": "term" }, { "from": "in-hospital", "type": "pathway", "name": "In hospital", "as": "The number the package fixed and the bill counts.", "rel": "term" }, { "from": "asa-grade", "type": "term", "name": "ASA grade", "as": "The number the grade changes first.", "rel": "term" }, { "from": "day-case", "type": "term", "name": "Day case", "as": "The count this category is excluded from, and rejoins the moment a night is added.", "rel": "contrast" }, { "from": "drg", "type": "term", "name": "DRG", "as": "The number a case rate made expensive, and the reason stays shortened everywhere it arrived.", "rel": "term" } ] }, { "id": "medical-tourism", "names": { "name": "Medical tourism", "aliases": [ "health tourism", "surgical tourism", "dental tourism", "cosmetic tourism", "medical travel" ], "said": "Ministries and accreditors use it. Trade publishers have been backing away from it since 2009. Researchers write it in scare quotes. Patients, asked, say they object to it." }, "etymology": { "root": "The two halves pull against each other. Medical is 1640s, from French médical and Late Latin medicalis, from Latin medicus, from medeor, to cure or heal. Tourism is 1811, from tour plus -ism, and the Online Etymology Dictionary carries the OED's note on it: \"Orig, usually depreciatory\"; the Century Dictionary marked it rare in 1891. Behind tour, c. 1300, a turn or circuit, sits Old French torner, Latin tornare, to turn on a lathe, from tornus, a lathe, from Greek tornos, the tool for drawing circles. The agent noun is 1772. Set beside it, travel is a variant of Middle English travailen, which meant to struggle, toil or labour, and patient is from Latin patientem, bearing, supporting, suffering. One half of the compound descends from suffering and the other from a lathe.", "first_attested": "1811 for tourism, 1772 for the agent noun; the compound is in journal titles by 1997", "tier": "cited", "source": "s:etymonline-tourism", "note": "This site's own validator treats the singular agent noun as a hard error in reader-facing prose, and strips quoted spans before it checks. That is why the phrase appears on this page in quotation marks and, elsewhere on the site, only inside a quotation or a proper name." }, "text": { "what": "The most widely used name for travelling to another country to be treated, and the most argued-about. This site writes medical travel and cross-border care instead. The rule is stated here rather than left for a reader to infer from an absence.", "story": "The compound is older than the industry that wears it, and it started in two unrelated registers. In 1997 Mark Sauer used it in a title in Human Reproduction, warning that restricting donor payment would lead to it. In the same year Rod Sheaff used it in Health Policy in the opposite sense, reporting that \"the NHS has official systems to discourage 'medical tourism'\" — foreigners arriving to use a health service, in scare quotes. In 1999 a Russian paper placed it inside health-resort medicine. In 2000 the BMJ ran a letter headed that it can do harm.\n\nGoogle's book corpus puts the crossover in 2005. Until that year health tourism was the commoner phrase in English books; medical tourism overtakes it in 2005, roughly triples in 2007, and rises about a hundred and sixty-fold between 2000 and 2019 — the years the consumer guidebooks and the trade bodies appeared.\n\nThe objections are collected in one place, with page numbers, in the OECD scoping review of 2011 by Neil Lunt and colleagues, which adopts the term and then quotes three refusals of it. Irene Glinos and colleagues, writing in Health and Place in 2010: the term \"insinuates leisurely travelling and does not capture the seriousness of most patient mobility\". Andrea Whittaker in Global Public Health in 2008: it \"is a misnomer, as it carries connotations of pleasure not always associated with this travel\". Beth Kangas in Medical Anthropology in 2010: \"A term that suggests leisure and frivolity. The term promotes a market place model that disregards the suffering that patients experience\". Leigh Turner's 2012 paper in Globalization and Health is titled to the same effect and opens by calling it \"what many journalists and health researchers label\" the thing.\n\nThe patients' own objection is on the record too. Sharon Bassan and Marie Alice Michaelsen, analysing German and Israeli press coverage in 2013, report that couples travelling for fertility treatment \"do not refer to themselves as 'reproductive tourists'. They might even be offended by this term\", and that they \"do not regard themselves as tourists but instead as patients\", because the word is \"associated with fun, leisure or holidays, while they often experience their journey as highly stressful\". The same paper records Roberto Matorras, then president of the Spanish Fertility Society, arguing that the word \"may be offensive both to couples and to professionals involved in the process\".\n\n*Inference —* the naming problem is also the counting problem. A category that holds an expatriate with a chest infection, a diaspora visitor seeing a doctor at home and a person who flew for a knee will produce the very large numbers this field is known for. The Philippine Institute for Development Studies said so about its own country in 2013: \"The exact size of the market (number of medical tourists) and its revenue potential remain unclear, however, due to the absence of an agreed-upon definition of medical tourism.\"", "how": "This site's rule is mechanical and worth stating. The banned-word list in its authoring guide carries the singular noun for a person who travels for pleasure, and the validator raises a hard error on it in any reader-facing text field. Quotation marks are the escape: the checker strips quoted spans before testing, so a phrase can be reported with a speaker attached. That is the mechanism by which the two-word name of this field survives on this page and nowhere else in the site's own prose. A directory that hides its own editorial rule is worse than one that states it.", "today": "As of 17 September 2026 no single name has won. Ministries and accreditors use this one, trade publishers use medical travel, the fertility literature uses cross border reproductive care, and the European Union uses patient mobility. This site reports which body uses which word on that body's own record, and never corrects a speaker's word inside a quotation.", "notes": "This record reports an argument about a word. It takes no view on who is right and tells no reader what to call anything." }, "kin": [ { "to": "medical-travel", "as": "The name this site uses instead, and the one the trade drifted to.", "rel": "contrast" }, { "to": "health-tourism", "as": "The older and wider administrative word, commoner in English books until 2005.", "rel": "contrast" }, { "to": "reproductive-exile", "as": "The counter-word, proposed from inside fertility medicine, and the sharpest objection on the record.", "rel": "contrast" }, { "to": "circumvention-travel", "as": "The part of the traffic a prohibition at home explains, named separately in the legal literature.", "rel": "term" }, { "to": "patient-mobility", "as": "The European administrative word for the same movement, with a directive behind it.", "rel": "term" }, { "to": "medical-tourism-association", "as": "The trade body that put this word in its own name in 2007.", "rel": "org" }, { "to": "imtj", "as": "The trade publisher that chose the other two words.", "rel": "org" }, { "to": "philippines", "as": "Where a government research body said the count fails for want of a definition.", "rel": "destination" }, { "to": "counting-patients", "as": "What a category this wide does to a national figure.", "rel": "story" } ], "sources": [ "s:etymonline-tourism", "s:etymonline-tourist", "s:etymonline-medical", "s:etymonline-travel", "s:etymonline-patient", "s:sauer-1997", "s:sheaff-1997", "s:bishop-litch-2000", "s:ngram-naming", "s:oecd-lunt-scoping-2011", "s:turner-beyond-2012", "s:bassan-michaelsen-2013", "s:pids-medical-tourism-2013", "s:cdc-yellowbook-medical-tourism", "s:mta-about", "s:imtj-wikipedia" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "the Glinos, Whittaker and Kangas quotations are verified as quoted, with page numbers, in the OECD review, not against the paywalled originals; the book-corpus figures are harvested from Google's Ngram JSON endpoint" }, "text.how": { "tier": "field", "note": "read off this project's own AUTHORING.txt and tools/validate.py on 17 September 2026; no external source" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "M" }, "blurb": "The most widely used name for travelling to another country to be treated, and the most argued-about. This site writes medical travel and cross-border care instead.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "medical-travel", "type": "term", "name": "Medical travel", "as": "The name this site uses instead, and the one the trade drifted to.", "rel": "contrast" }, { "to": "health-tourism", "type": "term", "name": "Health tourism", "as": "The older and wider administrative word, commoner in English books until 2005.", "rel": "contrast" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The counter-word, proposed from inside fertility medicine, and the sharpest objection on the record.", "rel": "contrast" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The part of the traffic a prohibition at home explains, named separately in the legal literature.", "rel": "term" }, { "to": "patient-mobility", "type": "term", "name": "Patient mobility", "as": "The European administrative word for the same movement, with a directive behind it.", "rel": "term" }, { "to": "medical-tourism-association", "type": "org", "name": "Medical Tourism Association", "as": "The trade body that put this word in its own name in 2007.", "rel": "org" }, { "to": "imtj", "type": "org", "name": "International Medical Travel Journal", "as": "The trade publisher that chose the other two words.", "rel": "org" }, { "to": "philippines", "type": "destination", "name": "Philippines", "as": "Where a government research body said the count fails for want of a definition.", "rel": "destination" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "What a category this wide does to a national figure.", "rel": "story" } ], "source_list": [ { "id": "s:etymonline-tourism", "kind": "dictionary", "title": "tourism (n.), tour (n.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/tourism", "accessed": "2026-09-17", "note": "1811 / c. 1300" }, { "id": "s:etymonline-tourist", "kind": "dictionary", "title": "tourist (n.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/tourist", "accessed": "2026-09-17", "note": "1772" }, { "id": "s:etymonline-medical", "kind": "dictionary", "title": "medical (adj.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/medical", "accessed": "2026-09-17", "note": "1640s, from Late Latin medicalis, from Latin medicus" }, { "id": "s:etymonline-travel", "kind": "dictionary", "title": "travel (v.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/travel", "accessed": "2026-09-17", "note": "late 14c., a variant of travailen, to struggle, toil, labour" }, { "id": "s:etymonline-patient", "kind": "dictionary", "title": "patient (n.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/patient", "accessed": "2026-09-17", "note": "late 14c., from Latin patientem, bearing, supporting, suffering" }, { "id": "s:sauer-1997", "kind": "paper", "title": "Reproductive prohibition: restricting donor payment will lead to medical tourism", "publisher": "Sauer MV. Human Reproduction 1997;12(9):1844-5", "url": "https://pubmed.ncbi.nlm.nih.gov/9363693/", "accessed": "2026-09-17", "note": "the earliest journal title carrying the compound that this project verified, through the NCBI eutils API (PMID 9363693)" }, { "id": "s:sheaff-1997", "kind": "paper", "title": "Healthcare access and mobility between the UK and other European Union states: an 'implementation surplus'", "publisher": "Sheaff R. Health Policy 1997;42(3):239-53", "url": "https://pubmed.ncbi.nlm.nih.gov/10176303/", "accessed": "2026-09-17", "note": "the same phrase in the older, gatekeeping sense, in scare quotes in the abstract (PMID 10176303)" }, { "id": "s:bishop-litch-2000", "kind": "paper", "title": "Medical tourism can do harm", "publisher": "Bishop R, Litch JA. BMJ 2000;320(7240):1017", "url": "https://pubmed.ncbi.nlm.nih.gov/10753174/", "accessed": "2026-09-17" }, { "id": "s:ngram-naming", "kind": "dataset", "title": "Relative frequency of medical tourism, health tourism, medical travel and wellness tourism in the Google Books English 2019 corpus", "publisher": "Google Books Ngram Viewer", "url": "https://books.google.com/ngrams/json?content=medical+tourism,health+tourism&year_start=1970&year_end=2019&corpus=en-2019&smoothing=0", "accessed": "2026-09-17", "note": "queried directly against the JSON endpoint, smoothing 0. The crossover year is 2005. Pre-1980 non-zero values in this corpus are OCR noise and are not read as attestations" }, { "id": "s:oecd-lunt-scoping-2011", "kind": "report", "title": "Medical Tourism: Treatments, Markets and Health System Implications — a scoping review, DELSA/HEA/WD/HWP(2011)3", "publisher": "Lunt N, Smith R, Exworthy M, Green ST, Horsfall D, Mannion R; OECD Directorate for Employment, Labour and Social Affairs", "url": "https://www.birmingham.ac.uk/documents/college-social-sciences/social-policy/hsmc/publications/2011/medical-tourism-scoping-review.pdf", "accessed": "2026-09-17", "note": "page 8 collects the objections to the term and quotes Glinos et al. (Health and Place 2010;16(6):1145-55), Whittaker (Global Public Health 2008;3(3):271-90, at 272) and Kangas (Medical Anthropology 2010;29(4):344-62, at 350). Those three quotations are verified as quoted here, not against the paywalled originals; the OECD text mis-dates Glinos as 2011 in the body and 2010 in its reference list. The oecd.org copy returns 403; this university mirror was read in full" }, { "id": "s:turner-beyond-2012", "kind": "paper", "title": "Beyond 'medical tourism': Canadian companies marketing medical travel", "publisher": "Turner L. Globalization and Health 2012;8:16", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC3503750/", "accessed": "2026-09-17", "note": "full text read; DOI 10.1186/1744-8603-8-16, PMID 22703873" }, { "id": "s:bassan-michaelsen-2013", "kind": "paper", "title": "Honeymoon, medical treatment or big business? An analysis of the meanings of the term 'reproductive tourism' in German and Israeli public media discourses", "publisher": "Bassan S, Michaelsen MA. Philosophy, Ethics, and Humanities in Medicine 2013;8:9", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC3854005/", "accessed": "2026-09-17", "note": "CC BY, full text read; carries the patients' objection, Matorras's ground and Pennings's counter-argument, all at one remove from the paywalled letters" }, { "id": "s:pids-medical-tourism-2013", "kind": "paper", "title": "Health-enhancing holidays: challenges in expanding medical tourism in the Philippines", "publisher": "Philippine Institute for Development Studies, Policy Notes No. 2013-11", "url": "https://pidswebs.pids.gov.ph/CDN/PUBLICATIONS/pidspn1311.pdf", "accessed": "2026-09-16", "note": "Oscar F. Picazo, October 2013, ISSN 1656-5266" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:mta-about", "kind": "org", "title": "About MTA", "publisher": "Medical Tourism Association", "url": "https://www.medicaltourismassociation.com/about-us", "accessed": "2026-09-16", "note": "founded 2007, non-profit, West Palm Beach, Florida; describes government, provider and insurer members" }, { "id": "s:imtj-wikipedia", "kind": "wikipedia", "title": "International Medical Travel Journal", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/International_Medical_Travel_Journal", "accessed": "2026-09-16", "note": "established 2007, UK trade publication, biweekly newsletter, Keith Pollard as editor in chief, annual Medical Travel Awards; imtj.com refused every fetch on this date" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "the Glinos, Whittaker and Kangas quotations are verified as quoted, with page numbers, in the OECD review, not against the paywalled originals; the book-corpus figures are harvested from Google's Ngram JSON endpoint" }, "text.how": { "tier": "field", "note": "read off this project's own AUTHORING.txt and tools/validate.py on 17 September 2026; no external source" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "medical-tourism-association", "type": "org", "name": "Medical Tourism Association", "as": "The word it put in its own name, and the fight over that word.", "rel": "term" }, { "from": "john-connell", "type": "person", "name": "John Connell", "as": "The word in his title, used academically before the trade contested it.", "rel": "term" }, { "from": "josef-woodman", "type": "person", "name": "Josef Woodman", "as": "The word in his title, and the fight over it.", "rel": "term" }, { "from": "istanbul-declaration-2008", "type": "event", "name": "The Declaration of Istanbul, 2008", "as": "The contested word — here attached, by a profession, to a specific practice it wanted stopped.", "rel": "term" }, { "from": "ndm-1-2010", "type": "event", "name": "NDM-1, 2010", "as": "The word the ministry used in its reply, and the fight over it in miniature.", "rel": "term" }, { "from": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The wider contested name, and the page where the argument over it is held.", "rel": "term" }, { "from": "health-tourism", "type": "term", "name": "Health tourism", "as": "The narrower and more contested word inside this one.", "rel": "contrast" }, { "from": "medical-travel", "type": "term", "name": "Medical travel", "as": "The word this one replaced, and the page where the fight over it is held.", "rel": "contrast" }, { "from": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The word this one was coined against.", "rel": "contrast" }, { "from": "world-bank-tourism-arrivals", "type": "dataset", "name": "International arrivals", "as": "The word whose market-size claims are built on numbers of this shape.", "rel": "term" }, { "from": "the-word-itself", "type": "story", "name": "The word itself", "as": "The word's own page, where the fight over it is the subject and the objections are quoted with their speakers.", "rel": "term" } ] }, { "id": "medical-travel", "names": { "name": "Medical travel", "aliases": [ "cross-border care", "cross-border healthcare", "treatment abroad", "international patient services" ], "said": "The trade's preferred substitute since about 2009. Hospitals put it, or international patient services, on the department that answers foreign enquiries." }, "etymology": { "root": "Plain English chosen against a loaded compound, and duller only on the surface. Travel is a late 14th-century variant of Middle English travailen, from 1300, which meant to struggle, toil or labour; the Online Etymology Dictionary suggests the journey sense came \"via the notion of 'go on a difficult journey.'\" The word this trade reached for as its neutral option is built on hardship, which is closer to the thing than the word it replaced.", "first_attested": "late 14c. for travel; the compound is the trade's preference from about 2009", "tier": "cited", "source": "s:etymonline-travel", "note": "The substitution is not neutral either. Travel drops the leisure claim and keeps the assumption that the journey was chosen, which is the assumption the exile literature disputes." }, "text": { "what": "Travelling from one country to another to be treated. It is the name this site uses throughout, alongside cross-border care, and the name the trade itself has moved towards over twenty years.", "story": "The drift is legible on the cover of one book. Josef Woodman's guide was published in March 2007 as \"Everybody's Guide to Affordable, World-Class Medical Tourism\". The cataloguing record for the 2011 edition reads \"Everybody's Guide to Affordable, World-Class Medical Travel\"; the 2012 and 2013 editions read \"Everybody's Guide to Affordable, World-Class Healthcare\"; the 2015 edition returns to medical travel. Three names on one book by one author inside eight years.\n\nA trade author wrote the reason down in 2009. Jeff Schult, who had published his own guide in 2006 with the other word in its title: \"I don't know anyone who likes to refer to 'Medical Tourism' as 'Medical Tourism.'\" and \"Increasingly, people in the business prefer the reference 'medical travel,' which doesn't have the assumed frivolity of 'tourism' as baggage.\"\n\nThe academic version of the same retreat is Leigh Turner's 2012 paper in Globalization and Health, whose finding is that the firms themselves do not fit the older label: \"During the search process it became apparent that many Canadian business promoting medical travel are not medical tourism companies.\"\n\n*Inference —* the substitution buys precision and costs a directory nothing. It covers the patient who flew for an operation, the patient sent by a state scheme and the patient who crossed a land border for a filling, without asserting a motive for any of them.", "how": "On this site the two names do specific work. Medical travel is the general term. Cross-border care appears where a payer, a directive or a statistical series is in view, because that is the phrase those instruments use. Neither is used inside a quotation, where the speaker's own word stands.", "today": "As of 17 September 2026 the subtitle sequence above rests on a single crowd-sourced cataloguing source and is carried here as such. The field has no agreed name, and this site claims only to state the one it uses." }, "kin": [ { "to": "medical-tourism", "as": "The word this one replaced, and the page where the fight over it is held.", "rel": "contrast" }, { "to": "patient-mobility", "as": "The administrative version, for patients moving inside a reimbursement scheme.", "rel": "term" }, { "to": "imtj", "as": "The trade publisher that took these two words as its title.", "rel": "org" }, { "to": "deciding-whether", "as": "The step where a reader first meets the thing this word names.", "rel": "step" }, { "to": "facilitator", "as": "The commercial layer that grew up inside this traffic.", "rel": "term" }, { "to": "bumrungrad", "as": "A hospital whose foreign-patient services are named in these terms rather than the other.", "rel": "facility" } ], "sources": [ "s:etymonline-travel", "s:openlibrary-pbb-editions", "s:openlibrary-pbb", "s:schult-origins-2009", "s:turner-beyond-2012", "s:imtj-wikipedia" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "source": "s:openlibrary-pbb-editions", "note": "the subtitle sequence comes from one crowd-sourced catalogue and was not confirmed against a second" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "medium", "needs_verification": true, "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "M" }, "blurb": "Travelling from one country to another to be treated. It is the name this site uses throughout, alongside cross-border care, and the name the trade itself has moved towards over twenty years.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The word this one replaced, and the page where the fight over it is held.", "rel": "contrast" }, { "to": "patient-mobility", "type": "term", "name": "Patient mobility", "as": "The administrative version, for patients moving inside a reimbursement scheme.", "rel": "term" }, { "to": "imtj", "type": "org", "name": "International Medical Travel Journal", "as": "The trade publisher that took these two words as its title.", "rel": "org" }, { "to": "deciding-whether", "type": "pathway", "name": "Deciding whether to go", "as": "The step where a reader first meets the thing this word names.", "rel": "step" }, { "to": "facilitator", "type": "term", "name": "Facilitator", "as": "The commercial layer that grew up inside this traffic.", "rel": "term" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "A hospital whose foreign-patient services are named in these terms rather than the other.", "rel": "facility" } ], "source_list": [ { "id": "s:etymonline-travel", "kind": "dictionary", "title": "travel (v.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/travel", "accessed": "2026-09-17", "note": "late 14c., a variant of travailen, to struggle, toil, labour" }, { "id": "s:openlibrary-pbb-editions", "kind": "catalogue", "title": "Patients Beyond Borders — edition records showing the subtitle changing across printings", "publisher": "Open Library", "url": "https://openlibrary.org/works/OL9228481W/editions.json", "accessed": "2026-09-17", "note": "first edition 12 March 2007 with medical tourism in the subtitle; 2011 with medical travel; 2012 and 2013 with healthcare; 2015 with medical travel again. One crowd-sourced cataloguing source, not confirmed against a second" }, { "id": "s:openlibrary-pbb", "kind": "catalogue", "title": "Patients Beyond Borders — Josef Woodman, Healthy Travel Media", "publisher": "Open Library", "url": "https://openlibrary.org/works/OL9228481W", "accessed": "2026-09-16", "note": "first publication year 2007; the author record /authors/OL3288597A carries thirteen works" }, { "id": "s:schult-origins-2009", "kind": "web", "title": "Origins of the Term 'Medical Tourism', 23 October 2009", "publisher": "Jeff Schult, beautyfromafar.com (author of Beauty from Afar, 2006)", "url": "https://beautyfromafar.com/2009/10/23/origins-of-the-term-medical-tourism/", "accessed": "2026-09-17", "note": "a trade author stating the drift as it happened; his own 2006 book title still used the other word" }, { "id": "s:turner-beyond-2012", "kind": "paper", "title": "Beyond 'medical tourism': Canadian companies marketing medical travel", "publisher": "Turner L. Globalization and Health 2012;8:16", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC3503750/", "accessed": "2026-09-17", "note": "full text read; DOI 10.1186/1744-8603-8-16, PMID 22703873" }, { "id": "s:imtj-wikipedia", "kind": "wikipedia", "title": "International Medical Travel Journal", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/International_Medical_Travel_Journal", "accessed": "2026-09-16", "note": "established 2007, UK trade publication, biweekly newsletter, Keith Pollard as editor in chief, annual Medical Travel Awards; imtj.com refused every fetch on this date" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "source": "s:openlibrary-pbb-editions", "note": "the subtitle sequence comes from one crowd-sourced catalogue and was not confirmed against a second" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "united-states", "type": "destination", "name": "United States", "as": "The word this site uses, and the argument over what to call the thing.", "rel": "term" }, { "from": "gamma-knife", "type": "procedure", "name": "Gamma knife radiosurgery", "as": "The plain name this directory uses for what a patient does to reach a machine in another country.", "rel": "term" }, { "from": "deciding-whether", "type": "pathway", "name": "Deciding whether to go", "as": "The name this site uses for what is being decided.", "rel": "term" }, { "from": "imtj", "type": "org", "name": "International Medical Travel Journal", "as": "The two words it put in its title, in preference to the other two.", "rel": "term" }, { "from": "keith-pollard", "type": "person", "name": "Keith Pollard", "as": "The two words his journal put in its title, and the ones he uses.", "rel": "term" }, { "from": "facilitator", "type": "term", "name": "Facilitator", "as": "The wider name for the traffic these firms sit inside.", "rel": "term" }, { "from": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The name this site uses instead, and the one the trade drifted to.", "rel": "contrast" }, { "from": "patient-mobility", "type": "term", "name": "Patient mobility", "as": "The wider name for the same movement outside any reimbursement scheme.", "rel": "contrast" }, { "from": "wellness-travel", "type": "term", "name": "Wellness travel", "as": "The traffic this one is routinely added to, and should not be.", "rel": "contrast" }, { "from": "the-word-itself", "type": "story", "name": "The word itself", "as": "The name this site uses, and the trade's own substitute since about 2009.", "rel": "term" } ] }, { "id": "medical-visa", "names": { "name": "Medical visa", "aliases": [ "treatment visa", "e-Medical Visa", "medical attendant visa", "health visa" ], "said": "States that issue one name it plainly. States that do not leave the patient to enter as a visitor, and the trip then leaves no trace in any count." }, "etymology": { "root": "visa, 1831, an official endorsement on a passport that the document has been examined and found correct, from French visa, from Modern Latin charta visa, \"verified paper\", literally paper that has been seen, from the feminine past participle of Latin videre, to see. It displaced the earlier visé, 1810. The word means somebody looked at the document, which is all a visa has ever promised.", "first_attested": "1831 in English", "tier": "cited", "source": "s:etymonline-visa", "note": "A medical class ties the stay to a named hospital's letter. That makes the purpose of the journey a matter of record, which cuts both ways." }, "text": { "what": "An entry permission issued for treatment. Some states run a dedicated class that names the hospital and admits a companion; others treat a patient arriving for surgery as an ordinary visitor. Which applies decides how long the patient may stay, whether anyone may come with them, and whether the journey appears in any official figure.", "story": "India's scheme states what a government thinks a treatment trip needs. The e-Medical Visa runs \"One year (365 days) from the date of arrival into India\" with multiple entries, and requires a \"Copy of Letter from the Hospital concerned in India on its letterhead which including the date / tentative date which admission have been suggested\". Beside it sits the e-Medical Attendant Visa, and the rule is arithmetic: \"Only two e-Medical Attendant Visas will be granted against one e-Medical Visa (patient)\".\n\nEurope takes the other route. A patient travelling into the Schengen area for treatment applies under the general short-stay conditions of the Visa Code, Regulation (EC) No 810/2009: Article 14 sets the supporting documents — purpose of journey, accommodation, means of subsistence, and information allowing an assessment of the intention to leave — and Article 15 sets the travel medical insurance minimum. The treatment is a purpose of journey, not a class of its own.\n\n*Inference —* where no medical class exists the trip is invisible to migration statistics, which is one reason the counts of who travels for care are as poor as they are.", "how": "A medical class typically wants the hospital's letter, evidence of funds and a return ticket, and typically runs from a date fixed weeks ahead. Treatment dates move; visa validity does not move with them. A change of provider after arrival is then a paperwork problem as well as a clinical one.", "today": "As of 17 September 2026 the visa classes that name treatment are held on individual rule records on this site, each naming its own instrument and date. The Indian classes described here are read off the Government of India's own e-Visa page." }, "kin": [ { "to": "the-visa", "as": "The step in the journey where this class is applied for.", "rel": "step" }, { "to": "india-e-medical-visa", "as": "The instrument behind the class this record reads, with its own dates.", "rel": "rule" }, { "to": "schengen-medical-visa", "as": "The other shape: general short-stay conditions applied to a treatment journey.", "rel": "rule" }, { "to": "the-companion", "as": "The person a medical class does or does not admit — India grants two.", "rel": "step" }, { "to": "circumvention-travel", "as": "Why a visa that records the purpose of a journey matters where the treatment is lawful there and not at home.", "rel": "term" }, { "to": "patient-mobility", "as": "The scheme where no visa is needed at all, because the border is already open.", "rel": "contrast" } ], "sources": [ "s:etymonline-visa", "s:india-emedical-visa", "s:eu-visa-code-810-2009" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "M" }, "blurb": "An entry permission issued for treatment. Some states run a dedicated class that names the hospital and admits a companion; others treat a patient arriving for surgery as an ordinary visitor.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "the-visa", "type": "pathway", "name": "The visa", "as": "The step in the journey where this class is applied for.", "rel": "step" }, { "to": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The instrument behind the class this record reads, with its own dates.", "rel": "rule" }, { "to": "schengen-medical-visa", "type": "rule", "name": "The Schengen visa, for treatment", "as": "The other shape: general short-stay conditions applied to a treatment journey.", "rel": "rule" }, { "to": "the-companion", "type": "pathway", "name": "The companion", "as": "The person a medical class does or does not admit — India grants two.", "rel": "step" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "Why a visa that records the purpose of a journey matters where the treatment is lawful there and not at home.", "rel": "term" }, { "to": "patient-mobility", "type": "term", "name": "Patient mobility", "as": "The scheme where no visa is needed at all, because the border is already open.", "rel": "contrast" } ], "source_list": [ { "id": "s:etymonline-visa", "kind": "dictionary", "title": "visa (n.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/visa", "accessed": "2026-09-17", "note": "1831, from French visa, Modern Latin charta visa" }, { "id": "s:india-emedical-visa", "kind": "web", "title": "e-Visa — e-Medical Visa and e-Medical Attendant Visa", "publisher": "Bureau of Immigration, Ministry of Home Affairs, Government of India", "url": "https://indianvisaonline.gov.in/evisa/tvoa.html", "accessed": "2026-09-16", "note": "one year from arrival, multiple entries, hospital letter on letterhead, two attendant visas per patient" }, { "id": "s:eu-visa-code-810-2009", "kind": "statute", "title": "Regulation (EC) No 810/2009 establishing a Community Code on Visas, Articles 14 and 15", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/eur/2009/810/article/15", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "liver-transplant", "type": "procedure", "name": "Liver transplant", "as": "The document the hospital that published this price offers to write a letter for.", "rel": "rule" }, { "from": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "The word this class is the clearest example of.", "rel": "term" }, { "from": "thai-medical-visa", "type": "rule", "name": "Thailand's medical treatment visa", "as": "The word, and what it does and does not name here.", "rel": "term" } ] }, { "id": "out-of-pocket", "names": { "name": "Out-of-pocket", "aliases": [ "OOP", "self-pay", "direct payment", "out-of-pocket expenditure" ], "said": "Health economists say out-of-pocket expenditure and mean a national share. Clinics say self-pay and mean this patient, today, by card." }, "etymology": { "root": "pocket is mid-14c. pokete, a small bag or pouch, from Anglo-French pokete, a diminutive of Old North French poque; by the early 18th century the word stands in for a person's money. The idiom itself is older than that sense: \"out of pocket\", to expend or lose money, is attested from the 1690s. The phrase has always meant money gone, not money budgeted.", "first_attested": "1690s for the idiom; mid-14c. for the noun", "tier": "cited", "source": "s:etymonline-pocket", "note": "Out-of-pocket means paid by the household directly to the provider. Anything a payer refunds afterwards stops being out-of-pocket, which is why a reimbursement scheme and a cash payment look identical at the counter and different in the statistics." }, "text": { "what": "Money a household hands to a provider itself, rather than through a tax, a premium or a pooled fund. It is how nearly every price on this site is actually paid, and it is the one payment form with no gatekeeper, no appeal and no ceiling.", "story": "The World Bank series that measures it, SH.XPD.OOPC.CH.ZS, defines it in one line: \"Share of out-of-pocket payments of total current health expenditures. Out-of-pocket payments are spending on health directly out-of-pocket by households.\" It is compiled from the WHO Global Health Expenditure Database, most recently updated on 12 December 2025. What that series does not separate is why the money left the household — a high share can mean a weak public system, a large private sector, or a country where people pay cash for care that is free to somebody else.\n\nThe American cap illustrates the trap in the word. A plan's out-of-pocket maximum is \"the most you have to pay for covered services in a plan year\", and four things sit outside it: \"Your monthly premiums\"; \"Anything you spend for services your plan doesn't cover\"; \"Out-of-network care and services\"; and \"Costs above the allowed amount for a service that a provider may charge\". A ceiling on covered, in-network spending is not a ceiling on spending.\n\n*Inference —* a hospital in another country is by definition out-of-network and usually not a covered service, so the whole of a foreign bill falls outside an American out-of-pocket maximum. Crossing a border converts a capped exposure into an uncapped one.", "how": "Three payments in this journey are almost always out-of-pocket wherever the patient lives: the deposit, the items on the package's exclusion list, and anything a complication adds after discharge. A reimbursement route can put some of it back later, and the patient carries the money in the meantime.", "today": "As of 17 September 2026 the out-of-pocket share by country is published annually through the WHO database the World Bank republishes. No series anywhere separates out what residents of one country pay to providers in another, which is the flow this site is about." }, "kin": [ { "to": "co-payment", "as": "The share a payer fixes in advance, and the only part of out-of-pocket spending anybody plans for.", "rel": "term" }, { "to": "the-deposit", "as": "The first out-of-pocket payment in almost every trip for treatment.", "rel": "step" }, { "to": "tariff", "as": "What a payer will refund, and the gap that becomes this.", "rel": "term" }, { "to": "prior-authorisation", "as": "The gate that decides whether a bill is covered at all, and so whether it lands here.", "rel": "term" }, { "to": "world-bank-health-spending", "as": "The companion series: what a country spends per person, beside how much of it households pay directly.", "rel": "dataset" }, { "to": "package-price", "as": "The form of price this money usually buys.", "rel": "term" } ], "sources": [ "s:etymonline-pocket", "s:worldbank-oop-indicator", "s:healthcare-gov-oop-max" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "O" }, "blurb": "Money a household hands to a provider itself, rather than through a tax, a premium or a pooled fund.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "co-payment", "type": "term", "name": "Co-payment", "as": "The share a payer fixes in advance, and the only part of out-of-pocket spending anybody plans for.", "rel": "term" }, { "to": "the-deposit", "type": "pathway", "name": "The deposit", "as": "The first out-of-pocket payment in almost every trip for treatment.", "rel": "step" }, { "to": "tariff", "type": "term", "name": "Tariff", "as": "What a payer will refund, and the gap that becomes this.", "rel": "term" }, { "to": "prior-authorisation", "type": "term", "name": "Prior authorisation", "as": "The gate that decides whether a bill is covered at all, and so whether it lands here.", "rel": "term" }, { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "The companion series: what a country spends per person, beside how much of it households pay directly.", "rel": "dataset" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The form of price this money usually buys.", "rel": "term" } ], "source_list": [ { "id": "s:etymonline-pocket", "kind": "dictionary", "title": "pocket (n.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/pocket", "accessed": "2026-09-17", "note": "mid-14c.; the idiom out of pocket from the 1690s" }, { "id": "s:worldbank-oop-indicator", "kind": "dataset", "title": "Out-of-pocket expenditure (% of current health expenditure), indicator SH.XPD.OOPC.CH.ZS", "publisher": "World Bank Open Data, from the WHO Global Health Expenditure Database", "url": "https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS", "api": "https://api.worldbank.org/v2/indicator/SH.XPD.OOPC.CH.ZS?format=json", "accessed": "2026-09-17", "note": "definition and the source database read off the World Bank indicator API on 17 September 2026; the API records the WHO database as updated 12 December 2025" }, { "id": "s:healthcare-gov-oop-max", "kind": "gov", "title": "Out-of-pocket maximum/limit — glossary", "publisher": "HealthCare.gov, US Centers for Medicare & Medicaid Services", "url": "https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/", "accessed": "2026-09-17" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "egg-freezing", "type": "procedure", "name": "Egg freezing", "as": "How this treatment is paid for almost everywhere, since few payers cover it without a medical indication.", "rel": "term" }, { "from": "the-deposit", "type": "pathway", "name": "The deposit", "as": "What almost every payment in this journey is.", "rel": "term" }, { "from": "us-medicare-abroad", "type": "rule", "name": "Medicare outside the United States", "as": "What a US patient abroad is, in one word.", "rel": "term" }, { "from": "co-payment", "type": "term", "name": "Co-payment", "as": "The wider category this sits inside, and the only part of it a payer has agreed to in advance.", "rel": "term" }, { "from": "prior-authorisation", "type": "term", "name": "Prior authorisation", "as": "What a bill becomes when this gate is closed, or when it never applied.", "rel": "term" }, { "from": "repatriation", "type": "term", "name": "Repatriation", "as": "What the bill becomes where the policy does not answer.", "rel": "term" }, { "from": "tariff", "type": "term", "name": "Tariff", "as": "What the gap between a tariff and a bill becomes.", "rel": "term" }, { "from": "world-bank-out-of-pocket", "type": "dataset", "name": "Out-of-pocket share of health spending", "as": "The word, and what the accounts mean by it.", "rel": "term" } ] }, { "id": "package-price", "names": { "name": "Package price", "aliases": [ "package", "all-inclusive package", "fixed-price package", "surgery package" ], "said": "Hospitals say package. Brokers say all-inclusive. Neither phrase is defined by anybody except the party selling it." }, "etymology": { "root": "package is pack plus the noun suffix -age, 1530s, and first meant the act of packing; the sense of a bundle or a quantity pressed together follows in 1722. The commercial compound arrives much later — the Online Etymology Dictionary dates package deal, \"transaction agreed to as a whole\", to 1952 — so the word this trade prices in comes from post-war selling, not from medicine.", "first_attested": "1722 for the bundle sense; 1952 for package deal", "tier": "cited", "source": "s:etymonline-package", "note": "A package is a list, not a total. Items left off the list are billed at the ordinary rate." }, "text": { "what": "One figure covering a named list of items for one episode of treatment: theatre time, a surgeon, an anaesthetist, a stated number of nights. It is the form almost every price on this site takes. Its meaning sits entirely in the two lists the seller publishes beside it — what the figure covers and what it does not.", "story": "Read one and the shape is plain. Bumrungrad's total knee replacement package, JOINT04, read on 16 September 2026, buys three hours of theatre, the nursing and surgical team within those three hours, three nights on the surgical ward, equipment and supplies, medications related to the procedure, the surgeon, an assistant surgeon if needed, and the anaesthesiologist. Its exclusion list is longer: the implant, the first consultation and the follow-up visits, specialist consultations, nights beyond three and any intensive care, blood transfusion, laboratory and imaging before or after surgery, take-home medication, outpatient charges before admission, and complex or emergency cases. The package name itself carries the word — exclude implant.\n\nA package can also be the instrument that hides a unit. Estenove in Istanbul prices hair restoration at 3,395, 4,595 and 6,595 euro for what it calls the maximum number of grafts, and states that it does not price per graft. One seller's package removes the unit of comparison; another seller's package removes the largest line on the bill.\n\n*Inference —* a package price is therefore comparable only against a package with the same list. A joint package that excludes the implant and one that includes it are two different objects wearing the same word, and the gap between them is not a discount.", "how": "Four things decide what a package figure means: whether the stated nights are a floor or a ceiling and what night N+1 costs; whether the price has an expiry date on the page; whether a complication is inside the package, outside it, or covered by a separate undertaking with its own duration; and whether the implant, prosthesis or device is a line of its own.", "today": "As of 17 September 2026 every price on this site that carries the kind package is read off a seller's own page with its date, its inclusion list and its exclusion list beside it. No regulator anywhere requires a common inclusion list, which is why two packages for the same operation cannot be subtracted from one another." }, "kin": [ { "to": "bundled-payment", "as": "The payer's version of the same idea: one price for an episode, set by an insurer instead of by a seller.", "rel": "contrast" }, { "to": "case-rate", "as": "The trade term for the flat fee a package is built out of.", "rel": "term" }, { "to": "reading-the-exclusions", "as": "The step in the journey where this form of price is actually read.", "rel": "step" }, { "to": "implant-excluded", "as": "The commonest missing line, and the reason two package prices are not comparable.", "rel": "risk" }, { "to": "getting-a-quote", "as": "Where a package number is first put in front of a patient.", "rel": "step" }, { "to": "knee-replacement", "as": "The operation whose package this record reads, implant excluded.", "rel": "procedure" } ], "sources": [ "s:etymonline-package", "s:bumrungrad-joint04", "s:estenove-cost" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "inference", "note": "the four questions are this project's, drawn from the exclusion lists it has read" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "P" }, "blurb": "One figure covering a named list of items for one episode of treatment: theatre time, a surgeon, an anaesthetist, a stated number of nights. It is the form almost every price on this site takes.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "bundled-payment", "type": "term", "name": "Bundled payment", "as": "The payer's version of the same idea: one price for an episode, set by an insurer instead of by a seller.", "rel": "contrast" }, { "to": "case-rate", "type": "term", "name": "Case rate", "as": "The trade term for the flat fee a package is built out of.", "rel": "term" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step in the journey where this form of price is actually read.", "rel": "step" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The commonest missing line, and the reason two package prices are not comparable.", "rel": "risk" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "Where a package number is first put in front of a patient.", "rel": "step" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The operation whose package this record reads, implant excluded.", "rel": "procedure" } ], "source_list": [ { "id": "s:etymonline-package", "kind": "dictionary", "title": "package (n.), package deal — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/package", "accessed": "2026-09-17", "note": "1530s; bundle sense 1722; package deal 1952" }, { "id": "s:bumrungrad-joint04", "kind": "web", "title": "Total Knee Replacement Surgery (Exclude implant) — package JOINT04", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery", "accessed": "2026-09-16", "note": "read off the hospital's own package page; price stated valid until 31 December 2026" }, { "id": "s:estenove-cost", "kind": "web", "title": "Hair Transplant Cost and Prices in Turkey", "publisher": "Estenove, Istanbul", "url": "https://www.estenove.com/hair-transplant-cost-istanbul-turkey/", "accessed": "2026-09-16", "note": "clinic's own package prices in euro, quoted per session rather than per graft" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference", "note": "the four questions are this project's, drawn from the exclusion lists it has read" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "argentina", "type": "destination", "name": "Argentina", "as": "The pricing form this country mostly does not use, quoting per procedure instead.", "rel": "term" }, { "from": "hungary", "type": "destination", "name": "Hungary", "as": "The form this country does not use: the bill here is itemised, not bundled.", "rel": "term" }, { "from": "thailand", "type": "destination", "name": "Thailand", "as": "The pricing form this country normalised.", "rel": "term" }, { "from": "tunisia", "type": "destination", "name": "Tunisia", "as": "The form the trade sells in, quoted in euros.", "rel": "term" }, { "from": "antalya", "type": "hub", "name": "Antalya", "as": "The form this city invented for holidays and now sells surgery in.", "rel": "term" }, { "from": "bangkok", "type": "hub", "name": "Bangkok", "as": "The unit of account a dozen hospitals within a few kilometres quote each other in.", "rel": "term" }, { "from": "istanbul", "type": "hub", "name": "Istanbul", "as": "The form the whole belt sells in, graft count included.", "rel": "term" }, { "from": "acl-reconstruction", "type": "procedure", "name": "Anterior cruciate ligament reconstruction", "as": "The form the Bangkok price takes, meniscus work folded in.", "rel": "term" }, { "from": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "The pricing form this technique is sold in, one arch at a time.", "rel": "term" }, { "from": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The pricing form this product is native to.", "rel": "term" }, { "from": "facelift", "type": "procedure", "name": "Facelift", "as": "The form that bundles hotel nights with theatre time, and which this operation depends on most.", "rel": "term" }, { "from": "gastric-balloon", "type": "procedure", "name": "Gastric balloon", "as": "The pricing form that puts a rented device in a column of permanent operations.", "rel": "term" }, { "from": "gastric-bypass", "type": "procedure", "name": "Gastric bypass", "as": "The pricing form this operation is sold in, and what the week-long bundle leaves out.", "rel": "term" }, { "from": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "The pricing form this operation is sold in, hotel and transfers inside, aftercare outside.", "rel": "term" }, { "from": "heart-valve-replacement", "type": "procedure", "name": "Heart valve replacement", "as": "The pricing form this operation is sold in, and the reason its exclusions matter.", "rel": "term" }, { "from": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "The pricing form this operation is sold in, and the reason its exclusions decide the bill.", "rel": "term" }, { "from": "icsi", "type": "procedure", "name": "Intracytoplasmic sperm injection", "as": "The form that hides this step inside a cycle price, or itemises it.", "rel": "term" }, { "from": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The pricing form a cycle is sold in, and the reason the drug bill sits outside it.", "rel": "term" }, { "from": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The pricing form this operation is usually sold in, and the reason its exclusions matter.", "rel": "term" }, { "from": "liposuction", "type": "procedure", "name": "Liposuction", "as": "The form in which areas, garments and ward nights are bundled or not.", "rel": "term" }, { "from": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "The pricing form that hides whether the implant, the ward night and the anaesthetist are in the number.", "rel": "term" }, { "from": "spinal-fusion", "type": "procedure", "name": "Spinal fusion", "as": "The form this operation is sold in, priced per level.", "rel": "term" }, { "from": "american-hospital-dubai", "type": "facility", "name": "American Hospital Dubai", "as": "Sells in this form, and shows what a bundle looks like when the bundle is fixed and the bill is not.", "rel": "term" }, { "from": "bangkok-hospital", "type": "facility", "name": "Bangkok Hospital", "as": "Sells in this form, with a usable-between window rather than an open-ended list price.", "rel": "term" }, { "from": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Sells in this form, with the inclusions and exclusions written out.", "rel": "term" }, { "from": "island-hospital-penang", "type": "facility", "name": "Island Hospital", "as": "Sells in this form, down to a redemption deadline printed on each product page.", "rel": "term" }, { "from": "liv-hospital", "type": "facility", "name": "Liv Hospital", "as": "Sells in this form, and states what each package contains by test count rather than by name.", "rel": "term" }, { "from": "medanta", "type": "facility", "name": "Medanta — The Medicity, Gurugram", "as": "Sells check-ups in this form; operations are still quoted case by case.", "rel": "term" }, { "from": "prince-court", "type": "facility", "name": "Prince Court Medical Centre", "as": "Sells in this form: a price, four inclusions, three exclusions and no expiry date.", "rel": "term" }, { "from": "raffles-hospital", "type": "facility", "name": "Raffles Hospital", "as": "Sells in this form, with the exclusions written as eligibility rules rather than as extras.", "rel": "term" }, { "from": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The pricing form this step almost always takes.", "rel": "term" }, { "from": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The form of price whose exclusions this step reads.", "rel": "term" }, { "from": "anaesthetic-risk-unscreened", "type": "risk", "name": "Fitness for anaesthesia, assessed on arrival", "as": "The pricing form that needs a predictable case, and says so in its eligibility list.", "rel": "term" }, { "from": "deposit-and-refund", "type": "risk", "name": "The deposit, and whether it comes back", "as": "The form the money is quoted in.", "rel": "term" }, { "from": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The pricing form whose stated length of stay sits against this interval.", "rel": "term" }, { "from": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The pricing form this risk lives inside.", "rel": "term" }, { "from": "the-escort-burden", "type": "risk", "name": "The escort burden", "as": "The number the second fare and the second bed sit outside.", "rel": "term" }, { "from": "defiant", "type": "org", "name": "Defiant", "as": "Sells in this form, with the price posted before the consultation.", "rel": "term" }, { "from": "josef-woodman", "type": "person", "name": "Josef Woodman", "as": "The unit his book listed hospitals in.", "rel": "term" }, { "from": "asa-grade", "type": "term", "name": "ASA grade", "as": "The price that assumes a low grade without saying so.", "rel": "term" }, { "from": "bundled-payment", "type": "term", "name": "Bundled payment", "as": "The seller's version of the same idea, with no payer and no published window.", "rel": "contrast" }, { "from": "case-rate", "type": "term", "name": "Case rate", "as": "What a case rate looks like when it is offered to the public instead of negotiated.", "rel": "term" }, { "from": "cycle", "type": "term", "name": "Cycle", "as": "The form a cycle price takes, and the inclusion list that decides what a cycle is.", "rel": "term" }, { "from": "day-case", "type": "term", "name": "Day case", "as": "The price that assumes the intended pathway held.", "rel": "term" }, { "from": "facilitator", "type": "term", "name": "Facilitator", "as": "What a facilitator sells: a single number assembled out of other people's services.", "rel": "term" }, { "from": "graft", "type": "term", "name": "Graft", "as": "The form that removes the unit altogether by selling a session instead.", "rel": "term" }, { "from": "length-of-stay", "type": "term", "name": "Length of stay", "as": "Where the nights are fixed, and where the night after them is priced.", "rel": "term" }, { "from": "out-of-pocket", "type": "term", "name": "Out-of-pocket", "as": "The form of price this money usually buys.", "rel": "term" }, { "from": "revision", "type": "term", "name": "Revision", "as": "The form of price whose revision clause is the fine print that matters most.", "rel": "term" }, { "from": "exchange-rate-table", "type": "dataset", "name": "The dated exchange rate table", "as": "What a package price is quoted in, before this table touches it.", "rel": "term" }, { "from": "how-this-was-built", "type": "story", "name": "How this was built", "as": "The form most prices here take, and the reason two of them cannot be subtracted.", "rel": "term" }, { "from": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The form of price this comparison is made of, and why two of them cannot be subtracted.", "rel": "term" }, { "from": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "The word, its root, and why two packages cannot be subtracted from one another.", "rel": "term" } ] }, { "id": "patient-mobility", "names": { "name": "Patient mobility", "aliases": [ "cross-border healthcare", "free movement of patients", "the Directive route" ], "said": "Brussels says patient mobility. It is an administrative word for a legal right, and it covers people who would never describe themselves as travellers." }, "region": [ "global", "europe-west", "europe-central", "europe-south", "europe-north", "europe-east" ], "etymology": { "root": "mobility is early 15c., \"capacity for motion, ability to move or be moved\", from Old French mobilité and Latin mobilitatem, from mobilis, movable, from movere, to move; the sociological sense arrives about 1900. Applied to patients it is a policy word, not a clinical one. What moves first in it is an entitlement; the patient moves after it.", "first_attested": "early 15c. for mobility; in a European Commission document title by 20 April 2004", "tier": "cited", "source": "s:etymonline-mobility", "note": "The only name in this glossary with a directive behind it. It describes movement inside a reimbursement scheme, not the private market most of this site describes." }, "text": { "what": "The European Union's word for patients receiving healthcare in a member state other than the one that insures them, and being reimbursed for it at home. Two separate legal routes carry it, with different rules and different arithmetic, and a patient on the wrong one is paid on the wrong basis.", "story": "The court moved first. On 28 April 1998 the Court of Justice decided two Luxembourg cases on the same day: Decker, Case C-120/95, on a pair of spectacles bought in Belgium, under the free movement of goods; and Kohll, Case C-158/96, on orthodontic treatment in Germany, under the freedom to provide services. Kohll held that the Treaty precluded national rules making reimbursement of treatment provided in another member state subject to the insurer's authorisation. In Watts, Case C-372/04, decided by the Grand Chamber on 16 May 2006, the court held that authorisation could not be refused on the bare existence of a waiting list: what mattered was whether the wait exceeded \"the period which is acceptable on the basis of an objective medical assessment of the clinical needs of the person concerned\".\n\nThe administration followed, and the phrase arrives with it. The Commission's communication of 20 April 2004, COM(2004) 301 final, is titled \"Follow-up to the high level reflection process on patient mobility and healthcare developments in the European Union\", and reports a process set up after the Health Council of June 2002 which produced nineteen recommendations.\n\nThe legislature wrote it down seven years later. Directive 2011/24/EU on the application of patients' rights in cross-border healthcare was done at Strasbourg on 9 March 2011, published in the Official Journal of 4 April 2011 at L 88/45, and had to be transposed by 25 October 2013. Its recital 10 gives the word a job: the directive aims \"to ensure patient mobility in accordance with the principles established by the Court of Justice\". Its arithmetic is Article 7(4): costs \"shall be reimbursed or paid directly by the Member State of affiliation up to the level of costs that would have been assumed by the Member State of affiliation, had this healthcare been provided in its territory, without exceeding the actual costs of healthcare received\". Article 8 lets a state keep prior authorisation, limited to care involving an overnight stay, highly specialised infrastructure, particular risk, or a provider raising quality and safety concerns.\n\n*Inference —* the ceiling in Article 7(4) is the character of the whole scheme. A patient is refunded at the home state's price and never more than was actually spent, so this is a route for being treated sooner or nearer, not for buying more cheaply.", "how": "The older route runs on different rails. Regulation (EC) No 883/2004 of 29 April 2004 coordinates social security between member states, and its planned-treatment authorisation — the S2 route in British usage — has the treating state's public system take the patient on its own terms, with the two states settling between themselves. The directive says how the two fit: recital 30 provides that \"either this Directive applies or the Union regulations on the coordination of social security systems apply\", and recital 31 requires the affiliation state to draw a patient's attention to the regulation route where that route is more advantageous. Pay first and claim back at home rates, or seek authorisation and be treated on the host state's public terms.", "today": "As of 17 September 2026 the European Commission publishes annual member-state data on cross-border patient healthcare under the directive, and uses this phrase for the series. The administrative vocabulary is not always careful with its own citations: the 2004 communication footnotes the Kohll judgment twice as Case C-155/96." }, "kin": [ { "to": "eu-directive-2011-24", "as": "The instrument this word carries, with its dates and its articles.", "rel": "rule" }, { "to": "s2-route", "as": "The other rail: authorisation first, then treatment on the host state's public terms.", "rel": "rule" }, { "to": "tariff", "as": "The home-state schedule a reimbursement is capped at.", "rel": "term" }, { "to": "prior-authorisation", "as": "The gate Article 8 allows a member state to keep, and the four grounds for it.", "rel": "term" }, { "to": "medical-travel", "as": "The wider name for the same movement outside any reimbursement scheme.", "rel": "contrast" }, { "to": "eu-national-contact-points", "as": "The network the directive created to answer the questions this word raises.", "rel": "org" } ], "sources": [ "s:etymonline-mobility", "s:eu-directive-2011-24", "s:com-2004-301", "s:ecj-decker-1998", "s:ecj-kohll-1998", "s:ecj-watts-2006", "s:eu-reg-883-2004", "s:nhs-s2-route", "s:ec-crossborder-2022" ], "provenance": { "default": { "tier": "cited" } }, "confidence": "high", "schema": 1, "type": "term", "updated": "2026-09-17", "facets": { "letter": "P" }, "blurb": "The European Union's word for patients receiving healthcare in a member state other than the one that insures them, and being reimbursed for it at home.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" }, { "key": "europe-central", "name": "Central Europe", "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia" }, { "key": "europe-south", "name": "Southern Europe", "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta" }, { "key": "europe-north", "name": "Northern Europe", "note": "the Nordics and the Baltics" }, { "key": "europe-east", "name": "Eastern Europe", "note": "Romania, Bulgaria, Serbia, Ukraine, Moldova, Albania, North Macedonia" } ], "kin_out": [ { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The instrument this word carries, with its dates and its articles.", "rel": "rule" }, { "to": "s2-route", "type": "rule", "name": "The S2 route", "as": "The other rail: authorisation first, then treatment on the host state's public terms.", "rel": "rule" }, { "to": "tariff", "type": "term", "name": "Tariff", "as": "The home-state schedule a reimbursement is capped at.", "rel": "term" }, { "to": "prior-authorisation", "type": "term", "name": "Prior authorisation", "as": "The gate Article 8 allows a member state to keep, and the four grounds for it.", "rel": "term" }, { "to": "medical-travel", "type": "term", "name": "Medical travel", "as": "The wider name for the same movement outside any reimbursement scheme.", "rel": "contrast" }, { "to": "eu-national-contact-points", "type": "org", "name": "EU National Contact Points for cross-border healthcare", "as": "The network the directive created to answer the questions this word raises.", "rel": "org" } ], "source_list": [ { "id": "s:etymonline-mobility", "kind": "dictionary", "title": "mobility (n.), mobile (adj.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/mobility", "accessed": "2026-09-17", "note": "early 15c. / late 15c." }, { "id": "s:eu-directive-2011-24", "kind": "web", "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare", "publisher": "Official Journal of the European Union", "year": 2011, "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024", "accessed": "2026-09-16" }, { "id": "s:com-2004-301", "kind": "regulation", "title": "Communication from the Commission — Follow-up to the high level reflection process on patient mobility and healthcare developments in the European Union, COM(2004) 301 final, 20 April 2004", "publisher": "European Commission, via EUR-Lex (CELEX 52004DC0301)", "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:52004DC0301", "accessed": "2026-09-17", "note": "the phrase patient mobility appears fifteen times in the English text; footnotes 1 and 2 mis-cite the Kohll judgment as Case C-155/96" }, { "id": "s:ecj-decker-1998", "kind": "ruling", "title": "Case C-120/95, Nicolas Decker v Caisse de maladie des employés privés, judgment of 28 April 1998, ECR 1998 I-1831", "publisher": "Court of Justice of the European Communities, via EUR-Lex (CELEX 61995CJ0120)", "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:61995CJ0120", "accessed": "2026-09-17", "note": "spectacles bought in Belgium; decided under the free movement of goods" }, { "id": "s:ecj-kohll-1998", "kind": "ruling", "title": "Case C-158/96, Raymond Kohll v Union des caisses de maladie, judgment of 28 April 1998, ECR 1998 I-1931", "publisher": "Court of Justice of the European Communities, via EUR-Lex (CELEX 61996CJ0158)", "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:61996CJ0158", "accessed": "2026-09-17", "note": "orthodontic treatment in Germany; decided under the freedom to provide services" }, { "id": "s:ecj-watts-2006", "kind": "ruling", "title": "Case C-372/04, The Queen (on the application of Yvonne Watts) v Bedford Primary Care Trust and Secretary of State for Health, Grand Chamber judgment of 16 May 2006", "publisher": "Court of Justice of the European Communities, via EUR-Lex (CELEX 62004CJ0372)", "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:62004CJ0372", "accessed": "2026-09-17" }, { "id": "s:eu-reg-883-2004", "kind": "statute", "title": "Regulation (EC) No 883/2004 on the coordination of social security systems, Article 20 (as adopted)", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/eur/2004/883/article/20/adopted", "accessed": "2026-09-16" }, { "id": "s:nhs-s2-route", "kind": "web", "title": "The Planned Treatment Scheme (S2 funding route)", "publisher": "NHS", "url": "https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/planned-treatment-s2-funding-route/", "accessed": "2026-09-16" }, { "id": "s:ec-crossborder-2022", "kind": "report", "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU — reference year 2022", "publisher": "European Commission, DG Health and Food Safety, Unit B.3; written by PredictBy Research and Consulting and Baltic Media; Publications Office of the European Union", "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf", "license": "CC BY 4.0", "accessed": "2026-09-16", "note": "final version January 2024, ISBN 978-92-68-14858-7. 23 countries reported 547,890 reimbursement requests for care not needing prior authorisation in 2022, of which France 300,254 and Germany 160,647 are 84%; Poland 14,176, Slovakia 13,904, Ireland 1,841, Romania 889, Czechia 440, Croatia 192, Lithuania 131, Greece 56, Cyprus 44, Portugal 27 (all refused), Spain 9. Total reimbursed EUR 86,462,491. For care needing prior authorisation, 4,552 requests and EUR 7,708,041. Belgium and Hungary could not report; Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway run no prior-authorisation system; only Denmark and Romania have a mechanism to limit inflow." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "cited" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "john-connell", "type": "person", "name": "John Connell", "as": "The other word for the same movement, preferred by the people who regulate it.", "rel": "term" }, { "from": "directive-2011-24-adopted", "type": "event", "name": "Directive 2011/24/EU adopted, 9 March 2011", "as": "The word Brussels uses for this, and why it is not the word the trade uses.", "rel": "term" }, { "from": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The European administrative word for the same movement, with a directive behind it.", "rel": "term" }, { "from": "medical-travel", "type": "term", "name": "Medical travel", "as": "The administrative version, for patients moving inside a reimbursement scheme.", "rel": "term" }, { "from": "medical-visa", "type": "term", "name": "Medical visa", "as": "The scheme where no visa is needed at all, because the border is already open.", "rel": "contrast" }, { "from": "prior-authorisation", "type": "term", "name": "Prior authorisation", "as": "The European scheme with its own prior approval, which does cross a border.", "rel": "term" }, { "from": "tariff", "type": "term", "name": "Tariff", "as": "The European scheme that refunds a patient at the home state's tariff, not the foreign one.", "rel": "term" }, { "from": "the-word-itself", "type": "story", "name": "The word itself", "as": "Brussels administrative language for an entitlement, with a directive behind it.", "rel": "term" } ] }, { "id": "prior-authorisation", "names": { "name": "Prior authorisation", "aliases": [ "prior authorization", "preauthorization", "pre-approval", "precertification", "prior approval" ], "said": "US plans say prior authorization or precertification. UK commissioners say prior approval or individual funding request. The act is the same: a payer deciding before the treatment, not after." }, "etymology": { "root": "prior, 1714, \"earlier, preceding in order of time\", from Latin prior, former or previous, the comparative of Old Latin pri, before; with authorize, late 14c. auctorisen, \"give formal approval or sanction to\", from Old French autoriser and Medieval Latin auctorizare, from Latin auctor, from auctus, past participle of augere, to increase. The phrase therefore means approval given beforehand — and nothing in the words promises money.", "first_attested": "1714 for prior; late 14c. for authorize", "tier": "cited", "source": "s:etymonline-authorize", "note": "The US federal glossary states the limit in terms: \"Preauthorization isn't a promise your health insurance or plan will cover the cost.\"" }, "text": { "what": "A payer's advance decision that a treatment is medically necessary. The US federal glossary defines it as \"A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary\", sometimes called prior authorization, prior approval or precertification.", "story": "The gate is where a payer's clinical policy becomes a patient's travel plan. Where a treatment is contested — a knee arthroscopy for degenerative change, a disc replacement with five written eligibility conditions — prior authorisation is the instrument that refuses it, and a refusal is one of the recurring reasons a patient starts pricing the same operation abroad.\n\nThe caveat the glossary attaches matters as much as the definition: \"Preauthorization isn't a promise your health insurance or plan will cover the cost.\" Authorisation is a finding about necessity, not an undertaking about money.\n\n*Inference —* the gate also does not travel. An authorisation issued against a domestic network says nothing about a hospital in another country, and US Medicare does not pay for care outside the United States except in narrow circumstances set out in 42 CFR Part 424, Subpart H. A patient who was refused at home and a patient who was approved at home are in the same position at a foreign cashier's desk.", "how": "Three questions decide whether an authorisation is worth anything abroad: whether the plan covers any care outside its own country, whether the foreign provider can be paid directly or only reimbursed, and whether the decision names the procedure or the provider. Reimbursement routes that do cross borders — the European directive route, the S2 route — run their own prior approval on their own terms, and those are held on rule records here.", "today": "As of 17 September 2026 this site carries prior authorisation as a reason a procedure is sought abroad, not as a route to paying for it. No record here reports a US plan authorising treatment in another country." }, "kin": [ { "to": "out-of-pocket", "as": "What a bill becomes when this gate is closed, or when it never applied.", "rel": "term" }, { "to": "co-payment", "as": "What remains owed once the gate has been passed.", "rel": "term" }, { "to": "knee-arthroscopy", "as": "The operation where a payer wrote a contested indication into the schedule itself.", "rel": "procedure" }, { "to": "disc-replacement", "as": "Five written eligibility conditions, which is what this gate looks like in a fee schedule.", "rel": "procedure" }, { "to": "patient-mobility", "as": "The European scheme with its own prior approval, which does cross a border.", "rel": "term" }, { "to": "deciding-whether", "as": "The step a refusal usually starts.", "rel": "step" } ], "sources": [ "s:etymonline-authorize", "s:healthcare-gov-preauthorization", "s:ecfr-42-424-h", "s:medicare-travel-outside-us" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "P" }, "blurb": "A payer's advance decision that a treatment is medically necessary.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "out-of-pocket", "type": "term", "name": "Out-of-pocket", "as": "What a bill becomes when this gate is closed, or when it never applied.", "rel": "term" }, { "to": "co-payment", "type": "term", "name": "Co-payment", "as": "What remains owed once the gate has been passed.", "rel": "term" }, { "to": "knee-arthroscopy", "type": "procedure", "name": "Knee arthroscopy", "as": "The operation where a payer wrote a contested indication into the schedule itself.", "rel": "procedure" }, { "to": "disc-replacement", "type": "procedure", "name": "Artificial disc replacement", "as": "Five written eligibility conditions, which is what this gate looks like in a fee schedule.", "rel": "procedure" }, { "to": "patient-mobility", "type": "term", "name": "Patient mobility", "as": "The European scheme with its own prior approval, which does cross a border.", "rel": "term" }, { "to": "deciding-whether", "type": "pathway", "name": "Deciding whether to go", "as": "The step a refusal usually starts.", "rel": "step" } ], "source_list": [ { "id": "s:etymonline-authorize", "kind": "dictionary", "title": "authorize (v.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/authorize", "accessed": "2026-09-17", "note": "late 14c., from Latin auctor" }, { "id": "s:healthcare-gov-preauthorization", "kind": "gov", "title": "Preauthorization — glossary", "publisher": "HealthCare.gov, US Centers for Medicare & Medicaid Services", "url": "https://www.healthcare.gov/glossary/preauthorization/", "accessed": "2026-09-17" }, { "id": "s:ecfr-42-424-h", "kind": "statute", "title": "42 CFR Part 424, Subpart H — Payment for services furnished in a foreign country (§§ 424.120–424.124)", "publisher": "Electronic Code of Federal Regulations, U.S. Government", "url": "https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-424/subpart-H", "accessed": "2026-09-16" }, { "id": "s:medicare-travel-outside-us", "kind": "web", "title": "Travel outside the U.S.", "publisher": "Medicare.gov, US Centers for Medicare & Medicaid Services", "url": "https://www.medicare.gov/coverage/travel-outside-the-u.s.", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "disc-replacement", "type": "procedure", "name": "Artificial disc replacement", "as": "What five written eligibility conditions amount to when a payer applies them.", "rel": "term" }, { "from": "knee-arthroscopy", "type": "procedure", "name": "Knee arthroscopy", "as": "The gate a payer uses where the indication is contested.", "rel": "term" }, { "from": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The gate Article 8 builds, and the word for it.", "rel": "term" }, { "from": "s2-route", "type": "rule", "name": "The S2 route", "as": "The word for the gate this route is entirely made of.", "rel": "term" }, { "from": "directive-2011-24-adopted", "type": "event", "name": "Directive 2011/24/EU adopted, 9 March 2011", "as": "The permission Article 8 lets a state require, and the conditions it may require it under.", "rel": "term" }, { "from": "co-payment", "type": "term", "name": "Co-payment", "as": "The gate that has to be passed before a co-payment is the only thing owed.", "rel": "term" }, { "from": "out-of-pocket", "type": "term", "name": "Out-of-pocket", "as": "The gate that decides whether a bill is covered at all, and so whether it lands here.", "rel": "term" }, { "from": "patient-mobility", "type": "term", "name": "Patient mobility", "as": "The gate Article 8 allows a member state to keep, and the four grounds for it.", "rel": "term" } ] }, { "id": "repatriation", "names": { "name": "Repatriation", "aliases": [ "medical evacuation", "medevac", "air ambulance", "repatriation of remains" ], "said": "Insurers say medical evacuation for the living and repatriation of remains for the dead. The trade uses repatriation for both." }, "etymology": { "root": "repatriate, 1610s, \"restore to one's own country\", from Late Latin repatriatus, past participle of repatriare, to return to one's country, from re-, back, plus patria, native land. The word is about a state taking a person back, and it was doing that work three centuries before an aeroplane could.", "first_attested": "1610s for the verb", "tier": "cited", "source": "s:etymonline-repatriate", "note": "Repatriation is not a medical decision. In almost every policy the insurer decides, not the patient and not the treating doctor." }, "text": { "what": "Moving a patient who cannot fly commercially from where they were treated to a hospital at home that can finish the job — or moving a body. It is the largest single bill in this subject, and the one least likely to be covered by the policy the traveller actually bought.", "story": "The CDC's travel insurance chapter states the range: \"The total cost of a medevac varies by location, ranging from USD 25,000 for transport within North America to over USD 250,000 for more distant and remote locations\", rising further where the patient is critically ill or needs complex infection control.\n\nWho decides is stated as plainly: \"The decision to medically evacuate is at the discretion of the insurance company; it is not made at the request of the traveler\".\n\nDomestic cover mostly does not reach. US Medicare does not pay for care outside the country except in limited circumstances, and does not pay for evacuation; Medigap plans C, D, F, G, M and N cover some emergency care begun in the first 60 days abroad, at 80% after a USD 250 deductible, with a USD 50,000 lifetime maximum. One distant evacuation can exceed that lifetime cap five times over.", "how": "An evacuation is an aircraft, a medical crew, ground transport at both ends and a receiving bed that has agreed to take the patient. The features that decide whether cover works are whether the insurer guarantees payment direct to the hospital, whether a 24-hour physician-backed centre answers, and whether the policy returns the patient home or only to the nearest adequate facility.", "today": "As of 17 September 2026 the published range this site carries is USD 25,000 to over USD 250,000, from the CDC's 2026 edition. Nothing counts how often an evacuation follows an elective operation abroad, or what share of those bills an insurer paid." }, "kin": [ { "to": "repatriation-cost", "as": "The risk record behind this word, with the CDC range and who decides.", "rel": "risk" }, { "to": "the-flight-home", "as": "The step this word replaces when the patient cannot board.", "rel": "step" }, { "to": "flying-after-surgery", "as": "The clinical reason a commercial seat is refused in the first place.", "rel": "risk" }, { "to": "out-of-pocket", "as": "What the bill becomes where the policy does not answer.", "rel": "term" }, { "to": "reading-the-exclusions", "as": "Where the cover for this is either found or not found.", "rel": "step" } ], "sources": [ "s:etymonline-repatriate", "s:cdc-yellowbook-travel-insurance", "s:cdc-yellowbook-2026-medical-tourism", "s:medicare-travel-outside-us" ], "provenance": { "default": { "tier": "cited" } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "R" }, "blurb": "Moving a patient who cannot fly commercially from where they were treated to a hospital at home that can finish the job — or moving a body.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "repatriation-cost", "type": "risk", "name": "Repatriation and medical evacuation cost", "as": "The risk record behind this word, with the CDC range and who decides.", "rel": "risk" }, { "to": "the-flight-home", "type": "pathway", "name": "The flight home", "as": "The step this word replaces when the patient cannot board.", "rel": "step" }, { "to": "flying-after-surgery", "type": "risk", "name": "Flying after surgery", "as": "The clinical reason a commercial seat is refused in the first place.", "rel": "risk" }, { "to": "out-of-pocket", "type": "term", "name": "Out-of-pocket", "as": "What the bill becomes where the policy does not answer.", "rel": "term" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "Where the cover for this is either found or not found.", "rel": "step" } ], "source_list": [ { "id": "s:etymonline-repatriate", "kind": "dictionary", "title": "repatriate (v.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/repatriate", "accessed": "2026-09-17", "note": "1610s, from Late Latin repatriare" }, { "id": "s:cdc-yellowbook-travel-insurance", "kind": "org", "title": "Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance — CDC Yellow Book 2026, chapter by Rhett J. Stoney", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/travel-insurance.html", "accessed": "2026-09-16", "note": "carries the USD 25,000 to over USD 250,000 medevac range, the Medicare and Medigap limits, and the finding that insurers fully paid two-thirds of travel health claims" }, { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:medicare-travel-outside-us", "kind": "web", "title": "Travel outside the U.S.", "publisher": "Medicare.gov, US Centers for Medicare & Medicaid Services", "url": "https://www.medicare.gov/coverage/travel-outside-the-u.s.", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "cited" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "assisted-dying", "type": "procedure", "name": "Assisted dying", "as": "Two of the five published Swiss lines are for what happens to the body and the paperwork afterwards.", "rel": "term" } ] }, { "id": "reproductive-exile", "names": { "name": "Reproductive exile", "aliases": [ "cross border reproductive care", "CBRC", "reproductive travel" ], "said": "Proposed in 2005 as a replacement for the leisure word, rejected in the same journal issue as overstating compulsion, and settled by a third phrase: cross border reproductive care." }, "etymology": { "root": "exile is c. 1300, \"forced removal from one's country\", from Old French exil and Latin exilium, banishment or a place of banishment, from exul, a banished person, on a root meaning to wander. The word asserts compulsion, and that assertion is both the argument for it and the argument against it.", "first_attested": "c. 1300 for exile; December 2005 for the compound, in Human Reproduction", "tier": "cited", "source": "s:etymonline-exile", "note": "Exile is not neutral either. It claims the patient was driven out, which is a claim about cause, and the cause differs case by case." }, "text": { "what": "Travelling abroad for fertility treatment because it is unlawful, unavailable or unaffordable at home. The phrase was proposed by clinicians and anthropologists as a correction to the leisure vocabulary, and it has been argued over ever since.", "story": "It was born as a rebuttal. Guido Pennings had published \"Legal harmonization and reproductive tourism in Europe\" in Human Reproduction in December 2004. Roberto Matorras replied in the same journal in December 2005 under the title \"Reproductive exile versus reproductive tourism\"; as reported by Bassan and Michaelsen, his ground was that the leisure word \"may be offensive both to couples and to professionals involved in the process\", and that exile \"better expresses the difficulties and constraints faced by infertile patients who are forced to travel globally\".\n\nPennings replied in turn, and the objection to the objection is worth as much as the objection. Again as reported by Bassan and Michaelsen, he agreed the first word was derogatory but held that exile \"creates the misleading impression that patients are forced to go abroad as a punishment\", and proposed a neutral phrase instead: cross border reproductive care. That is where the field's working term came from.\n\nMarcia Inhorn and Pasquale Patrizio made the fuller case in Fertility and Sterility in 2009, at 92(3):904-906, in their own words: \"Whereas reproductive 'tourism' implies leisure travel, reproductive 'exile' bespeaks the numerous difficulties and constraints faced by infertile patients who are 'forced' to travel globally for assisted reproduction. Given this reality, it is time to rethink the language of 'reproductive tourism,' replacing it with more accurate and patient-centered terms.\" One of the two authors is a practising fertility clinician.\n\nThe compromise then became institutional. Pennings and colleagues published the ESHRE Task Force on Ethics and Law paper under the new phrase in 2008, and the society's taskforce used it again for its six-country study in Human Reproduction in 2010, which found legal reasons predominant among Italian, German, French, Norwegian and Swedish patients crossing borders.\n\n*Inference —* the three words fit three different patients, which is why none of them won. A patient flying to a country with anonymous donation because her own law forbids it has been driven out by a prohibition. A patient flying to a cheaper clinic under the same law has been driven out by a price. A patient choosing a clinic abroad on its published results has not been driven out at all.", "how": "The reasons a fertility patient crosses a border are legal, financial and clinical, and one trip usually has several: a ban on donor gametes or on paid donation, a rule about who may be treated, an anonymity regime, a waiting list, a funding limit, a price. The rule records here carry the legal half country by country, each with its instrument and date.", "today": "As of 17 September 2026 the registers that count these cycles count them where they were performed, not where the patient came from. No register anywhere counts the journey, which is why the size of this traffic is estimated and not known." }, "kin": [ { "to": "ivf", "as": "The treatment most of these journeys are made for.", "rel": "procedure" }, { "to": "circumvention-travel", "as": "The same journeys named from the law's side rather than the patient's.", "rel": "contrast" }, { "to": "egg-donation", "as": "The treatment where an anonymity or payment rule most often forces the crossing.", "rel": "procedure" }, { "to": "eshre", "as": "The society whose taskforce adopted the compromise phrase and whose registry counts the cycles.", "rel": "org" }, { "to": "donor-anonymity-law", "as": "The rule that decides which country a patient must leave.", "rel": "rule" }, { "to": "medical-tourism", "as": "The word this one was coined against.", "rel": "contrast" }, { "to": "cycle", "as": "The unit these journeys are counted and sold in.", "rel": "term" } ], "sources": [ "s:etymonline-exile", "s:matorras-2005", "s:pennings-2004", "s:inhorn-patrizio-2009", "s:pennings-eshre-tf15-2008", "s:shenfield-2010", "s:bassan-michaelsen-2013" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "the Matorras and Pennings letters sit behind a paywall; their grounds are quoted here as reported in Bassan and Michaelsen 2013, which was read in full" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "R" }, "blurb": "Travelling abroad for fertility treatment because it is unlawful, unavailable or unaffordable at home.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment most of these journeys are made for.", "rel": "procedure" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The same journeys named from the law's side rather than the patient's.", "rel": "contrast" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The treatment where an anonymity or payment rule most often forces the crossing.", "rel": "procedure" }, { "to": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "The society whose taskforce adopted the compromise phrase and whose registry counts the cycles.", "rel": "org" }, { "to": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The rule that decides which country a patient must leave.", "rel": "rule" }, { "to": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The word this one was coined against.", "rel": "contrast" }, { "to": "cycle", "type": "term", "name": "Cycle", "as": "The unit these journeys are counted and sold in.", "rel": "term" } ], "source_list": [ { "id": "s:etymonline-exile", "kind": "dictionary", "title": "exile (n.), exile (v.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/exile", "accessed": "2026-09-17", "note": "c. 1300, from Latin exilium" }, { "id": "s:matorras-2005", "kind": "paper", "title": "Reproductive exile versus reproductive tourism", "publisher": "Matorras R. Human Reproduction 2005 Dec;20(12):3571 (with author reply 3571-2)", "url": "https://pubmed.ncbi.nlm.nih.gov/16308333/", "accessed": "2026-09-17", "note": "DOI 10.1093/humrep/dei223, PMID 16308333; a comment on Pennings 2004. The letter itself is paywalled and was not read; its ground is quoted here as reported in Bassan and Michaelsen 2013" }, { "id": "s:pennings-2004", "kind": "paper", "title": "Legal harmonization and reproductive tourism in Europe", "publisher": "Pennings G. Human Reproduction 2004 Dec;19(12):2689-94", "url": "https://pubmed.ncbi.nlm.nih.gov/15513984/", "accessed": "2026-09-17", "note": "DOI 10.1093/humrep/deh486; the paper Matorras was answering" }, { "id": "s:inhorn-patrizio-2009", "kind": "paper", "title": "Rethinking reproductive \"tourism\" as reproductive \"exile\"", "publisher": "Fertility and Sterility 92(3):904-906 (Inhorn MC, Patrizio P)", "url": "https://www.fertstert.org/article/S0015-0282(09)00046-6/fulltext", "accessed": "2026-09-16", "note": "citation and the authors' framing verified from the publisher's own article listing; the full text returned HTTP 403 and was not read" }, { "id": "s:pennings-eshre-tf15-2008", "kind": "paper", "title": "ESHRE Task Force on Ethics and Law 15: Cross-border reproductive care", "publisher": "Pennings G, de Wert G, Shenfield F, Cohen J, Tarlatzis B, Devroey P. Human Reproduction 2008 Oct;23(10):2182-4", "url": "https://pubmed.ncbi.nlm.nih.gov/18611918/", "accessed": "2026-09-17", "note": "DOI 10.1093/humrep/den184; the compromise phrase adopted by the society, with Pennings as first author" }, { "id": "s:shenfield-2010", "kind": "paper", "title": "Cross border reproductive care in six European countries", "publisher": "Human Reproduction 25(6):1361-1368, ESHRE Taskforce on Cross Border Reproductive Care", "url": "https://academic.oup.com/humrep/article/25/6/1361/2915759", "accessed": "2026-09-16" }, { "id": "s:bassan-michaelsen-2013", "kind": "paper", "title": "Honeymoon, medical treatment or big business? An analysis of the meanings of the term 'reproductive tourism' in German and Israeli public media discourses", "publisher": "Bassan S, Michaelsen MA. Philosophy, Ethics, and Humanities in Medicine 2013;8:9", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC3854005/", "accessed": "2026-09-17", "note": "CC BY, full text read; carries the patients' objection, Matorras's ground and Pennings's counter-argument, all at one remove from the paywalled letters" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "the Matorras and Pennings letters sit behind a paywall; their grounds are quoted here as reported in Bassan and Michaelsen 2013, which was read in full" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "czechia", "type": "destination", "name": "Czechia", "as": "The word for what a patient does when the treatment is lawful next door and not at home.", "rel": "term" }, { "from": "portugal", "type": "destination", "name": "Portugal", "as": "What a ruling about a child's rights did to its parents' travel plans.", "rel": "term" }, { "from": "spain", "type": "destination", "name": "Spain", "as": "The word for the journey most of these cycles represent.", "rel": "term" }, { "from": "barcelona", "type": "hub", "name": "Barcelona", "as": "The word for the journey most of this city's fertility traffic is making.", "rel": "term" }, { "from": "prague", "type": "hub", "name": "Prague", "as": "The word for what brings most of this city's fertility traffic.", "rel": "term" }, { "from": "tbilisi", "type": "hub", "name": "Tbilisi", "as": "The word for the journey most of this city's patients are making.", "rel": "term" }, { "from": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The word offered for the patient who must leave to be treated.", "rel": "term" }, { "from": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The word offered for patients who travel because home will not treat them.", "rel": "term" }, { "from": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "The word for the same journey told from the traveller's side.", "rel": "term" }, { "from": "abortion-travel-law", "type": "rule", "name": "Travelling for a termination", "as": "The neighbouring word, and the fight over which one to use.", "rel": "term" }, { "from": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "The word for what the rows below produce.", "rel": "term" }, { "from": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "The word for travelling because the law at home says no.", "rel": "term" }, { "from": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "The phrase researchers use for this traffic, and the argument inside it.", "rel": "term" }, { "from": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "The word for the patients who leave, and whom the register cannot see.", "rel": "term" }, { "from": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The same journeys named from the traveller's side rather than the law's.", "rel": "contrast" }, { "from": "cycle", "type": "term", "name": "Cycle", "as": "The word for why a patient buys this cycle in another country.", "rel": "term" }, { "from": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The counter-word, proposed from inside fertility medicine, and the sharpest objection on the record.", "rel": "contrast" }, { "from": "hfea-results", "type": "dataset", "name": "HFEA fertility treatment results", "as": "The word for the patients who leave, and who leave no record behind them.", "rel": "term" }, { "from": "circumvention", "type": "story", "name": "Circumvention", "as": "The name proposed for the patients this page describes, and the argument over whether it overstates compulsion.", "rel": "term" }, { "from": "the-word-itself", "type": "story", "name": "The word itself", "as": "The name proposed as a correction, and rejected in the same journal issue as overstating compulsion.", "rel": "term" } ] }, { "id": "revision", "names": { "name": "Revision", "aliases": [ "revision surgery", "redo", "corrective surgery", "revision arthroplasty" ], "said": "Surgeons say revision. Package pages say it too, and usually mean something narrower than the patient does." }, "etymology": { "root": "revision, 1610s, \"act of looking over again, re-examination and correction\", from French révision, from Late Latin revisionem; behind it the verb revise, 1560s, from Latin revisere, to look at again, a frequentative of revidere. The surgical sense keeps the literal one: the operation is looked at again, and cut again.", "first_attested": "1610s for the noun; 1560s for the verb", "tier": "cited", "source": "s:etymonline-revision", "note": "On a price page revision usually means the same surgeon correcting his own result within a stated window. A revision done at home by somebody else is a different event with a different payer." }, "text": { "what": "A second operation on the site of a first: an implant replaced, a nose re-cut, a sleeve converted, a graft redone. In cross-border care it is the event that decides who actually paid for the treatment, because the first price almost never covers it and the second surgeon is usually in another country.", "story": "The revision is the only part of this subject with a running set of published costs, because publicly funded systems that pay for it have a reason to count. Five UK plastic surgery units have published their own ledgers. A London teaching hospital costed 24 patients surgically managed between 2006 and 2018 for complications of cosmetic surgery abroad at USD 406,233, a mean of USD 16,296 each. A Birmingham tertiary centre costed 29 patients between 2020 and 2025 at £518,058.47, a mean of £17,864, with 82.8% of the original procedures done in Türkiye and nearly half the presentations being repeat attendances.\n\n*Inference —* a revision is harder than the original for reasons unrelated to the first surgeon's skill: the operative note is missing, the device model is unknown, the organism may be atypical, and the tissue has been cut once already. Where a device is involved, it is bought a second time.", "how": "Three questions separate a revision clause that means something from one that does not: whether it is a contractual term with a duration, whether it requires the patient to fly back, and who pays the fare. The General Medical Council requires a doctor on its register to say at the outset what revision or routine follow-up might cost. That duty binds the register, not the surgeon abroad.", "today": "As of 17 September 2026 no country publishes a national figure for revisions after treatment abroad, and no destination publishes what its own clinics spend on them. The published series are single-hospital counts of the patients who reached one hospital." }, "kin": [ { "to": "revision-at-home", "as": "The risk this word names, with the published ledgers behind it.", "rel": "risk" }, { "to": "rhinoplasty", "as": "The face operation revised more often than any other, and the first price never covers it.", "rel": "procedure" }, { "to": "follow-up-gap", "as": "The space a revision falls into when nobody at home agreed to see the patient.", "rel": "risk" }, { "to": "package-price", "as": "The form of price whose revision clause is the fine print that matters most.", "rel": "term" }, { "to": "when-it-goes-wrong", "as": "The step in the journey this word belongs to.", "rel": "step" } ], "sources": [ "s:etymonline-revision", "s:thacoor-nhs-cost-2019", "s:mafi-cosmetic-tourism-cost-2026", "s:gmc-cosmetic-interventions" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "inference", "note": "the three questions are this project's; the GMC duty is cited" } } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "R" }, "blurb": "A second operation on the site of a first: an implant replaced, a nose re-cut, a sleeve converted, a graft redone.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The risk this word names, with the published ledgers behind it.", "rel": "risk" }, { "to": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "The face operation revised more often than any other, and the first price never covers it.", "rel": "procedure" }, { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The space a revision falls into when nobody at home agreed to see the patient.", "rel": "risk" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The form of price whose revision clause is the fine print that matters most.", "rel": "term" }, { "to": "when-it-goes-wrong", "type": "pathway", "name": "When it goes wrong", "as": "The step in the journey this word belongs to.", "rel": "step" } ], "source_list": [ { "id": "s:etymonline-revision", "kind": "dictionary", "title": "revision (n.), revise (v.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/revision", "accessed": "2026-09-17", "note": "1610s / 1560s" }, { "id": "s:thacoor-nhs-cost-2019", "kind": "paper", "title": "Surgical Management of Cosmetic Surgery Tourism-Related Complications: Current Trends and Cost Analysis Study of the Financial Impact on the UK National Health Service", "publisher": "Aesthetic Surgery Journal 2019;39(7):786-791 (Thacoor A, van den Bosch P, Akhavani MA), Royal Free Hospital, London", "url": "https://pubmed.ncbi.nlm.nih.gov/30590431/", "accessed": "2026-09-16" }, { "id": "s:mafi-cosmetic-tourism-cost-2026", "kind": "paper", "title": "Recurrent Clinical Burden and Cost of Cosmetic Surgery Tourism Complications: A Five-Year Retrospective Study From a UK Tertiary Centre", "publisher": "Cureus 2026;18(5):e109006 (Mafi P, Patel K, Hoque-Uddin S, Warner R), Queen Elizabeth Hospital Birmingham", "url": "https://pubmed.ncbi.nlm.nih.gov/42311717/", "accessed": "2026-09-16" }, { "id": "s:gmc-cosmetic-interventions", "kind": "org", "title": "Guidance for doctors who offer cosmetic interventions — in effect 1 June 2016, updated 13 December 2024", "publisher": "General Medical Council (United Kingdom)", "url": "https://www.gmc-uk.org/professional-standards/the-professional-standards/cosmetic-interventions", "accessed": "2026-09-16", "note": "paragraph numbers cited on this site are from the sections Communication, partnership and teamwork (paras 14-45) and Maintaining trust (paras 46-56)" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference", "note": "the three questions are this project's; the GMC duty is cited" }, "text.today": { "tier": "cited" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "breast-augmentation", "type": "procedure", "name": "Breast augmentation", "as": "Implants are removed and replaced; the first price covers none of that.", "rel": "term" }, { "from": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "The second operation this one needs more often than any other face procedure, and which the first price never covers.", "rel": "term" }, { "from": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The word, and what it covers when a package says it is included.", "rel": "term" }, { "from": "fue", "type": "term", "name": "FUE", "as": "What follows an overharvested donor area, and what cannot be undone.", "rel": "term" } ] }, { "id": "tariff", "names": { "name": "Tariff", "aliases": [ "schedule fee", "fee schedule", "national tariff", "reimbursement rate" ], "said": "Payers say tariff or schedule fee. Patients hear a price. The two are rarely the same number." }, "etymology": { "root": "Arabic taʿrīf, a notification or making known, and so an inventory of fees to be paid, verbal noun of ʿarafa, he made known, he taught. It travelled into Medieval Latin tarifa, \"list of prices, book of rates\", and Italian tariffa, and reached English in the 1590s meaning an arithmetical table and an official list of customs duties. The word has meant a published list of what things cost for four centuries before any health service used it.", "first_attested": "1590s in English", "tier": "cited", "source": "s:etymonline-tariff", "note": "A tariff is a schedule, not a bill. What a schedule pays and what a hospital charges are separate numbers that need not meet." }, "text": { "what": "A schedule of amounts set by a state or an insurer for named items of care. It fixes what the payer will pay, or refund, for each item. It does not fix what a provider may charge, and in most systems the gap between the two falls on the patient.", "story": "Australia's Medicare Benefits Schedule shows the form at its plainest. Item 49318, total arthroplasty of hip, carries a schedule fee of A$1,577.30 as last updated on 1 July 2026, and the 75% benefit — what Medicare pays towards a private in-hospital service — is A$1,183.00. That fee prices the surgeon's work. It does not buy the hospital bed, the prosthesis, the anaesthetist or the assistant, and it is not what an Australian patient pays.\n\nA tariff can also be the instrument a state uses to send patients abroad. Ireland's Health Service Executive publishes a DRG guide for its cross-border schemes, so that a patient treated in another country is refunded against a case rate set at home rather than against the foreign invoice.\n\n*Inference —* that is why a tariff is the most misread number in this subject. It is neither a price nor a cost. It is one payer's statement of what it will part with, and a foreign hospital has never agreed to it.", "how": "Three different things wear the word. A payment tariff is what a public system pays a provider per case. A reimbursement tariff is what a payer refunds a patient who paid somebody else. A published tariff at a hospital or a resort is a list price, which is the word's original sense and the one a reader is most likely to meet on a clinic's own page.\n\nThe word also moves. England ran a National Tariff, formerly branded Payment by Results; NHS England states that \"The NHS Payment Scheme replaced the national tariff from 1 April 2023\", under the Health and Care Act 2022, and that the scheme \"is a set of rules, prices and guidance that determine how providers of NHS-funded healthcare are paid for the services they provide\". Its own exclusions are published with it: it \"does not cover primary care (GPs, dentists and pharmacies) or public health services like vaccinations\", and \"some high cost drugs and devices are excluded from the calculation of unit prices and national prices\".", "today": "As of 17 September 2026 every figure on this site carrying the price kind tariff names the schedule it came from and the date that schedule was set. A tariff row is never used here as evidence of what a procedure costs." }, "kin": [ { "to": "drg", "as": "The case-based unit most modern hospital tariffs are built on.", "rel": "term" }, { "to": "case-rate", "as": "The same idea sold privately: one agreed amount for one episode.", "rel": "term" }, { "to": "out-of-pocket", "as": "What the gap between a tariff and a bill becomes.", "rel": "term" }, { "to": "patient-mobility", "as": "The European scheme that refunds a patient at the home state's tariff, not the foreign one.", "rel": "term" }, { "to": "hip-replacement", "as": "The operation whose schedule fee this record reads.", "rel": "procedure" } ], "sources": [ "s:etymonline-tariff", "s:mbs-49318", "s:hse-cbd-niphs-drg-guide", "s:nhs-payment-scheme", "s:nhs-national-tariff" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "T" }, "blurb": "A schedule of amounts set by a state or an insurer for named items of care. It fixes what the payer will pay, or refund, for each item.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "drg", "type": "term", "name": "DRG", "as": "The case-based unit most modern hospital tariffs are built on.", "rel": "term" }, { "to": "case-rate", "type": "term", "name": "Case rate", "as": "The same idea sold privately: one agreed amount for one episode.", "rel": "term" }, { "to": "out-of-pocket", "type": "term", "name": "Out-of-pocket", "as": "What the gap between a tariff and a bill becomes.", "rel": "term" }, { "to": "patient-mobility", "type": "term", "name": "Patient mobility", "as": "The European scheme that refunds a patient at the home state's tariff, not the foreign one.", "rel": "term" }, { "to": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "The operation whose schedule fee this record reads.", "rel": "procedure" } ], "source_list": [ { "id": "s:etymonline-tariff", "kind": "dictionary", "title": "tariff (n.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/tariff", "accessed": "2026-09-17", "note": "1590s, from Italian tariffa and Arabic ta'rif" }, { "id": "s:mbs-49318", "kind": "gov", "title": "MBS item 49318 — total arthroplasty of hip", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=49318&qt=item", "accessed": "2026-09-16", "note": "schedule fee $1,577.30, fee last updated 01-Jul-2026" }, { "id": "s:hse-cbd-niphs-drg-guide", "kind": "gov", "title": "CBD / NIPHS Most Common Procedures DRG Guide", "publisher": "Health Service Executive (Ireland)", "url": "https://assets.hse.ie/media/documents/CBD-NIPHS-Most-Common-Procedures-DRG-Guide.pdf", "accessed": "2026-09-16", "note": "the tariff behind both the Cross Border Directive scheme and the Northern Ireland Planned Healthcare Scheme. Cataract procedures map to DRG C16Z LENS INTERVENTIONS at a day-case price of EUR 1,171, covering phacoemulsification or other extraction of the crystalline lens and capsulotomy; colonoscopy G48B EUR 1,001; gastroscopy G47C EUR 726. Same figure as the HSE's 2024 activity-based-funding day-case price list." }, { "id": "s:nhs-payment-scheme", "kind": "gov", "title": "NHS Payment Scheme", "publisher": "NHS England", "url": "https://www.england.nhs.uk/pay-syst/nhs-payment-scheme/", "accessed": "2026-09-17", "note": "the 2026/27 scheme took effect 1 April 2026; the page carries the primary-care and high-cost-drug exclusions" }, { "id": "s:nhs-national-tariff", "kind": "gov", "title": "National tariff", "publisher": "NHS England", "url": "https://www.england.nhs.uk/pay-syst/national-tariff/", "accessed": "2026-09-17", "note": "states that the NHS Payment Scheme replaced the national tariff from 1 April 2023" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "angioplasty-stent", "type": "procedure", "name": "Coronary angioplasty and stent", "as": "What the Australian figure on this page is, and why it is not a bill.", "rel": "term" }, { "from": "cabg", "type": "procedure", "name": "Coronary artery bypass grafting", "as": "What a schedule fee is, and why it cannot be read against a package price.", "rel": "term" }, { "from": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "What the Irish and Australian figures on this page are, and why they are not bills.", "rel": "term" }, { "from": "disc-replacement", "type": "procedure", "name": "Artificial disc replacement", "as": "What the Australian figure is, and why it is not a bill.", "rel": "term" }, { "from": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "What the Australian schedule fee is, and why it is not a price a patient pays.", "rel": "term" }, { "from": "shoulder-replacement", "type": "procedure", "name": "Total shoulder replacement", "as": "What a schedule fee is, and what it does not buy.", "rel": "term" }, { "from": "case-rate", "type": "term", "name": "Case rate", "as": "The schedule a case rate sits in.", "rel": "term" }, { "from": "co-payment", "type": "term", "name": "Co-payment", "as": "The schedule a co-payment is calculated against.", "rel": "term" }, { "from": "drg", "type": "term", "name": "DRG", "as": "The schedule a DRG is the unit of.", "rel": "term" }, { "from": "out-of-pocket", "type": "term", "name": "Out-of-pocket", "as": "What a payer will refund, and the gap that becomes this.", "rel": "term" }, { "from": "patient-mobility", "type": "term", "name": "Patient mobility", "as": "The home-state schedule a reimbursement is capped at.", "rel": "term" } ] }, { "id": "wellness-travel", "names": { "name": "Wellness travel", "aliases": [ "wellness tourism", "spa travel", "retreat travel", "high-level wellness" ], "said": "The sector names itself by the traveller's motive, and then counts everybody whose motive was partial." }, "etymology": { "root": "wellness is 1650s, \"state of being in good health\", from well as an adverb plus the suffix -ness, on the Proto-Indo-European root meaning to wish or will. It lay almost unused for three centuries. Halbert L. Dunn revived it in its modern sense in 1959, in \"High-level wellness for man and society\" in the American Journal of Public Health, and in the book High Level Wellness in 1961; Donald Ardell carried it to a general readership in 1977. The word has never meant a diagnosis or a treatment, which is what recommends it commercially.", "first_attested": "1650s; revived by Dunn in 1959", "tier": "cited", "source": "s:etymonline-wellness", "note": "The category is defined by motive, and a definition built on motive can be satisfied by a spa afternoon in the middle of a business trip. The sector's totals depend on that." }, "text": { "what": "Travel undertaken to maintain or improve wellbeing rather than to treat a condition. The body that publishes the sector's figures, the Global Wellness Institute, defines it as \"travel associated with the pursuit of maintaining or enhancing one's personal wellbeing\". It is not medicine, it is routinely counted beside medicine, and the two overlap wherever a state uses the wider health word.", "story": "The counting rule is published, which is more than most figures in this field manage. The institute splits travellers in two and counts both: a primary traveller, \"whose trip or destination choice is primarily motivated by wellness\", and a secondary one, who \"seeks to maintain wellness while traveling or participates in wellness experiences while taking any type of trip for leisure or business\".\n\nIt also counts the whole trip rather than the wellness part of it, and says so: \"In addition to wellness experiences, all wellness tourists need transportation, food and lodging, and they will likely seek out shopping or entertainment. All of these businesses—whether they are wellness-specific or not—benefit from wellness tourism and are part of the wellness tourism economy.\" Against that rule the institute puts the sector at 894 billion US dollars in 2024; its first report, in 2013, gave 439 billion for 2012.\n\nThe institute draws the line this site depends on and disowns the conflation itself: wellness travel sits on the proactive side of a health continuum, and travel for surgery or dentistry on the side of illness and injury, with \"health tourism\" named as the catch-all that causes the confusion.\n\n*Inference —* a total built on secondary motive and whole-trip spending is not a count of anything a hospital would recognise. It is how a national figure can run to millions of arrivals while the operating lists stay short.", "how": "Where a wellness figure and a treatment figure appear in the same national announcement they are frequently the same series. A record here names the publisher, the definition and the year, and does not add the two together.", "today": "As of 17 September 2026 no record on this site carries a wellness market size as a fact about treatment. The share of these trips that are primary rather than secondary is not published free of a form, and this project does not state one." }, "kin": [ { "to": "health-tourism", "as": "The administrative word that counts this category and surgery in one total.", "rel": "whole" }, { "to": "panchakarma", "as": "A course this site treats as a procedure and the sector counts as a retreat.", "rel": "procedure" }, { "to": "executive-health-screening", "as": "The other product sold to people who are not ill.", "rel": "procedure" }, { "to": "medical-travel", "as": "The traffic this one is routinely added to, and should not be.", "rel": "contrast" }, { "to": "counting-patients", "as": "Where the arithmetic of these categories is taken apart.", "rel": "story" } ], "sources": [ "s:etymonline-wellness", "s:dunn-1959", "s:gwi-wellness-tourism" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "schema": 1, "type": "term", "region": [ "global" ], "updated": "2026-09-17", "facets": { "letter": "W" }, "blurb": "Travel undertaken to maintain or improve wellbeing rather than to treat a condition.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "health-tourism", "type": "term", "name": "Health tourism", "as": "The administrative word that counts this category and surgery in one total.", "rel": "whole" }, { "to": "panchakarma", "type": "procedure", "name": "Panchakarma", "as": "A course this site treats as a procedure and the sector counts as a retreat.", "rel": "procedure" }, { "to": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The other product sold to people who are not ill.", "rel": "procedure" }, { "to": "medical-travel", "type": "term", "name": "Medical travel", "as": "The traffic this one is routinely added to, and should not be.", "rel": "contrast" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Where the arithmetic of these categories is taken apart.", "rel": "story" } ], "source_list": [ { "id": "s:etymonline-wellness", "kind": "dictionary", "title": "wellness (n.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/wellness", "accessed": "2026-09-17", "note": "1650s" }, { "id": "s:dunn-1959", "kind": "paper", "title": "High-level wellness for man and society", "publisher": "Dunn HL. American Journal of Public Health and the Nation's Health 1959;49(6):786-92", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC1372807/", "accessed": "2026-09-17", "note": "DOI 10.2105/ajph.49.6.786, PMID 13661471; the book High Level Wellness followed in 1961" }, { "id": "s:gwi-wellness-tourism", "kind": "org", "title": "What is Wellness Tourism?", "publisher": "Global Wellness Institute", "url": "https://globalwellnessinstitute.org/what-is-wellness/what-is-wellness-tourism/", "accessed": "2026-09-17", "note": "carries the definition, the primary and secondary traveller categories, the whole-trip counting rule, 894 billion US dollars for 2024 and 439 billion for 2012" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference" }, "etymology": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "budapest", "type": "hub", "name": "Budapest", "as": "The older trade the thermal baths belong to, sold beside the dentistry and counted separately.", "rel": "term" }, { "from": "cancun", "type": "hub", "name": "Cancún", "as": "The neighbouring trade, and the one the hotels were built for.", "rel": "term" }, { "from": "izmir", "type": "hub", "name": "İzmir", "as": "The Balçova springs belong to this older category, and the state counts them in the same programme.", "rel": "term" }, { "from": "tunis", "type": "hub", "name": "Tunis", "as": "The thalassotherapy coast belongs to this older category and is counted in the same figures.", "rel": "term" }, { "from": "addiction-rehab", "type": "procedure", "name": "Residential addiction treatment", "as": "The trade this one is marketed beside, and is repeatedly confused with.", "rel": "term" }, { "from": "executive-health-screening", "type": "procedure", "name": "Executive health screening", "as": "The neighbouring trade, and the one screening packages are sold beside in hotel and spa bundles.", "rel": "term" }, { "from": "panchakarma", "type": "procedure", "name": "Panchakarma", "as": "The category this is sold in, and the category it does not entirely fit.", "rel": "term" }, { "from": "health-tourism", "type": "term", "name": "Health tourism", "as": "The other half of this category, and the half that inflates its totals.", "rel": "term" }, { "from": "the-word-itself", "type": "story", "name": "The word itself", "as": "Defined by motive, counting secondary motive and whole-trip spending.", "rel": "term" } ] }, { "schema": 1, "id": "cdc-art-results", "type": "dataset", "names": { "name": "CDC assisted reproductive technology results", "aliases": [ "NASS", "National ART Surveillance System", "ART Success Rates" ], "said": "American clinics call it the CDC report. Reporting is federal law, and the law was passed because clinics were advertising their own numbers." }, "region": [ "global", "north-america" ], "facets": { "publisher": "US Centers for Disease Control and Prevention" }, "text": { "what": "What every reporting fertility clinic in the United States did in a year, and what came of it. \"The Fertility Clinic Success Rate and Certification Act of 1992 mandates that clinics performing ART annually provide data to CDC for ART procedures they perform\", and the CDC calculates standardised success rates from the returns. The most recent final year is 2022: \"In 2022, there were 435,426 ART cycles performed on 251,542 unique patients at 457 reporting U.S. clinics.\"", "story": "Those cycles produced 94,039 live-birth deliveries and 98,289 live-born infants, about 2.6% of all infants born in the United States that year. A further 184,423 of the reported cycles were egg or embryo banking, where everything was frozen for later.\n\nCompliance is not complete: \"A small number of clinics do not report data to CDC and are listed as nonreporters\", and because most of those are small the CDC estimates the system \"contains information on about 98% of all ART cycles in the United States\". A register with a statute behind it still names the clinics that will not answer.\n\nAnd like its British counterpart the CDC publishes the table under a warning: \"Comparison of success rates across clinics may not be meaningful\", and \"Clinic success rates do not reflect any one patient's chance of success\". Its reasons are the ones that defeat every clinic league table — different patients, different selection, different methods, rates that reflect cycles more than a year old, and small clinics whose numbers swing on a handful of cases.\n\n*Inference —* for this site the series is a benchmark rather than a destination record. It gives a dated, statutory, per-clinic figure for the country most fertility travellers leave rather than enter, which makes it the sharpest available measure of what a patient gives up by travelling to a market that publishes nothing comparable.", "notes": "ART is defined narrowly: treatments in which eggs or embryos are handled. Treatment in which only sperm are handled — intrauterine insemination — is outside it, as is ovulation induction with drugs alone." }, "dataset": { "publisher": "US Centers for Disease Control and Prevention, Division of Reproductive Health", "url": "https://www.cdc.gov/art/", "api": "https://data.cdc.gov/resource/9tjt-seye.json", "license": "US Government work; no licence statement was captured on the pages read on 17 September 2026", "unit": "ART cycles, and outcomes per cycle, per transfer and per retrieval", "indicator": "National ART Surveillance System (NASS)", "years": "2022 is the most recent final year published; earlier years sit in the CDC report archive", "countries": 1, "updated_by_publisher": "annually, as required by statute", "counts": "Every ART cycle performed at a reporting United States clinic in the calendar year — cycles, patients, transfers, live-birth deliveries and infants — reported clinic by clinic and nationally. National figures are noncumulative and cover only cycles performed in the reporting year.", "does_not_count": "Anything done outside a United States clinic. A US resident who travels to Mexico, Spain, Greece or the Czech Republic for IVF is outside the system entirely, and no American series counts them. It counts no intrauterine insemination and no ovulation induction, because neither is ART by CDC's definition; it counts nothing from the clinics listed as nonreporters, about 2% of cycles by CDC's own estimate; and its clinic rates describe cycles more than a year old, which the CDC says plainly should not be read as any individual's chance of success." }, "kin": [ { "to": "hfea-results", "as": "The British counterpart: a register with a statute behind it, publishing rates and warning against comparing them.", "rel": "dataset" }, { "to": "ivf", "as": "The treatment counted, cycle by cycle.", "rel": "procedure" }, { "to": "icsi", "as": "Counted inside the same cycles, as a laboratory method rather than a separate treatment.", "rel": "procedure" }, { "to": "egg-donation", "as": "Reported separately in the clinic tables, because donor cycles carry different rates.", "rel": "procedure" }, { "to": "united-states", "as": "The country the register covers, and the largest source market for fertility travel in this directory.", "rel": "destination" }, { "to": "counting-patients", "as": "A mandatory national register that still cannot see a patient who left.", "rel": "story" } ], "links": [ { "label": "CDC — ART surveillance", "url": "https://www.cdc.gov/art/php/surveillance/index.html" }, { "label": "National ART Surveillance System", "url": "https://www.cdc.gov/art/php/nass/index.html" }, { "label": "How to interpret ART success rates", "url": "https://www.cdc.gov/art/success-rates/interpret.html" } ], "sources": [ "s:cdc-art", "s:cdc-nass", "s:cdc-art-surveillance", "s:cdc-art-interpret", "s:cdc-art-about", "s:cdc-art-2022-summary" ], "provenance": { "default": { "tier": "cited", "source": "s:cdc-art-surveillance" }, "fields": { "text.story": { "tier": "cited", "source": "s:cdc-nass", "note": "the 2022 totals are from the CDC surveillance page, the reporting and nonreporter sentences from the NASS page, the warnings from the interpretation page; the closing paragraph is marked inference" }, "text.notes": { "tier": "cited", "source": "s:cdc-art-about" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "What every reporting fertility clinic in the United States did in a year, and what came of it.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "north-america", "name": "North America", "note": "the United States and Canada — the two biggest source markets in the world" } ], "kin_out": [ { "to": "hfea-results", "type": "dataset", "name": "HFEA fertility treatment results", "as": "The British counterpart: a register with a statute behind it, publishing rates and warning against comparing them.", "rel": "dataset" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment counted, cycle by cycle.", "rel": "procedure" }, { "to": "icsi", "type": "procedure", "name": "Intracytoplasmic sperm injection", "as": "Counted inside the same cycles, as a laboratory method rather than a separate treatment.", "rel": "procedure" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "Reported separately in the clinic tables, because donor cycles carry different rates.", "rel": "procedure" }, { "to": "united-states", "type": "destination", "name": "United States", "as": "The country the register covers, and the largest source market for fertility travel in this directory.", "rel": "destination" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "A mandatory national register that still cannot see a patient who left.", "rel": "story" } ], "source_list": [ { "id": "s:cdc-art", "kind": "dataset", "title": "Assisted Reproductive Technology Surveillance and clinic-level success rates", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/art/", "accessed": "2026-09-16" }, { "id": "s:cdc-nass", "kind": "org", "title": "National ART Surveillance System (NASS)", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/art/php/nass/index.html", "accessed": "2026-09-17", "note": "'The Fertility Clinic Success Rate and Certification Act of 1992 mandates that clinics performing ART annually provide data to CDC'; 'A small number of clinics do not report data to CDC and are listed as nonreporters'; NASS estimated to contain about 98% of all US ART cycles" }, { "id": "s:cdc-art-surveillance", "kind": "org", "title": "ART Surveillance — national totals", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/art/php/surveillance/index.html", "accessed": "2026-09-16" }, { "id": "s:cdc-art-interpret", "kind": "org", "title": "How to interpret ART success rates", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/art/success-rates/interpret.html", "accessed": "2026-09-17", "note": "'Comparison of success rates across clinics may not be meaningful' and 'Clinic success rates do not reflect any one patient's chance of success', with the reasons given" }, { "id": "s:cdc-art-about", "kind": "org", "title": "About assisted reproductive technology", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/art/about/index.html", "accessed": "2026-09-17", "note": "ART covers treatments in which eggs or embryos are handled; 'ART does NOT include treatments in which only sperm are handled (such as intrauterine insemination)'" }, { "id": "s:cdc-art-2022-summary", "kind": "dataset", "title": "2022 Final Assisted Reproductive Technology (ART) Summary", "publisher": "US Centers for Disease Control and Prevention", "url": "https://data.cdc.gov/Assisted-Reproductive-Technology-ART-/2022-Final-Assisted-Reproductive-Technology-ART-Su/9tjt-seye", "accessed": "2026-09-16", "note": "clinic-level and national rows; the national rows carry locationabbr NA. Queried through the Socrata endpoint https://data.cdc.gov/resource/9tjt-seye.json" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:cdc-art-surveillance" }, "text.story": { "tier": "cited", "source": "s:cdc-nass", "note": "the 2022 totals are from the CDC surveillance page, the reporting and nonreporter sentences from the NASS page, the warnings from the interpretation page; the closing paragraph is marked inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "united-states", "type": "destination", "name": "United States", "as": "The one US series that reports clinic-by-clinic outcomes, and what it does and does not cover.", "rel": "measured-by" }, { "from": "egg-freezing", "type": "procedure", "name": "Egg freezing", "as": "The US series behind the per-transfer figure for embryos from frozen eggs.", "rel": "measured-by" }, { "from": "icsi", "type": "procedure", "name": "Intracytoplasmic sperm injection", "as": "The US series behind the 77.7% of 2022 transfers using ICSI.", "rel": "measured-by" }, { "from": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "The US series behind the 58.2% of 2022 transfers carrying a tested embryo.", "rel": "measured-by" }, { "from": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "The only other register in the world publishing clinic-level rates, counted from a different starting line.", "rel": "dataset" }, { "from": "icmart", "type": "org", "name": "International Committee for Monitoring Assisted Reproductive Technologies", "as": "The American statutory register whose national totals reach the world report.", "rel": "dataset" }, { "from": "hfea-results", "type": "dataset", "name": "HFEA fertility treatment results", "as": "The American counterpart: mandatory reporting, clinic-level rates, and the same warning against comparing clinics.", "rel": "dataset" }, { "from": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "The same boundary in the United States, with its own limits stated by the agency.", "rel": "dataset" } ] }, { "schema": 1, "id": "exchange-rate-table", "type": "dataset", "names": { "name": "The dated exchange rate table", "aliases": [ "rates.json", "USD base rate table" ], "said": "One table, one date. Every dollar figure on this site is a published price multiplied by a number fetched on a stated day." }, "region": [ "global" ], "facets": { "publisher": "ExchangeRate-API" }, "text": { "what": "One set of exchange rates, fetched once and stamped, so prices published in twenty-odd currencies can sit on a single axis. The copy on disk holds 166 currencies against the US dollar, rates dated Wednesday 16 September 2026, fetched the same day from the open endpoint of ExchangeRate-API.", "story": "A price on this site keeps the currency it was published in. The dollar figure beside it is this table applied, and it moves whenever the table is refetched — so a page can change its dollar column without a hospital changing its price.\n\nThat is not a rounding problem. A Turkish package quoted at 60,000 lira in 2019 and the same 60,000 lira today are different amounts of money to a foreign buyer; converting an old price at a new rate reports something nobody paid. Two dates therefore travel with every converted figure on this site: the date the price was published and the date of the rate.\n\n*Inference —* the rate is also not the price of a transaction. A patient pays a card rate, an interbank rate plus a spread, a foreign-transaction fee, or a currency conversion offered at the terminal, and the difference between the mid-market rate in this table and what leaves an account can run to several per cent on a five-figure bill. This site converts at mid-market because it is a stated, dated, reproducible number, not because it is what anybody was charged.", "how": "tools/fetch_rates.py reads https://open.er-api.com/v6/latest/USD, keeps every positive numeric rate, and stores them with the provider's own time_last_update_utc as the rate date. A currency the table does not carry leaves its price unconverted, and the page prints it in its own currency. tools/build.py computes the usd field on every price row from this table; a usd figure typed by hand into a record is overwritten.", "notes": "The open endpoint updates once a day and requires attribution to ExchangeRate-API on any page that uses the rates; its terms do not permit redistributing the rate data itself." }, "dataset": { "publisher": "ExchangeRate-API (open endpoint, open.er-api.com)", "url": "https://www.exchangerate-api.com/docs/free", "api": "https://open.er-api.com/v6/latest/USD", "license": "Free open endpoint; attribution required, redistribution not permitted", "unit": "units of each currency per US dollar", "years": "a single snapshot, rates dated 16 September 2026", "countries": null, "updated_by_publisher": "once a day", "counts": "166 currency codes with a mid-market rate against the US dollar on one stated date.", "does_not_count": "What a patient's bank charges. This is a mid-market rate on one day: it carries no card spread, no foreign-transaction fee, no cash-advance charge and no airport-counter margin, and it is not the rate on the day any price on this site was published. It holds no history, so an old price converted here is converted at a new rate and says nothing about what that patient's currency bought at the time. Several of its rates are administered pegs rather than traded prices — the UAE dirham sits at 3.6725 and the Saudi riyal at 3.75 — and nothing in the file marks which is which." }, "kin": [ { "to": "package-price", "as": "What a package price is quoted in, before this table touches it.", "rel": "term" }, { "to": "the-price-that-isnt", "as": "The conversion is one of the several steps between a published figure and what somebody pays.", "rel": "story" }, { "to": "is-it-cheaper", "as": "Every comparison on that page passes through this table and inherits its date.", "rel": "story" }, { "to": "how-this-was-built", "as": "Why a rate is fetched once and stamped rather than looked up live.", "rel": "story" } ], "links": [ { "label": "Open endpoint documentation", "url": "https://www.exchangerate-api.com/docs/free" } ], "sources": [ "s:er-api", "s:er-api-free-terms" ], "provenance": { "default": { "tier": "harvested", "source": "s:er-api" }, "fields": { "text.story": { "tier": "inference", "note": "the rate date and currency count are from data/harvest/rates.json; the reasoning about what a mid-market rate is not is this project's" }, "text.notes": { "tier": "cited", "source": "s:er-api-free-terms" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "One set of exchange rates, fetched once and stamped, so prices published in twenty-odd currencies can sit on a single axis.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "package-price", "type": "term", "name": "Package price", "as": "What a package price is quoted in, before this table touches it.", "rel": "term" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "The conversion is one of the several steps between a published figure and what somebody pays.", "rel": "story" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "Every comparison on that page passes through this table and inherits its date.", "rel": "story" }, { "to": "how-this-was-built", "type": "story", "name": "How this was built", "as": "Why a rate is fetched once and stamped rather than looked up live.", "rel": "story" } ], "source_list": [ { "id": "s:er-api", "kind": "dataset", "title": "Open Exchange Rates API (open.er-api.com)", "publisher": "ExchangeRate-API", "url": "https://open.er-api.com/v6/latest/USD", "accessed": "2026-09-16", "note": "one dated rate table; every converted price on the site names the date" }, { "id": "s:er-api-free-terms", "kind": "web", "title": "Free exchange rate API documentation — open endpoint", "publisher": "ExchangeRate-API", "url": "https://www.exchangerate-api.com/docs/free", "accessed": "2026-09-17", "note": "open endpoint updates once per day and carries time_last_update_utc and time_next_update_utc; attribution to ExchangeRate-API is required on pages using the rates; redistribution of the data is not permitted" } ], "tiers": { "text.what": { "tier": "harvested", "source": "s:er-api" }, "text.story": { "tier": "inference", "note": "the rate date and currency count are from data/harvest/rates.json; the reasoning about what a mid-market rate is not is this project's" }, "text.how": { "tier": "harvested", "source": "s:er-api" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "how-this-was-built", "type": "story", "name": "How this was built", "as": "The one dated rate table every dollar figure on the site passes through.", "rel": "dataset" }, { "from": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The one dated rate table every dollar figure here passes through.", "rel": "dataset" } ] }, { "schema": 1, "id": "hfea-results", "type": "dataset", "names": { "name": "HFEA fertility treatment results", "aliases": [ "Choose a Fertility Clinic", "HFEA Register", "Fertility treatment: trends and figures" ], "said": "British clinics call it the Register. It is the longest-running record of fertility treatment anywhere, and it stops at the Channel." }, "region": [ "global", "europe-west" ], "facets": { "publisher": "HFEA" }, "text": { "what": "What every licensed fertility clinic in the United Kingdom did, and what came of it. The Human Fertilisation and Embryology Authority has collected data on all IVF and donor insemination treatments in the UK since 1 August 1991 under the Human Fertilisation and Embryology Act 1990, and publishes it two ways: an annual report, and a clinic-by-clinic comparison tool. The latest report, Fertility treatment 2024, was published on 16 June 2026 from a register snapshot taken on 6 May 2026.", "story": "The scale first. In 2024, 64,000 patients underwent over 100,000 treatment and freezing cycles at HFEA-licensed clinics; the register handles roughly a hundred thousand cycles a year and, in the Authority's own words, \"is believed to be the longest running database of fertility treatment in the world\". The average IVF birth rate per embryo transferred was 30% in 2024 — 38% for patients aged 18 to 34 and 8% for those aged 43 to 44. Birth outcomes for 2024 are marked preliminary, because outcomes arrive after the cycles do.\n\nThe regulator publishes the clinic table and then argues against reading it the way people read it: \"Use success rates as a rough guide and not a prediction\", because \"differences of just one or two percentage points are often down to chance rather than being a reflection of a clinic's abilities: a clinic that's performing particularly well one year may have lower success rates the following year and vice versa\". A published comparison and a warning not to compare, in the same place, by the same body.\n\nThe boundary is what makes this series matter to a directory about travel. Everyone treated in a licensed UK clinic is in the Register \"regardless of a person's residence\", and regions are assigned \"based on the location of the clinic rather than patient's residency\". So a woman who flies into London is counted, and the same woman flying out to Alicante, Prague or Kyrenia is not, because those clinics are \"not regulated by the HFEA\".\n\n*Inference —* that asymmetry runs one way for every patient leaving a regulated market. On the British side of a decision there is a named clinic, a dated birth rate, a licence and a complaints route; on the other side, for most destinations in this directory, no register of the same grain was found when this record was written. The comparison a traveller wants to make cannot be made from one side of it." }, "dataset": { "publisher": "Human Fertilisation and Embryology Authority (United Kingdom)", "url": "https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2024-trends-and-figures/", "api": "https://www.hfea.gov.uk/media/cvcpx4xy/fertility-treatment-2024-trends-and-figures-underlying-dataset.xlsx", "license": "no licence statement retrieved from the pages read on 17 September 2026; the report is designated an official statistic", "unit": "treatment cycles, and births per embryo transferred or per egg collection", "years": "1991 to 2024; 1991 is a partial year, from August", "countries": 1, "updated_by_publisher": "annually", "counts": "Every IVF and donor insemination cycle performed in a UK licensed clinic, with the patient's age band and the outcome, whoever the patient is and wherever they live. 107 clinics held a licence in 2023/24.", "does_not_count": "Treatment abroad. A UK resident who has IVF in Spain, Czechia or northern Cyprus leaves no trace in this register, because the clinic is not licensed by the HFEA — the one flow this directory exists to describe is the one the register is defined to exclude. It also holds no detailed information on partner intrauterine insemination, nothing on treatment outside licensed clinics, and nothing about surrogacy arrangements beyond the treatment cycle itself. Birth rates for the most recent year are preliminary, and the Authority changed how it calculates them, so figures are not comparable back through earlier reports." }, "kin": [ { "to": "hfea", "as": "The regulator that keeps the register, licenses the clinics and publishes the table.", "rel": "org" }, { "to": "ivf", "as": "The treatment counted, cycle by cycle, since 1991.", "rel": "procedure" }, { "to": "cdc-art-results", "as": "The American counterpart: mandatory reporting, clinic-level rates, and the same warning against comparing clinics.", "rel": "dataset" }, { "to": "reproductive-exile", "as": "The word for the patients who leave, and who leave no record behind them.", "rel": "term" }, { "to": "north-cyprus", "as": "A destination British patients travel to, and one this register cannot see.", "rel": "destination" }, { "to": "counting-patients", "as": "A register that counts arrivals into one country and nothing leaving it.", "rel": "story" }, { "to": "united-kingdom", "as": "The jurisdiction the register covers, clinic by clinic.", "rel": "destination" } ], "links": [ { "label": "Fertility treatment 2024: trends and figures", "url": "https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2024-trends-and-figures/" }, { "label": "Choose a fertility clinic", "url": "https://www.hfea.gov.uk/choose-a-fertility-clinic/" }, { "label": "Finding the right clinic for you", "url": "https://www.hfea.gov.uk/choose-a-fertility-clinic/finding-the-best-fertility-clinic-for-you/" } ], "sources": [ "s:hfea-2024-trends", "s:hfea-2024-methodology", "s:hfea-choose-clinic", "s:hfea-key-facts", "s:hfea" ], "provenance": { "default": { "tier": "cited", "source": "s:hfea-2024-trends" }, "fields": { "text.story": { "tier": "cited", "source": "s:hfea-2024-methodology", "note": "the figures are from the 2024 report, the quoted boundary sentences from its quality and methodology report, the comparison warning from the clinic-choosing page; the closing paragraph is marked inference" }, "dataset.counts": { "tier": "cited", "source": "s:hfea-key-facts", "note": "the 107-clinic figure is HFEA's key facts page for 2023/24" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "What every licensed fertility clinic in the United Kingdom did, and what came of it.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" }, { "key": "europe-west", "name": "Western Europe", "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria" } ], "kin_out": [ { "to": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "The regulator that keeps the register, licenses the clinics and publishes the table.", "rel": "org" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "The treatment counted, cycle by cycle, since 1991.", "rel": "procedure" }, { "to": "cdc-art-results", "type": "dataset", "name": "CDC assisted reproductive technology results", "as": "The American counterpart: mandatory reporting, clinic-level rates, and the same warning against comparing clinics.", "rel": "dataset" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The word for the patients who leave, and who leave no record behind them.", "rel": "term" }, { "to": "north-cyprus", "type": "destination", "name": "Northern Cyprus", "as": "A destination British patients travel to, and one this register cannot see.", "rel": "destination" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "A register that counts arrivals into one country and nothing leaving it.", "rel": "story" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The jurisdiction the register covers, clinic by clinic.", "rel": "destination" } ], "source_list": [ { "id": "s:hfea-2024-trends", "kind": "org", "title": "Fertility treatment 2024: trends and figures", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2024-trends-and-figures/", "accessed": "2026-09-17", "note": "published 16 June 2026 from a register snapshot of 6 May 2026; 64,000 patients and over 100,000 treatment and freezing cycles in 2024; average IVF birth rate per embryo transferred 30%, 38% at ages 18-34 and 8% at 43-44; 2024 birth outcomes marked preliminary" }, { "id": "s:hfea-2024-methodology", "kind": "org", "title": "Fertility treatment 2024: quality and methodology report", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2024-trends-and-figures/quality-and-methodology-report/", "accessed": "2026-09-17", "note": "people are in the Register 'regardless of a person's residence'; 'We do not hold detailed information on partner intrauterine insemination (IUI), or treatments that takes place outside of licensed clinics'; regions are assigned 'based on the location of the clinic rather than patient's residency'; the Register runs since 1991 and is described as the longest running database of fertility treatment in the world" }, { "id": "s:hfea-choose-clinic", "kind": "org", "title": "Finding the right clinic for you", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/choose-a-fertility-clinic/finding-the-best-fertility-clinic-for-you/", "accessed": "2026-09-17", "note": "'Use success rates as a rough guide and not a prediction', and the passage on differences of one or two percentage points being down to chance" }, { "id": "s:hfea-key-facts", "kind": "org", "title": "Key facts and statistics", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/about-us/media-centre/key-facts-and-statistics/", "accessed": "2026-09-16", "note": "set up by the Human Fertilisation and Embryology Act 1990; 107 licensed clinics in 2023/24; records of every treatment in a licensed clinic since 1991; 2022 figures for patients, cycles, pregnancy rate per fresh embryo transfer and the NHS-funded share" }, { "id": "s:hfea", "kind": "org", "title": "Human Fertilisation and Embryology Authority — clinic licensing and published results", "publisher": "HFEA (United Kingdom)", "url": "https://www.hfea.gov.uk/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:hfea-2024-trends" }, "text.story": { "tier": "cited", "source": "s:hfea-2024-methodology", "note": "the figures are from the 2024 report, the quoted boundary sentences from its quality and methodology report, the comparison warning from the clinic-choosing page; the closing paragraph is marked inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "hfea", "type": "org", "name": "Human Fertilisation and Embryology Authority", "as": "The register this authority keeps and the clinic table it publishes out of it.", "rel": "dataset" }, { "from": "cdc-art-results", "type": "dataset", "name": "CDC assisted reproductive technology results", "as": "The British counterpart: a register with a statute behind it, publishing rates and warning against comparing them.", "rel": "dataset" }, { "from": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "Holds every licensed UK cycle and nothing done abroad, which is the flow by definition.", "rel": "dataset" } ] }, { "schema": 1, "id": "jci-accredited-list", "type": "dataset", "names": { "name": "The JCI list of accredited organizations", "aliases": [ "JCI accredited organizations directory", "Gold Seal list" ], "said": "Hospitals call it being on the list. It is a register of organisations that applied, paid and passed, kept by the body they paid." }, "region": [ "global" ], "facets": { "publisher": "Joint Commission International" }, "text": { "what": "The directory of hospitals, clinics and programmes outside the United States currently holding Joint Commission International accreditation. It is the register behind almost every accreditation claim in this trade, and the only place a reader can check whether the mark on a hospital's homepage is still live.", "story": "It is not a survey of hospitals. An organisation decides to apply, signs a contract, pays, prepares, and is surveyed on an agreed date; accreditation then runs three years. So the list maps demand for inspection, not distribution of quality. A hospital absent from it may never have applied, may have let it lapse, may hold a different mark, or may have failed — the list does not distinguish those four, and three of them look identical from outside.\n\nThat selection has a geography. Accreditation costs money in a currency the applicant may not earn, and the hospitals that buy it are disproportionately the ones selling to foreigners, because the mark is worth most where the buyer cannot judge the hospital any other way. A country with a strong public system and no export trade can have excellent hospitals and almost no entries.\n\n*Inference —* counting is therefore the only defensible use. This site records an accreditation as an event with a body, a date and a source, and eleven facility records on this disk carry a JCI row. None of them is read as a score, none is weighed against another body's mark, and none is treated as current evidence about a hospital without its date.", "today": "As of 17 September 2026 the directory could not be read by this project. jointcommissioninternational.org answers with a permanent redirect to jointcommission.org/en/, and every path under it refused an automated request with HTTP 403 — robots.txt included. No count of accredited organisations is carried here for that reason. Every accreditation on this site is therefore taken from the accredited hospital's own page or from a named secondary source, with the date it was read." }, "dataset": { "publisher": "Joint Commission International", "url": "https://www.jointcommission.org/en/who-we-are/who-we-work-with/find-accredited-organizations/", "license": "no reuse terms retrieved; the site refused every automated request on 17 September 2026", "unit": "accredited organizations, one row per organization", "years": "a live directory of current accreditations, with no published archive of lapsed ones", "countries": null, "updated_by_publisher": "continuously, as surveys are completed and accreditations expire", "counts": "Organizations that applied for JCI accreditation, paid for the survey, met the standards on the survey date, and are inside a three-year cycle.", "does_not_count": "Everybody who did not apply. This is a register of purchased inspections, so it maps who bought one rather than who is any good, and no hospital appears in it involuntarily. It carries no outcome data — no infection rate, no mortality, no revision rate — no price, no patient volume, and no record of a complaint. Nor does it show the lapsed: an accreditation that expired leaves a hospital's website long after it leaves the list, and the list itself keeps no public history of who used to be on it." }, "kin": [ { "to": "jci", "as": "The body that keeps the list, sells the standards and takes the fee.", "rel": "org" }, { "to": "the-accreditation-question", "as": "What a bought inspection proves, argued at length.", "rel": "story" }, { "to": "bumrungrad", "as": "On the list since 2002, the first hospital in Asia to be.", "rel": "facility" }, { "to": "osm-facilities", "as": "The opposite selection problem: a map of who got mapped, against a register of who applied.", "rel": "dataset" }, { "to": "temos", "as": "A rival register, built for facilities treating international patients.", "rel": "org" }, { "to": "isqua-ieea", "as": "The body that accredits the accreditors, and the answer to who audits this register.", "rel": "org" } ], "links": [ { "label": "Find accredited organizations (Joint Commission)", "url": "https://www.jointcommission.org/en/who-we-are/who-we-work-with/find-accredited-organizations/" } ], "sources": [ "s:jci-accreditation", "s:jci-wikipedia" ], "provenance": { "default": { "tier": "cited", "source": "s:jci-wikipedia" }, "fields": { "text.story": { "tier": "inference", "note": "the three-year cycle, the applicant-pays structure and the scheduled survey are cited to the source; the selection argument and the count of eleven facility records are this project's" }, "dataset.does_not_count": { "tier": "inference", "note": "what a voluntary purchased register cannot contain, reasoned from how the scheme works" }, "text.today": { "tier": "inference", "note": "the redirect and the 403 were observed from this machine on 2026-09-17" } } }, "needs_verification": true, "confidence": "medium", "updated": "2026-09-17", "blurb": "The directory of hospitals, clinics and programmes outside the United States currently holding Joint Commission International accreditation.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The body that keeps the list, sells the standards and takes the fee.", "rel": "org" }, { "to": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "What a bought inspection proves, argued at length.", "rel": "story" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "On the list since 2002, the first hospital in Asia to be.", "rel": "facility" }, { "to": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The opposite selection problem: a map of who got mapped, against a register of who applied.", "rel": "dataset" }, { "to": "temos", "type": "org", "name": "Temos International Healthcare Accreditation", "as": "A rival register, built for facilities treating international patients.", "rel": "org" }, { "to": "isqua-ieea", "type": "org", "name": "ISQua External Evaluation Association", "as": "The body that accredits the accreditors, and the answer to who audits this register.", "rel": "org" } ], "source_list": [ { "id": "s:jci-accreditation", "kind": "org", "title": "Joint Commission International — accreditation standards and accredited organizations", "publisher": "Joint Commission International", "url": "https://www.jointcommissioninternational.org/", "accessed": "2026-09-16" }, { "id": "s:jci-wikipedia", "kind": "wikipedia", "title": "Joint Commission International", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Joint_Commission_International", "accessed": "2026-09-16", "note": "used for the 1998 founding, the Joint Commission Resources affiliation, the quoted average annual fee and the announced-survey criticism; jointcommissioninternational.org redirected to jointcommission.org, which refused every fetch on this date" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:jci-wikipedia" }, "text.story": { "tier": "inference", "note": "the three-year cycle, the applicant-pays structure and the scheduled survey are cited to the source; the selection argument and the count of eleven facility records are this project's" }, "text.today": { "tier": "inference", "note": "the redirect and the 403 were observed from this machine on 2026-09-17" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "jci", "type": "org", "name": "Joint Commission International", "as": "The published directory this site draws its accreditation counts from.", "rel": "measured-by" }, { "from": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The opposite selection: a register of who applied and paid, against a map of who got mapped.", "rel": "dataset" }, { "from": "how-this-was-built", "type": "story", "name": "How this was built", "as": "Counted and never weighted, which is a rule rather than a judgement about any hospital.", "rel": "dataset" }, { "from": "the-accreditation-question", "type": "story", "name": "The accreditation question", "as": "The register itself, and the sentence saying what it does not hold.", "rel": "dataset" }, { "from": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "A register of purchased inspections, with no outcome, no price and no history of the lapsed.", "rel": "dataset" } ] }, { "schema": 1, "id": "natural-earth-countries", "type": "dataset", "names": { "name": "Natural Earth country outlines", "aliases": [ "ne_110m_admin_0_countries", "Admin 0 – Countries" ], "said": "Cartographers say Admin 0 and mean the national outline. Every map on this site is drawn from one file of them." }, "region": [ "global" ], "facets": { "publisher": "Natural Earth" }, "text": { "what": "The country shapes every map on this site is drawn with. Natural Earth's Admin 0 countries at 1:110 million, fetched once and simplified: 220 country rows, 357 rings, 6,571 coordinate pairs at two decimal places. A closer file sits beside it for the detail maps — the same 220 countries from the 1:50 million source, 1,303 rings and 29,823 points at three decimal places. Public domain, in the publisher's own words: \"No permission is needed to use Natural Earth.\"", "story": "The coarseness is deliberate. These maps are about nine hundred pixels wide, and a coastline drawn finer than a pixel costs bandwidth and shows nothing; the rings are reduced by Douglas–Peucker at 0.2° for the world map and 0.05° for the close-ups.\n\nThe file's join key is what matters for the rest of the site. Every chart, table and country page keys on ISO 3166-1 alpha-2, and Natural Earth leaves that field as -99 for a handful of places, so tools/fetch_geo.py patches five by name: France and Norway, whose codes sit on dependency rows, and Kosovo, Somaliland and northern Cyprus, which have no ISO alpha-2 at all. The patched codes — XK, XS, XN — are placeholders this project chose, and they will not match a World Bank series, because no such series carries a row for them.\n\n*Inference —* that is not a technicality for this subject, and one of the placeholders is worse than a blank. XN in the World Bank's tables is not a place at all but the aggregate Lower middle income, which carried 0.71 physicians per 1,000 in 2022 — so a map that joined blindly on the code would paint northern Cyprus, a fertility destination this directory writes about, with an income group's average. Taiwan has an ISO code and an outline here and carries no value in any of the five World Bank series on this disk. Monaco, Macau and the Vatican have no polygon at all.", "how": "tools/fetch_geo.py downloads the GeoJSON from the Natural Earth vector repository, keeps every country with an ISO alpha-2 code, simplifies each ring and rounds coordinates. The 1:110m file omits several small states, small island states and city states; those are filled in from the 1:50m file so the country list is one list.", "notes": "Names in the file are the file's own: Turkey rather than Türkiye, United States of America, Dem. Rep. Congo. This site carries its own names in the records and uses the outlines only for geometry. Natural Earth's terms add that its authors \"are not responsible for any problems relating to accuracy, content, design, and how it is used\", and boundaries drawn at this scale are a cartographic convenience, not a statement about a border." }, "dataset": { "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/downloads/", "api": "https://raw.githubusercontent.com/nvkelso/natural-earth-vector/master/geojson/ne_110m_admin_0_countries.geojson", "license": "Public domain", "unit": "polygon rings, [lon, lat]", "years": "a versioned release, fetched 16 September 2026", "countries": 220, "updated_by_publisher": "on release, every few years", "counts": "National outlines: one row per country with an ISO 3166-1 alpha-2 code, simplified for a screen-width map.", "does_not_count": "Anything about the people inside the outline. It is geometry, and it joins to the rest of this site only through a country code — so a place with no ISO alpha-2 code, or one too small to carry a polygon at this scale, silently drops out of every map and every chart. Northern Cyprus, Kosovo and Somaliland are here under codes this project invented for them; Monaco, Macau and the Vatican are not here at all. Disputed borders are drawn one way at one scale and are not a ruling on anything." }, "kin": [ { "to": "world-bank-health-spending", "as": "What the outlines are coloured by, joined on the country code.", "rel": "dataset" }, { "to": "north-cyprus", "as": "Carried here under a placeholder code, and therefore absent from every series keyed on ISO.", "rel": "measures" }, { "to": "osm-facilities", "as": "The other map layer: this one draws countries, that one draws the clinics inside nine of them.", "rel": "dataset" }, { "to": "what-the-data-cannot-see", "as": "A country that has no code has no row, and a missing row looks like an empty country.", "rel": "story" }, { "to": "how-this-was-built", "as": "The simplification, the rounding and the five patched codes are all in the method.", "rel": "story" } ], "links": [ { "label": "Natural Earth downloads", "url": "https://www.naturalearthdata.com/downloads/" }, { "label": "Natural Earth terms of use", "url": "https://www.naturalearthdata.com/about/terms-of-use/" } ], "sources": [ "s:natural-earth", "s:natural-earth-terms" ], "provenance": { "default": { "tier": "harvested", "source": "s:natural-earth" }, "fields": { "text.story": { "tier": "harvested", "source": "s:natural-earth", "note": "ring and point counts taken off data/geo/countries.json on 2026-09-17; the closing paragraph is marked inference" }, "text.notes": { "tier": "cited", "source": "s:natural-earth-terms" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "The country shapes every map on this site is drawn with. Natural Earth's Admin 0 countries at 1:110 million, fetched once and simplified: 220 country rows, 357 rings, 6,571 coordinate pairs at two decimal places.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "What the outlines are coloured by, joined on the country code.", "rel": "dataset" }, { "to": "north-cyprus", "type": "destination", "name": "Northern Cyprus", "as": "Carried here under a placeholder code, and therefore absent from every series keyed on ISO.", "rel": "measures" }, { "to": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The other map layer: this one draws countries, that one draws the clinics inside nine of them.", "rel": "dataset" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "A country that has no code has no row, and a missing row looks like an empty country.", "rel": "story" }, { "to": "how-this-was-built", "type": "story", "name": "How this was built", "as": "The simplification, the rounding and the five patched codes are all in the method.", "rel": "story" } ], "source_list": [ { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" }, { "id": "s:natural-earth-terms", "kind": "web", "title": "Terms of Use", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/about/terms-of-use/", "license": "Public domain", "accessed": "2026-09-17", "note": "'All versions of Natural Earth raster + vector map data found on this website are in the public domain.' and 'No permission is needed to use Natural Earth.' The same page disclaims responsibility for accuracy and content." } ], "tiers": { "text.what": { "tier": "harvested", "source": "s:natural-earth" }, "text.story": { "tier": "harvested", "source": "s:natural-earth", "note": "ring and point counts taken off data/geo/countries.json on 2026-09-17; the closing paragraph is marked inference" }, "text.how": { "tier": "harvested", "source": "s:natural-earth" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "how-this-was-built", "type": "story", "name": "How this was built", "as": "The geometry every Equal Earth map is drawn from, and the codes that drop out of it.", "rel": "dataset" }, { "from": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "The geometry every map joins through, and the codes that drop out of it silently.", "rel": "dataset" } ] }, { "schema": 1, "id": "oecd-waiting-times", "type": "dataset", "names": { "name": "OECD waiting times for elective surgery", "aliases": [ "DSD_HEALTH_PROC@DF_WAITING", "waiting times for selected elective surgeries" ], "said": "Health systems call it the list. The OECD measures it two different ways, and a country that publishes one of them is not comparable with a country that publishes the other." }, "region": [ "global" ], "facets": { "publisher": "OECD" }, "text": { "what": "How long patients wait for seven non-emergency operations in the countries that measure it. Part of OECD Health Statistics, published with a definitions document dated 10 September 2025. The extract fetched here holds 6,609 observations from 24 countries, 2000 to 2024, covering cataract surgery, coronary angioplasty, coronary bypass, prostatectomy, hysterectomy, hip replacement and knee replacement, each pinned to ICD-9-CM procedure codes.", "story": "Two clocks, and they do not tell the same time. \"Waiting times from specialist assessment to treatment includes the time elapsed for patients on the non-emergency (elective) surgery waiting list from the date they were added to the waiting list for the procedure (following specialist assessment) to the date they were admitted for treatment\" — a retrospective measure, taken from people who have already had the operation. \"Waiting times of patients on the list includes the time elapsed for patients on the non-emergency (elective) surgery waiting list from the date they were added to the waiting list for the procedure (following specialist assessment) to a designated census date\" — a snapshot of people still waiting, which includes those who will wait longest. In this extract 3,925 observations use the first and 2,684 the second.\n\nBoth clocks start late. The OECD excludes \"the time elapsed from the date of referral of the general practitioner to the date of specialist assessment (in some countries, this is referred to as 'outpatient waiting time')\". For a patient the wait begins at the family doctor; in this series it begins after somebody has already been seen by a consultant, and in several countries that first stretch is the longer one.\n\nThe definitions document then records, country by country, where a country departs from the definition. Norway's own note says its figures \"are longer because they start from the date the GP referral is received, not the date the GP referral is assessed\", and concludes that \"waiting times published for Norway are longer than they would be using the OECD definition\". Australia measures from placement on the list because assessment dates are not collected. Romania excludes revision hip and knee operations. Denmark changed method in 2020 and broke its own series.\n\nMedian waits for a knee replacement in 2024 give the range: Italy 45 days and Denmark 55 on the specialist-to-treatment clock, Poland 109, Canada 151, Spain 166.3, Finland 193, New Zealand 217, Chile 797. On the census clock the same year, the United Kingdom recorded 185 days, Poland 476, Slovenia 730 and Chile 1,181. The United Kingdom reports only the census measure, so no cell in this table compares a British wait with an Italian one.\n\n*Inference —* the queue is half the reason anyone travels for planned surgery, and this is the only cross-country measurement of it. It is also the series most likely to be quoted without its clock, its country note or its year." }, "dataset": { "publisher": "OECD Health Statistics, Health Division", "url": "https://www.oecd.org/en/data/datasets/oecd-health-statistics.html", "api": "https://sdmx.oecd.org/public/rest/data/OECD.ELS.HD,DSD_HEALTH_PROC@DF_WAITING,1.1/all?format=csvfile", "license": "OECD terms and conditions; the definitions document and the SDMX extract were read directly, the terms page refused an automated fetch on 17 September 2026", "unit": "days (mean or median), or % of patients waiting more than three months", "indicator": "DSD_HEALTH_PROC@DF_WAITING", "years": "2000 to 2024; 19 countries report for 2024", "countries": 24, "updated_by_publisher": "annually, with the OECD Health Statistics release", "counts": "Waiting time for seven named elective procedures, for \"all publicly-funded patients (including patients who have received the treatment either by publicly- or privately-owned providers)\", reported either as the wait of patients treated or as the wait so far of patients still on the list at a census date.", "does_not_count": "The wait before the specialist. The clock starts after assessment, so the months between a family doctor's referral and a consultant's opinion are outside the series by definition. It counts no privately-funded patient, which removes the domestic private route that competes with travelling abroad. It counts no country that does not publish: Austria, Belgium, Czechia, France, Germany, Japan, Korea, Latvia, Luxembourg, Mexico, the Slovak Republic, Switzerland, Türkiye and the United States are all marked data not available, and several of them are among the largest sources of patients travelling for planned surgery. And it counts nobody who left the list — died, gave up, went private, or flew somewhere else." }, "kin": [ { "to": "knee-replacement", "as": "One of the seven procedures, and the one this site prices most closely.", "rel": "procedure" }, { "to": "cataract-surgery", "as": "The shortest queue in the series and the commonest operation in it.", "rel": "procedure" }, { "to": "united-kingdom", "as": "Reports only the census measure, 185 days median for a knee in 2024, so it compares with nobody who reports the other.", "rel": "measures" }, { "to": "s2-route", "as": "The entitlement a long queue can turn into a funded trip across a European border.", "rel": "rule" }, { "to": "eu-directive-2011-24", "as": "The instrument that lets a patient leave the queue and claim the home tariff back.", "rel": "rule" }, { "to": "is-it-cheaper", "as": "The other half of the comparison: the wait at home against the fee abroad.", "rel": "story" }, { "to": "oecd", "as": "The publisher, and the same body that measured how little of this trade the health accounts can see.", "rel": "org" } ], "links": [ { "label": "OECD Health Statistics", "url": "https://www.oecd.org/en/data/datasets/oecd-health-statistics.html" }, { "label": "Definitions, sources and methods — waiting times for selected elective surgeries", "url": "https://stats.oecd.org/wbos/fileview2.aspx?IDFile=cae608c4-fa81-4f56-8d7f-a0d4d609de80" } ], "sources": [ "s:oecd-waiting-definitions-2025", "s:oecd-waiting-sdmx", "s:oecd-health-statistics" ], "provenance": { "default": { "tier": "cited", "source": "s:oecd-waiting-definitions-2025" }, "fields": { "text.story": { "tier": "cited", "source": "s:oecd-waiting-definitions-2025", "note": "the quoted definitions and country notes are from the OECD definitions document; the 2024 medians and the observation counts were read off the SDMX extract on 2026-09-17; the closing paragraph is marked inference" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "How long patients wait for seven non-emergency operations in the countries that measure it. Part of OECD Health Statistics, published with a definitions document dated 10 September 2025.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "One of the seven procedures, and the one this site prices most closely.", "rel": "procedure" }, { "to": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "The shortest queue in the series and the commonest operation in it.", "rel": "procedure" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Reports only the census measure, 185 days median for a knee in 2024, so it compares with nobody who reports the other.", "rel": "measures" }, { "to": "s2-route", "type": "rule", "name": "The S2 route", "as": "The entitlement a long queue can turn into a funded trip across a European border.", "rel": "rule" }, { "to": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The instrument that lets a patient leave the queue and claim the home tariff back.", "rel": "rule" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The other half of the comparison: the wait at home against the fee abroad.", "rel": "story" }, { "to": "oecd", "type": "org", "name": "Organisation for Economic Co-operation and Development", "as": "The publisher, and the same body that measured how little of this trade the health accounts can see.", "rel": "org" } ], "source_list": [ { "id": "s:oecd-waiting-definitions-2025", "kind": "report", "title": "OECD Health Statistics 2025 — Definitions, Sources and Methods: waiting times for selected elective surgeries", "publisher": "OECD, Health Division", "url": "https://stats.oecd.org/wbos/fileview2.aspx?IDFile=cae608c4-fa81-4f56-8d7f-a0d4d609de80", "accessed": "2026-09-17", "note": "PDF dated 10 September 2025; carries the two waiting-time definitions, the inclusion of publicly-funded patients, the exclusion of the GP-referral-to-assessment stretch, the seven procedures with ICD-9-CM codes, the per-country 'Deviation from the definition' notes and the 'Data not available' entries for Austria, Belgium, Czechia, France, Germany, Japan, Korea, Latvia, Luxembourg, Mexico, the Slovak Republic, Switzerland, Türkiye and the United States" }, { "id": "s:oecd-waiting-sdmx", "kind": "dataset", "title": "Waiting times dataflow DSD_HEALTH_PROC@DF_WAITING, OECD SDMX API", "publisher": "OECD", "url": "https://sdmx.oecd.org/public/rest/data/OECD.ELS.HD,DSD_HEALTH_PROC@DF_WAITING,1.1/all?format=csvfile", "accessed": "2026-09-17", "note": "the extract read for this project holds 6,609 observations, 24 countries, 2000-2024, 19 countries reporting for 2024; WTSP 3,925 observations and WTPA 2,684; the 2024 knee-replacement medians quoted in the record were read from it" }, { "id": "s:oecd-health-statistics", "kind": "dataset", "title": "OECD Health Statistics", "publisher": "Organisation for Economic Co-operation and Development", "url": "https://www.oecd.org/en/data/datasets/oecd-health-statistics.html", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:oecd-waiting-definitions-2025" }, "text.story": { "tier": "cited", "source": "s:oecd-waiting-definitions-2025", "note": "the quoted definitions and country notes are from the OECD definitions document; the 2024 medians and the observation counts were read off the SDMX extract on 2026-09-17; the closing paragraph is marked inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "canada", "type": "destination", "name": "Canada", "as": "The series that puts this country's queue beside everyone else's.", "rel": "measured-by" }, { "from": "ireland", "type": "destination", "name": "Ireland", "as": "The series that would put this queue beside other countries', if the counts were of the same thing.", "rel": "measured-by" }, { "from": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The series that puts this queue beside other countries'.", "rel": "measured-by" }, { "from": "vilnius", "type": "hub", "name": "Vilnius", "as": "The series that measures the queue this cluster sells against.", "rel": "measured-by" }, { "from": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "The series that counts how long a public patient waits for this operation.", "rel": "measured-by" }, { "from": "gallbladder-removal", "type": "procedure", "name": "Gallbladder removal", "as": "The series that counts the queue for exactly this kind of operation.", "rel": "measured-by" }, { "from": "hernia-repair", "type": "procedure", "name": "Hernia repair", "as": "The series that counts the queue for exactly this kind of operation.", "rel": "measured-by" }, { "from": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "The series that counts the queue this operation is best known for.", "rel": "measured-by" }, { "from": "hysterectomy", "type": "procedure", "name": "Hysterectomy", "as": "The series that counts the queue this operation leaves home to escape.", "rel": "measured-by" }, { "from": "prostatectomy", "type": "procedure", "name": "Prostatectomy", "as": "The series that counts the queue this operation waits in at home.", "rel": "measured-by" }, { "from": "deciding-whether", "type": "pathway", "name": "Deciding whether to go", "as": "The published series behind the queue at home that is half of this decision.", "rel": "measured-by" }, { "from": "eu-directive-2011-24", "type": "rule", "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare", "as": "The series behind the queue this route was argued over.", "rel": "measured-by" }, { "from": "s2-route", "type": "rule", "name": "The S2 route", "as": "The series that measures the queue Article 20(2) turns on.", "rel": "measured-by" }, { "from": "uk-nhs-treatment-abroad", "type": "rule", "name": "NHS funding for treatment abroad", "as": "The queue that sends the patients.", "rel": "measured-by" }, { "from": "oecd", "type": "org", "name": "Organisation for Economic Co-operation and Development", "as": "The series behind the queue at home, which is half of why anyone travels.", "rel": "measures" }, { "from": "covid-shutdown-2020", "type": "event", "name": "The 2020 shutdown", "as": "Where the backlog the cancellations built shows up, in the countries that measure it.", "rel": "dataset" }, { "from": "directive-2011-24-adopted", "type": "event", "name": "Directive 2011/24/EU adopted, 9 March 2011", "as": "The queue Article 8(5) turns into an entitlement, measured where anybody measures it.", "rel": "dataset" }, { "from": "waiting-lists", "type": "story", "name": "The queue is the product", "as": "The series, and the sentence about where its clock starts.", "rel": "measured-by" }, { "from": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "The series closest to the motive, and the one that removes everybody who left the list.", "rel": "dataset" } ] }, { "schema": 1, "id": "osm-facilities", "type": "dataset", "names": { "name": "OpenStreetMap hospitals, clinics and dental surgeries", "aliases": [ "OSM facilities harvest", "Overpass hub query" ], "said": "Mappers call them POIs. Each row is a point somebody typed a name onto, and the tags are whatever that person thought worth typing." }, "region": [ "global" ], "facets": { "publisher": "OpenStreetMap" }, "text": { "what": "Every named hospital, clinic and dental surgery OpenStreetMap carried within a set radius of each hub on this site, fetched through the Overpass API. The copy on disk holds 14,356 rows across 14 hubs, fetched on 16 and 17 September 2026: 5,532 tagged amenity=clinic, 5,323 amenity=hospital, 2,651 amenity=dentist, and 788 carrying a healthcare tag with no amenity tag at all.", "story": "The count follows the mappers, not the medicine. Bengaluru returns 2,548 rows inside 25 km and Bangkok 521 inside the same 25 km; Delhi NCR returns 2,275 inside 40 km, Mumbai 1,849, Chennai 1,529, Istanbul 1,297 inside 30 km, Kuala Lumpur 1,287, Bogotá 894, Barcelona 621, Budapest 549, Dubai 545, İzmir 206, Amman 139 and Antalya 96 inside 25 km. India supplies 8,201 of the 14,356 rows. Nobody should read that as India having sixteen times the clinics of Thailand; India has a larger and more active mapping community, and Thai medical addresses are often mapped in Thai script under names a Latin-script query does not reach.\n\nThe tags thin out fast. Of 14,356 rows, 1,621 carry a website, 1,581 a telephone number, 3,775 a street address, 1,375 an operator — and 42 carry a bed count. A bed count on three rows in a thousand is not a capacity dataset.\n\n*Inference —* the country code on each row shows how the sausage is made. It is taken from the mapper's own addr:country tag where there is one, and from the hub's country otherwise. One clinic in Dubai Marina carries addr:country=UA, so the harvest files it under Ukraine. One row in 14,356, visible only because somebody counted; the same class of error is invisible everywhere it happens to agree with the hub.", "how": "tools/harvest_osm.py runs one Overpass query per hub at the radius the hub record names: nwr[\"amenity\"=\"hospital\"], amenity=clinic, amenity=dentist and healthcare in hospital, clinic, centre, dentist, fertility_clinic, rehabilitation or laboratory, each requiring a name, around the hub's own point. Ways and relations are reduced to their centre. Rows are deduplicated by OSM id across hubs, and twenty-eight tag keys are kept — name, operator, healthcare speciality, beds, website, phone, address parts, wheelchair, wikidata and a few more.", "notes": "ODbL 1.0, which is share-alike: the attribution travels with the rows onto the page and into anything built from them. © OpenStreetMap contributors." }, "dataset": { "publisher": "OpenStreetMap contributors, through the Overpass API", "url": "https://www.openstreetmap.org/", "api": "https://overpass-api.de/api/interpreter", "license": "ODbL 1.0", "unit": "named points, one row per OSM object", "years": "a snapshot, fetched 16 and 17 September 2026", "countries": 9, "updated_by_publisher": "continuously — OpenStreetMap changes by the minute, and this file does not", "counts": "Points, ways and relations inside the radius that carry a name and one of the queried amenity or healthcare tags on the fetch date.", "does_not_count": "Anything nobody mapped. A hospital missing from this file is missing from OpenStreetMap, which is a fact about mappers and not about the city: absence here is absence of mapping. The rows carry no accreditation, no ownership, no price, no quality measure, no patient volume and no indication that a place treats foreigners — and a clinic that closed last year sits in the file until somebody edits it out. A name is not a licence: a row proves only that a point on a map once had that name typed on it." }, "kin": [ { "to": "bangkok", "as": "521 rows inside 25 km of the hub's point, against Bengaluru's 2,548 inside the same radius.", "rel": "measures" }, { "to": "bengaluru", "as": "The largest harvest on this site at 2,548 rows, and a lesson in reading map coverage as medical density.", "rel": "measures" }, { "to": "istanbul", "as": "1,297 rows inside 30 km, in the city with the loudest advertising in this trade.", "rel": "measures" }, { "to": "jci-accredited-list", "as": "The opposite selection: a register of who applied and paid, against a map of who got mapped.", "rel": "dataset" }, { "to": "what-the-data-cannot-see", "as": "Absence of mapping, read as absence of a hospital, is the commonest mistake this file invites.", "rel": "story" }, { "to": "how-this-was-built", "as": "The Overpass query, the radii and the tag list are all in the method.", "rel": "story" } ], "links": [ { "label": "OpenStreetMap", "url": "https://www.openstreetmap.org/" }, { "label": "ODbL 1.0", "url": "https://opendatacommons.org/licenses/odbl/1-0/" } ], "sources": [ "s:osm", "s:odbl-1-0" ], "provenance": { "default": { "tier": "harvested", "source": "s:osm" }, "fields": { "text.story": { "tier": "harvested", "source": "s:osm", "note": "every count was taken off data/harvest/osm-facilities.json on 2026-09-17; the closing paragraph is marked inference" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "Every named hospital, clinic and dental surgery OpenStreetMap carried within a set radius of each hub on this site, fetched through the Overpass API.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "bangkok", "type": "hub", "name": "Bangkok", "as": "521 rows inside 25 km of the hub's point, against Bengaluru's 2,548 inside the same radius.", "rel": "measures" }, { "to": "bengaluru", "type": "hub", "name": "Bengaluru", "as": "The largest harvest on this site at 2,548 rows, and a lesson in reading map coverage as medical density.", "rel": "measures" }, { "to": "istanbul", "type": "hub", "name": "Istanbul", "as": "1,297 rows inside 30 km, in the city with the loudest advertising in this trade.", "rel": "measures" }, { "to": "jci-accredited-list", "type": "dataset", "name": "The JCI list of accredited organizations", "as": "The opposite selection: a register of who applied and paid, against a map of who got mapped.", "rel": "dataset" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "Absence of mapping, read as absence of a hospital, is the commonest mistake this file invites.", "rel": "story" }, { "to": "how-this-was-built", "type": "story", "name": "How this was built", "as": "The Overpass query, the radii and the tag list are all in the method.", "rel": "story" } ], "source_list": [ { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" }, { "id": "s:odbl-1-0", "kind": "web", "title": "Open Database License (ODbL) v1.0", "publisher": "Open Data Commons", "url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-17", "note": "the share-alike licence OpenStreetMap data carries: attribution, and any adapted database shared under the same terms" } ], "tiers": { "text.what": { "tier": "harvested", "source": "s:osm" }, "text.story": { "tier": "harvested", "source": "s:osm", "note": "every count was taken off data/harvest/osm-facilities.json on 2026-09-17; the closing paragraph is marked inference" }, "text.how": { "tier": "harvested", "source": "s:osm" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "bangkok", "type": "hub", "name": "Bangkok", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 25 kilometres of this point.", "rel": "measured-by" }, { "from": "bengaluru", "type": "hub", "name": "Bengaluru", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 25 kilometres of this point.", "rel": "measured-by" }, { "from": "chennai", "type": "hub", "name": "Chennai", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 20 kilometres of this point.", "rel": "measured-by" }, { "from": "colombo", "type": "hub", "name": "Colombo", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 15 kilometres of this point.", "rel": "measured-by" }, { "from": "delhi-ncr", "type": "hub", "name": "Delhi NCR", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 40 kilometres of this point.", "rel": "measured-by" }, { "from": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 25 kilometres of this point.", "rel": "measured-by" }, { "from": "mumbai", "type": "hub", "name": "Mumbai", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 25 kilometres of this point.", "rel": "measured-by" }, { "from": "penang", "type": "hub", "name": "Penang", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 15 kilometres of this point.", "rel": "measured-by" }, { "from": "phuket", "type": "hub", "name": "Phuket", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 15 kilometres of this point.", "rel": "measured-by" }, { "from": "seoul", "type": "hub", "name": "Seoul", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 20 kilometres of this point.", "rel": "measured-by" }, { "from": "singapore-city", "type": "hub", "name": "Singapore", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 15 kilometres of this point.", "rel": "measured-by" }, { "from": "taipei", "type": "hub", "name": "Taipei", "as": "The harvest that pulls every mapped hospital, clinic and dental surgery within 20 kilometres of this point.", "rel": "measured-by" }, { "from": "jci-accredited-list", "type": "dataset", "name": "The JCI list of accredited organizations", "as": "The opposite selection problem: a map of who got mapped, against a register of who applied.", "rel": "dataset" }, { "from": "natural-earth-countries", "type": "dataset", "name": "Natural Earth country outlines", "as": "The other map layer: this one draws countries, that one draws the clinics inside nine of them.", "rel": "dataset" }, { "from": "how-this-was-built", "type": "story", "name": "How this was built", "as": "The harvest that supplies the hub maps, under ODbL with attribution.", "rel": "dataset" }, { "from": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "Where absence is absence of mapping, and a row proves only that somebody typed a name.", "rel": "dataset" } ] }, { "schema": 1, "id": "who-global-health-observatory", "type": "dataset", "names": { "name": "WHO Global Health Observatory", "aliases": [ "GHO", "GHO OData API" ], "said": "The GHO is where a health number becomes comparable — and comparable means adjusted, which is not the same as what the country said." }, "region": [ "global" ], "facets": { "publisher": "World Health Organization" }, "text": { "what": "The World Health Organization's public statistics repository. In its own words, \"The GHO data repository is WHO's gateway to health-related statistics for its 194 Member States. It provides access to over 1000 indicators on priority health topics\". Its OData interface answered with 3,099 indicator records and 202 dimensions when this record was written, on 17 September 2026.", "story": "The sentence that matters on this site is WHO's own disclaimer: \"Many of these datasets represent the best estimates of WHO using methodologies for specific indicators that aim for comparability across countries and time; they are updated as more recent or revised data become available, or when there are changes to the methodology being used. Therefore, they are not always the same as official national estimates\".\n\nRead that twice before reading any chart. A GHO figure is not the number a ministry published; it is a number WHO modelled so that a hundred ministries can be put on one axis, and it moves when the model changes rather than when the country does. Both the World Bank health-spending series and the out-of-pocket series on this site come through WHO databases of this family, so the caveat travels with them.\n\n*Inference —* the repository is organised by disease, risk factor and health system, and none of its thousand-odd indicators is about a patient crossing a border. Health workforce, hospital beds, service coverage and financial protection are all here; treatment purchased in one country by a resident of another is not an indicator anybody publishes.", "how": "The OData API at ghoapi.azureedge.net takes no key: /api/Indicator lists the indicator codes, /api/Dimension the dimensions, and /api/{IndicatorCode} returns the observations for one of them. This site does not draw a chart directly from the GHO; it reaches most of these numbers through the World Bank's republished versions, which carry country codes already.", "notes": "Terms of use, read on 17 September 2026: WHO's site terms permit reproduction for research or private study \"but not for sale or for use in conjunction with commercial purposes\", and its publications carry CC BY-NC-SA 3.0 IGO, which allows non-commercial reuse with acknowledgement. The GHO API page carries no licence statement of its own and gives an email address for enquiries." }, "dataset": { "publisher": "World Health Organization", "url": "https://www.who.int/data/gho", "api": "https://ghoapi.azureedge.net/api/Indicator", "license": "WHO terms of use — non-commercial reuse with attribution; commercial use by written permission", "unit": "varies by indicator; each row is one observation of one indicator for one place, time and disaggregation", "years": "varies by indicator; no single reference year", "countries": 194, "updated_by_publisher": "continuously, as data and methods are revised", "counts": "Health statistics for WHO Member States, most of them modelled to be comparable across countries and across time.", "does_not_count": "Anybody who crossed a border for treatment. No indicator in the repository counts a foreign patient, a treatment bought abroad, or a payment made in another country's health system. Its figures are also WHO estimates rather than national returns, so a value here may differ from the one the same country publishes at home — WHO says so itself — and it can change because the method changed rather than because anything happened." }, "kin": [ { "to": "who", "as": "The publisher, in its own record.", "rel": "org" }, { "to": "world-bank-health-spending", "as": "The republished form most of this site actually reads, with the country codes attached.", "rel": "dataset" }, { "to": "world-bank-out-of-pocket", "as": "Comes through the same WHO expenditure database, and inherits the same caveat.", "rel": "dataset" }, { "to": "counting-patients", "as": "A repository of a thousand indicators with no field for a patient who travelled.", "rel": "story" }, { "to": "what-the-data-cannot-see", "as": "The gap is structural, not an oversight: nobody collects it.", "rel": "story" } ], "links": [ { "label": "Global Health Observatory", "url": "https://www.who.int/data/gho" }, { "label": "About the Observatory", "url": "https://www.who.int/data/gho/info/about-the-observatory" }, { "label": "GHO OData API", "url": "https://www.who.int/data/gho/info/gho-odata-api" } ], "sources": [ "s:who-gho", "s:who-gho-about", "s:who-gho-odata", "s:who-terms-of-use" ], "provenance": { "default": { "tier": "cited", "source": "s:who-gho-about" }, "fields": { "text.what": { "tier": "cited", "source": "s:who-gho-about", "note": "the indicator and dimension counts were read off the OData API on 2026-09-17; the 'over 1000' figure is WHO's own" }, "text.story": { "tier": "cited", "source": "s:who-gho-about", "note": "the closing paragraph is marked inference" }, "text.notes": { "tier": "cited", "source": "s:who-terms-of-use" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "The World Health Organization's public statistics repository. In its own words, \"The GHO data repository is WHO's gateway to health-related statistics for its 194 Member States.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "who", "type": "org", "name": "World Health Organization", "as": "The publisher, in its own record.", "rel": "org" }, { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "The republished form most of this site actually reads, with the country codes attached.", "rel": "dataset" }, { "to": "world-bank-out-of-pocket", "type": "dataset", "name": "Out-of-pocket share of health spending", "as": "Comes through the same WHO expenditure database, and inherits the same caveat.", "rel": "dataset" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "A repository of a thousand indicators with no field for a patient who travelled.", "rel": "story" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "The gap is structural, not an oversight: nobody collects it.", "rel": "story" } ], "source_list": [ { "id": "s:who-gho", "kind": "dataset", "title": "Global Health Observatory", "publisher": "World Health Organization", "url": "https://www.who.int/data/gho", "accessed": "2026-09-16" }, { "id": "s:who-gho-about", "kind": "web", "title": "About the Global Health Observatory", "publisher": "World Health Organization", "url": "https://www.who.int/data/gho/info/about-the-observatory", "accessed": "2026-09-17", "note": "the 194 Member States and 'over 1000 indicators' description, and the disclaimer that GHO datasets are WHO best estimates aiming at comparability and 'are not always the same as official national estimates'" }, { "id": "s:who-gho-odata", "kind": "dataset", "title": "GHO OData API", "publisher": "World Health Organization", "url": "https://www.who.int/data/gho/info/gho-odata-api", "accessed": "2026-09-17", "note": "the API at https://ghoapi.azureedge.net/api returned 3,099 indicator records and 202 dimensions on this date; the page carries no licence statement of its own" }, { "id": "s:who-terms-of-use", "kind": "web", "title": "Terms of use", "publisher": "World Health Organization", "url": "https://www.who.int/about/policies/terms-of-use", "accessed": "2026-09-17", "note": "reproduction for research or private study is permitted 'but not for sale or for use in conjunction with commercial purposes'; WHO publications carry CC BY-NC-SA 3.0 IGO" } ], "tiers": { "text.what": { "tier": "cited", "source": "s:who-gho-about", "note": "the indicator and dimension counts were read off the OData API on 2026-09-17; the 'over 1000' figure is WHO's own" }, "text.story": { "tier": "cited", "source": "s:who-gho-about", "note": "the closing paragraph is marked inference" }, "text.how": { "tier": "cited", "source": "s:who-gho-about" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "who", "type": "org", "name": "World Health Organization", "as": "The data platform it publishes, and what that platform does and does not count.", "rel": "measures" }, { "from": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "Three thousand indicators, none of which counts a foreign patient.", "rel": "dataset" } ] }, { "schema": 1, "id": "world-bank-beds", "type": "dataset", "names": { "name": "Hospital beds per 1,000 people", "aliases": [ "SH.MED.BEDS.ZS", "bed density" ], "said": "A bed is the unit hospitals are sized in, and the one number a ministry will give out when it will not give out anything else." }, "region": [ "global" ], "facets": { "publisher": "World Bank" }, "text": { "what": "How many hospital beds a country has for every thousand residents. The World Bank republishes WHO data supplemented by country returns, under a definition that is broad on purpose: \"Hospital beds include inpatient beds available in public, private, general, and specialized hospitals and rehabilitation centers. In most cases beds for both acute and chronic care are included.\" 177 codes carry a value here — the thinnest coverage of the four World Bank series on this site.", "story": "The spread is wider than any other capacity number and it does not run the way a reader expects. Korea stands at 12.81 beds per 1,000 in 2022 and Japan at 12.59; Germany at 7.55 in 2023; the United States at 2.68 in 2022 and the United Kingdom at 2.42. India stands at 1.59 in 2021, Mexico at 1.01 in 2022, the Dominican Republic at 0.75 in 2023. Countries with a great many beds are not the countries people fly to, and countries with few include several that sell surgery.\n\n*Inference —* a bed count is an inventory, not a capability. The same number covers an intensive care bed with a ventilator and a rehabilitation bed in a district hospital; it says nothing about operating theatres, staffing, sterile supply or whether the bed is free tonight. For this subject the relevant capacity is a small private sector inside a large national total, and the series cannot see inside it.\n\nCoverage is where this one is weakest. South Africa's most recent figure in the series is 2010, Uganda's and Zambia's are 2010, and Nigeria carries no value at all. A map drawn from the latest available year puts a fifteen-year-old figure next to a two-year-old one unless it prints both dates, which is why every value on this site travels with its year.", "notes": "Country counts on this page were re-read on 17 September 2026, after the harvest started dropping the World Bank's own aggregates — income groups, regions, the euro area — which arrive on the same endpoint wearing two-letter codes. One of them, XN, is \"Lower middle income\" at the Bank and northern Cyprus on this site's map." }, "dataset": { "publisher": "World Bank Open Data, from WHO data supplemented by country data", "url": "https://data.worldbank.org/indicator/SH.MED.BEDS.ZS", "api": "https://api.worldbank.org/v2/country/all/indicator/SH.MED.BEDS.ZS?format=json", "license": "CC BY 4.0", "unit": "hospital beds per 1,000 people", "indicator": "SH.MED.BEDS.ZS", "years": "2010 to the most recent reporting year; 74 codes stand at 2023, 46 at 2022, and nine at 2010", "countries": 177, "updated_by_publisher": "irregularly, as country returns arrive", "counts": "Inpatient beds in public, private, general and specialised hospitals and rehabilitation centres, acute and chronic care in most cases, divided by mid-year population and multiplied by a thousand.", "does_not_count": "Whether a bed is staffed, equipped or empty. It counts no operating theatre, no intensive-care capability, no dialysis station and no day-case chair, and it draws no line between the public system a resident queues for and the private wing a foreign patient is admitted to. Forty-seven of the 220 country outlines this site draws carry no value at all — Nigeria, the Democratic Republic of the Congo, Côte d'Ivoire, Namibia and South Sudan among them — and twenty-seven codes that carry a doctor count carry no bed count. Absence here is absence of a return, not absence of beds." }, "kin": [ { "to": "world-bank-doctors", "as": "The staff number beside this one, counted per thousand the same way.", "rel": "dataset" }, { "to": "world-bank-health-spending", "as": "What the country spends, against what it has built.", "rel": "dataset" }, { "to": "south-korea", "as": "12.81 beds per 1,000 in 2022, the highest national figure among this site's destinations.", "rel": "measures" }, { "to": "india", "as": "1.59 per 1,000 in 2021, in the country with the largest private hospital export trade in this directory.", "rel": "measures" }, { "to": "what-the-data-cannot-see", "as": "Twenty-seven countries with no value, and a South African figure dated 2010.", "rel": "story" } ], "links": [ { "label": "World Bank indicator page", "url": "https://data.worldbank.org/indicator/SH.MED.BEDS.ZS" } ], "sources": [ "s:wb-hospital-beds", "s:worldbank-open-data", "s:who-gho" ], "provenance": { "default": { "tier": "harvested", "source": "s:wb-hospital-beds" }, "fields": { "text.story": { "tier": "harvested", "source": "s:wb-hospital-beds", "note": "values counted off data/harvest/worldbank.json on 2026-09-17; the middle paragraph is marked as this project's inference" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "How many hospital beds a country has for every thousand residents.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "world-bank-doctors", "type": "dataset", "name": "Physicians per 1,000 people", "as": "The staff number beside this one, counted per thousand the same way.", "rel": "dataset" }, { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "What the country spends, against what it has built.", "rel": "dataset" }, { "to": "south-korea", "type": "destination", "name": "South Korea", "as": "12.81 beds per 1,000 in 2022, the highest national figure among this site's destinations.", "rel": "measures" }, { "to": "india", "type": "destination", "name": "India", "as": "1.59 per 1,000 in 2021, in the country with the largest private hospital export trade in this directory.", "rel": "measures" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "Twenty-seven countries with no value, and a South African figure dated 2010.", "rel": "story" } ], "source_list": [ { "id": "s:wb-hospital-beds", "kind": "dataset", "title": "Hospital beds (per 1,000 people) — indicator SH.MED.BEDS.ZS", "publisher": "World Bank Open Data", "url": "https://data.worldbank.org/indicator/SH.MED.BEDS.ZS", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-17", "note": "definition read off https://api.worldbank.org/v2/indicator/SH.MED.BEDS.ZS?format=json — inpatient beds in public, private, general and specialised hospitals and rehabilitation centres, acute and chronic care in most cases; WHO data supplemented by country data" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:who-gho", "kind": "dataset", "title": "Global Health Observatory", "publisher": "World Health Organization", "url": "https://www.who.int/data/gho", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "harvested", "source": "s:wb-hospital-beds" }, "text.story": { "tier": "harvested", "source": "s:wb-hospital-beds", "note": "values counted off data/harvest/worldbank.json on 2026-09-17; the middle paragraph is marked as this project's inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "world-bank-doctors", "type": "dataset", "name": "Physicians per 1,000 people", "as": "The other capacity number, counted per thousand the same way and just as blind to where the beds are.", "rel": "dataset" }, { "from": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "Cannot say whether a bed is staffed, or which side of the system it sits on.", "rel": "dataset" } ] }, { "schema": 1, "id": "world-bank-doctors", "type": "dataset", "names": { "name": "Physicians per 1,000 people", "aliases": [ "SH.MED.PHYS.ZS", "doctors per 1,000", "physician density" ], "said": "The trade quotes it as doctors per thousand, usually without the year, and usually against a country it has already decided about." }, "region": [ "global" ], "facets": { "publisher": "World Bank" }, "text": { "what": "How many doctors a country has for every thousand residents. The World Bank republishes it from WHO Global Health Workforce Statistics, the OECD and country returns, under a one-line definition: \"Physicians include generalist and specialist medical practitioners.\" In the fetch on this disk 194 codes carry a value, and the year behind each differs — 104 stand at 2022, 58 at 2023, and the Isle of Man's at 2010.", "story": "The series is a headcount over a population, and both halves move. A country that trains doctors and loses them to emigration counts them in the country they practise in, not the country that paid for the degree; a country that imports them counts them too. The ratio is arithmetic on two national totals and holds no information about where inside the country anybody works.\n\n*Inference —* that is the gap a reader of this site walks into. Thailand stands at 0.54 physicians per 1,000 in 2021 and India at 0.72 in 2020, and both sell surgery to foreigners; Germany stands at 4.53 in 2022 and imports almost nobody. The private hospitals a foreign patient actually reaches sit in a handful of districts of a handful of cities, and a national ratio cannot see a district. Cuba, at 9.54 in 2021, is the highest value in the series and describes a state medical workforce, not a market.", "how": "Fetched by tools/harvest_worldbank.py from the World Bank indicator API, no key, values from 2010 onwards, the most recent non-null year kept per country with the year stored beside the value.", "notes": "Thirty of the 194 codes will not colour on this site's map. Twenty-four are the Bank's own aggregates, which arrive on the same endpoint with two-letter codes that look like country codes and are not — High income (XD), OECD members (OE), Sub-Saharan Africa (ZG), European Union (EU). The other six are real countries the 1:110m outline file has no polygon for: Monaco, San Marino, Maldives, St Kitts and Nevis, Nauru, Tuvalu. Country counts on this page were re-read on 17 September 2026, after the harvest started dropping the World Bank's own aggregates — income groups, regions, the euro area — which arrive on the same endpoint wearing two-letter codes. One of them, XN, is \"Lower middle income\" at the Bank and northern Cyprus on this site's map." }, "dataset": { "publisher": "World Bank Open Data, from WHO Global Health Workforce Statistics, the OECD, and country data", "url": "https://data.worldbank.org/indicator/SH.MED.PHYS.ZS", "api": "https://api.worldbank.org/v2/country/all/indicator/SH.MED.PHYS.ZS?format=json", "license": "CC BY 4.0", "unit": "physicians per 1,000 people", "indicator": "SH.MED.PHYS.ZS", "years": "2010 to the most recent reporting year, which differs by country", "countries": 194, "updated_by_publisher": "annually, as WHO and OECD workforce returns arrive", "counts": "Generalist and specialist medical practitioners registered as working in the country, divided by mid-year population and multiplied by a thousand.", "does_not_count": "Where the doctors are. A national ratio cannot separate the capital from the province, the private hospital from the district clinic, or the surgeon who operates on visitors from the physician who never sees one. It counts no nurse — that is a separate indicator — records no specialty, and holds no measure of what any of them do. Nothing in it distinguishes a doctor trained at home from one trained abroad, and nothing in it counts the foreign patients treated.", "used_on": [ "/numbers/", "every country page" ] }, "kin": [ { "to": "world-bank-health-spending", "as": "The money series beside this one, from the same publisher and with the same year-by-country problem.", "rel": "dataset" }, { "to": "world-bank-beds", "as": "The other capacity number, counted per thousand the same way and just as blind to where the beds are.", "rel": "dataset" }, { "to": "thailand", "as": "0.54 physicians per 1,000 in 2021, in a country that sells surgery to foreigners.", "rel": "measures" }, { "to": "india", "as": "0.72 per 1,000 in 2020, the lowest of the large destinations in this series.", "rel": "measures" }, { "to": "what-the-data-cannot-see", "as": "A national average over a population is the clearest case of it.", "rel": "story" } ], "links": [ { "label": "World Bank indicator page", "url": "https://data.worldbank.org/indicator/SH.MED.PHYS.ZS" }, { "label": "WHO health workforce data", "url": "https://www.who.int/data/gho/data/themes/topics/health-workforce" } ], "sources": [ "s:wb-physicians", "s:worldbank-open-data", "s:who-health-workforce" ], "provenance": { "default": { "tier": "harvested", "source": "s:wb-physicians" }, "fields": { "text.story": { "tier": "inference", "note": "the values are harvested; the second paragraph is this project reasoning about what a national ratio can support" }, "text.notes": { "tier": "harvested", "note": "counted off data/harvest/worldbank.json against data/geo/countries.json on 2026-09-17" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "How many doctors a country has for every thousand residents. The World Bank republishes it from WHO Global Health Workforce Statistics, the OECD and country returns, under a one-line definition: \"Physicians include…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "The money series beside this one, from the same publisher and with the same year-by-country problem.", "rel": "dataset" }, { "to": "world-bank-beds", "type": "dataset", "name": "Hospital beds per 1,000 people", "as": "The other capacity number, counted per thousand the same way and just as blind to where the beds are.", "rel": "dataset" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "0.54 physicians per 1,000 in 2021, in a country that sells surgery to foreigners.", "rel": "measures" }, { "to": "india", "type": "destination", "name": "India", "as": "0.72 per 1,000 in 2020, the lowest of the large destinations in this series.", "rel": "measures" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "A national average over a population is the clearest case of it.", "rel": "story" } ], "source_list": [ { "id": "s:wb-physicians", "kind": "dataset", "title": "Physicians (per 1,000 people) — indicator SH.MED.PHYS.ZS", "publisher": "World Bank Open Data", "url": "https://data.worldbank.org/indicator/SH.MED.PHYS.ZS", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-17", "note": "definition and source organisation read off the indicator metadata endpoint https://api.worldbank.org/v2/indicator/SH.MED.PHYS.ZS?format=json — 'Physicians include generalist and specialist medical practitioners'; sourced from WHO Global Health Workforce Statistics, the OECD and country data" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:who-health-workforce", "kind": "dataset", "title": "Health workforce — Global Health Observatory theme", "publisher": "World Health Organization", "url": "https://www.who.int/data/gho/data/themes/topics/health-workforce", "accessed": "2026-09-17", "note": "the WHO collection the World Bank names as the upstream of its physicians indicator" } ], "tiers": { "text.what": { "tier": "harvested", "source": "s:wb-physicians" }, "text.story": { "tier": "inference", "note": "the values are harvested; the second paragraph is this project reasoning about what a national ratio can support" }, "text.how": { "tier": "harvested", "source": "s:wb-physicians" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "kenya", "type": "destination", "name": "Kenya", "as": "The series behind the specialist density the outflow is a response to.", "rel": "measured-by" }, { "from": "morocco", "type": "destination", "name": "Morocco", "as": "The series behind the workforce shortage its own auditors describe.", "rel": "measured-by" }, { "from": "world-bank-beds", "type": "dataset", "name": "Hospital beds per 1,000 people", "as": "The staff number beside this one, counted per thousand the same way.", "rel": "dataset" }, { "from": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "Cannot say where the doctors are, or which of them ever sees a visiting patient.", "rel": "dataset" } ] }, { "schema": 1, "id": "world-bank-health-spending", "type": "dataset", "names": { "name": "Current health expenditure per person", "aliases": [ "SH.XPD.CHEX.PC.CD", "health spending per capita" ], "said": "Everyone calls it health spending per capita. The World Bank calls it current health expenditure, and the word current is doing work." }, "region": [ "global" ], "facets": { "publisher": "World Bank" }, "text": { "what": "What a country spends on health in a year, divided by its population, in current US dollars. The World Bank republishes it from the WHO Global Health Expenditure Database. It is the series behind this site's first world map, and 193 countries carry a value.", "story": "The number is assembled from national health accounts, which countries compile to a shared WHO framework and submit on their own schedule. That is why the most recent year differs by country: some report within eighteen months, some are four years behind. Every value on this site carries its own year for that reason.\n\n*Inference —* the series is also the reason a price comparison needs a second column. A country can be cheap to be operated in because its wages are low, because its state absorbs the capital cost of the hospital, because its currency fell, or because the operation billed is a smaller thing than the one billed at home. Spending per person separates none of those out. It is a scale, not an explanation.", "how": "Fetched by tools/harvest_worldbank.py from the World Bank indicator API, no key, most recent non-null year kept per country, the year stored beside the value. Aggregates — the Bank's own regions and income groups — are dropped, because their iso2 codes are not country codes.", "notes": "Current US dollars, not adjusted for what a dollar buys locally. A purchasing-power version exists and tells a different story; this site does not carry it yet. Country counts on this page were re-read on 17 September 2026, after the harvest started dropping the World Bank's own aggregates — income groups, regions, the euro area — which arrive on the same endpoint wearing two-letter codes. One of them, XN, is \"Lower middle income\" at the Bank and northern Cyprus on this site's map." }, "dataset": { "publisher": "World Bank Open Data, from the WHO Global Health Expenditure Database", "url": "https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD", "api": "https://api.worldbank.org/v2/country/all/indicator/SH.XPD.CHEX.PC.CD?format=json", "license": "CC BY 4.0", "unit": "current US$ per person per year", "indicator": "SH.XPD.CHEX.PC.CD", "years": "1960 to the most recent reporting year, which differs by country", "countries": 193, "updated_by_publisher": "annually, as national health accounts arrive", "counts": "Final consumption of health goods and services in a year: government schemes, compulsory insurance, voluntary insurance, and household out-of-pocket payments, divided by mid-year population.", "does_not_count": "Capital spending — a new hospital building does not appear. Nor does anything a foreign patient pays for treatment in that country, which is exactly the flow this site is about: a country can run a large export trade in surgery and show nothing for it here.", "used_on": [ "/map/", "/numbers/", "every country page" ] }, "kin": [ { "to": "thailand", "as": "One of 193 countries carrying a value in this series.", "rel": "measures" }, { "to": "counting-patients", "as": "The same problem one layer up: what a health number counts is rarely what a reader assumes.", "rel": "story" } ], "links": [ { "label": "World Bank indicator page", "url": "https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD" } ], "sources": [ "s:worldbank-open-data", "s:who-gho" ], "provenance": { "default": { "tier": "harvested", "source": "s:worldbank-open-data" }, "fields": { "text.story": { "tier": "inference", "note": "the second paragraph is this project reasoning about what the series can and cannot support" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "What a country spends on health in a year, divided by its population, in current US dollars. The World Bank republishes it from the WHO Global Health Expenditure Database.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "thailand", "type": "destination", "name": "Thailand", "as": "One of 193 countries carrying a value in this series.", "rel": "measures" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "The same problem one layer up: what a health number counts is rarely what a reader assumes.", "rel": "story" } ], "source_list": [ { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:who-gho", "kind": "dataset", "title": "Global Health Observatory", "publisher": "World Health Organization", "url": "https://www.who.int/data/gho", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "harvested", "source": "s:worldbank-open-data" }, "text.story": { "tier": "inference", "note": "the second paragraph is this project reasoning about what the series can and cannot support" }, "text.how": { "tier": "harvested", "source": "s:worldbank-open-data" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "indonesia", "type": "destination", "name": "Indonesia", "as": "The series behind what this country spends on health per person, and behind the outflow.", "rel": "measured-by" }, { "from": "jordan", "type": "destination", "name": "Jordan", "as": "The series behind what this country spends on health per person.", "rel": "measured-by" }, { "from": "saudi-arabia", "type": "destination", "name": "Saudi Arabia", "as": "The series behind what this country spends on health per person.", "rel": "measured-by" }, { "from": "sri-lanka", "type": "destination", "name": "Sri Lanka", "as": "The series that shows this country doing well on the average and says nothing about the gap at the top.", "rel": "measured-by" }, { "from": "switzerland", "type": "destination", "name": "Switzerland", "as": "The series that places its cost base near the top of the world.", "rel": "measured-by" }, { "from": "thailand", "type": "destination", "name": "Thailand", "as": "The series behind what this country spends on health per person.", "rel": "measured-by" }, { "from": "cairo", "type": "hub", "name": "Cairo", "as": "The series behind what this country spends on health per person, and the scale the private sector sits on top of.", "rel": "measured-by" }, { "from": "johannesburg", "type": "hub", "name": "Johannesburg", "as": "The series behind the gap between this country's private sector and its public one.", "rel": "measured-by" }, { "from": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The series behind the map of what each country spends on health per person.", "rel": "measured-by" }, { "from": "who", "type": "org", "name": "World Health Organization", "as": "The series the World Bank republishes from WHO's health expenditure database.", "rel": "measures" }, { "from": "out-of-pocket", "type": "term", "name": "Out-of-pocket", "as": "The companion series: what a country spends per person, beside how much of it households pay directly.", "rel": "dataset" }, { "from": "natural-earth-countries", "type": "dataset", "name": "Natural Earth country outlines", "as": "What the outlines are coloured by, joined on the country code.", "rel": "dataset" }, { "from": "who-global-health-observatory", "type": "dataset", "name": "WHO Global Health Observatory", "as": "The republished form most of this site actually reads, with the country codes attached.", "rel": "dataset" }, { "from": "world-bank-beds", "type": "dataset", "name": "Hospital beds per 1,000 people", "as": "What the country spends, against what it has built.", "rel": "dataset" }, { "from": "world-bank-doctors", "type": "dataset", "name": "Physicians per 1,000 people", "as": "The money series beside this one, from the same publisher and with the same year-by-country problem.", "rel": "dataset" }, { "from": "world-bank-out-of-pocket", "type": "dataset", "name": "Out-of-pocket share of health spending", "as": "The amount this one is a share of.", "rel": "dataset" }, { "from": "world-bank-tourism-arrivals", "type": "dataset", "name": "International arrivals", "as": "The money series beside it, and the one that also cannot see a foreign patient.", "rel": "dataset" }, { "from": "how-this-was-built", "type": "story", "name": "How this was built", "as": "The series behind the first world map, and the exemplar record this schema was written against.", "rel": "dataset" }, { "from": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "Excludes anything a foreign patient pays, which is the flow this site is about.", "rel": "dataset" } ] }, { "schema": 1, "id": "world-bank-out-of-pocket", "type": "dataset", "names": { "name": "Out-of-pocket share of health spending", "aliases": [ "SH.XPD.OOPC.CH.ZS", "OOP share" ], "said": "Households paying at the counter, as a share of everything a country spends on health. It is the closest a public series comes to the question a traveller is actually asking." }, "region": [ "global" ], "facets": { "publisher": "World Bank" }, "text": { "what": "What share of a country's health spending comes straight out of households' pockets, rather than from government schemes or insurance. The World Bank republishes it from the WHO Global Health Expenditure Database, which its own metadata records as updated on 12 December 2025. 193 codes carry a value here; 193 of them stand at 2023 and 24 at 2024.", "story": "The range is the widest of any series on this site. Armenia stands at 80.47% in 2023, Bangladesh at 79.31%, Turkmenistan at 77.39% and Afghanistan at 77.14%. Nigeria stands at 71.90%, India at 43.89% and Mexico at 41.24%. Thailand, which sells more surgery to foreigners than either, stands at 9.93%, below Germany's 10.71% and the United States' 10.93%.\n\n*Inference —* the share describes what residents pay at home, and it runs in two directions for this subject at once. A high share is a push: a country whose own citizens already pay cash for care is a country whose citizens shop, compare and cross borders, and much of the world's outbound traffic starts in one. A low share is a pull in the other direction: Thailand's public system is not what the trade sells, and the same country can carry a small out-of-pocket share and a large private export hospital sector without contradiction.\n\nWhat the series cannot do is follow the money across a border. The OECD's 2011 report on measuring trade in health services under the same accounting framework found the traditional sources — balance of payments — \"become less and less adequate\", and put the level of trade in health care at \"0.0 to 1.0% of total health spending\" for the vast majority of countries, an estimate its authors called likely to be low. A payment by a visiting patient is a rounding error inside the denominator of this indicator, if it is inside it at all.", "how": "Fetched by tools/harvest_worldbank.py from the World Bank indicator API, values from 2010 onwards, the most recent non-null year kept per country with the year stored beside the value.", "notes": "A share, not an amount. A country can shift on this indicator because households paid more or because the state paid less, and the series does not say which. Country counts on this page were re-read on 17 September 2026, after the harvest started dropping the World Bank's own aggregates — income groups, regions, the euro area — which arrive on the same endpoint wearing two-letter codes. One of them, XN, is \"Lower middle income\" at the Bank and northern Cyprus on this site's map." }, "dataset": { "publisher": "World Bank Open Data, from the WHO Global Health Expenditure Database", "url": "https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS", "api": "https://api.worldbank.org/v2/country/all/indicator/SH.XPD.OOPC.CH.ZS?format=json", "license": "CC BY 4.0", "unit": "% of current health expenditure", "indicator": "SH.XPD.OOPC.CH.ZS", "years": "2010 to the most recent reporting year; 193 codes stand at 2023 and 24 at 2024", "countries": 193, "updated_by_publisher": "annually, as national health accounts arrive", "counts": "Spending on health paid directly by households at the point of use — fees, co-payments, medicines bought over the counter — as a percentage of everything the country spends on health in the same year.", "does_not_count": "The amount. It is a ratio, and a poor country with a high share may pay less per household than a rich country with a low one; the amount sits in a separate series. It counts nothing a foreign patient pays for treatment in the country, which belongs to the other side of the account as an export. It does not separate a co-payment inside an insured system from a whole bill paid in cash, and it does not distinguish a payment made by choice from one made because nothing else was on offer." }, "kin": [ { "to": "world-bank-health-spending", "as": "The amount this one is a share of.", "rel": "dataset" }, { "to": "out-of-pocket", "as": "The word, and what the accounts mean by it.", "rel": "term" }, { "to": "india", "as": "43.89% in 2023, in a country that is both a destination and a large source of outbound patients.", "rel": "measures" }, { "to": "nigeria", "as": "71.90% in 2023, in the country this directory treats as an outbound market first.", "rel": "measures" }, { "to": "is-it-cheaper", "as": "The share a household already pays at home is where the comparison starts.", "rel": "story" }, { "to": "oecd", "as": "Whose 2011 report measured what this indicator cannot: the trade across the border.", "rel": "org" } ], "links": [ { "label": "World Bank indicator page", "url": "https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS" }, { "label": "WHO Global Health Expenditure Database", "url": "https://apps.who.int/nha/database" } ], "sources": [ "s:wb-oop-share", "s:worldbank-open-data", "s:who-nha-database", "s:oecd-trade-health-2011" ], "provenance": { "default": { "tier": "harvested", "source": "s:wb-oop-share" }, "fields": { "text.story": { "tier": "cited", "source": "s:oecd-trade-health-2011", "note": "the values are harvested from disk; the middle paragraph is marked inference; the quoted sentences are from the OECD 2011 report" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "What share of a country's health spending comes straight out of households' pockets, rather than from government schemes or insurance.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "The amount this one is a share of.", "rel": "dataset" }, { "to": "out-of-pocket", "type": "term", "name": "Out-of-pocket", "as": "The word, and what the accounts mean by it.", "rel": "term" }, { "to": "india", "type": "destination", "name": "India", "as": "43.89% in 2023, in a country that is both a destination and a large source of outbound patients.", "rel": "measures" }, { "to": "nigeria", "type": "destination", "name": "Nigeria", "as": "71.90% in 2023, in the country this directory treats as an outbound market first.", "rel": "measures" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The share a household already pays at home is where the comparison starts.", "rel": "story" }, { "to": "oecd", "type": "org", "name": "Organisation for Economic Co-operation and Development", "as": "Whose 2011 report measured what this indicator cannot: the trade across the border.", "rel": "org" } ], "source_list": [ { "id": "s:wb-oop-share", "kind": "dataset", "title": "Out-of-pocket expenditure (% of current health expenditure) — indicator SH.XPD.OOPC.CH.ZS", "publisher": "World Bank Open Data", "url": "https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-17", "note": "definition read off https://api.worldbank.org/v2/indicator/SH.XPD.OOPC.CH.ZS?format=json; source organisation given as the WHO Global Health Expenditure Database, updated December 12th, 2025" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:who-nha-database", "kind": "dataset", "title": "Global Health Expenditure Database", "publisher": "World Health Organization", "url": "https://apps.who.int/nha/database", "accessed": "2026-09-17", "note": "the national health accounts database behind the World Bank's spending and out-of-pocket indicators" }, { "id": "s:oecd-trade-health-2011", "kind": "paper", "title": "Improving estimates of exports and imports of health services and goods under the SHA framework — final report", "publisher": "OECD, funded by DG SANCO of the European Commission", "year": 2011, "url": "https://www.oecd.org/content/dam/oecd/en/topics/policy-issue-focus/sha-guidelines/49011758.pdf", "accessed": "2026-09-16", "note": "June 2011; states that trade in health care is typically 0.0 to 1.0% of total health spending for the vast majority of countries, that balance-of-payments sources have proved mostly inadequate, and that cosmetic surgery and patient transport sit on or outside the boundary of health care" } ], "tiers": { "text.what": { "tier": "harvested", "source": "s:wb-oop-share" }, "text.story": { "tier": "cited", "source": "s:oecd-trade-health-2011", "note": "the values are harvested from disk; the middle paragraph is marked inference; the quoted sentences are from the OECD 2011 report" }, "text.how": { "tier": "harvested", "source": "s:wb-oop-share" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "egypt", "type": "destination", "name": "Egypt", "as": "The series behind the share of Egyptian health spending households pay themselves.", "rel": "measured-by" }, { "from": "nigeria", "type": "destination", "name": "Nigeria", "as": "The series behind what Nigerian households pay for care at home.", "rel": "measured-by" }, { "from": "who-global-health-observatory", "type": "dataset", "name": "WHO Global Health Observatory", "as": "Comes through the same WHO expenditure database, and inherits the same caveat.", "rel": "dataset" } ] }, { "schema": 1, "id": "world-bank-tourism-arrivals", "type": "dataset", "names": { "name": "International arrivals", "aliases": [ "ST.INT.ARVL", "international tourist arrivals" ], "said": "Every market-size claim about this field eventually leans on an arrivals number. The series counts crossings." }, "region": [ "global" ], "facets": { "publisher": "World Bank" }, "text": { "what": "How many international arrivals a country recorded in a year. The World Bank republishes it from UN Tourism's Yearbook and Compendium of Tourism Statistics. Its own definition sets the boundary: \"International inbound tourists (overnight visitors) are the number of tourists who travel to a country other than that in which they have their usual residence, but outside their usual environment, for a period not exceeding 12 months\". 199 codes carry a value here.", "story": "Two sentences in the World Bank's own metadata do most of the work. The first: \"The data on inbound tourists refer to the number of arrivals, not to the number of people traveling. Thus a person who makes several trips to a country during a given period is counted each time as a new arrival.\" A patient who flies out for a consultation, again for the operation and again for a review is three arrivals and one person.\n\nThe second concerns comparability. Collection differs by country — border police in one, hotel registrations in another, air arrivals only in a third — and some countries count nationals resident abroad while others do not: \"Caution should thus be used in comparing arrivals across countries.\" Where a country cannot supply overnight visitors, the Bank prints visitors instead, which includes same-day crossings, cruise passengers and crew. Poland's 88,515,000 for 2019 and Hungary's 31,641,000 for 2020 are counts of that kind, and neither describes a holiday, still less a hospital admission.\n\nThe third thing is the calendar. For 132 of the 199 codes in this fetch the most recent year with a value is 2020, and for 70 more it is 2019. A map drawn from the latest available year therefore draws the year the borders shut, and this site says so beside the map rather than under it.\n\n*Inference —* the series has no field for purpose. Somebody who flew in for a knee replacement and somebody who flew in for a beach sit in the same cell, and no arithmetic on this table separates them. The market-research totals for this field are usually built by taking a number of this shape and applying a percentage from elsewhere; that operation is not in the data.", "how": "Fetched by tools/harvest_worldbank.py from the World Bank indicator API, values from 2010 onwards, the most recent non-null year kept per country with the year stored beside the value.", "notes": "The Bank's own aggregates ride the same endpoint with two-letter codes — High income (XD), OECD members (OE), Latin America & Caribbean (ZJ) — and are the largest values in the table. They are not countries and they are excluded from this site's maps by joining on the country outline file rather than on the series. Country counts on this page were re-read on 17 September 2026, after the harvest started dropping the World Bank's own aggregates — income groups, regions, the euro area — which arrive on the same endpoint wearing two-letter codes. One of them, XN, is \"Lower middle income\" at the Bank and northern Cyprus on this site's map." }, "dataset": { "publisher": "World Bank Open Data, from UN Tourism (Yearbook and Compendium of Tourism Statistics)", "url": "https://data.worldbank.org/indicator/ST.INT.ARVL", "api": "https://api.worldbank.org/v2/country/all/indicator/ST.INT.ARVL?format=json", "license": "CC BY 4.0", "unit": "arrivals a year", "indicator": "ST.INT.ARVL", "years": "2010 to the most recent reporting year; 132 codes stand at 2020 and 70 at 2019", "countries": 199, "updated_by_publisher": "annually, as UN Tourism compiles national returns; coverage past 2020 is thin", "counts": "Arrivals of overnight visitors from abroad, or, where a country cannot report those, visitors — which takes in same-day crossings, cruise passengers and crew.", "does_not_count": "People. Each trip by the same person counts again, so the total is crossings, not travellers. Nothing in the series records why anybody came: there is no treatment field, no purpose field, and no way to separate a patient from a holidaymaker or a visiting relative. It counts nobody who crossed by land where a country reports air arrivals only — which removes most of the Mexican border dental trade — and nobody who did not appear at a border at all." }, "kin": [ { "to": "counting-patients", "as": "The story this series is the main exhibit in: what an arrivals figure will and will not carry.", "rel": "story" }, { "to": "world-bank-health-spending", "as": "The money series beside it, and the one that also cannot see a foreign patient.", "rel": "dataset" }, { "to": "mexico", "as": "51,128,000 arrivals in 2020, in the country whose dental trade mostly walks across a line.", "rel": "measures" }, { "to": "thailand", "as": "39,916,000 arrivals in 2019, the figure most often repurposed as a medical-travel total.", "rel": "measures" }, { "to": "what-the-data-cannot-see", "as": "A table with no field for why anyone came.", "rel": "story" }, { "to": "medical-tourism", "as": "The word whose market-size claims are built on numbers of this shape.", "rel": "term" } ], "links": [ { "label": "World Bank indicator page", "url": "https://data.worldbank.org/indicator/ST.INT.ARVL" }, { "label": "UN Tourism statistics database", "url": "https://www.unwto.org/tourism-statistics/tourism-statistics-database" } ], "sources": [ "s:wb-tourist-arrivals", "s:worldbank-open-data", "s:un-tourism-statistics" ], "provenance": { "default": { "tier": "harvested", "source": "s:wb-tourist-arrivals" }, "fields": { "text.story": { "tier": "cited", "source": "s:wb-tourist-arrivals", "note": "the quoted sentences are the World Bank's own indicator metadata; the values and year counts are from data/harvest/worldbank.json; the closing paragraph is marked inference" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "How many international arrivals a country recorded in a year. The World Bank republishes it from UN Tourism's Yearbook and Compendium of Tourism Statistics.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "The story this series is the main exhibit in: what an arrivals figure will and will not carry.", "rel": "story" }, { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "The money series beside it, and the one that also cannot see a foreign patient.", "rel": "dataset" }, { "to": "mexico", "type": "destination", "name": "Mexico", "as": "51,128,000 arrivals in 2020, in the country whose dental trade mostly walks across a line.", "rel": "measures" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "39,916,000 arrivals in 2019, the figure most often repurposed as a medical-travel total.", "rel": "measures" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "A table with no field for why anyone came.", "rel": "story" }, { "to": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The word whose market-size claims are built on numbers of this shape.", "rel": "term" } ], "source_list": [ { "id": "s:wb-tourist-arrivals", "kind": "dataset", "title": "International tourism, number of arrivals — indicator ST.INT.ARVL", "publisher": "World Bank Open Data", "url": "https://data.worldbank.org/indicator/ST.INT.ARVL", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-17", "note": "the long definition and its caveats read off https://api.worldbank.org/v2/indicator/ST.INT.ARVL?format=json, including the sentences on differing national collection methods and on arrivals not being people; source organisation UN Tourism, Yearbook and Compendium of Tourism Statistics" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:un-tourism-statistics", "kind": "dataset", "title": "Tourism Statistics Database", "publisher": "UN Tourism (World Tourism Organization)", "url": "https://www.unwto.org/tourism-statistics/tourism-statistics-database", "accessed": "2026-09-17", "note": "the Yearbook and Compendium of Tourism Statistics, which the World Bank republishes as ST.INT.ARVL" } ], "tiers": { "text.what": { "tier": "harvested", "source": "s:wb-tourist-arrivals" }, "text.story": { "tier": "cited", "source": "s:wb-tourist-arrivals", "note": "the quoted sentences are the World Bank's own indicator metadata; the values and year counts are from data/harvest/worldbank.json; the closing paragraph is marked inference" }, "text.how": { "tier": "harvested", "source": "s:wb-tourist-arrivals" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "south-africa", "type": "destination", "name": "South Africa", "as": "The series the survey share above is a percentage of.", "rel": "measured-by" }, { "from": "covid-shutdown-2020", "type": "event", "name": "The 2020 shutdown", "as": "The series where 2020 is still the most recent year for 132 of 223 codes.", "rel": "dataset" }, { "from": "counting-patients", "type": "story", "name": "Counting patients", "as": "The arrivals series with no purpose field at all, which is why it cannot be used here.", "rel": "dataset" }, { "from": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "Counts crossings with no purpose field, and misses the land border entirely where a country reports air arrivals only.", "rel": "dataset" } ] }, { "schema": 1, "id": "circumvention", "type": "story", "names": { "name": "Circumvention", "aliases": [ "doing lawfully elsewhere what is prohibited at home", "the residence gate" ], "said": "The legal literature calls it \"circumvention tourism\", after the paper that named it. The instrument that governs it is almost never a rule about leaving." }, "region": [ "global" ], "facets": { "kind": "essay" }, "text": { "what": "Travelling to a country where a treatment is lawful because it is prohibited at home. The act is legal where it happens; the traveller's own state mostly does not reach it. What this page reports, from the legality rows on this site's rule records, is the shape the law actually takes: not a prohibition on going, but a residence or nationality condition attached to the lawful act at the other end, and a set of procedural gates that do the same work without naming a border.", "story": "I. Glenn Cohen named the category in the Cornell Law Review in 2012, defining it as travel \"for services that are legal in the patient's destination country but illegal in the patient's home country\". His four worked examples were female genital cutting, abortion, assisted reproduction and assisted suicide. The argument is still running: the Journal of Law, Medicine and Ethics carried an exchange on it in 2022. *Inference —* a category defined by a legal difference behaves unlike the rest of this subject. A price gap narrows when a currency moves; a prohibition does not, so the traffic is steady and points one way until the law at home changes.\n\nRead across the six rule records on this site that carry legality rows, and the commonest instrument is not a prohibition at all. It is a residence condition on the permissive side. Every European Union state that has legislated for surrogacy requires the intended parents, the surrogate, or both to live there: Greece, Cyprus, Portugal and Ireland, with Ireland asking for two years. Spain's euthanasia law requires Spanish nationality, lawful residence, or a municipal register certificate showing more than twelve months. France's law of 18 August 2026 requires nationality or stable and regular residence as one of five cumulative conditions. California's end-of-life statute wants a driver's licence, a voter registration, a property interest or a tax return. India and Thailand closed their surrogacy markets by nationality rather than by conduct — India's 2021 Act defines a couple as a legally married Indian man and woman; Thailand's 2015 Act requires adult Thai citizenship. *Inference —* a nationality gate is the cleanest instrument available to a legislature: it does not ask what was paid or who arranged it, and no quantity of documentation satisfies it.\n\nThe second instrument is structural and is written nowhere. Neither the Dutch nor the Belgian euthanasia Act contains a nationality or residence clause. The gate is the due-care regime: a physician satisfied that the request is voluntary and well-considered and the suffering without prospect of improvement, and a second independent physician who has seen the patient. That is a relationship built over time, and arriving does not create one. Canada reaches the same result through its health system, keying eligibility to entitlement to government-funded health services and forgiving only an applicable minimum residence or waiting period — which does nothing for a visitor with no entitlement at all.\n\nTwo statutes in this file exclude a non-resident on their face, and the better-known one is the less interesting. Singapore's Termination of Pregnancy Act 1974, section 3, confines treatment to citizens, wives of citizens, work-pass holders and their wives, or a person resident in Singapore for at least four months, with an exception where the procedure is needed to save the woman's life. Czechia's is older and quieter: section 10 of zákon č. 66/1986 Sb. bars the procedure for foreign women who are in the country only temporarily. It is unamended and in force, and the standard comparative database of abortion policy records other Czech restrictions and not this one.\n\nEverywhere else the friction is procedural, and procedure is what defeats a traveller. Italy invites a seven-day pause. Belgium requires six days from the first consultation. Germany requires counselling and then three days; Hungary, Portugal and Ireland the same; Singapore and Malaysia two. Thailand requires counselling on alternatives between twelve and twenty weeks. *Inference —* a waiting period is a residence requirement for anybody holding two air tickets, and none of those statutes was drafted with that in mind. Consent rules do the same work by another route: Japan's Maternal Health Act still requires the spouse's consent, and Türkiye and Taiwan require it on named grounds.\n\nExtraterritorial reach — a home state making the conduct abroad an offence — is rare, and this file holds two named instances. Article 12(6) of Italy's Legge 40/2004 was amended in November 2024 to reach Italian nationals who conclude a surrogacy agreement abroad, and it is the only such clause among the Member States the European Parliamentary Research Service surveyed. Türkiye's 2010 regulation on assisted reproduction bans donor gametes and, on the account in this site's source for it, reaches citizens who go abroad to obtain them. Against those two sit the ordinary rules, which reach the assistance rather than the journey: section 2 of the United Kingdom's Suicide Act 1961 makes assisting an offence, and what the offence attaches to is the help, not the departure.\n\nOne door has opened rather than closed. Oregon removed its residency requirement in 2023 after a federal suit settled, and ORS 127.805 as amended carries no residency language — which means the frequently repeated statement that Switzerland is the only jurisdiction admitting non-residents is at minimum incomplete. Switzerland's own position is an omission rather than a permission: Article 115 of the Criminal Code punishes inciting or assisting suicide only where the person acts from a selfish motive, and says nothing about nationality or residence because the article was written about motive and not about this.\n\nThe grid shows a correlation and cannot show a cause, and one pair of rows makes the point. Spain's Ley 14/2006, article 5.5, makes donor anonymity compulsory; Britain ended it for donations made from 1 April 2005 by the 2004 Disclosure of Donor Information Regulations. Spain is also the largest egg-donation destination in Europe: its registry recorded 27,564 cycles in 2022 for patients resident in other countries — France 39.0 per cent, Italy 20.6, the United Kingdom 9.0, Germany 6.4 — and 52.3 per cent of those cycles used donated eggs. The registry did not record why the patient came in 90.8 per cent of them. Waiting lists, price, age caps and access rules for single women and female couples all point the same way, and no register separates them. The arguments on either side are on the record and this page joins neither: a residence gate stops a state becoming a destination for something its neighbours prohibit, and a residence gate also means access turns on where a person happens to be registered and that the people who travel are the people who can afford to. Transplantation is the one corner where an international text draws the line itself, and it draws it somewhere else entirely: the Declaration of Istanbul holds that crossing a border for a transplant is not wrong in itself, and that buying the organ is.", "how": "A legality row on this site is one reading of one named instrument in one jurisdiction on one date. Six statuses: lawful, lawful with conditions, residents only, prohibited, unregulated, and not read by this project — which is hatched on the grid and is a fact about this directory rather than about the country. A status describes the position for an act performed in that jurisdiction. It does not describe whether the home state will recognise the result, which is a separate body of law: since 2014 the European Court of Human Rights has issued a run of judgments on parenthood established abroad, and the European Commission's proposed parenthood regulation of 2022 is still with the Council. Nothing here is legal advice and no row says what anybody should do.", "today": "As of 17 September 2026 this site holds 151 legality rows across its rule and destination records: 41 lawful with conditions, 14 lawful, 14 prohibited, eight residents only, three unregulated — and 71 marked not read by this project. That last figure is the largest category by some distance, and the pattern in which it falls is itself informative: the statutes this project could read are those of states that publish their law in machine-readable form on a stable government portal, which is not the same set as the states this question is most often asked about. Georgia, Ukraine and Mexico are among the places most named in the surrogacy trade and no national instrument for any of them was read on this pass." }, "kin": [ { "to": "circumvention-travel", "as": "The word, its root, and the paper that named the category in 2012.", "rel": "term" }, { "to": "surrogacy-law", "as": "Where the residence requirement is clearest: every EU state that legislated for it requires somebody to live there.", "rel": "rule" }, { "to": "assisted-dying-law", "as": "Three different ways of writing a residence gate, and the one omission that is not one.", "rel": "rule" }, { "to": "abortion-travel-law", "as": "The two statutes that bar a non-resident on their face, and the waiting periods that do it without saying so.", "rel": "rule" }, { "to": "donor-anonymity-law", "as": "Spain's compulsory anonymity against Britain's identity release, and the registry that did not ask why.", "rel": "rule" }, { "to": "transplant-prohibition", "as": "Where the international text draws the line at payment rather than at the border.", "rel": "rule" }, { "to": "gender-affirming-care-access", "as": "Where the gate is a court's permission at the destination, and whether it binds a foreign patient is unread.", "rel": "rule" }, { "to": "stem-cell-regulation", "as": "The other direction: a clinic that cannot satisfy one national regime moves to a jurisdiction with none.", "rel": "rule" }, { "to": "reproductive-exile", "as": "The name proposed for the patients this page describes, and the argument over whether it overstates compulsion.", "rel": "term" }, { "to": "surrogacy", "as": "The arrangement where the law does not change the price but decides whether the thing exists.", "rel": "procedure" }, { "to": "egg-donation", "as": "The treatment whose destination is chosen by a rule about the donor rather than by a price.", "rel": "procedure" }, { "to": "spain", "as": "The largest egg-donation destination in Europe, running the opposite anonymity rule to most of its neighbours.", "rel": "destination" } ], "links": [ { "label": "Cohen, Circumvention Tourism, Cornell Law Review 97:1309", "url": "https://scholarship.law.cornell.edu/clr/vol97/iss6/1" }, { "label": "The Declaration of Istanbul, 2018 edition", "url": "https://www.declarationofistanbul.org/" } ], "sources": [ "s:cohen-circumvention-2012", "s:cohen-patients-with-passports-2014", "s:jlme-circumvention-2022", "s:ep-surrogacy-2025", "s:in-surrogacy-act-2021", "s:stasi-thailand-art-act-2017", "s:es-ley-14-2006", "s:uk-donor-info-regs-2004", "s:sef-registro-2022", "s:cz-act-66-1986", "s:sg-termination-act", "s:it-legge-194-1978", "s:jp-maternal-health-act", "s:gurtin-2011-turkey", "s:es-lo-3-2021", "s:fr-loi-2026-794", "s:ca-criminal-code-241-2", "s:or-ors-127-805", "s:ch-criminal-code", "s:nl-euthanasia-act-2002", "s:be-euthanasia-law-2002", "s:uk-suicide-act-1961", "s:us-ca-hsc-443-2", "s:declaration-of-istanbul", "s:who-guiding-principles", "s:who-gapd", "s:hcch-parentage-surrogacy", "s:shenfield-2010" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "every instrument is named and dated on a legality row elsewhere on this site; the structural readings are marked Inference inline" }, "text.how": { "tier": "cited", "note": "the status vocabulary is this project's; the recognition law is cited" }, "text.today": { "tier": "inference", "note": "counted over the legality rows on disk on 17 September 2026" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "Travelling to a country where a treatment is lawful because it is prohibited at home. The act is legal where it happens; the traveller's own state mostly does not reach it.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "The word, its root, and the paper that named the category in 2012.", "rel": "term" }, { "to": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "Where the residence requirement is clearest: every EU state that legislated for it requires somebody to live there.", "rel": "rule" }, { "to": "assisted-dying-law", "type": "rule", "name": "Assisted dying, and who may cross a border for it", "as": "Three different ways of writing a residence gate, and the one omission that is not one.", "rel": "rule" }, { "to": "abortion-travel-law", "type": "rule", "name": "Travelling for a termination", "as": "The two statutes that bar a non-resident on their face, and the waiting periods that do it without saying so.", "rel": "rule" }, { "to": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "Spain's compulsory anonymity against Britain's identity release, and the registry that did not ask why.", "rel": "rule" }, { "to": "transplant-prohibition", "type": "rule", "name": "Buying an organ, and being transplanted abroad", "as": "Where the international text draws the line at payment rather than at the border.", "rel": "rule" }, { "to": "gender-affirming-care-access", "type": "rule", "name": "Access to gender-affirming care", "as": "Where the gate is a court's permission at the destination, and whether it binds a foreign patient is unread.", "rel": "rule" }, { "to": "stem-cell-regulation", "type": "rule", "name": "Regulating cell and tissue therapies", "as": "The other direction: a clinic that cannot satisfy one national regime moves to a jurisdiction with none.", "rel": "rule" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The name proposed for the patients this page describes, and the argument over whether it overstates compulsion.", "rel": "term" }, { "to": "surrogacy", "type": "procedure", "name": "Surrogacy", "as": "The arrangement where the law does not change the price but decides whether the thing exists.", "rel": "procedure" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "The treatment whose destination is chosen by a rule about the donor rather than by a price.", "rel": "procedure" }, { "to": "spain", "type": "destination", "name": "Spain", "as": "The largest egg-donation destination in Europe, running the opposite anonymity rule to most of its neighbours.", "rel": "destination" } ], "source_list": [ { "id": "s:cohen-circumvention-2012", "kind": "paper", "title": "Circumvention Tourism", "publisher": "Cornell Law Review 97(6):1309 (Cohen IG)", "url": "https://scholarship.law.cornell.edu/clr/vol97/iss6/1", "accessed": "2026-09-16" }, { "id": "s:cohen-patients-with-passports-2014", "kind": "book", "title": "Patients with Passports: Medical Tourism, Law, and Ethics", "publisher": "Oxford University Press, 2014 (Cohen IG), ISBN 9780199975099", "url": "https://openlibrary.org/works/OL21085324W", "accessed": "2026-09-16" }, { "id": "s:jlme-circumvention-2022", "kind": "paper", "title": "The Flaw in Formalist Accounts of Circumvention Tourism, and Revisiting the Ethics of Circumvention Tourism", "publisher": "Shaw J, pp. 551-562; Snyder JC, pp. 563-565. Journal of Law, Medicine and Ethics 2022;50(3)", "url": "https://doi.org/10.1017/jme.2022.93", "accessed": "2026-09-17", "note": "metadata confirmed through Crossref; the articles themselves were not read" }, { "id": "s:ep-surrogacy-2025", "kind": "report", "title": "Surrogacy: The legal situation in the EU (Briefing PE 769.508), by David de Groot", "publisher": "European Parliamentary Research Service", "url": "https://www.europarl.europa.eu/RegData/etudes/BRIE/2025/769508/EPRS_BRI(2025)769508_EN.pdf", "accessed": "2026-09-16", "note": "published February 2025; names the national instrument for each Member State" }, { "id": "s:in-surrogacy-act-2021", "kind": "statute", "title": "The Surrogacy (Regulation) Act, 2021 (Act No. 47 of 2021)", "publisher": "Parliament of India, text hosted by PRS Legislative Research", "url": "https://prsindia.org/files/bills_acts/acts_parliament/2021/The%20Surrogacy%20(Regulation)%20Act,%202021.pdf", "accessed": "2026-09-16" }, { "id": "s:stasi-thailand-art-act-2017", "kind": "paper", "title": "Protection for Children Born Through Assisted Reproductive Technologies Act, B.E. 2558: The Changing Profile of Surrogacy in Thailand, by Alessandro Stasi", "publisher": "Clinical Medicine Insights: Reproductive Health, via PubMed Central PMC5753847", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC5753847/", "accessed": "2026-09-17", "note": "enacted by the National Legislative Assembly 19 February 2015. Section 21(1): the intending parents must be adult Thai citizens, or where only one is a Thai citizen must have been married at least three years, and must be a legally married couple whose wife cannot conceive. Penalties at sections 24 and 48 (surrogacy for profit: 10 years and up to 200,000 baht) and sections 27 and 49 (acting as an agent: 5 years and up to 100,000 baht)." }, { "id": "s:es-ley-14-2006", "kind": "statute", "title": "Ley 14/2006, de 26 de mayo, sobre técnicas de reproducción humana asistida, artículos 5 y 10", "publisher": "Boletín Oficial del Estado", "url": "https://www.boe.es/buscar/act.php?id=BOE-A-2006-9292", "accessed": "2026-09-16" }, { "id": "s:uk-donor-info-regs-2004", "kind": "statute", "title": "The Human Fertilisation and Embryology Authority (Disclosure of Donor Information) Regulations 2004 (SI 2004/1511)", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/uksi/2004/1511/made", "accessed": "2026-09-16" }, { "id": "s:sef-registro-2022", "kind": "dataset", "title": "Registro Nacional de Actividad 2022 — Registro SEF, Técnicas de Reproducción Asistida (FIV/ICSI and IA)", "publisher": "Sociedad Española de Fertilidad for the Spanish Ministry of Health; the official national ART registry", "url": "https://www.registrosef.com/public/docs/sef2022_IAFIV.pdf", "accessed": "2026-09-16", "note": "section 3.20: 27,564 fresh and frozen cycles in 2022 were for patients resident in other countries — France 39.0%, Italy 20.6%, the United Kingdom 9.0%, Germany 6.4%, Morocco 0.6%, Portugal 0.3%, other 18.3%, country not recorded 5.7%. Of those cycles 52.3% used donated eggs. The reason for coming was not recorded in 90.8% of them; where it was, 1.6% named a technique unlawful at home and 1.1% a patient who did not meet the legal conditions at home." }, { "id": "s:cz-act-66-1986", "kind": "statute", "title": "Zákon č. 66/1986 Sb., o umělém přerušení těhotenství, § 10", "publisher": "Zákony pro lidi (AION CS), consolidated Czech statute text", "url": "https://www.zakonyprolidi.cz/cs/1986-66", "accessed": "2026-09-16" }, { "id": "s:sg-termination-act", "kind": "statute", "title": "Termination of Pregnancy Act 1974, section 3 (restriction on treatment)", "publisher": "Singapore Statutes Online, Attorney-General's Chambers", "url": "https://sso.agc.gov.sg/Act/TPA1974", "accessed": "2026-09-16" }, { "id": "s:it-legge-194-1978", "kind": "statute", "title": "Legge 22 maggio 1978, n. 194, articoli 4 e 5", "publisher": "Normattiva, Government of Italy", "url": "https://www.normattiva.it/uri-res/N2Ls?urn:nir:stato:legge:1978-05-22;194~art5", "accessed": "2026-09-17", "note": "the first 90 days, and the seven-day reflection the doctor must invite under article 5" }, { "id": "s:jp-maternal-health-act", "kind": "statute", "title": "母体保護法 (Maternal Health Act, Act No. 156 of 1948), article 14", "publisher": "World Health Organization, Global Abortion Policies Database country record for Japan", "url": "https://abortion-policies.srhr.org/country/japan", "accessed": "2026-09-17", "note": "spousal consent is required, waived only where the spouse is unknown, cannot express an intention, or is dead. Read in the WHO database's copy of the Act rather than in the Japanese statute database." }, { "id": "s:gurtin-2011-turkey", "kind": "paper", "title": "Banning reproductive travel: Turkey's ART legislation and third-party assisted reproduction", "publisher": "Reproductive BioMedicine Online (Gurtin ZB)", "url": "https://www.rbmojournal.com/article/S1472-6483(11)00470-6/fulltext", "accessed": "2026-09-16", "note": "citation and the 2010 regulation's extraterritorial clause verified from the journal's own article listing; the full text returned HTTP 403 and was not read. Treated as needing verification wherever it is relied on." }, { "id": "s:es-lo-3-2021", "kind": "statute", "title": "Ley Orgánica 3/2021, de regulación de la eutanasia, artículo 5", "publisher": "Boletín Oficial del Estado", "url": "https://www.boe.es/buscar/act.php?id=BOE-A-2021-4628", "accessed": "2026-09-16" }, { "id": "s:fr-loi-2026-794", "kind": "statute", "title": "LOI n° 2026-794 du 18 août 2026 relative à l'aide à mourir, article 4, inserting Code de la santé publique article L. 1111-12-2", "publisher": "Légifrance, Government of France", "url": "https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000054706877", "accessed": "2026-09-17", "note": "French nationality or stable and regular residence in France is one of five cumulative conditions. Read on this pass by a research agent rather than by the author of the records that cite it." }, { "id": "s:ca-criminal-code-241-2", "kind": "statute", "title": "Criminal Code (R.S.C. 1985, c. C-46), section 241.2 — eligibility for medical assistance in dying", "publisher": "Justice Laws Website, Government of Canada", "url": "https://laws-lois.justice.gc.ca/eng/acts/C-46/section-241.2.html", "accessed": "2026-09-16" }, { "id": "s:or-ors-127-805", "kind": "statute", "title": "Oregon Death with Dignity Act, ORS 127.805 (s. 2.01), as amended by Or. Laws 2023 ch. 241 § 2", "publisher": "oregon.public.law, reproduction of the Oregon Revised Statutes", "url": "https://oregon.public.law/statutes/ors_127.805", "accessed": "2026-09-17", "note": "the current text carries no residency clause; the requirement was removed by HB 2279 (2023) following the settlement of a federal suit in 2022" }, { "id": "s:ch-criminal-code", "kind": "statute", "title": "Swiss Criminal Code (SR 311.0), Article 115 — Inciting and assisting suicide (English translation)", "publisher": "Fedlex, the Swiss federal law portal", "url": "https://www.fedlex.admin.ch/filestore/fedlex.data.admin.ch/eli/cc/54/757_781_799/20250101/en/html/fedlex-data-admin-ch-eli-cc-54-757_781_799-20250101-en-html.html", "accessed": "2026-09-16" }, { "id": "s:nl-euthanasia-act-2002", "kind": "statute", "title": "Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding, artikel 2 (zorgvuldigheidseisen)", "publisher": "Overheid.nl, wetten.overheid.nl", "url": "https://wetten.overheid.nl/BWBR0012410/2023-04-01/0/Hoofdstuk2", "accessed": "2026-09-16" }, { "id": "s:be-euthanasia-law-2002", "kind": "statute", "title": "Loi du 28 mai 2002 relative à l'euthanasie, article 3", "publisher": "Service public fédéral Justice, Belgium (ejustice)", "url": "https://www.ejustice.just.fgov.be/cgi_loi/change_lg.pl?language=fr&la=F&cn=2002052837&table_name=loi", "accessed": "2026-09-17", "note": "article 3 sets the conditions — adult or emancipated minor, capable and conscious, a voluntary, considered and repeated request, a hopeless medical situation and constant unbearable suffering. The article carries no nationality or residence condition." }, { "id": "s:uk-suicide-act-1961", "kind": "statute", "title": "Suicide Act 1961, section 2 (as amended by the Coroners and Justice Act 2009)", "publisher": "The National Archives, legislation.gov.uk", "url": "https://www.legislation.gov.uk/ukpga/Eliz2/9-10/60/section/2", "accessed": "2026-09-16" }, { "id": "s:us-ca-hsc-443-2", "kind": "statute", "title": "California End of Life Option Act, Health and Safety Code § 443.2(a)(3)", "publisher": "California Legislative Information", "url": "https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC§ionNum=443.2", "accessed": "2026-09-17", "note": "the applicant must be a resident of California, proved by a California driver's licence or state identification, California voter registration, ownership or lease of California property, or a California tax return for the most recent year" }, { "id": "s:declaration-of-istanbul", "kind": "org", "title": "The Declaration of Istanbul on Organ Trafficking and Transplant Tourism (2018 edition)", "publisher": "Declaration of Istanbul Custodian Group", "url": "https://www.declarationofistanbul.org/", "accessed": "2026-09-16" }, { "id": "s:who-guiding-principles", "kind": "org", "title": "WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation, as endorsed by the Sixty-third World Health Assembly, May 2010, in Resolution WHA63.22", "publisher": "World Health Organization", "url": "https://iris.who.int/server/api/core/bitstreams/53e1102b-4874-49bf-97bc-c529b1c246f0/content", "accessed": "2026-09-16" }, { "id": "s:who-gapd", "kind": "dataset", "title": "Global Abortion Policies Database", "publisher": "World Health Organization (HRP)", "url": "https://abortion-policies.srhr.org/", "accessed": "2026-09-16", "note": "country profiles naming each jurisdiction's instrument; cited here where a national instrument was not read directly" }, { "id": "s:hcch-parentage-surrogacy", "kind": "org", "title": "Parentage / Surrogacy Project", "publisher": "Hague Conference on Private International Law (HCCH)", "url": "https://www.hcch.net/en/projects/legislative-projects/parentage-surrogacy", "accessed": "2026-09-16", "note": "the intergovernmental project on cross-border parentage; cited here where a national instrument was not read" }, { "id": "s:shenfield-2010", "kind": "paper", "title": "Cross border reproductive care in six European countries", "publisher": "Human Reproduction 25(6):1361-1368, ESHRE Taskforce on Cross Border Reproductive Care", "url": "https://academic.oup.com/humrep/article/25/6/1361/2915759", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "every instrument is named and dated on a legality row elsewhere on this site; the structural readings are marked Inference inline" }, "text.how": { "tier": "cited", "note": "the status vocabulary is this project's; the recognition law is cited" }, "text.today": { "tier": "inference", "note": "counted over the legality rows on disk on 17 September 2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "china", "type": "destination", "name": "China", "as": "Travel to reach a treatment the law at home has not approved — here arranged by the state itself.", "rel": "story" }, { "from": "cyprus", "type": "destination", "name": "Cyprus", "as": "What a border twenty minutes wide does to a fertility law.", "rel": "story" }, { "from": "north-cyprus", "type": "destination", "name": "Northern Cyprus", "as": "A twenty-minute drive as a legal strategy.", "rel": "story" }, { "from": "havana", "type": "hub", "name": "Havana", "as": "Travel because of what the state at home forbids — here the forbidding state is the patient's own.", "rel": "story" }, { "from": "tbilisi", "type": "hub", "name": "Tbilisi", "as": "Why a permission in one country becomes an industry in its capital.", "rel": "story" }, { "from": "tijuana", "type": "hub", "name": "Tijuana", "as": "Travel undertaken because the thing is not available at home; Tijuana is the North American case.", "rel": "story" }, { "from": "complaint-and-claim", "type": "pathway", "name": "Complaint and claim", "as": "Why some patients cannot complain at home without disclosing what they travelled for.", "rel": "story" }, { "from": "the-visa", "type": "pathway", "name": "The visa", "as": "Why the stated purpose of a trip is sometimes the sensitive part.", "rel": "story" }, { "from": "abortion-travel-law", "type": "rule", "name": "Travelling for a termination", "as": "The essay on the traffic a prohibition creates, of which this is the oldest and largest case.", "rel": "story" }, { "from": "assisted-dying-law", "type": "rule", "name": "Assisted dying, and who may cross a border for it", "as": "The essay on crossing a border to do what is prohibited at home, in the one case where the traveller does not come back.", "rel": "story" }, { "from": "donor-anonymity-law", "type": "rule", "name": "Donor anonymity", "as": "Why a rule about who a donor may be sends patients across a border, argued at length.", "rel": "story" }, { "from": "gender-affirming-care-access", "type": "rule", "name": "Access to gender-affirming care", "as": "The essay on travel driven by a rule rather than a price, which is what most of this table is.", "rel": "story" }, { "from": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "Why a named purpose of travel is sometimes the sensitive part.", "rel": "story" }, { "from": "surrogacy-law", "type": "rule", "name": "Surrogacy law across borders", "as": "The essay on travelling to do lawfully elsewhere what is prohibited at home; this table is the evidence it argues from.", "rel": "story" }, { "from": "transplant-prohibition", "type": "rule", "name": "Buying an organ, and being transplanted abroad", "as": "The essay on prohibition-driven travel, and the case in which the prohibition is nearly universal and the traffic persists anyway.", "rel": "story" }, { "from": "declaration-of-istanbul-group", "type": "org", "name": "Declaration of Istanbul Custodian Group", "as": "The wider pattern of travelling to do what is unlawful at home, of which this is the hardest case.", "rel": "story" }, { "from": "how-this-was-built", "type": "story", "name": "How this was built", "as": "The law rule applied across six subjects, one named instrument at a time.", "rel": "story" } ] }, { "schema": 1, "id": "counting-patients", "type": "story", "names": { "name": "Counting patients", "aliases": [ "how many people actually travel", "the volume numbers" ], "said": "Every destination has a number. No two of them count the same thing, and several say so on their own pages." }, "region": [ "global" ], "facets": { "kind": "essay" }, "text": { "what": "Why the headline figures for how many people travel for treatment cannot be added, compared or trusted as counts of people. Twelve of the 52 country records on this site carry an inbound figure. They are assembled from a trade council's member returns, a compulsory ministry register, an emirate's press release, a border exit survey of stated purpose, a visa class, a minister's statement, one pilot zone, and a hospital association counting the patients it billed. Each is described here with the unit it actually uses.", "story": "Four different objects circulate under one word. A count of people who crossed a border in order to be treated. A count of episodes of care given to somebody holding a foreign passport. A count of arrivals recorded at a frontier under a stated purpose. And a count of registrations. The first is the thing readers assume; it is also the one almost nobody publishes.\n\nMalaysia's series is the clearest case of the drift. The Malaysia Healthcare Travel Council, set up inside the Ministry of Health in 2009, has published a traveller count ever since: 641,000 in 2011, 728,800 in 2012, 881,000 in 2013, 882,000 in 2014, 859,000 in 2015, 921,000 in 2016. For 2024 it reported 1.6 million healthcare travellers and 2.72 billion ringgit of revenue. *Inference —* the step from 921,000 to 1.6 million is steeper than any plausible growth in operating theatres, and the council publishes no definition of a healthcare traveller. A figure of that size in a country of about 34 million reads as foreign patients seen at member facilities — every check-up, every follow-up visit, every resident expatriate with a fever — rather than people who crossed a border for treatment. The revenue line is the one with a defensible denominator.\n\nSouth Korea does the hardest version and is worth setting out because it is the exception. Facilities that treat foreign patients must register under the Act on Supporting Overseas Expansion of Medical Services and Attraction of International Patients, Act No. 13599 of 22 December 2015, and report; the Korea Health Industry Development Institute compiles the returns and the Ministry of Health and Welfare published the 2024 figures on 3 April 2025. The total is 1,170,467 patients from 202 countries, stated as unique patients excluding repeat visits, with 999,642 of them treated in Seoul, 82.0 per cent at clinics rather than hospitals, and dermatology and plastic surgery leading. *Inference —* a stated counting rule and a compulsory register put this in a different class of evidence from a market total. It is still not a count of journeys made for treatment, because the series is administrative: it grows when registration grows, and a 93 per cent rise in one year is a fact about how many facilities enrolled as well as about how many patients arrived. The fastest-growing origins that year were Taiwan, up 550.6 per cent, and Japan, up 135.0 per cent — two-hour flights to a dermatology clinic, not admissions.\n\nDubai publishes a number whose own composition gives it away. The Dubai Health Authority reported more than 691,000 health travellers in 2023 against 674,000 the year before, with AED 1.03 billion of direct spending, and broke the demand down as 29 per cent dentistry, 27 per cent dermatology and 13 per cent gynaecology. *Inference —* a total led by teeth and skin is a count of short outpatient contacts, and the release does not publish the rule separating a visiting patient from one of the emirate's own large resident foreign population. It is also one emirate, not the federation; health regulation in the UAE is emirate-level, and no federal equivalent exists.\n\nThe Philippines is the country whose own government wrote the problem down. The Philippine Institute for Development Studies, the state's policy research body, published Oscar Picazo's assessment in October 2013 and recorded that \"The exact size of the market (number of medical tourists) and its revenue potential remain unclear, however, due to the absence of an agreed-upon definition of medical tourism.\" Against the benchmark for a standardised database, the same note records: \"Very weak; absence of key data; hesitance of private sector to share sensitive data.\" Against coordination it counts 48 offices and agencies involved and no council or board. The country therefore publishes no national patient number, and this site carries none for it.\n\nTürkiye and India both count at the border, and the border counts trips. USHAŞ, the health ministry's international services company, puts 2025 at 1,398,580, attributing it to the national statistical institute, whose own footer calls the instrument a Departing Visitors Survey — an exit survey of stated purpose rather than a count of patients treated. Of that total, 250,401 were Turkish citizens resident abroad, which is a different journey from the one the number is usually cited to describe. India's Press Information Bureau records 507,244 foreign nationals arriving for medical treatment in 2025, about 5.5 per cent of 9.15 million foreign arrivals, counted by visa purpose: a patient who leaves and returns is two, and attendants travel on a separate visa class and are counted apart. Two of those three units — survey responses and visa stamps — are counts of crossings.\n\nSingapore ran both methods at once and they disagreed. The Ministry of Health told Parliament on 22 January 2009 that the tourism board's airport exit survey estimated about 348,000 medical travellers for 2007 against about 410,000 for 2006, and attached its own caveat: every hospital had reported higher admissions and patient-days in 2007 while the survey showed a 15 per cent fall, and the board was re-examining the method. No later official count was read for this record. *Inference —* that is the cleanest natural experiment in this file. One country, one year, two instruments, opposite directions, and the discrepancy was published rather than reconciled.\n\nThe rest of the file behaves the same way. Iran's 1.2 million for the year to March 2025 is a tourism minister's statement with no method attached. China's 410,000 is one pilot zone on Hainan, where the visitor is most likely domestic, and is not a national count of foreigners treated. Tunisia's 500,000 admissions plus more than two million outpatient episodes are episodes rather than people, given by a health ministry official to a news agency. Jordan's 230,000 for 2025 comes from the Private Hospitals Association, counts what its members billed, includes clinic episodes — the association itself says only a quarter were treated in hospitals — and was published by a body arguing for the sector it counts. *Inference —* none of these is dishonest reporting. Each is a real measurement of something, published by an institution that had a reason to measure it, and the distortion happens later, when a summary strips the unit off and adds the totals together.", "how": "What a reader can do with a volume figure depends entirely on three questions the publisher usually answers somewhere: what the unit is — people, episodes, arrivals, registrations; who collected it — a regulator with a statutory return, a trade body with member submissions, a statistics office with a survey, or a ministry at a press conference; and what the denominator is. Where a destination publishes revenue as well as headcount, the revenue is normally the firmer number, because money has an accounting trail and a patient does not. Where a destination publishes a facility-level count, that count belongs to the facility and this site carries it as the facility's own.", "today": "As of 17 September 2026 twelve of the 52 country records on this site carry an inbound figure, and every one of them states its unit and its collector in the record's metrics note. Forty carry none. Thailand, the destination most often named in this trade, carries no inbound count here at all: the figures in circulation come from market summaries whose method this project could not read, and the hospital-level counts on the facility pages are what the Thai records stand on instead." }, "kin": [ { "to": "malaysia", "as": "The council series that runs from 641,000 to 1.6 million without publishing a definition.", "rel": "destination" }, { "to": "south-korea", "as": "The compulsory register, and the one national figure here with a stated counting rule.", "rel": "destination" }, { "to": "khidi", "as": "The institute that compiles the Korean returns and states the count excludes repeat visits.", "rel": "org" }, { "to": "uae", "as": "The emirate figure whose own breakdown — 29 per cent dentistry, 27 per cent dermatology — says what it counts.", "rel": "destination" }, { "to": "philippines", "as": "The government research body that rated its own database very weak and published no total.", "rel": "destination" }, { "to": "turkiye", "as": "The border exit survey of stated purpose, 250,401 of it citizens resident abroad.", "rel": "destination" }, { "to": "india", "as": "Arrivals counted by visa purpose, so a patient who returns is two.", "rel": "destination" }, { "to": "singapore", "as": "The year an exit survey and the hospitals' own admissions moved in opposite directions.", "rel": "destination" }, { "to": "jordan", "as": "Counted by the hospitals that billed them, three quarters of it outpatient work.", "rel": "destination" }, { "to": "mhtc", "as": "The council whose membership list is a marketing roster rather than a register of who may operate.", "rel": "org" }, { "to": "world-bank-tourism-arrivals", "as": "The arrivals series with no purpose field at all, which is why it cannot be used here.", "rel": "dataset" }, { "to": "what-the-data-cannot-see", "as": "The same problem across every series this site draws a chart from.", "rel": "story" } ], "links": [ { "label": "PIDS Policy Note 2013-11 — medical travel in the Philippines", "url": "https://pidswebs.pids.gov.ph/CDN/PUBLICATIONS/pidspn1311.pdf" }, { "label": "Korean Ministry of Health and Welfare, foreign patient statistics 2024", "url": "https://www.mohw.go.kr/board.es?mid=a20401000000&bid=0032&act=view&list_no=1485207" } ], "sources": [ "s:mhtc-mymt-2026", "s:mhtc-wikipedia", "s:mohw-kr-foreign-patients-2024", "s:khidi-medicalkorea", "s:kr-act-13599", "s:dubai-media-office-health-2023", "s:pids-medical-tourism-2013", "s:ushas-saglik-turizmi-verileri", "s:pib-india-mvt-2026", "s:pib-medical-wellness-tourism-2026", "s:moh-sg-medical-travellers-2009", "s:tehran-times-health-travel-2025", "s:govcn-lecheng-2025", "s:afp-tunisia-2024", "s:agbi-jordan-2026", "s:wb-tourist-arrivals", "s:imtj-wikipedia", "s:mti-home" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "every figure is the publisher's own, cited to it; the readings of what each figure counts are marked Inference inline" }, "text.how": { "tier": "inference", "note": "this project's three questions, drawn from the records it has written" }, "text.today": { "tier": "inference", "note": "counted over the destination records on disk on 17 September 2026" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "Why the headline figures for how many people travel for treatment cannot be added, compared or trusted as counts of people. Twelve of the 52 country records on this site carry an inbound figure.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "malaysia", "type": "destination", "name": "Malaysia", "as": "The council series that runs from 641,000 to 1.6 million without publishing a definition.", "rel": "destination" }, { "to": "south-korea", "type": "destination", "name": "South Korea", "as": "The compulsory register, and the one national figure here with a stated counting rule.", "rel": "destination" }, { "to": "khidi", "type": "org", "name": "Korea Health Industry Development Institute", "as": "The institute that compiles the Korean returns and states the count excludes repeat visits.", "rel": "org" }, { "to": "uae", "type": "destination", "name": "United Arab Emirates", "as": "The emirate figure whose own breakdown — 29 per cent dentistry, 27 per cent dermatology — says what it counts.", "rel": "destination" }, { "to": "philippines", "type": "destination", "name": "Philippines", "as": "The government research body that rated its own database very weak and published no total.", "rel": "destination" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "The border exit survey of stated purpose, 250,401 of it citizens resident abroad.", "rel": "destination" }, { "to": "india", "type": "destination", "name": "India", "as": "Arrivals counted by visa purpose, so a patient who returns is two.", "rel": "destination" }, { "to": "singapore", "type": "destination", "name": "Singapore", "as": "The year an exit survey and the hospitals' own admissions moved in opposite directions.", "rel": "destination" }, { "to": "jordan", "type": "destination", "name": "Jordan", "as": "Counted by the hospitals that billed them, three quarters of it outpatient work.", "rel": "destination" }, { "to": "mhtc", "type": "org", "name": "Malaysia Healthcare Travel Council", "as": "The council whose membership list is a marketing roster rather than a register of who may operate.", "rel": "org" }, { "to": "world-bank-tourism-arrivals", "type": "dataset", "name": "International arrivals", "as": "The arrivals series with no purpose field at all, which is why it cannot be used here.", "rel": "dataset" }, { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "The same problem across every series this site draws a chart from.", "rel": "story" } ], "source_list": [ { "id": "s:mhtc-mymt-2026", "kind": "web", "title": "Malaysia Healthcare Travel Council Launches MYMT 2026, Malaysia's First Medical Tourism Year", "publisher": "Malaysia Healthcare Travel Council", "url": "https://www.prnewswire.com/apac/news-releases/malaysia-healthcare-travel-council-launches-mymt-2026-malaysias-first-medical-tourism-year-302513594.html", "accessed": "2026-09-16", "note": "MHTC's own release, dated 25 July 2025, carrying its 2024 healthcare-traveller and revenue figures. The council's own site returned a server error on the date of access" }, { "id": "s:mhtc-wikipedia", "kind": "wikipedia", "title": "Malaysia Healthcare Travel Council", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Malaysia_Healthcare_Travel_Council", "accessed": "2026-09-16", "note": "set up 2005, incorporated as an independent entity 2011, moved from the Ministry of Health to the Ministry of Finance in 2018, and the 2019 arrivals figure; mhtc.org.my returned HTTP 500 on this date" }, { "id": "s:mohw-kr-foreign-patients-2024", "kind": "web", "title": "Korea Attracts 1.17 Million Foreign Patients in 2024", "publisher": "Ministry of Health and Welfare (Republic of Korea)", "url": "https://www.mohw.go.kr/board.es?mid=a20401000000&bid=0032&act=view&list_no=1485207", "accessed": "2026-09-16", "note": "press release of 3 April 2025; the annual foreign-patient statistics are compiled for the ministry by the Korea Health Industry Development Institute" }, { "id": "s:khidi-medicalkorea", "kind": "org", "title": "About KHIDI — Medical Korea", "publisher": "Korea Health Industry Development Institute", "url": "http://www.medicalkorea.or.kr/en/aboutkhidi", "accessed": "2026-09-16", "note": "government-affiliated institution under the Ministry of Health and Welfare; the registration system, registered hospitals and registered facilitators" }, { "id": "s:kr-act-13599", "kind": "statute", "title": "Act on Supporting Overseas Expansion of Medical Services and Attraction of International Patients (Act No. 13599, 22 December 2015)", "publisher": "Korea Legislation Research Institute, Korea Law Translation Center", "url": "https://elaw.klri.re.kr/eng_mobile/viewer.do?hseq=60070&type=part&key=36", "accessed": "2026-09-17", "note": "Article 6 registration conditions — specialists by department and malpractice cover for an institution; guaranty insurance, minimum capital and a domestic office for an agency. Article 7 bars transfer or lease of a certificate. Article 8 requires posting and foreign-language information on diagnosis, cost and dispute resolution. Unregistered operation: up to three years or 30 million won." }, { "id": "s:dubai-media-office-health-2023", "kind": "gov", "title": "Dubai welcomes more than 691,000 international health travellers in 2023", "publisher": "Dubai Media Office, Government of Dubai", "url": "https://mediaoffice.ae/en/news/2024/august/19-08/dubai-welcomes-more-than-691k", "accessed": "2026-09-16", "note": "Dubai Health Authority figures released 19 August 2024; gives arrivals, spend, regional split and the leading specialties. The release does not publish the counting rule behind the headline number." }, { "id": "s:pids-medical-tourism-2013", "kind": "paper", "title": "Health-enhancing holidays: challenges in expanding medical tourism in the Philippines", "publisher": "Philippine Institute for Development Studies, Policy Notes No. 2013-11", "url": "https://pidswebs.pids.gov.ph/CDN/PUBLICATIONS/pidspn1311.pdf", "accessed": "2026-09-16", "note": "Oscar F. Picazo, October 2013, ISSN 1656-5266" }, { "id": "s:ushas-saglik-turizmi-verileri", "kind": "gov", "title": "Sağlık Turizmi Verileri (health tourism data by year)", "publisher": "USHAŞ — Uluslararası Sağlık Hizmetleri A.Ş., the Turkish Ministry of Health's international health services company", "url": "https://ushas.gov.tr/saglik-turizmi-verileri/", "accessed": "2026-09-16", "note": "USHAŞ publishes the series it attributes to TÜİK, the Turkish statistical institute: visitors and revenue by year — 2019 756,926 and USD 1.459bn; 2020 435,691; 2021 729,592; 2022 1,381,807; 2023 1,538,643; 2024 1,506,442; 2025 1,398,580 and USD 3,022,452 thousand; first half of 2026 563,327 and USD 1.580bn. The unit is a visitor arriving with a health purpose, not an operation." }, { "id": "s:pib-india-mvt-2026", "kind": "gov", "title": "Medical and Wellness Tourism in India — PIB Backgrounder", "publisher": "Press Information Bureau, Government of India", "url": "https://www.pib.gov.in/PressReleasePage.aspx?PRID=2257447®=3&lang=1", "accessed": "2026-09-16", "note": "posted 2 May 2026; gives 2025 arrivals in India for medical purpose in total and for the seven leading source countries" }, { "id": "s:pib-medical-wellness-tourism-2026", "kind": "web", "title": "Medical and Wellness Tourism in India", "publisher": "Press Information Bureau, Government of India", "url": "https://static.pib.gov.in/WriteReadData/specificdocs/documents/2026/may/doc202652862301.pdf", "accessed": "2026-09-16", "note": "backgrounder dated 2 May 2026; carries the 2025 medical-purpose arrival count, the top source countries, the NABH accreditation count and the visa categories" }, { "id": "s:moh-sg-medical-travellers-2009", "kind": "web", "title": "Medical Travellers Update", "publisher": "Ministry of Health, Singapore", "url": "https://www.moh.gov.sg/newsroom/medical-travellers-update/", "accessed": "2026-09-16", "note": "written answer to a parliamentary question from Dr Lam Pin Min, 22 January 2009, giving the Singapore Tourism Board's airport exit-survey estimates and the ministry's own doubt about the method" }, { "id": "s:tehran-times-health-travel-2025", "kind": "web", "title": "Iran sets target to attract two million medical tourists over five years", "publisher": "Tehran Times", "url": "https://www.tehrantimes.com/news/513984/Iran-sets-target-to-attract-two-million-medical-tourists-over", "accessed": "2026-09-16", "note": "dated 7 June 2025, reporting tourism minister Seyyed Reza Salehi-Amiri" }, { "id": "s:govcn-lecheng-2025", "kind": "web", "title": "Hainan emerges as China's premier international medical tourism destination", "publisher": "Xinhua, on the State Council of the People's Republic of China website", "url": "https://english.www.gov.cn/news/202507/05/content_WS6868ce92c6d0868f4e8f3dc5.html", "accessed": "2026-09-16", "note": "dated 5 July 2025; figures for the Boao Lecheng International Medical Tourism Pilot Zone" }, { "id": "s:afp-tunisia-2024", "kind": "news", "title": "Dans une Tunisie en crise, le tourisme médical est en pleine santé", "publisher": "Agence France-Presse, carried by VOA Afrique", "url": "https://www.voaafrique.com/a/dans-une-tunisie-en-crise-le-tourisme-m%C3%A9dical-est-en-pleine-sant%C3%A9/7464645.html", "accessed": "2026-09-16", "note": "published 31 January 2024; quotes Dr Nadia Fenina of the Tunisian Ministry of Health and gives patient counts, revenue and the ranking of source countries" }, { "id": "s:agbi-jordan-2026", "kind": "news", "title": "Middle East drives Jordan's medical tourism earnings to $1bn", "publisher": "AGBI (Arabian Gulf Business Insight)", "url": "https://www.agbi.com/tourism/2026/06/middle-east-drives-jordans-medical-tourism-earnings-to-1bn/", "accessed": "2026-09-16", "note": "published 17 June 2026, reporting Fawzi Hammouri, president of the Private Hospitals Association, as carried by the Jordan Times" }, { "id": "s:wb-tourist-arrivals", "kind": "dataset", "title": "International tourism, number of arrivals — indicator ST.INT.ARVL", "publisher": "World Bank Open Data", "url": "https://data.worldbank.org/indicator/ST.INT.ARVL", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-17", "note": "the long definition and its caveats read off https://api.worldbank.org/v2/indicator/ST.INT.ARVL?format=json, including the sentences on differing national collection methods and on arrivals not being people; source organisation UN Tourism, Yearbook and Compendium of Tourism Statistics" }, { "id": "s:imtj-wikipedia", "kind": "wikipedia", "title": "International Medical Travel Journal", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/International_Medical_Travel_Journal", "accessed": "2026-09-16", "note": "established 2007, UK trade publication, biweekly newsletter, Keith Pollard as editor in chief, annual Medical Travel Awards; imtj.com refused every fetch on this date" }, { "id": "s:mti-home", "kind": "web", "title": "The Medical Tourism Index 2020-21", "publisher": "International Healthcare Research Center", "url": "https://www.medicaltourism.com/mti/home", "accessed": "2026-09-16", "note": "authorship, the three editions and their destination counts, the three dimensions and 41 criteria, and the survey of 3,030 Americans" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "every figure is the publisher's own, cited to it; the readings of what each figure counts are marked Inference inline" }, "text.how": { "tier": "inference", "note": "this project's three questions, drawn from the records it has written" }, "text.today": { "tier": "inference", "note": "counted over the destination records on disk on 17 September 2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "argentina", "type": "destination", "name": "Argentina", "as": "Why a procedure count is not a patient count, here as everywhere.", "rel": "story" }, { "from": "belgium", "type": "destination", "name": "Belgium", "as": "A country that treats its neighbours and cannot say how many.", "rel": "story" }, { "from": "brazil", "type": "destination", "name": "Brazil", "as": "Why a procedure count and a patient count are different animals.", "rel": "story" }, { "from": "china", "type": "destination", "name": "China", "as": "How a zone's visitor count becomes a national destination claim.", "rel": "story" }, { "from": "croatia", "type": "destination", "name": "Croatia", "as": "Why a trade crossing a land border by car leaves almost no countable trace.", "rel": "story" }, { "from": "germany", "type": "destination", "name": "Germany", "as": "Why the largest cross-border number in Europe is not a count of journeys.", "rel": "story" }, { "from": "india", "type": "destination", "name": "India", "as": "Why an arrivals count and a market estimate are not the same number.", "rel": "story" }, { "from": "iran", "type": "destination", "name": "Iran", "as": "A national total announced by a minister, with no series behind it.", "rel": "story" }, { "from": "ireland", "type": "destination", "name": "Ireland", "as": "A country whose best-counted flow crosses a sea and whose largest may cross a field.", "rel": "story" }, { "from": "jordan", "type": "destination", "name": "Jordan", "as": "Why a trade body's count of its own members' patients is read slowly here.", "rel": "story" }, { "from": "malaysia", "type": "destination", "name": "Malaysia", "as": "Why a 1.6 million figure with no published definition is a marketing number.", "rel": "story" }, { "from": "nigeria", "type": "destination", "name": "Nigeria", "as": "The billion-dollar figure with no series behind it is this page's whole argument.", "rel": "story" }, { "from": "philippines", "type": "destination", "name": "Philippines", "as": "A government research body writing down why it cannot give a number.", "rel": "story" }, { "from": "saudi-arabia", "type": "destination", "name": "Saudi Arabia", "as": "Why this page carries an outbound number and refuses an inbound one.", "rel": "story" }, { "from": "singapore", "type": "destination", "name": "Singapore", "as": "The health ministry's own doubt about an exit survey, stated in 2009.", "rel": "story" }, { "from": "south-africa", "type": "destination", "name": "South Africa", "as": "Why a share of arrivals who named a purpose is not a count of operations.", "rel": "story" }, { "from": "south-korea", "type": "destination", "name": "South Korea", "as": "Why a registration series and a patient count are not the same thing.", "rel": "story" }, { "from": "thailand", "type": "destination", "name": "Thailand", "as": "Why the headline patient numbers for this country should be read slowly.", "rel": "story" }, { "from": "tunisia", "type": "destination", "name": "Tunisia", "as": "Why half a million admissions and two million outpatient episodes are not half a million people.", "rel": "story" }, { "from": "turkiye", "type": "destination", "name": "Türkiye", "as": "Why a figure of 1.4 million visitors is not 1.4 million operations.", "rel": "story" }, { "from": "uae", "type": "destination", "name": "United Arab Emirates", "as": "Why a figure of 691,000 needs its counting rule before it can be read.", "rel": "story" }, { "from": "united-states", "type": "destination", "name": "United States", "as": "Why 'millions a year' is a sentence and not a measurement.", "rel": "story" }, { "from": "vietnam", "type": "destination", "name": "Vietnam", "as": "Why an unattributed 300,000 does not become a fact by being reprinted.", "rel": "story" }, { "from": "amman", "type": "hub", "name": "Amman", "as": "Why two-decade-old arrival figures keep getting repeated as current.", "rel": "story" }, { "from": "barcelona", "type": "hub", "name": "Barcelona", "as": "Why a national cycle count is not a count of people who travelled.", "rel": "story" }, { "from": "chennai", "type": "hub", "name": "Chennai", "as": "Why the daily arrival figures quoted for this city disagree with each other.", "rel": "story" }, { "from": "havana", "type": "hub", "name": "Havana", "as": "A number published by the ministry that owns the hospitals and sells the packages is a particular kind of number.", "rel": "story" }, { "from": "kuala-lumpur", "type": "hub", "name": "Kuala Lumpur", "as": "Why a count of foreign passports in a hospital is not a count of medical travellers.", "rel": "story" }, { "from": "mumbai", "type": "hub", "name": "Mumbai", "as": "Why a million footfalls is not a million patients.", "rel": "story" }, { "from": "penang", "type": "hub", "name": "Penang", "as": "Why a foreign passport in a hospital register is not a medical traveller.", "rel": "story" }, { "from": "seoul", "type": "hub", "name": "Seoul", "as": "Why a clinic registration count is not a headcount of travellers.", "rel": "story" }, { "from": "sopron", "type": "hub", "name": "Sopron", "as": "Why this town's clinic count is a reputation rather than a census.", "rel": "story" }, { "from": "tel-aviv", "type": "hub", "name": "Tel Aviv", "as": "Why a fifteen-year-old newspaper figure is still the count in circulation.", "rel": "story" }, { "from": "tunis", "type": "hub", "name": "Tunis", "as": "Why a ranking keeps standing in for a count here.", "rel": "story" }, { "from": "albert-einstein-sao-paulo", "type": "facility", "name": "Hospital Israelita Albert Einstein", "as": "A hospital cited everywhere in this field that publishes no count of anything.", "rel": "story" }, { "from": "american-hospital-dubai", "type": "facility", "name": "American Hospital Dubai", "as": "Dubai counted 691,000 international health travellers in 2023, and this hospital counts none of its own in public.", "rel": "story" }, { "from": "asan-medical-center", "type": "facility", "name": "Asan Medical Center", "as": "11,377 a day, 654,536 a year and 19,482 from abroad are three counters measuring three different things.", "rel": "story" }, { "from": "king-hussein-cancer-center", "type": "facility", "name": "King Hussein Cancer Center", "as": "7,000 new patients, 14,000 admissions and 250,000 outpatient visits are three different numbers about the same year.", "rel": "story" }, { "from": "medicana", "type": "facility", "name": "Medicana Health Group", "as": "5.5 million a year, across eighteen hospitals in three countries, domestic and foreign together, counting attendances.", "rel": "story" }, { "from": "memorial-sisli", "type": "facility", "name": "Memorial Şişli Hospital", "as": "167 countries is the group's headline figure, and it counts countries because nobody publishes patients.", "rel": "story" }, { "from": "mount-elizabeth", "type": "facility", "name": "Mount Elizabeth Hospital", "as": "About 30 per cent of one named hospital's patients from abroad is worth more than any national arrivals total.", "rel": "story" }, { "from": "samsung-medical-center", "type": "facility", "name": "Samsung Medical Center", "as": "1.17 million foreign patients in Korea for 2024 counts registered episodes at every provider, from this hospital to a skin clinic.", "rel": "story" }, { "from": "severance", "type": "facility", "name": "Severance Hospital", "as": "2.5 million outpatients and 840,000 inpatients, both counting attendances at one hospital in one system of five.", "rel": "story" }, { "from": "sheba", "type": "facility", "name": "Sheba Medical Center", "as": "A million a year, and the word in the source is visits.", "rel": "story" }, { "from": "deciding-whether", "type": "pathway", "name": "Deciding whether to go", "as": "Why the headline number of people who travel is not a count of people.", "rel": "story" }, { "from": "the-visa", "type": "pathway", "name": "The visa", "as": "Why a patient admitted as a visitor is a patient nobody counted.", "rel": "story" }, { "from": "india-e-medical-visa", "type": "rule", "name": "India's e-Medical Visa", "as": "A named class makes a patient countable; most states issue none.", "rel": "story" }, { "from": "korea-foreign-patient-registration", "type": "rule", "name": "Korea's foreign patient attraction registration", "as": "What a registration-based count does and does not count.", "rel": "story" }, { "from": "schengen-medical-visa", "type": "rule", "name": "The Schengen visa, for treatment", "as": "A visitor visa with a hospital letter leaves no category to count.", "rel": "story" }, { "from": "thai-medical-visa", "type": "rule", "name": "Thailand's medical treatment visa", "as": "Why a patient on an endorsed visitor visa is a patient nobody counted.", "rel": "story" }, { "from": "dha-dubai", "type": "org", "name": "Dubai Health Authority", "as": "Why 691,000 cannot be read until somebody says what a one in it is.", "rel": "story" }, { "from": "eu-national-contact-points", "type": "org", "name": "EU National Contact Points for cross-border healthcare", "as": "Where the administrative floor and the cash trade are set side by side.", "rel": "story" }, { "from": "icmart", "type": "org", "name": "International Committee for Monitoring Assisted Reproductive Technologies", "as": "A world total assembled from voluntary returns on unlike definitions.", "rel": "story" }, { "from": "imtj", "type": "org", "name": "International Medical Travel Journal", "as": "Where its long argument with the industry's headline numbers is set out.", "rel": "story" }, { "from": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "What a projection from 2,975 questionnaires can and cannot be asked to carry.", "rel": "story" }, { "from": "ishrs", "type": "org", "name": "International Society of Hair Restoration Surgery", "as": "A trade with no register, counted by asking the people who compete with it.", "rel": "story" }, { "from": "khidi", "type": "org", "name": "Korea Health Industry Development Institute", "as": "The one national count on this site whose counting rule is published.", "rel": "story" }, { "from": "medical-tourism-association", "type": "org", "name": "Medical Tourism Association", "as": "Where the industry's market-size figures are traced back to their sources.", "rel": "story" }, { "from": "mhtc", "type": "org", "name": "Malaysia Healthcare Travel Council", "as": "Where a national healthcare-traveller total is taken apart.", "rel": "story" }, { "from": "oecd", "type": "org", "name": "Organisation for Economic Co-operation and Development", "as": "The residency and boundary problems this report names, one layer up.", "rel": "story" }, { "from": "turkiye-health-services-directorate", "type": "org", "name": "Türkiye General Directorate of Health Services", "as": "A register of who may treat, beside a border survey of who said they came for treatment.", "rel": "story" }, { "from": "john-connell", "type": "person", "name": "John Connell", "as": "The problem his book named twenty years before the market reports learned to state it.", "rel": "story" }, { "from": "josef-woodman", "type": "person", "name": "Josef Woodman", "as": "Where the two-million figure in his publisher's release is taken apart.", "rel": "story" }, { "from": "keith-pollard", "type": "person", "name": "Keith Pollard", "as": "His paper's long argument with the industry's headline figures is the best-known part of his editing.", "rel": "story" }, { "from": "covid-shutdown-2020", "type": "event", "name": "The 2020 shutdown", "as": "A hole in every series at once, and what charts do to cover it.", "rel": "story" }, { "from": "dominican-republic-ntm-outbreak", "type": "event", "name": "The Dominican mycobacterial outbreaks, 2013–14 and 2017", "as": "Two outbreak counts with no denominator between them.", "rel": "story" }, { "from": "imtj-summit", "type": "event", "name": "The IMTJ Medical Travel Summit and Awards", "as": "Where many of the field's circulating numbers are first said out loud.", "rel": "story" }, { "from": "mexico-fungal-meningitis-2023", "type": "event", "name": "The Matamoros fungal meningitis outbreak, 2023", "as": "Twelve deaths with no denominator is the shape of almost every number in this field.", "rel": "story" }, { "from": "ndm-1-2010", "type": "event", "name": "NDM-1, 2010", "as": "Seventeen travel histories carried a global argument for a decade.", "rel": "story" }, { "from": "turkiye-hair-boom", "type": "event", "name": "Türkiye's hair transplant boom", "as": "A sector with its own regulation and no published count of its own operations.", "rel": "story" }, { "from": "health-tourism", "type": "term", "name": "Health tourism", "as": "Where the arithmetic of these categories is taken apart.", "rel": "story" }, { "from": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "What a category this wide does to a national figure.", "rel": "story" }, { "from": "wellness-travel", "type": "term", "name": "Wellness travel", "as": "Where the arithmetic of these categories is taken apart.", "rel": "story" }, { "from": "cdc-art-results", "type": "dataset", "name": "CDC assisted reproductive technology results", "as": "A mandatory national register that still cannot see a patient who left.", "rel": "story" }, { "from": "hfea-results", "type": "dataset", "name": "HFEA fertility treatment results", "as": "A register that counts arrivals into one country and nothing leaving it.", "rel": "story" }, { "from": "who-global-health-observatory", "type": "dataset", "name": "WHO Global Health Observatory", "as": "A repository of a thousand indicators with no field for a patient who travelled.", "rel": "story" }, { "from": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "The same problem one layer up: what a health number counts is rarely what a reader assumes.", "rel": "story" }, { "from": "world-bank-tourism-arrivals", "type": "dataset", "name": "International arrivals", "as": "The story this series is the main exhibit in: what an arrivals figure will and will not carry.", "rel": "story" }, { "from": "how-this-was-built", "type": "story", "name": "How this was built", "as": "Why a headline volume figure is never carried here without its unit and its collector.", "rel": "story" }, { "from": "the-word-itself", "type": "story", "name": "The word itself", "as": "What happens downstream: the word chosen decides the category, and the category decides the count.", "rel": "story" }, { "from": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "The same problem one layer up, in the figures destinations publish about themselves.", "rel": "story" }, { "from": "who-travels", "type": "story", "name": "Who travels", "as": "What each of these figures actually counts, set out one instrument at a time.", "rel": "story" } ] }, { "schema": 1, "id": "how-this-was-built", "type": "story", "names": { "name": "How this was built", "aliases": [ "the method", "rebuilding this directory" ], "said": "One JSON file per thing, every field carrying where it came from, and a validator that refuses a price with no date." }, "region": [ "global" ], "facets": { "kind": "method" }, "text": { "what": "The record shape, the provenance tiers, the price rule, the law rule, the harvests and their licences, the map projection and the editorial rules — set out so that somebody with none of these files could build the same thing and check this one. Nothing on this site is medical advice or legal advice, and the rules below are most of the reason it is not.", "story": "The unit is a record, not a page. One JSON file sits at data/nodes//.json, the id is the filename, and thirteen types carry the whole subject: a country as a place people are treated in or leave, a city cluster, a procedure, a named hospital or clinic, one step of the journey, a risk, a rule, an organisation, a person, an event, a word, a dataset, and a longer piece of writing like this one. A schema at schema/node.schema.json states what a record must look like, and tools/validate.py runs it before anything is built: identifier against filename, type against folder, every kin target resolving, every source identifier existing, every country code ISO 3166-1 alpha-2, every price carrying a currency and a date and a source, every legality row carrying an instrument date and a source, every image licence on a free-to-use allowlist, and every provenance path pointing at a field the record actually has.\n\nProvenance is the point of the project, so it sits on the record and on individual fields. Five tiers: cited, where a named source backs it; harvested, where a tool fetched it from an open dataset; tradition, which is how the trade works and is hedged in the prose; inference, which is this project reasoning from the above and says so; and field, meaning somebody stood there — nothing on this site carries it yet. A record declares a default and overrides per dotted field path, and the prose marks each stretch inline, so that plain prose is cited and the reasoning is labelled where it happens rather than in a footnote. Records also carry a confidence of high, medium or low and a needs_verification flag: of 330 records on disk, 175 are high, 129 medium and 26 low, and 160 are flagged for verification.\n\nKin is the spine and it is directional. Each entry says, in one sentence, what another node is to this one, written from here — not see also. The other record answers in its own words from its own page, so a pair of records produces two different sentences about the same relationship. There are 2,742 such edges across the 330 records, and a rich record carries five to twelve of them.\n\nA price is a number somebody published, read off their own page. Not a quote a patient was given, not an average this project computed, not a range with no source: the schema has no field for an average, and the validator rejects a price with no date or no source outright. Each row carries the currency it was billed in, the date it was published or read, one of seven kinds — a provider's package, a single list price, a state tariff, an insurer's reimbursement, a published survey figure, a published estimate with its method named, or an advertised range — and the seller's own inclusion list and exclusion list in the seller's own words. Dollar figures are the row's own currency put through one table of mid-market rates whose date is printed on the page, because a 2019 lira price converted at a 2026 rate is not what that patient paid, and both dates sit on the row so the gap is visible. The price chart uses a logarithmic axis, because the published prices for one operation run over two orders of magnitude.\n\nA legality row is one reading of one named instrument, in one jurisdiction, on one date. Six statuses: lawful, lawful with conditions, residents only, prohibited, unregulated, and not read by this project — which is hatched on the grid and is a statement about this directory rather than about the country. Law moves between the reading and the reader, so every cell carries the date it was read, and a stale row is a wrong row rather than an old one. Nothing on the site says what a reader should do about any of it.\n\nFour harvests supply the charts, and each keeps its licence. Eleven World Bank series, one request each, CC BY 4.0, most recent non-null year per country with the year stored beside the value and the Bank's own regional and income aggregates dropped because their codes are not country codes. Every named hospital, clinic and dental surgery within a set radius of each hub, fetched through the OpenStreetMap Overpass API under ODbL 1.0 with attribution to OpenStreetMap contributors. Country outlines from Natural Earth, public domain in the publisher's own words: \"No permission is needed to use Natural Earth.\" And one dated exchange-rate table from an open endpoint whose terms require attribution and forbid redistribution. The WHO repository is used under terms allowing non-commercial reuse with attribution. Every fetch date is stored in the file it produced.\n\nEvery map is drawn in Equal Earth, the equal-area pseudocylindrical projection published by Bojan Šavrič, Tom Patterson and Bernhard Jenny in 2018, implemented directly in tools/worldmap.py. *Inference —* the reason is specific to this subject. Most of these maps colour countries by a rate, and on Mercator the high northern latitudes swell to several times their true area — which is exactly where the patients come from rather than where they go, so the commonest projection would inflate the wrong end of every map on the site. On Equal Earth a square kilometre takes the same ink anywhere. What it trades away is shape: high latitudes are stretched east-west and squashed north-south, which is the price every equal-area projection pays, and Antarctica is cropped because nobody in this directory flies there. Distances elsewhere are great-circle kilometres on a 6,371-kilometre sphere, and the flying times printed beside them are that distance at 850 km/h plus 45 minutes — arithmetic rather than a timetable, and the page says so where it prints one.\n\nThe editorial rules are enforced by the same validator, as hard errors, and both lists are escapable the same way: put the words in quotation marks and name who said them. The first list is the fleet's, and the sixth entry on it is the field's own name for itself — which is why this site writes medical travel and cross-border care throughout, and why the familiar two-word compound appears only inside a quotation, inside a proper name, or on the word's own page, where the argument over it is the subject. That list also bars an adjective meaning truthful, on the ground that prose claiming the quality rarely has it. The second list is what this subject attracts: the brochure adjectives, the savings claim with no date attached, and the second-person instruction. A directory that tells a reader what to do about their own hip has become a clinic, and this is not one. *Inference —* two further rules follow from the same place. A number nobody published stays null and prints on the page as a gap rather than a zero. And a university hospital and a back-street hair clinic are described in the same voice, under the same evidence rules, with the arguments around both reported and neither joined.", "how": "The pipeline runs in order from the repository root. python3 tools/validate.py — every record must pass, and BUILD_DRAFT=1 downgrades unwritten kin targets to warnings while records are still being drafted, which is not a state to publish from. python3 tools/build.py assembles records and harvests into build/api, the search tables, the price table, the legality grid and the country join. python3 tools/cards.py draws the share cards it is missing. python3 tools/site.py writes build/site — pages, maps, charts, search, JSON-LD, a sitemap, llms.txt, robots, and CSV and JSONL exports. python3 tools/serve.py serves it locally. The harvests refresh independently: harvest_worldbank.py, fetch_rates.py, fetch_geo.py and harvest_osm.py, each stamping its own fetch date into the file it writes. build/ is generated and safe to delete.", "today": "As of 17 September 2026 this site holds 330 records — 58 procedures, 52 countries, 40 city clusters, 34 hospitals and clinics, 26 words, 23 rules, 23 risks, 22 organisations, 17 journey steps, 13 datasets, nine longer pieces, eight events and five people — drawing on 762 registered sources, carrying 214 published price rows across 21 countries and twelve currencies, 151 legality rows, 166 evidenced tags and 2,742 kin edges. Fourteen records carry a default provenance tier other than cited. No record carries the field tier, because nobody has stood anywhere yet." }, "kin": [ { "to": "what-the-data-cannot-see", "as": "The thirteen series this method draws on, and the sentence each of them cannot answer.", "rel": "story" }, { "to": "natural-earth-countries", "as": "The geometry every Equal Earth map is drawn from, and the codes that drop out of it.", "rel": "dataset" }, { "to": "exchange-rate-table", "as": "The one dated rate table every dollar figure on the site passes through.", "rel": "dataset" }, { "to": "osm-facilities", "as": "The harvest that supplies the hub maps, under ODbL with attribution.", "rel": "dataset" }, { "to": "world-bank-health-spending", "as": "The series behind the first world map, and the exemplar record this schema was written against.", "rel": "dataset" }, { "to": "is-it-cheaper", "as": "The price rule applied end to end to one operation.", "rel": "story" }, { "to": "the-price-that-isnt", "as": "Why every price row carries the seller's own exclusion list.", "rel": "story" }, { "to": "circumvention", "as": "The law rule applied across six subjects, one named instrument at a time.", "rel": "story" }, { "to": "counting-patients", "as": "Why a headline volume figure is never carried here without its unit and its collector.", "rel": "story" }, { "to": "the-word-itself", "as": "The naming rule this method enforces, and where the argument over it is set out.", "rel": "story" }, { "to": "package-price", "as": "The form most prices here take, and the reason two of them cannot be subtracted.", "rel": "term" }, { "to": "jci-accredited-list", "as": "Counted and never weighted, which is a rule rather than a judgement about any hospital.", "rel": "dataset" } ], "links": [ { "label": "Equal Earth projection", "url": "https://doi.org/10.1080/13658816.2018.1504949" }, { "label": "Natural Earth terms of use", "url": "https://www.naturalearthdata.com/about/terms-of-use/" } ], "sources": [ "s:savric-equal-earth-2018", "s:wp-equal-earth", "s:natural-earth", "s:natural-earth-terms", "s:osm", "s:odbl-1-0", "s:worldbank-open-data", "s:er-api", "s:er-api-free-terms", "s:who-gho", "s:who-terms-of-use", "s:cdc-yellowbook-2026-medical-tourism" ], "provenance": { "default": { "tier": "inference", "note": "this record describes the repository it sits in; the projection, the licences and the terms of use are cited to their publishers" }, "fields": { "text.story": { "tier": "inference", "note": "an account of this project's own method, with the projection paper and every licence cited" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference", "note": "counted over the records on disk on 17 September 2026" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "The record shape, the provenance tiers, the price rule, the law rule, the harvests and their licences, the map projection and the editorial rules — set out so that somebody with none of these files could build the same…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "what-the-data-cannot-see", "type": "story", "name": "What the data cannot see", "as": "The thirteen series this method draws on, and the sentence each of them cannot answer.", "rel": "story" }, { "to": "natural-earth-countries", "type": "dataset", "name": "Natural Earth country outlines", "as": "The geometry every Equal Earth map is drawn from, and the codes that drop out of it.", "rel": "dataset" }, { "to": "exchange-rate-table", "type": "dataset", "name": "The dated exchange rate table", "as": "The one dated rate table every dollar figure on the site passes through.", "rel": "dataset" }, { "to": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The harvest that supplies the hub maps, under ODbL with attribution.", "rel": "dataset" }, { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "The series behind the first world map, and the exemplar record this schema was written against.", "rel": "dataset" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The price rule applied end to end to one operation.", "rel": "story" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "Why every price row carries the seller's own exclusion list.", "rel": "story" }, { "to": "circumvention", "type": "story", "name": "Circumvention", "as": "The law rule applied across six subjects, one named instrument at a time.", "rel": "story" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "Why a headline volume figure is never carried here without its unit and its collector.", "rel": "story" }, { "to": "the-word-itself", "type": "story", "name": "The word itself", "as": "The naming rule this method enforces, and where the argument over it is set out.", "rel": "story" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The form most prices here take, and the reason two of them cannot be subtracted.", "rel": "term" }, { "to": "jci-accredited-list", "type": "dataset", "name": "The JCI list of accredited organizations", "as": "Counted and never weighted, which is a rule rather than a judgement about any hospital.", "rel": "dataset" } ], "source_list": [ { "id": "s:savric-equal-earth-2018", "kind": "paper", "title": "The Equal Earth map projection", "publisher": "Savric B, Patterson T, Jenny B. International Journal of Geographical Information Science 2019;33(3):454-465, published online 7 August 2018, doi:10.1080/13658816.2018.1504949", "url": "https://doi.org/10.1080/13658816.2018.1504949", "accessed": "2026-09-17", "note": "the publisher's page returned HTTP 403; the citation and the description of the projection as an equal-area pseudocylindrical world projection were read on the encyclopedia article registered as s:wp-equal-earth. The projection's coefficients are implemented in tools/worldmap.py." }, { "id": "s:wp-equal-earth", "kind": "web", "title": "Equal Earth projection", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Equal_Earth_projection", "accessed": "2026-09-17", "note": "used only for the citation and date of the projection paper, which could not be fetched from the publisher" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" }, { "id": "s:natural-earth-terms", "kind": "web", "title": "Terms of Use", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/about/terms-of-use/", "license": "Public domain", "accessed": "2026-09-17", "note": "'All versions of Natural Earth raster + vector map data found on this website are in the public domain.' and 'No permission is needed to use Natural Earth.' The same page disclaims responsibility for accuracy and content." }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" }, { "id": "s:odbl-1-0", "kind": "web", "title": "Open Database License (ODbL) v1.0", "publisher": "Open Data Commons", "url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-17", "note": "the share-alike licence OpenStreetMap data carries: attribution, and any adapted database shared under the same terms" }, { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:er-api", "kind": "dataset", "title": "Open Exchange Rates API (open.er-api.com)", "publisher": "ExchangeRate-API", "url": "https://open.er-api.com/v6/latest/USD", "accessed": "2026-09-16", "note": "one dated rate table; every converted price on the site names the date" }, { "id": "s:er-api-free-terms", "kind": "web", "title": "Free exchange rate API documentation — open endpoint", "publisher": "ExchangeRate-API", "url": "https://www.exchangerate-api.com/docs/free", "accessed": "2026-09-17", "note": "open endpoint updates once per day and carries time_last_update_utc and time_next_update_utc; attribution to ExchangeRate-API is required on pages using the rates; redistribution of the data is not permitted" }, { "id": "s:who-gho", "kind": "dataset", "title": "Global Health Observatory", "publisher": "World Health Organization", "url": "https://www.who.int/data/gho", "accessed": "2026-09-16" }, { "id": "s:who-terms-of-use", "kind": "web", "title": "Terms of use", "publisher": "World Health Organization", "url": "https://www.who.int/about/policies/terms-of-use", "accessed": "2026-09-17", "note": "reproduction for research or private study is permitted 'but not for sale or for use in conjunction with commercial purposes'; WHO publications carry CC BY-NC-SA 3.0 IGO" }, { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" } ], "tiers": { "text.what": { "tier": "inference", "note": "this record describes the repository it sits in; the projection, the licences and the terms of use are cited to their publishers" }, "text.story": { "tier": "inference", "note": "an account of this project's own method, with the projection paper and every licence cited" }, "text.how": { "tier": "inference" }, "text.today": { "tier": "inference", "note": "counted over the records on disk on 17 September 2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "exchange-rate-table", "type": "dataset", "name": "The dated exchange rate table", "as": "Why a rate is fetched once and stamped rather than looked up live.", "rel": "story" }, { "from": "natural-earth-countries", "type": "dataset", "name": "Natural Earth country outlines", "as": "The simplification, the rounding and the five patched codes are all in the method.", "rel": "story" }, { "from": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "The Overpass query, the radii and the tag list are all in the method.", "rel": "story" }, { "from": "the-word-itself", "type": "story", "name": "The word itself", "as": "Where this rule is enforced, alongside the rest of the editorial rules.", "rel": "story" } ] }, { "schema": 1, "id": "is-it-cheaper", "type": "story", "names": { "name": "Is it cheaper", "aliases": [ "the price comparison, worked", "one knee, two prices" ], "said": "The trade answers with a percentage. This page answers with two published numbers and a list of what neither of them contains." }, "region": [ "global" ], "facets": { "kind": "essay" }, "text": { "what": "One operation, two published prices, worked to the end. A Bangkok hospital's knee package set against an English provider's self-pay list price for the same operation, with the implant, the nights past the package, the two flights and the follow-up at home added back in one line at a time. Every figure is read off a seller's own page with its own date and put through one dated exchange-rate table. The point of the exercise is not the ratio it produces. It is the count of lines nobody publishes.", "story": "Bumrungrad International Hospital in Bangkok prices package JOINT04, a unilateral total knee replacement, at 356,500 baht, and states the price valid until 31 December 2026. Practice Plus Group in England lists knee replacement surgery at £13,799, under the line \"Prices correct as at April 2026\", with the initial consultation priced separately at £145. Put both through this site's single rate table, dated 16 September 2026, and they come to 10,707 and 18,596 US dollars. The English number is 1.74 times the Thai one. The difference between them is 7,889 dollars.\n\nThat ratio is the last defensible thing on this page, and it is already wrong, because the two numbers are not descriptions of the same object.\n\nThe English list says what it buys: a pre-operative nurse review, prescriptions, dressings and equipment, the anaesthetic, \"any overnight stay required\", physiotherapy, \"pathology and histology needed whilst admitted\", \"any post operative appointments required\", and a named consultant from start to finish. The Bangkok package buys three hours of theatre, the nursing and surgical team fees inside those three hours, three nights on the surgical ward, equipment and supplies, medications related to the procedure, the surgeon, an assistant surgeon if needed, and the anaesthesiologist. It then names nine things it does not buy: the implant, the first consultation and the follow-up visits, specialist consultations, nights beyond three and any intensive care, blood transfusion, laboratory and imaging before or after surgery, take-home medication, outpatient charges before admission, and complex or emergency cases. Seven of those nine sit inside the English price.\n\nThe first missing line is the largest. The Bangkok package excludes the implant, and says so in its own title. The English list does not name the implant on either side — neither as an inclusion nor as an exclusion — which is a different silence rather than a smaller one. No page read for this record, in any country, publishes what a knee implant costs. *Inference —* the 7,889-dollar difference is therefore headroom measured against an unpriced item. If the device and its fitting run to more than that at the Bangkok end, the trip is dearer before anybody boards an aircraft, and nothing published by either seller settles the question either way.\n\nThe second line is the nights. Three are named in Bangkok and the fourth is billed; in England the phrase is \"any overnight stay required\". The side of the comparison with a capped stay is the side that can overrun, and the overrun is priced by the party the patient is already committed to.\n\nThe third line is the flights, and this site's own price table is the evidence about them. Of 214 published price rows on disk, twelve name flights among their exclusions and none names them among the inclusions. There is no fare anywhere in the table, because a fare is not a published price with an inclusion list. What can be got is a scale: the International Air Transport Association's fact sheet, updated June 2026, forecasts 839 billion US dollars of passenger revenue in 2026 against 4,343 million origin-and-destination passengers. *Inference —* that is about 193 dollars a journey, it is this project's division rather than any figure the association publishes, and it is the average of every seat sold on earth including domestic hops, so it is the wrong number for London to Bangkok. It is the right number for the shape of the argument: against a 7,889-dollar gap, two long-haul fares move the answer without deciding it. Against a dental crown at a few hundred dollars, the fares are the entire transaction.\n\nThe fourth line is the follow-up at home, and the only published figures for it are failure figures. Gold Coast University Hospital in Queensland costed twelve patients presenting in 2012–13 with complications of cosmetic surgery done in Thailand at AUD$151,172.52 to that hospital in one year, averaging AUD$12,597.71 each. An NHS Scotland series of 81 patients over five years came to £755,559.68, \"an average of over £9,327.90 per patient\". Surgeons at the University of California San Diego reviewed 91 patients who had bariatric surgery in Mexico and then presented to them between 2014 and 2024, and put mean total hospital charges at $193,445.08 each. *Inference —* none of those is a term to add to a quotation. Each is conditional on something having gone wrong, and none has a denominator. What they establish is the size of the tail, not its likelihood.\n\nSo what the 1.74 covers is this: one hospital's package against one provider's list price, on their own stated dates, at one day's exchange rate, for the lines both sellers name. What it does not cover is the implant at either end, the consultation at either end, the nights past the third, the two fares, the hotel, the companion's bed, the physiotherapy after discharge, the six-week review, the revision if there is one, and the movement of the baht and the pound between the day the price was published and the day it is paid. A facilitator routing knees to Thai hospitals advertises 10,000 to 16,000 dollars for the operation; the top of that advertised range is 86 per cent of the English list price, and for hips the same facilitator's range tops out within 800 dollars of the English one.", "how": "Every price on this site keeps the currency it was published in. The dollar figure beside it is that currency put through one table of mid-market rates dated 16 September 2026, printed on the page, and a price published in 2019 converted at that table is not what its patient paid — both dates sit on the row so the gap is visible. The rate table carries no card spread, no foreign-transaction fee and no cash-advance charge. The price page, the exclusion list and the validity date are read off the seller's own page rather than taken from a comparison site, and the arithmetic in this record is division, stated so it can be checked.", "today": "As of 17 September 2026 this site holds 214 published price rows across 21 countries and twelve currencies: 69 packages, 62 list prices, 44 advertised ranges, 17 published estimates, 14 state tariffs, seven survey figures and one reimbursement. Thirty-six of them carry no exclusion list at all. Of those that carry both lists, 68 have more exclusions than inclusions. No regulator in any jurisdiction read for this project requires a seller to publish a common inclusion list, which is the reason two prices for the same operation cannot be subtracted from one another." }, "kin": [ { "to": "knee-replacement", "as": "The operation worked end to end on this page.", "rel": "procedure" }, { "to": "bumrungrad", "as": "Publishes the Bangkok package that forms one half of the comparison.", "rel": "facility" }, { "to": "hip-replacement", "as": "The same arithmetic on the other joint, where the facilitator's advertised range nearly meets the English list price.", "rel": "procedure" }, { "to": "implant-excluded", "as": "The unpriced line the whole comparison turns on.", "rel": "risk" }, { "to": "the-price-that-isnt", "as": "The companion piece: the exclusion lists themselves, across every procedure on this site.", "rel": "story" }, { "to": "package-price", "as": "The form of price this comparison is made of, and why two of them cannot be subtracted.", "rel": "term" }, { "to": "reading-the-exclusions", "as": "The step in the journey where the nine excluded lines are found, when they are found.", "rel": "step" }, { "to": "exchange-rate-table", "as": "The one dated rate table every dollar figure here passes through.", "rel": "dataset" }, { "to": "the-follow-up-nobody-books", "as": "The longer piece on the last line of the sum, and who ends up paying it.", "rel": "story" }, { "to": "united-kingdom", "as": "Where the self-pay list price on this page is published.", "rel": "place" }, { "to": "thailand", "as": "Where the package price on this page is sold.", "rel": "place" }, { "to": "getting-a-quote", "as": "The step where a headline number arrives and the device price does not.", "rel": "step" } ], "links": [ { "label": "Bumrungrad package JOINT04", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery" }, { "label": "Practice Plus Group — knee surgery self-pay prices", "url": "https://practiceplusgroup.com/treatments/knee-surgery/" }, { "label": "IATA Industry Statistics fact sheet", "url": "https://www.iata.org/en/iata-repository/pressroom/fact-sheets/industry-statistics/" } ], "sources": [ "s:bumrungrad-joint04", "s:practiceplus-knee", "s:practiceplus-hip", "s:bumrungrad-joint08", "s:defiant-prices", "s:er-api", "s:iata-industry-statistics", "s:eplasty-cosmetic-tourism-cost", "s:wounds-uk-cosmetic-tourism", "s:spurzem-bariatric-tourism-2025", "s:mbs-49318", "s:cdc-yellowbook-travel-insurance", "s:nordorthopaedics-prices" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "every price is read off the seller's own page and cited; the four stretches of arithmetic and reasoning are marked Inference inline" }, "text.how": { "tier": "harvested", "source": "s:er-api", "note": "the conversion method is this repository's, and the rate table is the harvested one" }, "text.today": { "tier": "inference", "note": "counts computed over the price rows on disk on 17 September 2026" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "One operation, two published prices, worked to the end. A Bangkok hospital's knee package set against an English provider's self-pay list price for the same operation, with the implant, the nights past the package, the…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The operation worked end to end on this page.", "rel": "procedure" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Publishes the Bangkok package that forms one half of the comparison.", "rel": "facility" }, { "to": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "The same arithmetic on the other joint, where the facilitator's advertised range nearly meets the English list price.", "rel": "procedure" }, { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The unpriced line the whole comparison turns on.", "rel": "risk" }, { "to": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "The companion piece: the exclusion lists themselves, across every procedure on this site.", "rel": "story" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The form of price this comparison is made of, and why two of them cannot be subtracted.", "rel": "term" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step in the journey where the nine excluded lines are found, when they are found.", "rel": "step" }, { "to": "exchange-rate-table", "type": "dataset", "name": "The dated exchange rate table", "as": "The one dated rate table every dollar figure here passes through.", "rel": "dataset" }, { "to": "the-follow-up-nobody-books", "type": "story", "name": "The follow-up nobody books", "as": "The longer piece on the last line of the sum, and who ends up paying it.", "rel": "story" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Where the self-pay list price on this page is published.", "rel": "place" }, { "to": "thailand", "type": "destination", "name": "Thailand", "as": "Where the package price on this page is sold.", "rel": "place" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "The step where a headline number arrives and the device price does not.", "rel": "step" } ], "source_list": [ { "id": "s:bumrungrad-joint04", "kind": "web", "title": "Total Knee Replacement Surgery (Exclude implant) — package JOINT04", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery", "accessed": "2026-09-16", "note": "read off the hospital's own package page; price stated valid until 31 December 2026" }, { "id": "s:practiceplus-knee", "kind": "web", "title": "Private knee surgery and treatment — self-pay price list", "publisher": "Practice Plus Group", "url": "https://practiceplusgroup.com/treatments/knee-surgery/", "accessed": "2026-09-16" }, { "id": "s:practiceplus-hip", "kind": "web", "title": "Hip surgery: costs and care plans — self-pay price list", "publisher": "Practice Plus Group", "url": "https://practiceplusgroup.com/treatments/hip-surgery/", "accessed": "2026-09-16" }, { "id": "s:bumrungrad-joint08", "kind": "web", "title": "Total Hip Replacement Surgery (Exclude implant) — package JOINT08", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/total-hip-replacement-surgery", "accessed": "2026-09-16", "note": "425,200 THB, four nights, implant excluded; price stated valid until 31 December 2026" }, { "id": "s:defiant-prices", "kind": "web", "title": "Defiant — posted prices index", "publisher": "Defiant (defiant.to)", "url": "https://defiant.to/procedures/", "accessed": "2026-09-16" }, { "id": "s:er-api", "kind": "dataset", "title": "Open Exchange Rates API (open.er-api.com)", "publisher": "ExchangeRate-API", "url": "https://open.er-api.com/v6/latest/USD", "accessed": "2026-09-16", "note": "one dated rate table; every converted price on the site names the date" }, { "id": "s:iata-industry-statistics", "kind": "org", "title": "Industry Statistics — fact sheet, table \"Global airline industry\", updated 6/2026", "publisher": "International Air Transport Association, Sustainability and Economics", "url": "https://www.iata.org/en/iata-repository/pressroom/fact-sheets/industry-statistics/", "accessed": "2026-09-17", "note": "read as a PDF and extracted with pdftotext. The rows used here are O-D passengers, million (4,343 forecast for 2026) and Passenger, USD billion (839 forecast for 2026). The fact sheet publishes no average-fare line; the figure derived from those two rows is marked as this project's arithmetic wherever it appears." }, { "id": "s:eplasty-cosmetic-tourism-cost", "kind": "paper", "title": "The real cost of cosmetic tourism: cost analysis study of cosmetic tourism complications presenting to a public hospital", "publisher": "Livingston R, Berlund P, Eccles-Smith J, Sawhney R. Eplasty 2015;15:e34", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC4522144/", "accessed": "2026-09-16", "note": "Gold Coast University Hospital, Queensland, financial year 2012–13, 12 patients" }, { "id": "s:wounds-uk-cosmetic-tourism", "kind": "paper", "title": "Cosmetic tourism: the cost of going 'under the knife' abroad for cosmetic surgery", "publisher": "Hatch J. Wounds UK 2025;21(4):44–49", "url": "https://wounds-uk.com/journal-articles/cosmetic-tourism-the-cost-of-going-under-the-knife-abroad-for-cosmetic-surgery/", "accessed": "2026-09-16", "note": "carries the BAAPS national audit figures and the NHS Scotland series" }, { "id": "s:spurzem-bariatric-tourism-2025", "kind": "journal", "title": "Getting more than what you pay for? Managing complications of bariatric tourism at an academic center near the US-Mexico border", "publisher": "Spurzem GJ et al., Surgical Endoscopy, 2025, doi:10.1007/s00464-025-11850-x", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12222374/", "accessed": "2026-09-16" }, { "id": "s:mbs-49318", "kind": "gov", "title": "MBS item 49318 — total arthroplasty of hip", "publisher": "Australian Government Department of Health, Disability and Ageing", "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=49318&qt=item", "accessed": "2026-09-16", "note": "schedule fee $1,577.30, fee last updated 01-Jul-2026" }, { "id": "s:cdc-yellowbook-travel-insurance", "kind": "org", "title": "Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance — CDC Yellow Book 2026, chapter by Rhett J. Stoney", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/travel-insurance.html", "accessed": "2026-09-16", "note": "carries the USD 25,000 to over USD 250,000 medevac range, the Medicare and Medigap limits, and the finding that insurers fully paid two-thirds of travel health claims" }, { "id": "s:nordorthopaedics-prices", "kind": "web", "title": "Orthopaedic Surgery Prices", "publisher": "Nordorthopaedics Clinic, Kaunas", "url": "https://www.nordorthopaedics.com/hip-knee-wrist-hand-ankle-foot-shoulder-surgery-prices/", "accessed": "2026-09-16", "note": "every figure is written as a 'from' price in euro and sterling; the page carries no inclusion list" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "every price is read off the seller's own page and cited; the four stretches of arithmetic and reasoning are marked Inference inline" }, "text.how": { "tier": "harvested", "source": "s:er-api", "note": "the conversion method is this repository's, and the rate table is the harvested one" }, "text.today": { "tier": "inference", "note": "counts computed over the price rows on disk on 17 September 2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "australia", "type": "destination", "name": "Australia", "as": "The question a returned patient's second operation reopens.", "rel": "story" }, { "from": "nepal", "type": "destination", "name": "Nepal", "as": "The question this survey's respondents did not answer the way the field expects.", "rel": "story" }, { "from": "switzerland", "type": "destination", "name": "Switzerland", "as": "The country that answers the question by refusing the premise.", "rel": "story" }, { "from": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The question a 12-week median wait answers differently for each patient.", "rel": "story" }, { "from": "singapore-city", "type": "hub", "name": "Singapore", "as": "The destination that answers no, and sells on something else.", "rel": "story" }, { "from": "knee-arthroscopy", "type": "procedure", "name": "Knee arthroscopy", "as": "The question a day case answers worst, once the flight is counted.", "rel": "story" }, { "from": "heidelberg-university-hospital", "type": "facility", "name": "Heidelberg University Hospital", "as": "A Bangkok package and a Heidelberg estimate are two different contracts, and comparing their numbers compares nothing.", "rel": "story" }, { "from": "narayana-health", "type": "facility", "name": "Narayana Health", "as": "The 95,000-rupee figure against the Cleveland Clinic's 106,385 dollars is the comparison that essay exists to take apart.", "rel": "story" }, { "from": "deciding-whether", "type": "pathway", "name": "Deciding whether to go", "as": "The comparison this step is built on, taken apart.", "rel": "story" }, { "from": "uk-nhs-treatment-abroad", "type": "rule", "name": "NHS funding for treatment abroad", "as": "The arithmetic that looks different once the home system is paying for the revision.", "rel": "story" }, { "from": "oecd", "type": "org", "name": "Organisation for Economic Co-operation and Development", "as": "Where the 0.0 to 1.0 per cent finding is set against the market-size claims.", "rel": "story" }, { "from": "devi-shetty", "type": "person", "name": "Devi Prasad Shetty", "as": "Volume against price, which is his claim and this site's question.", "rel": "story" }, { "from": "directive-2011-24-adopted", "type": "event", "name": "Directive 2011/24/EU adopted, 9 March 2011", "as": "A reimbursement at the home tariff changes the arithmetic that every other page here does out of pocket.", "rel": "story" }, { "from": "exchange-rate-table", "type": "dataset", "name": "The dated exchange rate table", "as": "Every comparison on that page passes through this table and inherits its date.", "rel": "story" }, { "from": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The other half of the comparison: the wait at home against the fee abroad.", "rel": "story" }, { "from": "world-bank-out-of-pocket", "type": "dataset", "name": "Out-of-pocket share of health spending", "as": "The share a household already pays at home is where the comparison starts.", "rel": "story" }, { "from": "how-this-was-built", "type": "story", "name": "How this was built", "as": "The price rule applied end to end to one operation.", "rel": "story" }, { "from": "the-follow-up-nobody-books", "type": "story", "name": "The follow-up nobody books", "as": "The comparison this is the missing last term of.", "rel": "story" }, { "from": "the-price-that-isnt", "type": "story", "name": "The price that isn't", "as": "The same exclusions carried through one comparison to a ratio.", "rel": "story" }, { "from": "waiting-lists", "type": "story", "name": "The queue is the product", "as": "The money question this one sits behind.", "rel": "story" } ] }, { "schema": 1, "id": "the-accreditation-question", "type": "story", "names": { "name": "The accreditation question", "aliases": [ "who inspects the inspector", "reading a badge wall" ], "said": "The badge says a named body inspected named systems on a named date. Everything else on the badge wall is inference." }, "region": [ "global" ], "facets": { "kind": "explainer" }, "text": { "what": "An accreditation is a fact about an inspection somebody bought. The organisation applies, the organisation pays, the survey is scheduled, and the mark runs for a fixed term. This page sets out what the fee buys, what the standards measure, what they do not, who assesses the bodies that issue them, and why the ten schemes on this site are ten different instruments wearing one word.", "story": "Every voluntary accreditation in this trade runs on the same transaction. The hospital applies. The hospital pays. The body it pays then decides whether to grant the mark the hospital will put on its homepage. That is not a scandal and it is not unusual — it is the structure of nearly every voluntary certification on earth — but a reader cannot size any of these marks without holding it in view, and most pages that cite them leave it out.\n\nThe fees are published often enough to be quoted. Joint Commission International states an average of 46,000 US dollars a year to hold its accreditation, plus travel and other costs, with the fee set from the services a hospital offers and its average daily census. The ISQua External Evaluation Association charges a once-off Access Fee that \"entitles an organisation to enter the International Accreditation Programme and to receive the full information pack\", banded by the World Bank income group of the applicant's country: 1,716 to 2,946 euros for 2026. Temos publishes a fee table scaling with level of care and bed count, quoted over three years with a first and a second annual fee, covering professional services but not \"travel and accommodation costs for the Temos assessors\". *Inference —* that last clause means a small clinic somewhere an assessor must fly to pays a different real price from a large one near the office, and the difference falls on the applicant rather than on the scheme.\n\nThe survey is also scheduled. JCI's American surveys are unannounced; its international ones, on the account carried in this site's source for it, take place at a time known in advance by the hospital, often after considerable preparation. DNV's NIAHO programme in the United States is unusual in surveying annually rather than at the end of a three-year cycle, which changes what its certificate means: a recent inspection rather than one that may be nearly three years old. *Inference —* a reader who takes any of these marks as a snapshot of an ordinary Tuesday is reading it wrong. What it certifies is that named systems conformed on a named date after a period in which the organisation knew the date.\n\nWhat the register holds is narrower still. This site's dataset record for the JCI directory states the boundary: it counts organisations that applied, paid for the survey, met the standards on the survey date and are inside a three-year cycle — and it carries no infection rate, no mortality, no revision rate, no price, no patient volume and no record of a complaint. Nobody appears in it involuntarily. It also keeps no public history of the lapsed, so an expired accreditation leaves a hospital's website long after it leaves the list, and no reader can check what used to be there.\n\nThe obvious question has exactly one industrial answer. The ISQua External Evaluation Association, established in 2018 by the International Society for Quality in Health Care and registered in Switzerland, assesses the bodies: health and social care standards, external evaluation organisations, surveyor training programmes, and quality and safety training programmes, with an award running four years against annual progress reports. It states plainly that it \"does not directly accredit health or social care services\". It does not audit a hospital and it does not re-run an accreditor's surveys. *Inference —* so the chain runs applicant pays accreditor, accreditor pays meta-accreditor, and no one in the chain is paid by a patient. The chain is nonetheless the most useful thing on a badge wall, because an ISQua EEA award is dated at both ends by a third party: the American Accreditation Commission International holds an organisational award for 2022 to 2026, a standards award for 2023 to 2027 and a surveyor training award for 2024 to 2028, and an award that expires says something precise.\n\nThe ten schemes on this site are not substitutes for one another, and adding their marks together is the commonest error made with them. Saudi Arabia's central board is mandatory for Ministry of Health hospitals, so its mark is evidence of a floor the state requires of everyone rather than a choice a hospital made. India's national board is reassessed every two years and is the gate to domestic government and insurer empanelment, so an Indian hospital chasing it is chasing a reimbursement channel as well as a foreign patient's confidence. DNV's programmes are built on ISO 9001, which audits a quality management system rather than a clinical standard, and a system audit answers a narrower question than a badge wall implies. Global Healthcare Accreditation surveys the journey — the enquiry, the quotation, the transfer, the interpreter, the discharge pack, the handover — and not the ward, which is why a GHA mark and a JCI mark answer different questions. The Australian council's standards are part of a compulsory national safety system at home and a purchasable product abroad: the mark is the same, what stands behind it is not.\n\nTwo things that appear on the same walls are not inspections at all. Costa Rica's PROMED issues a Seal of Quality to members who pay it, in a scheme that also admits hotels, law firms and marketing agencies. The International Medical Travel Journal runs the Medical Travel Awards, judged by a panel chaired by its editor, which entrants pay to enter. *Inference —* a trade award is evidence that a company entered a competition and a panel preferred its entry; a membership seal is evidence of membership with conditions. Neither has a standard behind it, neither is an external inspection of a clinical service, and neither should be counted beside an accreditation.\n\nSo a count of marks measures attention bought, and buying attention costs money, which is why the large private hospitals in this directory carry several and the district hospital next door carries none. This site holds 63 recognition rows across 35 records: 20 from JCI, ten from a magazine ranking, eight ISQua EEA awards, five Turkish ministry authorisations, and the rest scattered. Each row names its issuer, its year and its source. None of them is read here as a quality score, and none is weighted against another.", "how": "What can be established about a badge, in order: who issued it, on what date, for how long, and whether the issuing body itself holds a dated award from the meta-accreditor. Then whether the register is public and searchable, because a scheme whose accredited list cannot be read gives a reader no way to check that a mark is still live. Then what the mark covers — the whole organisation, one programme, one laboratory, or one department. Several schemes on this site publish none of the cycle length, the fee or the register, and those gaps are left open in their records rather than filled.", "today": "As of 17 September 2026 this site carries records for ten accreditors and certifying bodies, one meta-accreditor, and two trade organisations whose marks are frequently mistaken for accreditations. JCI's own site refused every automated request from this project on 16 and 17 September 2026, so the counts in its record are dated rather than current, and Saudi Arabia's board refused every connection, so the gaps in that record stay open. No scheme read for this project publishes outcome data alongside its mark." }, "kin": [ { "to": "jci", "as": "The mark most often named, at a stated average of 46,000 dollars a year, surveyed on an agreed date.", "rel": "org" }, { "to": "isqua-ieea", "as": "The body that assesses the bodies, and the only dated third-party check on a badge wall.", "rel": "org" }, { "to": "jci-accredited-list", "as": "The register itself, and the sentence saying what it does not hold.", "rel": "dataset" }, { "to": "temos", "as": "Publishes its fee table, and puts the assessors' travel on the applicant.", "rel": "org" }, { "to": "gha", "as": "Surveys the journey rather than the ward, which is why its mark is not a substitute for a clinical one.", "rel": "org" }, { "to": "cbahi", "as": "Mandatory rather than voluntary, so its mark is evidence of a floor rather than of a choice.", "rel": "org" }, { "to": "nabh", "as": "A national scheme with domestic reimbursement attached, reassessed every two years.", "rel": "org" }, { "to": "dnv-healthcare", "as": "Surveys annually and audits a management system, which is a narrower question.", "rel": "org" }, { "to": "achsi", "as": "A regulator's partner at home and a vendor abroad, selling the same standards into systems with nothing behind them.", "rel": "org" }, { "to": "promed", "as": "A membership seal from a body its members pay, in a scheme that also admits hotels.", "rel": "org" }, { "to": "imtj", "as": "Runs a paid-entry trade award that is routinely counted beside an inspection.", "rel": "org" }, { "to": "bumrungrad", "as": "Took the mark in 2002, early for Asia, and states it in its own footer.", "rel": "facility" } ], "links": [ { "label": "ISQua EEA International Accreditation Programme", "url": "https://ieea.ch/" }, { "label": "JCI accreditation", "url": "https://www.jointcommissioninternational.org/" } ], "sources": [ "s:jci-accreditation", "s:jci-wikipedia", "s:ieea-iap", "s:isqua-about", "s:temos-company", "s:temos-medical-care", "s:gha-about", "s:gha-accredited-list", "s:aaci-about", "s:nabh-home", "s:nabh-wikipedia", "s:cbahi-jmdh-2023", "s:achsi-home", "s:dnv-niaho", "s:dnv-wikipedia", "s:promed-salud-cr", "s:imtj-wikipedia" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "every fee, term and statement is the scheme's own or its cited secondary source; the readings are marked Inference inline" }, "text.how": { "tier": "inference", "note": "this project's reading order, drawn from the accreditor records it has written" }, "text.today": { "tier": "inference", "note": "counted over the records on disk on 17 September 2026" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "An accreditation is a fact about an inspection somebody bought. The organisation applies, the organisation pays, the survey is scheduled, and the mark runs for a fixed term.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "jci", "type": "org", "name": "Joint Commission International", "as": "The mark most often named, at a stated average of 46,000 dollars a year, surveyed on an agreed date.", "rel": "org" }, { "to": "isqua-ieea", "type": "org", "name": "ISQua External Evaluation Association", "as": "The body that assesses the bodies, and the only dated third-party check on a badge wall.", "rel": "org" }, { "to": "jci-accredited-list", "type": "dataset", "name": "The JCI list of accredited organizations", "as": "The register itself, and the sentence saying what it does not hold.", "rel": "dataset" }, { "to": "temos", "type": "org", "name": "Temos International Healthcare Accreditation", "as": "Publishes its fee table, and puts the assessors' travel on the applicant.", "rel": "org" }, { "to": "gha", "type": "org", "name": "Global Healthcare Accreditation", "as": "Surveys the journey rather than the ward, which is why its mark is not a substitute for a clinical one.", "rel": "org" }, { "to": "cbahi", "type": "org", "name": "Saudi Central Board for Accreditation of Healthcare Institutions", "as": "Mandatory rather than voluntary, so its mark is evidence of a floor rather than of a choice.", "rel": "org" }, { "to": "nabh", "type": "org", "name": "National Accreditation Board for Hospitals and Healthcare Providers", "as": "A national scheme with domestic reimbursement attached, reassessed every two years.", "rel": "org" }, { "to": "dnv-healthcare", "type": "org", "name": "DNV Healthcare", "as": "Surveys annually and audits a management system, which is a narrower question.", "rel": "org" }, { "to": "achsi", "type": "org", "name": "ACHS International", "as": "A regulator's partner at home and a vendor abroad, selling the same standards into systems with nothing behind them.", "rel": "org" }, { "to": "promed", "type": "org", "name": "PROMED", "as": "A membership seal from a body its members pay, in a scheme that also admits hotels.", "rel": "org" }, { "to": "imtj", "type": "org", "name": "International Medical Travel Journal", "as": "Runs a paid-entry trade award that is routinely counted beside an inspection.", "rel": "org" }, { "to": "bumrungrad", "type": "facility", "name": "Bumrungrad International Hospital", "as": "Took the mark in 2002, early for Asia, and states it in its own footer.", "rel": "facility" } ], "source_list": [ { "id": "s:jci-accreditation", "kind": "org", "title": "Joint Commission International — accreditation standards and accredited organizations", "publisher": "Joint Commission International", "url": "https://www.jointcommissioninternational.org/", "accessed": "2026-09-16" }, { "id": "s:jci-wikipedia", "kind": "wikipedia", "title": "Joint Commission International", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Joint_Commission_International", "accessed": "2026-09-16", "note": "used for the 1998 founding, the Joint Commission Resources affiliation, the quoted average annual fee and the announced-survey criticism; jointcommissioninternational.org redirected to jointcommission.org, which refused every fetch on this date" }, { "id": "s:ieea-iap", "kind": "org", "title": "International Accreditation Programme", "publisher": "ISQua External Evaluation Association", "url": "https://ieea.ch/international-accreditation-programme/", "accessed": "2026-09-16", "note": "four assessment categories, the statement that ISQua EEA does not directly accredit health or social care services, the once-off Access Fee and the 2026 fee band" }, { "id": "s:isqua-about", "kind": "org", "title": "International Society for Quality in Health Care", "publisher": "ISQua", "url": "https://isqua.org/", "accessed": "2026-09-16", "note": "Dublin base, Irish registered charity number 20072445, and the statement that ISQua EEA was established by ISQua in 2018" }, { "id": "s:temos-company", "kind": "web", "title": "Company — Temos International GmbH", "publisher": "Temos International GmbH", "url": "https://temos-worldwide.com/about-us/company/", "accessed": "2026-09-16", "note": "founded 2010, registered address in Bergisch Gladbach, the six programmes, and the public Accredited Partners list" }, { "id": "s:temos-medical-care", "kind": "web", "title": "International Hospital Accreditation — Medical Care", "publisher": "Temos International GmbH", "url": "https://temos-worldwide.com/accreditation-programs/medical-care/", "accessed": "2026-09-16", "note": "fees by level of care and bed count, three-year fee schedule with first and second annual fees, assessor travel and accommodation excluded" }, { "id": "s:gha-about", "kind": "web", "title": "What is Global Healthcare Accreditation?", "publisher": "Global Healthcare Accreditation", "url": "https://www.globalhealthcareaccreditation.com/about-gha", "accessed": "2026-09-16", "note": "the three competencies of the medical travel care continuum and the ISQua accreditation of Standards for Medical Travel 5.0" }, { "id": "s:gha-accredited-list", "kind": "web", "title": "Accredited and Certified Organizations", "publisher": "Global Healthcare Accreditation", "url": "https://www.globalhealthcareaccreditation.com/accredited-organizations", "accessed": "2026-09-16", "note": "public directory searchable by region; entries carry start dates and, for some, an expiry date such as 24 November 2022 to 24 November 2025" }, { "id": "s:aaci-about", "kind": "web", "title": "About us — American Accreditation Commission International", "publisher": "AACI", "url": "https://aacihealthcare.com/about-us/", "accessed": "2026-09-16", "note": "Hendersonville, North Carolina address, and three current ISQua EEA awards with their year ranges" }, { "id": "s:nabh-home", "kind": "web", "title": "National Accreditation Board for Hospitals & Healthcare Providers", "publisher": "NABH", "url": "https://nabh.co/", "accessed": "2026-09-16", "note": "the programme list, the Find an Accredited Healthcare Organisation search, and the headline figure of more than 30,000 accreditations and certifications" }, { "id": "s:nabh-wikipedia", "kind": "wikipedia", "title": "National Accreditation Board for Hospitals & Healthcare Providers", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/National_Accreditation_Board_for_Hospitals_%26_Healthcare_Providers", "accessed": "2026-09-16", "note": "2005 establishment under the Quality Council of India, the two-year reassessment interval, and the count of accredited hospitals" }, { "id": "s:cbahi-jmdh-2023", "kind": "paper", "title": "Impact of the Accreditation Program of the Saudi Central Board for Accreditation of Healthcare Institutions on the Safety Dimension of the Institute of Medicine Quality", "publisher": "Journal of Multidisciplinary Healthcare", "year": 2023, "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10153434/", "accessed": "2026-09-16", "note": "CBAHI established October 2005, the only legally recognised evaluator of governmental and private providers in Saudi Arabia, mandatory for Ministry of Health hospitals, standards editions 2006 and 2012; portal.cbahi.gov.sa refused every connection on this date" }, { "id": "s:achsi-home", "kind": "web", "title": "ACHS International", "publisher": "Australian Council on Healthcare Standards International", "url": "https://www.achsi.org/", "accessed": "2026-09-16", "note": "wholly owned subsidiary of ACHS, EQuIP standards, more than 25 countries and more than 1,600 member organisations" }, { "id": "s:dnv-niaho", "kind": "web", "title": "Hospital accreditation — NIAHO and DIAS programs", "publisher": "DNV", "url": "https://www.dnv.com/services/hospital-accreditation-niaho-and-dias-programs/", "accessed": "2026-09-16", "note": "NIAHO for US hospitals and DIAS for hospitals and clinics outside it, both built on ISO 9001" }, { "id": "s:dnv-wikipedia", "kind": "wikipedia", "title": "DNV", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/DNV", "accessed": "2026-09-16", "note": "1864 founding, Høvik headquarters, ownership by the Det Norske Veritas Foundation, and the Business Assurance division that certifies American hospitals" }, { "id": "s:promed-salud-cr", "kind": "web", "title": "PROMED — English", "publisher": "Cámara Costarricense de la Salud", "url": "https://salud.co.cr/english/", "accessed": "2026-09-16", "note": "promedcostarica.org now redirects here; membership categories and the Seal of Quality are described on this page" }, { "id": "s:imtj-wikipedia", "kind": "wikipedia", "title": "International Medical Travel Journal", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/International_Medical_Travel_Journal", "accessed": "2026-09-16", "note": "established 2007, UK trade publication, biweekly newsletter, Keith Pollard as editor in chief, annual Medical Travel Awards; imtj.com refused every fetch on this date" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "every fee, term and statement is the scheme's own or its cited secondary source; the readings are marked Inference inline" }, "text.how": { "tier": "inference", "note": "this project's reading order, drawn from the accreditor records it has written" }, "text.today": { "tier": "inference", "note": "counted over the records on disk on 17 September 2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "bogota", "type": "hub", "name": "Bogotá", "as": "A dated six-cycle timeline is the most useful answer this batch found to it.", "rel": "story" }, { "from": "cancun", "type": "hub", "name": "Cancún", "as": "A page listing four accreditations and three expired validity dates is the question in one screen.", "rel": "story" }, { "from": "monterrey", "type": "hub", "name": "Monterrey", "as": "A large university hospital naming national certifications and no international mark is one answer to it.", "rel": "story" }, { "from": "albert-einstein-sao-paulo", "type": "facility", "name": "Hospital Israelita Albert Einstein", "as": "1999, first outside the United States — the date the accreditation trade starts from.", "rel": "story" }, { "from": "anadolu-medical-center", "type": "facility", "name": "Anadolu Medical Center", "as": "An American affiliation signed three years before the hospital opened is what an accreditation mark is bought to do.", "rel": "story" }, { "from": "clinica-biblica", "type": "facility", "name": "Hospital Clínica Bíblica", "as": "Five listings above the fold and no bed count below it.", "rel": "story" }, { "from": "fundacion-santa-fe", "type": "facility", "name": "Fundación Santa Fe de Bogotá", "as": "One hospital-wide accreditation and twenty-one programme certifications, all voluntary and all paid for by the applicant.", "rel": "story" }, { "from": "hadassah", "type": "facility", "name": "Hadassah Medical Center", "as": "Fourth in a small country and 242nd in the world, from one ranking in one year.", "rel": "story" }, { "from": "kokilaben", "type": "facility", "name": "Kokilaben Dhirubhai Ambani Hospital", "as": "Four accreditations at once, four fees, four scopes, and no ranking among them.", "rel": "story" }, { "from": "max-saket", "type": "facility", "name": "Max Super Speciality Hospital, Saket", "as": "No accreditation is recorded here, which is a gap in this project's reading rather than a finding about the hospital.", "rel": "story" }, { "from": "choosing-a-facilitator", "type": "pathway", "name": "Choosing a facilitator", "as": "What an accreditation mark on a broker's page does and does not say.", "rel": "story" }, { "from": "malaysia-mhtc-licence", "type": "rule", "name": "Malaysia's healthcare travel registration", "as": "Why two things called accreditation are not the same instrument.", "rel": "story" }, { "from": "uae-clinic-licensing", "type": "rule", "name": "Licensing a clinic in the United Arab Emirates", "as": "A licence is not an accreditation, and neither is a quality score.", "rel": "story" }, { "from": "aaci", "type": "org", "name": "American Accreditation Commission International", "as": "Where a badge wall is counted rather than weighed.", "rel": "story" }, { "from": "achsi", "type": "org", "name": "ACHS International", "as": "Where a national standard sold abroad is separated from the system it came from.", "rel": "story" }, { "from": "cbahi", "type": "org", "name": "Saudi Central Board for Accreditation of Healthcare Institutions", "as": "Where a compulsory floor and a bought badge are pulled apart.", "rel": "story" }, { "from": "dnv-healthcare", "type": "org", "name": "DNV Healthcare", "as": "Where a system audit and a clinical audit are separated.", "rel": "story" }, { "from": "gha", "type": "org", "name": "Global Healthcare Accreditation", "as": "Where a pathway mark and a clinical mark are pulled apart.", "rel": "story" }, { "from": "isqua-ieea", "type": "org", "name": "ISQua External Evaluation Association", "as": "Where the chain of who pays whom is followed to the end.", "rel": "story" }, { "from": "jci", "type": "org", "name": "Joint Commission International", "as": "The argument over what a bought inspection proves, laid out at length.", "rel": "story" }, { "from": "thai-ha-institute", "type": "org", "name": "Healthcare Accreditation Institute", "as": "Where a domestic standard and an exported one are separated.", "rel": "story" }, { "from": "keith-pollard", "type": "person", "name": "Keith Pollard", "as": "Where a trade award chaired by an editor and an inspection paid for by a hospital are told apart.", "rel": "story" }, { "from": "leigh-turner", "type": "person", "name": "Leigh Turner", "as": "His 2011 paper on oversight of medical travel companies sits at the centre of it.", "rel": "story" }, { "from": "imtj-summit", "type": "event", "name": "The IMTJ Medical Travel Summit and Awards", "as": "Where a trade award and an inspection are told apart.", "rel": "story" }, { "from": "jci-accredited-list", "type": "dataset", "name": "The JCI list of accredited organizations", "as": "What a bought inspection proves, argued at length.", "rel": "story" } ] }, { "schema": 1, "id": "the-follow-up-nobody-books", "type": "story", "names": { "name": "The follow-up nobody books", "aliases": [ "who takes the stitches out", "where the bill for the second operation lands" ], "said": "The package called it follow-up and meant the week in the hotel. At home it means whoever is on take at two in the morning." }, "region": [ "global" ], "facets": { "kind": "essay" }, "text": { "what": "The operation is bought in one country and its consequences are managed in another. Wound checks, stitch removal, physiotherapy and the first sight of a complication happen at home, performed by clinicians who were not party to the consent, did not choose the implant, hold no record beyond what the patient carries, and were paid nothing. Nine published series from four countries have costed what arrives at their own doors. None of them has a denominator, and that is the second half of the subject.", "story": "The asymmetry is stated plainly by the NHS for its own readers: \"If you have complications after an operation in the UK, it's the surgeon's responsibility to provide follow-up treatment\", while \"Overseas clinics may not provide follow-up treatment, or they may not provide it to the same standard as in the UK.\" Nothing in that sentence is disputed by anybody. What follows from it is a transfer, and the only parties who count the transfer are the ones receiving it.\n\nSo the ledgers all come from public hospitals. A cost analysis at Gold Coast University Hospital in Queensland totalled twelve patients presenting in the 2012–13 financial year with complications of cosmetic surgery performed in Thailand: AUD$151,172.52 to that hospital in one year, averaging AUD$12,597.71 a patient, running from AUD$1,190.28 to AUD$33,060.02. That is a single hospital, a single year, a single specialty and a single country of origin, and it is one of the better-documented numbers in this entire subject.\n\nThe United Kingdom has published five of them and they agree in shape. A London teaching hospital costed 24 patients surgically managed between 2006 and 2018 at USD 406,233, a mean of USD 16,296 and a range from USD 817 to USD 41,778, with gluteal enhancement the commonest procedure at 38 per cent and infection the commonest complication at 92 per cent; most of the operations had been done in Türkiye. A major trauma centre reviewing January 2013 to August 2017 found 20 patients and costed them against national tariffs by severity: eight minor at £3,448, eight intermediate at £18,271, four major at £42,083.59 — and all four major complications were gluteal augmentations. A Manchester breast unit saw 25 patients across twelve months in 2022 and 2023, 20 of them operated on abroad and 15 of those in Türkiye, at a cost of at least £37,000. A London hospital across seventeen months to 2025 found that 96 per cent of its surgical patients presenting with complications had been operated on abroad, 73 per cent in Türkiye, at an estimated £110,690. A Birmingham tertiary centre screened 749 records for 2020 to 2025 and found 29 patients making 58 hospital presentations, 82.8 per cent of the procedures done in Türkiye, mean inpatient stay 9.2 days, 27 theatre interventions, and — the figure that distinguishes it — 48.3 per cent of presentations were repeat attendances after an earlier complication. Total £518,058.47, mean £17,864 a patient, individual presentations from about £46 to £57,691. Separately, an NHS Scotland series of 81 patients over five years came to £755,559.68, \"an average of over £9,327.90 per patient\", alongside audit figures reporting UK residents needing NHS hospital treatment after surgery abroad up \"by 94% in 3 years\", \"75% citing Turkey as the origin of their surgery\", and an average NHS cost of \"£15,000 per person, depending on the treatment required\".\n\nThe largest per-patient figure in this file is American and is not cosmetic. Surgeons at the University of California San Diego, thirty miles from the Mexican border, reviewed 91 patients who had bariatric surgery in Mexico and then presented to them with complications between 2014 and 2024. A sleeve gastrectomy in 69.2 per cent of them. A leak at the staple line or the join in 33.0 per cent. Admission in 56.0 per cent, intensive care in 19.8 per cent, and three deaths — 3.3 per cent. Mean total hospital charges came to $193,445.08 a patient, and to $424,975.89 where the complication was a leak.\n\nThe newest series is Australian and adds the timing. Res and colleagues reviewed patients presenting to Westmead Hospital in New South Wales across July 2022 to January 2023 and May to December 2024: 24 patients, Türkiye the country of surgery in 54.2 per cent, abdominoplasty the commonest procedure at 54.2 per cent, and 58.3 per cent having had multiple procedures in one sitting. Wound dehiscence in 45.8 per cent, infection in 41.7. Median time from surgery to presentation, 3.8 weeks. The authors state that costing was outside the study's scope. *Inference —* 3.8 weeks is the number to hold beside a price page. It is after the return flight, after the travel policy has lapsed, after the hotel recovery the package paid for, and after the operating clinic has closed the file.\n\nWhat arrives is not only a patient but an absence of information. The Manchester unit recorded the precise date of surgery for 48 per cent of its patients, the name of the clinic for 8 per cent, and the name of the surgeon for 0 per cent, with 72 per cent presenting within eight weeks. That is not a study of infection or of technique. It is a study of what walks through the door: a patient, a complication, and no identifiable counterparty. The second surgeon then operates without an operative note, without the implant model, on tissue that has been opened once already, against an organism that may be atypical and slow-growing.\n\nThe duties that would prevent this exist and do not travel. The General Medical Council requires a doctor on its register to give patients a named contact for complications outside working hours, to provide written information detailed enough \"to enable another medical professional to take over the patient's care\", to keep records organised so that patients treated with a particular device can be identified if a safety concern arises, and to be clear at the outset about what is in a quoted price \"including possible charges for revision or routine follow up\". Those bind a doctor on the UK register. The clinic that performed the operation is not on it. The American Medical Association's guiding principles, reproduced in the CDC's chapter, ask that \"local follow-up care should be coordinated\" before travel and that coverage include the cost of follow-up on return; the same chapter notes that \"some overseas facilities and healthcare professionals charge substantial fees for follow-up care in addition to the base cost\". None of it is enforceable at a distance, and follow-up offered by message or video cannot take a swab, remove a suture or drain a collection.\n\n*Inference —* the arithmetic underneath is a transfer with no invoice. The fee was paid to a private provider in one country; the correction is paid for by a public system in another that was never party to the transaction and cannot bill anyone for it. Every total above is a floor rather than an estimate, because no national system records in its own data that an episode of care was caused by treatment obtained abroad, so there is no denominator and no rate can be computed from any of them. Two further things are unresolved on the record. A publicly funded system will treat a complication; whether it will redo an unsatisfactory cosmetic result is usually answered no, and this project found no published national policy stating where that line sits. And the professional bodies publishing loudest about this — the Australian plastic surgeons' society among them — argue that restricted theatre access and cost at home are pushing patients out, which is an argument from a body with an interest in where its members' patients are operated on. Both of those are reported here and neither is settled.", "how": "Each series counts arrivals at one hospital over a fixed period in one specialty, costed either against national tariffs or against the hospital's own billed charges — and a billed charge is not an amount paid. They cannot be added into a national figure and they cannot be turned into a complication rate, because nobody counts the people who travelled and came home well. What they establish is the direction of the transfer, the concentration of the origin country in the cosmetic series, the interval before presentation, and the order of magnitude of a single bad outcome.", "today": "As of 17 September 2026 the five UK plastic surgery series on this site total roughly £1.1 million across 123 patients, at five hospitals, over periods running from one year to twelve; NHS Scotland's 81 patients over five years add £755,559.68 to that. No country publishes a national figure, no destination publishes what its own clinics spend on revisions, and no published measure exists anywhere of how many people who travelled for surgery attended any follow-up at all. The figures that exist are recording rates in the patients who came back with a problem — a sample selected for having one." }, "kin": [ { "to": "follow-up-gap", "as": "The risk record for the interval this piece is about, and the recording rates inside it.", "rel": "risk" }, { "to": "revision-at-home", "as": "The five UK ledgers in full, with each series and its period.", "rel": "risk" }, { "to": "aftercare-at-home", "as": "The step in the journey that this is the failure of.", "rel": "step" }, { "to": "the-discharge-summary", "as": "The document that would close the gap, when it exists and is in a language the next clinician reads.", "rel": "step" }, { "to": "when-it-goes-wrong", "as": "Where the patient goes at week three, and who is on take.", "rel": "step" }, { "to": "malpractice-recourse", "as": "Without the surgeon's name, recorded for none of 25 patients in one series, there is no defendant.", "rel": "risk" }, { "to": "turkiye", "as": "Named as the country of the first operation in most of the UK and Australian series.", "rel": "destination" }, { "to": "united-kingdom", "as": "The system that published its own ledgers, which is the only reason this page has numbers.", "rel": "destination" }, { "to": "australia", "as": "Where the newest series puts the median interval before presentation at 3.8 weeks.", "rel": "destination" }, { "to": "mexico", "as": "Where the largest per-patient charge in this file originated, in bariatric work counted from San Diego.", "rel": "destination" }, { "to": "bbl", "as": "Gluteal augmentation was the commonest procedure and the source of every major complication in two series.", "rel": "procedure" }, { "to": "is-it-cheaper", "as": "The comparison this is the missing last term of.", "rel": "story" } ], "links": [ { "label": "NHS — cosmetic surgery abroad", "url": "https://www.nhs.uk/conditions/cosmetic-procedures/going-abroad-for-cosmetic-surgery/" }, { "label": "GMC — guidance for doctors who offer cosmetic interventions", "url": "https://www.gmc-uk.org/professional-standards/the-professional-standards/cosmetic-interventions" } ], "sources": [ "s:nhs-cosmetic-surgery-abroad", "s:eplasty-cosmetic-tourism-cost", "s:wounds-uk-cosmetic-tourism", "s:thacoor-nhs-cost-2019", "s:farid-cosmetic-abroad-2019", "s:ahari-breast-unit-2024", "s:whiteman-nhs-burden-2025", "s:mafi-cosmetic-tourism-cost-2026", "s:spurzem-bariatric-tourism-2025", "s:anzjs-cosmetic-tourism-2026", "s:asps-cosmetic-tourism-2024", "s:gmc-cosmetic-interventions", "s:cdc-yellowbook-2026-medical-tourism", "s:cdc-yellowbook-medical-tourism", "s:gov-uk-foreign-travel-insurance", "s:alkaelani-aesthetic-review-2023" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "every figure is read off the published series and carried on the risk and pathway records; the readings of what they can support are marked Inference inline" }, "text.how": { "tier": "inference", "note": "this project's account of what a single-centre cost series can and cannot show" }, "text.today": { "tier": "cited", "source": "s:mafi-cosmetic-tourism-cost-2026" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "The operation is bought in one country and its consequences are managed in another.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The risk record for the interval this piece is about, and the recording rates inside it.", "rel": "risk" }, { "to": "revision-at-home", "type": "risk", "name": "Revision at home", "as": "The five UK ledgers in full, with each series and its period.", "rel": "risk" }, { "to": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The step in the journey that this is the failure of.", "rel": "step" }, { "to": "the-discharge-summary", "type": "pathway", "name": "The discharge summary", "as": "The document that would close the gap, when it exists and is in a language the next clinician reads.", "rel": "step" }, { "to": "when-it-goes-wrong", "type": "pathway", "name": "When it goes wrong", "as": "Where the patient goes at week three, and who is on take.", "rel": "step" }, { "to": "malpractice-recourse", "type": "risk", "name": "Malpractice recourse across a border", "as": "Without the surgeon's name, recorded for none of 25 patients in one series, there is no defendant.", "rel": "risk" }, { "to": "turkiye", "type": "destination", "name": "Türkiye", "as": "Named as the country of the first operation in most of the UK and Australian series.", "rel": "destination" }, { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "The system that published its own ledgers, which is the only reason this page has numbers.", "rel": "destination" }, { "to": "australia", "type": "destination", "name": "Australia", "as": "Where the newest series puts the median interval before presentation at 3.8 weeks.", "rel": "destination" }, { "to": "mexico", "type": "destination", "name": "Mexico", "as": "Where the largest per-patient charge in this file originated, in bariatric work counted from San Diego.", "rel": "destination" }, { "to": "bbl", "type": "procedure", "name": "Gluteal fat grafting", "as": "Gluteal augmentation was the commonest procedure and the source of every major complication in two series.", "rel": "procedure" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The comparison this is the missing last term of.", "rel": "story" } ], "source_list": [ { "id": "s:nhs-cosmetic-surgery-abroad", "kind": "org", "title": "Cosmetic surgery abroad", "publisher": "NHS (England)", "url": "https://www.nhs.uk/tests-and-treatments/cosmetic-procedures/advice/cosmetic-surgery-abroad/", "accessed": "2026-09-16", "note": "read for aftercare responsibility, flying intervals and the statement on travel insurance" }, { "id": "s:eplasty-cosmetic-tourism-cost", "kind": "paper", "title": "The real cost of cosmetic tourism: cost analysis study of cosmetic tourism complications presenting to a public hospital", "publisher": "Livingston R, Berlund P, Eccles-Smith J, Sawhney R. Eplasty 2015;15:e34", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC4522144/", "accessed": "2026-09-16", "note": "Gold Coast University Hospital, Queensland, financial year 2012–13, 12 patients" }, { "id": "s:wounds-uk-cosmetic-tourism", "kind": "paper", "title": "Cosmetic tourism: the cost of going 'under the knife' abroad for cosmetic surgery", "publisher": "Hatch J. Wounds UK 2025;21(4):44–49", "url": "https://wounds-uk.com/journal-articles/cosmetic-tourism-the-cost-of-going-under-the-knife-abroad-for-cosmetic-surgery/", "accessed": "2026-09-16", "note": "carries the BAAPS national audit figures and the NHS Scotland series" }, { "id": "s:thacoor-nhs-cost-2019", "kind": "paper", "title": "Surgical Management of Cosmetic Surgery Tourism-Related Complications: Current Trends and Cost Analysis Study of the Financial Impact on the UK National Health Service", "publisher": "Aesthetic Surgery Journal 2019;39(7):786-791 (Thacoor A, van den Bosch P, Akhavani MA), Royal Free Hospital, London", "url": "https://pubmed.ncbi.nlm.nih.gov/30590431/", "accessed": "2026-09-16" }, { "id": "s:farid-cosmetic-abroad-2019", "kind": "paper", "title": "Complications of Cosmetic Surgery Abroad — Cost Analysis and Patient Perception", "publisher": "Plastic and Reconstructive Surgery Global Open 2019;7(6):e2281 (Farid M, Nikkhah D, Little M, Edwards D, Needham W, Shibu M), Royal London Hospital", "url": "https://pubmed.ncbi.nlm.nih.gov/31624684/", "accessed": "2026-09-16" }, { "id": "s:ahari-breast-unit-2024", "kind": "paper", "title": "The impact of cosmetic tourism across one year on an NHS breast surgery unit", "publisher": "Journal of Plastic, Reconstructive and Aesthetic Surgery 2024;99:462-467 (Ahari D, Zaccariah ZR, Preston M, Highton L), Wythenshawe Hospital", "url": "https://pubmed.ncbi.nlm.nih.gov/39476527/", "accessed": "2026-09-16" }, { "id": "s:whiteman-nhs-burden-2025", "kind": "paper", "title": "The rising NHS burden from cosmetic surgery procedures performed abroad and non-surgical procedures performed in the United Kingdom", "publisher": "Journal of Plastic, Reconstructive and Aesthetic Surgery 2025;102:39-41 (Whiteman E, Romain K, Welman T, et al.)", "url": "https://pubmed.ncbi.nlm.nih.gov/39892185/", "accessed": "2026-09-16" }, { "id": "s:mafi-cosmetic-tourism-cost-2026", "kind": "paper", "title": "Recurrent Clinical Burden and Cost of Cosmetic Surgery Tourism Complications: A Five-Year Retrospective Study From a UK Tertiary Centre", "publisher": "Cureus 2026;18(5):e109006 (Mafi P, Patel K, Hoque-Uddin S, Warner R), Queen Elizabeth Hospital Birmingham", "url": "https://pubmed.ncbi.nlm.nih.gov/42311717/", "accessed": "2026-09-16" }, { "id": "s:spurzem-bariatric-tourism-2025", "kind": "journal", "title": "Getting more than what you pay for? Managing complications of bariatric tourism at an academic center near the US-Mexico border", "publisher": "Spurzem GJ et al., Surgical Endoscopy, 2025, doi:10.1007/s00464-025-11850-x", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12222374/", "accessed": "2026-09-16" }, { "id": "s:anzjs-cosmetic-tourism-2026", "kind": "journal", "title": "The Impact of Overseas Cosmetic Tourism on the Australian Public Hospital System", "publisher": "Res A, He B, Karunaratne YG, Cheung M, Hsieh F. ANZ Journal of Surgery 2026;96(3):607–613", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13006713/", "accessed": "2026-09-16", "note": "doi 10.1111/ans.70513; retrospective review of patients presenting to one Sydney hospital with complications after cosmetic surgery abroad" }, { "id": "s:asps-cosmetic-tourism-2024", "kind": "org", "title": "ASPS statement re Cosmetic Tourism, January 2024", "publisher": "Australian Society of Plastic Surgeons", "url": "https://plasticsurgery.org.au/wp-content/uploads/2024/01/FINAL-ASPS-cosmetic-tourism-statement-for-Sunrise-Jan-2024.pdf", "accessed": "2026-09-16", "note": "the position of a professional body with a direct interest in where its members' patients are operated on; read as such" }, { "id": "s:gmc-cosmetic-interventions", "kind": "org", "title": "Guidance for doctors who offer cosmetic interventions — in effect 1 June 2016, updated 13 December 2024", "publisher": "General Medical Council (United Kingdom)", "url": "https://www.gmc-uk.org/professional-standards/the-professional-standards/cosmetic-interventions", "accessed": "2026-09-16", "note": "paragraph numbers cited on this site are from the sections Communication, partnership and teamwork (paras 14-45) and Maintaining trust (paras 46-56)" }, { "id": "s:cdc-yellowbook-2026-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html", "accessed": "2026-09-16", "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page" }, { "id": "s:cdc-yellowbook-medical-tourism", "kind": "org", "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel", "publisher": "US Centers for Disease Control and Prevention", "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism", "accessed": "2026-09-16", "note": "the standing public-health account of what travelling for treatment involves and what goes wrong" }, { "id": "s:gov-uk-foreign-travel-insurance", "kind": "org", "title": "Foreign travel insurance", "publisher": "UK Foreign, Commonwealth and Development Office, gov.uk", "url": "https://www.gov.uk/guidance/foreign-travel-insurance", "accessed": "2026-09-16", "note": "read for repatriation, emergency transport, declaration of existing conditions and the limits of EHIC/GHIC" }, { "id": "s:alkaelani-aesthetic-review-2023", "kind": "paper", "title": "Complications of Medical Tourism in Aesthetic Surgery: A Systematic Review", "publisher": "Annals of Plastic Surgery 2023;91(6):668-673 (Alkaelani MT, Koussayer B, Blount T, et al.)", "url": "https://pubmed.ncbi.nlm.nih.gov/37962261/", "accessed": "2026-09-16" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "every figure is read off the published series and carried on the risk and pathway records; the readings of what they can support are marked Inference inline" }, "text.how": { "tier": "inference", "note": "this project's account of what a single-centre cost series can and cannot show" }, "text.today": { "tier": "cited", "source": "s:mafi-cosmetic-tourism-cost-2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "aftercare-at-home", "type": "pathway", "name": "Aftercare at home", "as": "The longer piece on this gap.", "rel": "story" }, { "from": "follow-up-gap", "type": "risk", "name": "The follow-up gap", "as": "The longer piece on this.", "rel": "story" }, { "from": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The longer piece on the last line of the sum, and who ends up paying it.", "rel": "story" } ] }, { "schema": 1, "id": "the-price-that-isnt", "type": "story", "names": { "name": "The price that isn't", "aliases": [ "the exclusion list", "what a package leaves out" ], "said": "A package is a list, not a total. The interesting half of the list is the second one." }, "region": [ "global" ], "facets": { "kind": "explainer" }, "text": { "what": "A published price covers a named list of things and excludes another named list, and across 214 price rows on this site the second list is longer than the first 68 times. This page works through the real exclusions: the implant missing from a joint package, the donor eggs missing from a donor-egg price, the lifetime multivitamins missing from a weight-loss package, the drugs missing from a fertility cycle, the second jaw missing from a full-mouth price, and the 36 rows that publish no exclusion list at all.", "story": "Bumrungrad International Hospital in Bangkok prices a unilateral total knee replacement at 356,500 baht and titles the page Total Knee Replacement Surgery (Exclude implant). The inclusion list runs to eight lines: three hours of theatre, the nursing and surgical team fees inside those hours, three nights on the surgical ward, equipment and supplies, medications related to the procedure, the surgeon, an assistant surgeon if needed, the anaesthesiologist. The exclusion list runs to ten, and the device that will be cemented into the patient is the first of them. Nothing about the page is concealed. What the exclusion does is make the number incomparable: a knee price that contains the joint and a knee price that does not are two different objects wearing one word, and the gap between them is not a discount.\n\nFertility sells the same shape. Newlife IVF in Thessaloniki lists treatment with frozen donor oocytes from an external bank at 3,300 euros, and names among its exclusions \"donor egg cost\" and the shipment of the eggs from the bank to the clinic. The cheapest donor-egg line on the page is the one that does not include the donor eggs. On the same list, preliminary tests and medications sit outside every line.\n\nSome exclusions name the operation's permanent cost. ALO Bariatrics in Tijuana sells a package it describes as covering everything — consultations, pre-operative blood work in Mexico, the surgeon, the anaesthetist, one or two nights in a private room, two nights of hotel recovery, transfers, post-operative medications, a bilingual coordinator, nutrition support and follow-up calls — from 4,500 US dollars for a sleeve and 5,900 for a bypass. Its exclusion list names round-trip flights, the travel companion's hotel and meals, pre-operative blood work done at home, optional complication insurance, body-contouring surgery, and lifetime daily multivitamins. *Inference —* that last line is the decade written into the small print of a price that sells the week. A sleeve gastrectomy makes those supplements compulsory for as long as the patient lives, and the package that excludes them is quoting the operation without its consequence.\n\nThe commonest missing line across the whole table is drugs. CNY Fertility in Syracuse publishes a base IVF price of 4,999 dollars with monitoring and medications outside it, a complete cycle at 7,994 to 12,888 once monitoring and standard add-ons are counted, and medications billed separately at about 2,700 dollars typically and 1,500 to over 7,000 across protocols — a spread wider than the cycle it attaches to. Reprofit in Brno publishes a five-page self-payer price list valid from 1 January 2026 on which stimulation medication appears in no inclusion column of any line. Newlife names medications in its exclusions in terms. Of 214 price rows on this site, thirteen name medications among their exclusions and none names them among the inclusions; twelve name flights the same way.\n\nDentistry hides the unit instead. Sani Dental in Los Algodones lists a titanium implant fixture at 890 dollars and the implant crown including abutment at 720 on the same page, so one restored tooth is 1,610 rather than 890. M Dental in Budapest prices the fixture at 381 euros, the laboratory fee at 255, the abutment at 258, the crown at 226 plus 152 of lab — four price lines to finish one tooth, under the clinic's own note that many treatments carry both a treatment price and a separate fabrication fee. Full-arch work does it with a single word: the Mexican, Thai and Hungarian full-mouth rows read for this site all exclude the second arch, so a price that looks like a whole mouth is half of one. Genetic testing does it per embryo — 600 euros each at Reprofit, which makes six embryos 3,600, more than the same clinic's entire standard cycle at 3,245.\n\nThe opposite move exists too. Estenove in Istanbul prices hair restoration at 3,395, 4,595 and 6,595 euros for what it calls the maximum number of grafts, and states that it does not price per graft. *Inference —* one seller's package removes the largest line on the bill; another seller's package removes the unit that would let the bill be compared at all. Both leave a reader holding a number that cannot be set beside anything.\n\nThirty-six of the 214 rows carry no exclusion list whatsoever, thirteen of them recorded here as not stated on the page. A Lithuanian orthopaedic clinic advertises a hip from 4,560 euros with no inclusion or exclusion list at all. In England, Practice Plus Group lists knee replacement at £13,799 with a long inclusion list — the nurse review, the anaesthetic, any overnight stay required, physiotherapy, any post-operative appointments required — and names the implant on neither side. *Inference —* silence is not inclusion. An item that appears in neither list has not been promised, and the only page on which the answer exists is one no reader has seen.\n\nThe last thing on many of these pages is a comparison the seller wrote. Sani Dental prints a United States column of 25,000, 27,000 and 30,000 dollars beside its own full-arch rows; Index Medica prints columns labelled average UK price; a facilitator routing patients to Thai hospitals prints a US comparison beside every line. None of the three names a source for the figure it is beaten by. *Inference —* a price page that supplies its own comparator has closed the comparison, which is the function of printing it. None of those columns is carried as a price row on this site, and the reason is the same reason the exclusion lists are carried in the seller's own words: a number with no publisher behind it is not evidence of anything.", "how": "What can be read off a price page, in order. Whether the figure says from, which makes it a floor. Whether it says one side, per arch, per embryo, per graft or per session, which is where the unit hides. What the stated number of nights is and what night N plus one costs — a Polish clinic prints 800 zloty a day beside prices that exclude the ward entirely. Whether there is a separate laboratory or fabrication fee. Whether there is a validity date: several packages here expire on 30 September or 31 December 2026. And whether any device, prosthesis, implant, processor, valve or stent has a line of its own. Every price row on this site carries the seller's inclusion and exclusion lists in the seller's own words for exactly these reasons.", "today": "As of 17 September 2026 this site holds 214 price rows: 69 packages, 62 list prices, 44 advertised ranges, 17 published estimates, 14 state tariffs, seven survey figures and one reimbursement, across 21 countries and twelve currencies. Thirty-six carry no exclusion list, 25 carry no inclusion list, and 68 of the rest exclude more lines than they include. No regulator read for this project requires a common inclusion list for a published price, and no destination read for this project requires a device price to be published beside a package that excludes it." }, "kin": [ { "to": "implant-excluded", "as": "The risk record for the single commonest missing line, worked on the knee package.", "rel": "risk" }, { "to": "package-price", "as": "The word, its root, and why two packages cannot be subtracted from one another.", "rel": "term" }, { "to": "is-it-cheaper", "as": "The same exclusions carried through one comparison to a ratio.", "rel": "story" }, { "to": "reading-the-exclusions", "as": "The step where this is caught, against a second exclusion list written by an insurer.", "rel": "step" }, { "to": "egg-donation", "as": "Where the cheapest donor-egg line on the page excludes the donor eggs.", "rel": "procedure" }, { "to": "gastric-sleeve", "as": "Where lifetime daily multivitamins sit in the exclusions of an operation that requires them.", "rel": "procedure" }, { "to": "ivf", "as": "Where the drugs are the missing line, at 1,500 to over 7,000 dollars on one clinic's own page.", "rel": "procedure" }, { "to": "all-on-four", "as": "Where the excluded item is the other half of the mouth.", "rel": "procedure" }, { "to": "dental-implant", "as": "Four price lines to finish one tooth, on a page that says so.", "rel": "procedure" }, { "to": "pgt", "as": "Priced per embryo, so six embryos cost more than the cycle that made them.", "rel": "procedure" }, { "to": "getting-a-quote", "as": "Where the headline number arrives and the excluded lines do not.", "rel": "step" }, { "to": "knee-replacement", "as": "The operation whose package names the exclusion in its own title.", "rel": "procedure" } ], "links": [ { "label": "Bumrungrad package JOINT04", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery" }, { "label": "Reprofit self-payer price list, valid from 1 January 2026", "url": "https://www.reprofit.cz/en/price-list/" } ], "sources": [ "s:bumrungrad-joint04", "s:newlife-ivf-costs", "s:alo-bariatrics-cost", "s:cny-ivf-cost", "s:reprofit-pricelist-2026", "s:pronatal-prices", "s:sani-dental-prices", "s:sani-price-list", "s:mdental-budapest-prices", "s:indexmedica-prices", "s:bidc-fees", "s:artplastica-cennik", "s:estenove-cost", "s:practiceplus-knee", "s:nordorthopaedics-prices", "s:defiant-prices", "s:hfea-egg-freezing", "s:gmc-cosmetic-interventions" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "every inclusion and exclusion is quoted or paraphrased from the seller's own page and carried on a price row elsewhere on this site; the readings are marked Inference inline" }, "text.how": { "tier": "inference", "note": "this project's reading order, drawn from the price pages it has read" }, "text.today": { "tier": "inference", "note": "counted over the price rows on disk on 17 September 2026" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "A published price covers a named list of things and excludes another named list, and across 214 price rows on this site the second list is longer than the first 68 times.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The risk record for the single commonest missing line, worked on the knee package.", "rel": "risk" }, { "to": "package-price", "type": "term", "name": "Package price", "as": "The word, its root, and why two packages cannot be subtracted from one another.", "rel": "term" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The same exclusions carried through one comparison to a ratio.", "rel": "story" }, { "to": "reading-the-exclusions", "type": "pathway", "name": "Reading the exclusions", "as": "The step where this is caught, against a second exclusion list written by an insurer.", "rel": "step" }, { "to": "egg-donation", "type": "procedure", "name": "Egg donation", "as": "Where the cheapest donor-egg line on the page excludes the donor eggs.", "rel": "procedure" }, { "to": "gastric-sleeve", "type": "procedure", "name": "Sleeve gastrectomy", "as": "Where lifetime daily multivitamins sit in the exclusions of an operation that requires them.", "rel": "procedure" }, { "to": "ivf", "type": "procedure", "name": "In vitro fertilisation", "as": "Where the drugs are the missing line, at 1,500 to over 7,000 dollars on one clinic's own page.", "rel": "procedure" }, { "to": "all-on-four", "type": "procedure", "name": "All-on-4", "as": "Where the excluded item is the other half of the mouth.", "rel": "procedure" }, { "to": "dental-implant", "type": "procedure", "name": "Dental implant", "as": "Four price lines to finish one tooth, on a page that says so.", "rel": "procedure" }, { "to": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "Priced per embryo, so six embryos cost more than the cycle that made them.", "rel": "procedure" }, { "to": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "Where the headline number arrives and the excluded lines do not.", "rel": "step" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The operation whose package names the exclusion in its own title.", "rel": "procedure" } ], "source_list": [ { "id": "s:bumrungrad-joint04", "kind": "web", "title": "Total Knee Replacement Surgery (Exclude implant) — package JOINT04", "publisher": "Bumrungrad International Hospital", "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery", "accessed": "2026-09-16", "note": "read off the hospital's own package page; price stated valid until 31 December 2026" }, { "id": "s:newlife-ivf-costs", "kind": "web", "title": "IVF costs, egg donation costs", "publisher": "Newlife IVF, Thessaloniki", "url": "https://www.newlife-ivf.co.uk/ivf-costs", "accessed": "2026-09-16" }, { "id": "s:alo-bariatrics-cost", "kind": "web", "title": "Gastric sleeve cost", "publisher": "ALO Bariatrics, Tijuana", "url": "https://www.alobariatrics.com/gastric-sleeve-cost/", "accessed": "2026-09-16" }, { "id": "s:cny-ivf-cost", "kind": "web", "title": "IVF Cost 2026: breakdown of prices, add-ons", "publisher": "CNY Fertility", "url": "https://www.cnyfertility.com/ivf-cost/", "accessed": "2026-09-16", "note": "page dated 7 July 2026; carries the clinic's own list prices and unattributed national ranges" }, { "id": "s:reprofit-pricelist-2026", "kind": "web", "title": "Pricelist — Assisted Reproduction, valid from 01.01.2026 (document 0331.26ENG)", "publisher": "Reprofit International s.r.o., Brno", "url": "https://www.reprofit.cz/media/filer_public/3d/7a/3d7a97cf-ec54-477b-af94-585766aa8f35/0331eng_cenik_vykonu_ivf_pro_samoplatce.pdf", "accessed": "2026-09-16", "note": "the clinic's own self-payer price list, five pages, each line naming its inclusions and its exclusions" }, { "id": "s:pronatal-prices", "kind": "web", "title": "Price list", "publisher": "PRONATAL, Prague", "url": "https://www.pronatal.cz/en/price-list/", "accessed": "2026-09-16", "note": "read 16 September 2026: IVF with own eggs from EUR 3,000 including basic laboratory methods; donor egg programme with guarantee from EUR 5,950 including basic laboratory methods; frozen embryo transfer from EUR 990; egg freezing for non-medical reasons from EUR 1,990, which excludes medication and includes two years of storage; IUI from EUR 400; donor embryo transfer from EUR 1,850" }, { "id": "s:sani-dental-prices", "kind": "web", "title": "Dental Price List in Mexico", "publisher": "Sani Dental Group, Los Algodones", "url": "https://sanidentalgroup.com/price-list", "accessed": "2026-09-16", "note": "prices in US dollars with a Mexican peso figure beside each; the page states every price is a base or starting price" }, { "id": "s:sani-price-list", "kind": "web", "title": "Dental Price List in Mexico", "publisher": "Sani Dental Group", "url": "https://sanidentalgroup.com/price-list", "accessed": "2026-09-16", "note": "prices in US dollars and Mexican pesos, read off the page on 16 September 2026; the page states that all prices are a base or starting-at price and carries no location qualifier, though the group lists clinics in Los Algodones, Cancún and Playa del Carmen" }, { "id": "s:mdental-budapest-prices", "kind": "web", "title": "Treatment Prices", "publisher": "Medicare Dental Clinic, Budapest", "url": "https://www.mdentalclinic.eu/prices", "accessed": "2026-09-16", "note": "treatment price and lab fee shown as separate lines; packages name accommodation and transfers" }, { "id": "s:indexmedica-prices", "kind": "web", "title": "Prices — dental treatment in Kraków", "publisher": "Index Medica, Kraków", "url": "https://www.indexmedica.com/prices/", "accessed": "2026-09-16", "note": "two tables, one in sterling against a column the clinic labels average UK price, one in euro against average Irish price. Read 16 September 2026: complete implant including screw, healing ring, individual abutment and full-ceramic zirconia crown GBP 1,450 or EUR 1,552; implant screw alone GBP 575; full-ceramic zirconia crown GBP 429 or EUR 469; root canal on a front tooth GBP 120. Examination, x-rays and local anaesthetic are listed free. A deposit of 80% of each stage is due on signing the treatment plan; American Express and Diners Club are not accepted." }, { "id": "s:bidc-fees", "kind": "web", "title": "Dental Fees — standardised treatment fees", "publisher": "Bangkok International Dental Center", "url": "https://bangkokdentalcenter.com/fees/", "accessed": "2026-09-16", "note": "implant fixture and implant crown priced in separate columns; page states package rates applicable till 30 September 2026" }, { "id": "s:artplastica-cennik", "kind": "web", "title": "Cennik zabiegow i operacji plastycznych", "publisher": "Beauty Group - Artplastica, Szczecin", "url": "https://www.artplastica.pl/cennik-zabiegi-operacje-plastyczne/", "accessed": "2026-09-16", "note": "clinic's own price list in zloty; the page states the prices are indicative and may change at consultation, and lists hospitalisation at 800 PLN a day separately" }, { "id": "s:estenove-cost", "kind": "web", "title": "Hair Transplant Cost and Prices in Turkey", "publisher": "Estenove, Istanbul", "url": "https://www.estenove.com/hair-transplant-cost-istanbul-turkey/", "accessed": "2026-09-16", "note": "clinic's own package prices in euro, quoted per session rather than per graft" }, { "id": "s:practiceplus-knee", "kind": "web", "title": "Private knee surgery and treatment — self-pay price list", "publisher": "Practice Plus Group", "url": "https://practiceplusgroup.com/treatments/knee-surgery/", "accessed": "2026-09-16" }, { "id": "s:nordorthopaedics-prices", "kind": "web", "title": "Orthopaedic Surgery Prices", "publisher": "Nordorthopaedics Clinic, Kaunas", "url": "https://www.nordorthopaedics.com/hip-knee-wrist-hand-ankle-foot-shoulder-surgery-prices/", "accessed": "2026-09-16", "note": "every figure is written as a 'from' price in euro and sterling; the page carries no inclusion list" }, { "id": "s:defiant-prices", "kind": "web", "title": "Defiant — posted prices index", "publisher": "Defiant (defiant.to)", "url": "https://defiant.to/procedures/", "accessed": "2026-09-16" }, { "id": "s:hfea-egg-freezing", "kind": "org", "title": "Egg freezing", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/treatments/fertility-preservation/egg-freezing/", "accessed": "2026-09-16", "note": "carries the 55-year storage limit and the regulator's own average UK cost" }, { "id": "s:gmc-cosmetic-interventions", "kind": "org", "title": "Guidance for doctors who offer cosmetic interventions — in effect 1 June 2016, updated 13 December 2024", "publisher": "General Medical Council (United Kingdom)", "url": "https://www.gmc-uk.org/professional-standards/the-professional-standards/cosmetic-interventions", "accessed": "2026-09-16", "note": "paragraph numbers cited on this site are from the sections Communication, partnership and teamwork (paras 14-45) and Maintaining trust (paras 46-56)" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "every inclusion and exclusion is quoted or paraphrased from the seller's own page and carried on a price row elsewhere on this site; the readings are marked Inference inline" }, "text.how": { "tier": "inference", "note": "this project's reading order, drawn from the price pages it has read" }, "text.today": { "tier": "inference", "note": "counted over the price rows on disk on 17 September 2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "iran", "type": "destination", "name": "Iran", "as": "Prices that move with the exchange rate rather than with the medicine.", "rel": "story" }, { "from": "morocco", "type": "destination", "name": "Morocco", "as": "Why a package quoted in euros is not the whole bill.", "rel": "story" }, { "from": "poland", "type": "destination", "name": "Poland", "as": "The comparison column on a clinic's price list, and who wrote it.", "rel": "story" }, { "from": "budapest", "type": "hub", "name": "Budapest", "as": "Why a per-implant quote and a final bill are different objects.", "rel": "story" }, { "from": "cairo", "type": "hub", "name": "Cairo", "as": "Why a price quoted in a falling currency is not the price paid.", "rel": "story" }, { "from": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "A base-price list with the crown on its own line is the clearest case this site has of the problem.", "rel": "story" }, { "from": "panama-city", "type": "hub", "name": "Panama City", "as": "A city that sells on price and publishes none, with a statutory discount that only residents can claim.", "rel": "story" }, { "from": "san-jose-cr", "type": "hub", "name": "San José, Costa Rica", "as": "A hospital that sells on price and prints none is the other half of that argument.", "rel": "story" }, { "from": "disc-replacement", "type": "procedure", "name": "Artificial disc replacement", "as": "A headline price with the prosthesis taken out of it.", "rel": "story" }, { "from": "egg-freezing", "type": "procedure", "name": "Egg freezing", "as": "A headline price with a drug bill outside it and a storage bill after it.", "rel": "story" }, { "from": "liposuction", "type": "procedure", "name": "Liposuction", "as": "Four prices for one operation, each counting a different quantity.", "rel": "story" }, { "from": "pgt", "type": "procedure", "name": "Preimplantation genetic testing", "as": "A per-embryo charge that can exceed the cycle it is added to.", "rel": "story" }, { "from": "rhinoplasty", "type": "procedure", "name": "Rhinoplasty", "as": "Why four published prices for one operation are not four comparable numbers.", "rel": "story" }, { "from": "acibadem", "type": "facility", "name": "Acıbadem Healthcare Group", "as": "A page headed packages and prices that carries no price.", "rel": "story" }, { "from": "charite-international", "type": "facility", "name": "Charité International Patients", "as": "A hospital that publishes nothing is a different problem from one that publishes a figure with from in front of it.", "rel": "story" }, { "from": "liv-hospital", "type": "facility", "name": "Liv Hospital", "as": "Fifteen prices, every one of them prefixed with the word from.", "rel": "story" }, { "from": "narayana-health", "type": "facility", "name": "Narayana Health", "as": "A group figure from 2013, reprinted as a current price ever since.", "rel": "story" }, { "from": "raffles-hospital", "type": "facility", "name": "Raffles Hospital", "as": "A published screening price is real, and it is also the cheapest thing the hospital does.", "rel": "story" }, { "from": "getting-a-quote", "type": "pathway", "name": "Getting a quote", "as": "What happens between a quoted package and a discharge bill.", "rel": "story" }, { "from": "implant-excluded", "type": "risk", "name": "The implant is excluded", "as": "The longer piece on what a published price covers.", "rel": "story" }, { "from": "advertising-rules", "type": "rule", "name": "What a clinic may say", "as": "The claim these codes do not reach.", "rel": "story" }, { "from": "insurance-exclusions", "type": "rule", "name": "Insurance exclusions for treatment abroad", "as": "Why a package price and a total cost are different numbers.", "rel": "story" }, { "from": "exchange-rate-table", "type": "dataset", "name": "The dated exchange rate table", "as": "The conversion is one of the several steps between a published figure and what somebody pays.", "rel": "story" }, { "from": "how-this-was-built", "type": "story", "name": "How this was built", "as": "Why every price row carries the seller's own exclusion list.", "rel": "story" }, { "from": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The companion piece: the exclusion lists themselves, across every procedure on this site.", "rel": "story" } ] }, { "schema": 1, "id": "the-word-itself", "type": "story", "names": { "name": "The word itself", "aliases": [ "why this site says medical travel", "the naming rule" ], "said": "The rule is stated here rather than left for a reader to work out from an absence." }, "region": [ "global" ], "facets": { "kind": "explainer" }, "text": { "what": "This site writes medical travel and cross-border care. The more familiar compound appears only inside a quotation with a speaker attached, inside a proper name, or on the word's own page, where the argument over it is the subject rather than a convention. This page states the rule and points at where the argument is set out.", "story": "The mechanism is a regular expression, not a judgement. This project's validator treats the singular agent noun behind the familiar compound as a hard error in reader-facing prose, and strips quoted spans and a short list of proper names before it checks. So a page may report what somebody said, name an organisation that has the word in its title, or discuss the word as a word — and may not use it to describe a patient. Saying that plainly is better than leaving a reader to infer a position from the gap.\n\nThe argument the rule sits on top of is long, and it is written out on this site's record for the term. In short: the compound is older than the industry wearing it, appearing in two unrelated registers in 1997 — once as a warning about restricting donor payment, once in scare quotes for foreigners arriving to use a health service. Its crossover in the English book corpus comes in 2005, after which it rises steeply through the years the consumer guidebooks and the trade bodies appeared. The OECD scoping review of 2011 adopts the term and then quotes three refusals of it: that it \"insinuates leisurely travelling and does not capture the seriousness of most patient mobility\"; that it \"is a misnomer, as it carries connotations of pleasure not always associated with this travel\"; and that it is \"A term that suggests leisure and frivolity\" which \"promotes a market place model that disregards the suffering that patients experience\". The patients' own objection is on the record too: analysing German and Israeli press coverage in 2013, Sharon Bassan and Marie Alice Michaelsen report that couples travelling for fertility treatment \"do not refer to themselves as 'reproductive tourists'. They might even be offended by this term\".\n\nThe substitutes are not neutral either, and this directory's vocabulary records say so one by one. Medical travel drops the leisure claim and keeps the assumption that the journey was chosen, which is the assumption the exile literature disputes. Reproductive exile asserts compulsion, which is a claim about cause, and the cause differs case by case — it was proposed in 2005, rejected in the same journal as overstating it, and settled by a third phrase, cross border reproductive care. Patient mobility is Brussels administrative language for an entitlement and covers people who would never call themselves travellers. Circumvention travel names a legal difference rather than a motive. Health tourism is the widest of them, and is usually the category sitting behind a very large national figure: Türkiye's 2017 regulation defines it twice and then defines it again by subtraction, excluding everybody reached by a social security arrangement, a treaty, refugee status or a state programme. Wellness travel is defined by motive, counts the traveller whose motive was secondary, and counts the whole trip.\n\n*Inference —* which is why the vocabulary records sit beside the country records here rather than in a glossary at the back. The choice of word decides the category, the category decides the count, and the count is what a ministry publishes. A destination that counts under the widest word publishes a figure dominated by its cheapest contents; a directory that writes the narrowest word has to leave out the patient sent by a state scheme and the patient who walked across a land border for a filling. Neither problem is solved by picking a better word, and this site does not claim to have picked one. It has picked a rule, and printed it.", "today": "As of 17 September 2026 this site holds 26 vocabulary records. Six of them are names for this subject as a whole — the contested compound, medical travel, health tourism, wellness travel, patient mobility and circumvention travel — with reproductive exile beside them for the fertility case. Each carries its root, its earliest dated use this project could name, and the argument where there is one." }, "kin": [ { "to": "medical-tourism", "as": "The word's own page, where the fight over it is the subject and the objections are quoted with their speakers.", "rel": "term" }, { "to": "medical-travel", "as": "The name this site uses, and the trade's own substitute since about 2009.", "rel": "term" }, { "to": "health-tourism", "as": "The widest category, and the one usually sitting behind a very large national figure.", "rel": "term" }, { "to": "patient-mobility", "as": "Brussels administrative language for an entitlement, with a directive behind it.", "rel": "term" }, { "to": "wellness-travel", "as": "Defined by motive, counting secondary motive and whole-trip spending.", "rel": "term" }, { "to": "circumvention-travel", "as": "A name for a legal difference rather than for a motive.", "rel": "term" }, { "to": "reproductive-exile", "as": "The name proposed as a correction, and rejected in the same journal issue as overstating compulsion.", "rel": "term" }, { "to": "counting-patients", "as": "What happens downstream: the word chosen decides the category, and the category decides the count.", "rel": "story" }, { "to": "how-this-was-built", "as": "Where this rule is enforced, alongside the rest of the editorial rules.", "rel": "story" } ], "links": [ { "label": "OECD Health Working Paper 70 — medical travel scoping review", "url": "https://www.oecd.org/en/publications/medical-tourism_5kgj0r4gbd60-en.html" } ], "sources": [ "s:etymonline-tourism", "s:etymonline-tourist", "s:etymonline-travel", "s:etymonline-exile", "s:etymonline-mobility", "s:oecd-lunt-scoping-2011", "s:turner-beyond-2012", "s:bassan-michaelsen-2013", "s:ngram-naming", "s:inhorn-patrizio-2009", "s:matorras-2005", "s:pennings-2004", "s:cohen-circumvention-2012", "s:schult-origins-2009", "s:sauer-1997", "s:sheaff-1997", "s:rg-saglik-turizmi-2017", "s:gwi-wellness-tourism", "s:connell-2006" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "the quotations and dates are drawn from the vocabulary records and their sources; the closing reading is marked Inference inline" }, "text.what": { "tier": "inference", "note": "this project stating its own naming rule" }, "text.today": { "tier": "inference", "note": "counted over the term records on disk on 17 September 2026" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "This site writes medical travel and cross-border care. The more familiar compound appears only inside a quotation with a speaker attached, inside a proper name, or on the word's own page, where the argument over it is…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "medical-tourism", "type": "term", "name": "Medical tourism", "as": "The word's own page, where the fight over it is the subject and the objections are quoted with their speakers.", "rel": "term" }, { "to": "medical-travel", "type": "term", "name": "Medical travel", "as": "The name this site uses, and the trade's own substitute since about 2009.", "rel": "term" }, { "to": "health-tourism", "type": "term", "name": "Health tourism", "as": "The widest category, and the one usually sitting behind a very large national figure.", "rel": "term" }, { "to": "patient-mobility", "type": "term", "name": "Patient mobility", "as": "Brussels administrative language for an entitlement, with a directive behind it.", "rel": "term" }, { "to": "wellness-travel", "type": "term", "name": "Wellness travel", "as": "Defined by motive, counting secondary motive and whole-trip spending.", "rel": "term" }, { "to": "circumvention-travel", "type": "term", "name": "Circumvention travel", "as": "A name for a legal difference rather than for a motive.", "rel": "term" }, { "to": "reproductive-exile", "type": "term", "name": "Reproductive exile", "as": "The name proposed as a correction, and rejected in the same journal issue as overstating compulsion.", "rel": "term" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "What happens downstream: the word chosen decides the category, and the category decides the count.", "rel": "story" }, { "to": "how-this-was-built", "type": "story", "name": "How this was built", "as": "Where this rule is enforced, alongside the rest of the editorial rules.", "rel": "story" } ], "source_list": [ { "id": "s:etymonline-tourism", "kind": "dictionary", "title": "tourism (n.), tour (n.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/tourism", "accessed": "2026-09-17", "note": "1811 / c. 1300" }, { "id": "s:etymonline-tourist", "kind": "dictionary", "title": "tourist (n.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/tourist", "accessed": "2026-09-17", "note": "1772" }, { "id": "s:etymonline-travel", "kind": "dictionary", "title": "travel (v.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/travel", "accessed": "2026-09-17", "note": "late 14c., a variant of travailen, to struggle, toil, labour" }, { "id": "s:etymonline-exile", "kind": "dictionary", "title": "exile (n.), exile (v.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/exile", "accessed": "2026-09-17", "note": "c. 1300, from Latin exilium" }, { "id": "s:etymonline-mobility", "kind": "dictionary", "title": "mobility (n.), mobile (adj.) — etymology", "publisher": "Online Etymology Dictionary, compiled by Douglas Harper", "url": "https://www.etymonline.com/word/mobility", "accessed": "2026-09-17", "note": "early 15c. / late 15c." }, { "id": "s:oecd-lunt-scoping-2011", "kind": "report", "title": "Medical Tourism: Treatments, Markets and Health System Implications — a scoping review, DELSA/HEA/WD/HWP(2011)3", "publisher": "Lunt N, Smith R, Exworthy M, Green ST, Horsfall D, Mannion R; OECD Directorate for Employment, Labour and Social Affairs", "url": "https://www.birmingham.ac.uk/documents/college-social-sciences/social-policy/hsmc/publications/2011/medical-tourism-scoping-review.pdf", "accessed": "2026-09-17", "note": "page 8 collects the objections to the term and quotes Glinos et al. (Health and Place 2010;16(6):1145-55), Whittaker (Global Public Health 2008;3(3):271-90, at 272) and Kangas (Medical Anthropology 2010;29(4):344-62, at 350). Those three quotations are verified as quoted here, not against the paywalled originals; the OECD text mis-dates Glinos as 2011 in the body and 2010 in its reference list. The oecd.org copy returns 403; this university mirror was read in full" }, { "id": "s:turner-beyond-2012", "kind": "paper", "title": "Beyond 'medical tourism': Canadian companies marketing medical travel", "publisher": "Turner L. Globalization and Health 2012;8:16", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC3503750/", "accessed": "2026-09-17", "note": "full text read; DOI 10.1186/1744-8603-8-16, PMID 22703873" }, { "id": "s:bassan-michaelsen-2013", "kind": "paper", "title": "Honeymoon, medical treatment or big business? An analysis of the meanings of the term 'reproductive tourism' in German and Israeli public media discourses", "publisher": "Bassan S, Michaelsen MA. Philosophy, Ethics, and Humanities in Medicine 2013;8:9", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC3854005/", "accessed": "2026-09-17", "note": "CC BY, full text read; carries the patients' objection, Matorras's ground and Pennings's counter-argument, all at one remove from the paywalled letters" }, { "id": "s:ngram-naming", "kind": "dataset", "title": "Relative frequency of medical tourism, health tourism, medical travel and wellness tourism in the Google Books English 2019 corpus", "publisher": "Google Books Ngram Viewer", "url": "https://books.google.com/ngrams/json?content=medical+tourism,health+tourism&year_start=1970&year_end=2019&corpus=en-2019&smoothing=0", "accessed": "2026-09-17", "note": "queried directly against the JSON endpoint, smoothing 0. The crossover year is 2005. Pre-1980 non-zero values in this corpus are OCR noise and are not read as attestations" }, { "id": "s:inhorn-patrizio-2009", "kind": "paper", "title": "Rethinking reproductive \"tourism\" as reproductive \"exile\"", "publisher": "Fertility and Sterility 92(3):904-906 (Inhorn MC, Patrizio P)", "url": "https://www.fertstert.org/article/S0015-0282(09)00046-6/fulltext", "accessed": "2026-09-16", "note": "citation and the authors' framing verified from the publisher's own article listing; the full text returned HTTP 403 and was not read" }, { "id": "s:matorras-2005", "kind": "paper", "title": "Reproductive exile versus reproductive tourism", "publisher": "Matorras R. Human Reproduction 2005 Dec;20(12):3571 (with author reply 3571-2)", "url": "https://pubmed.ncbi.nlm.nih.gov/16308333/", "accessed": "2026-09-17", "note": "DOI 10.1093/humrep/dei223, PMID 16308333; a comment on Pennings 2004. The letter itself is paywalled and was not read; its ground is quoted here as reported in Bassan and Michaelsen 2013" }, { "id": "s:pennings-2004", "kind": "paper", "title": "Legal harmonization and reproductive tourism in Europe", "publisher": "Pennings G. Human Reproduction 2004 Dec;19(12):2689-94", "url": "https://pubmed.ncbi.nlm.nih.gov/15513984/", "accessed": "2026-09-17", "note": "DOI 10.1093/humrep/deh486; the paper Matorras was answering" }, { "id": "s:cohen-circumvention-2012", "kind": "paper", "title": "Circumvention Tourism", "publisher": "Cornell Law Review 97(6):1309 (Cohen IG)", "url": "https://scholarship.law.cornell.edu/clr/vol97/iss6/1", "accessed": "2026-09-16" }, { "id": "s:schult-origins-2009", "kind": "web", "title": "Origins of the Term 'Medical Tourism', 23 October 2009", "publisher": "Jeff Schult, beautyfromafar.com (author of Beauty from Afar, 2006)", "url": "https://beautyfromafar.com/2009/10/23/origins-of-the-term-medical-tourism/", "accessed": "2026-09-17", "note": "a trade author stating the drift as it happened; his own 2006 book title still used the other word" }, { "id": "s:sauer-1997", "kind": "paper", "title": "Reproductive prohibition: restricting donor payment will lead to medical tourism", "publisher": "Sauer MV. Human Reproduction 1997;12(9):1844-5", "url": "https://pubmed.ncbi.nlm.nih.gov/9363693/", "accessed": "2026-09-17", "note": "the earliest journal title carrying the compound that this project verified, through the NCBI eutils API (PMID 9363693)" }, { "id": "s:sheaff-1997", "kind": "paper", "title": "Healthcare access and mobility between the UK and other European Union states: an 'implementation surplus'", "publisher": "Sheaff R. Health Policy 1997;42(3):239-53", "url": "https://pubmed.ncbi.nlm.nih.gov/10176303/", "accessed": "2026-09-17", "note": "the same phrase in the older, gatekeeping sense, in scare quotes in the abstract (PMID 10176303)" }, { "id": "s:rg-saglik-turizmi-2017", "kind": "web", "title": "Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik", "publisher": "Resmî Gazete, Republic of Türkiye (Ministry of Health)", "url": "https://www.resmigazete.gov.tr/eskiler/2017/07/20170713-3.htm", "accessed": "2026-09-16", "note": "Resmî Gazete 13 July 2017, No. 30123. Read in Turkish off the Resmî Gazete page. Article 5(1) makes an international health tourism authorisation certificate (yetki belgesi) compulsory for both the health facility and the intermediary; the Ministry halts the activity of anyone without one. Transitional Article 1 gave those already trading one year to comply. Article 16: in force on publication. REPEALED: MADDE 17 of the regulation of 26 April 2025 (Resmî Gazete 32882) revokes this one. Cite it for what the regime was, not for what it is." }, { "id": "s:gwi-wellness-tourism", "kind": "org", "title": "What is Wellness Tourism?", "publisher": "Global Wellness Institute", "url": "https://globalwellnessinstitute.org/what-is-wellness/what-is-wellness-tourism/", "accessed": "2026-09-17", "note": "carries the definition, the primary and secondary traveller categories, the whole-trip counting rule, 894 billion US dollars for 2024 and 439 billion for 2012" }, { "id": "s:connell-2006", "kind": "journal", "title": "Medical tourism: Sea, sun, sand and … surgery", "publisher": "Tourism Management, 2006;27(6):1093–1100", "url": "https://doi.org/10.1016/j.tourman.2005.11.005", "accessed": "2026-09-16", "note": "Connell J. Citation confirmed through the Crossref API" } ], "tiers": { "text.what": { "tier": "inference", "note": "this project stating its own naming rule" }, "text.story": { "tier": "cited", "note": "the quotations and dates are drawn from the vocabulary records and their sources; the closing reading is marked Inference inline" }, "text.today": { "tier": "inference", "note": "counted over the term records on disk on 17 September 2026" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "how-this-was-built", "type": "story", "name": "How this was built", "as": "The naming rule this method enforces, and where the argument over it is set out.", "rel": "story" } ] }, { "schema": 1, "id": "waiting-lists", "type": "story", "names": { "name": "The queue is the product", "aliases": [ "waiting lists", "the wait" ], "said": "The trade sells a price. What most of its customers are buying is a date." }, "region": [ "global" ], "facets": { "kind": "essay" }, "text": { "what": "Half this directory is about money and the other half is about law, and both miss the commonest reason a person with an insured, funded, free-at-the-point-of-use operation available to them gets on a plane anyway: the operation is available in fourteen months. A queue is not a price, and no price comparison on this site can see it.", "story": "England publishes its queue monthly, which makes it the easiest one to read. At the end of July 2026, 7.3 million referral-to-treatment pathways were waiting to start treatment — an estimated 6.2 million people, since a person can wait on more than one pathway at once. The median wait was 12.0 weeks. 111,379 pathways had been waiting more than a year. 65.4 per cent were inside eighteen weeks, against a standard of 92 per cent.\n\nCanada measures the same thing from the other end and gets a number that sounds better until you take its complement. CIHI reported hip replacements at 68 per cent and knee replacements at 61 per cent inside the 182-day benchmark for 2024. Read the other side of that: close to four knee patients in ten were still waiting more than six months after being found ready for surgery, in a country where the surgery itself carries no bill at all.\n\n*Inference —* this is why the price table on this site explains less than it appears to. A Canadian who flies to Bangkok for a knee is not choosing between 356,500 baht and nothing; they are choosing between 356,500 baht now and nothing in eight months, and the second figure in that comparison is not a figure. The published price is doing work the queue set up.\n\nThe measurement itself has a seam in it, and the OECD names it. Its waiting-time series counts from specialist assessment to treatment, and excludes, in its own words, \"the time elapsed from the date of referral of the general practitioner to the date of specialist assessment\". In systems where the bottleneck is getting seen by the specialist in the first place, the published wait begins after the part the patient experienced as the wait. Two countries with identical numbers can be running very different queues.\n\n*Inference —* and the queue explains something about the destination mix that price alone does not. Hips and knees, cataracts, hernias, gallbladders, hysterectomies — the operations that travel on waiting lists — are unglamorous, high-volume, and cheap to do well. They are not the operations a brochure leads with, and they are a large part of what actually crosses borders. The brochure sells the saving. The queue sells the calendar.\n\nOne thing this directory cannot do is put the two on one axis. A month of pain has no exchange rate, nobody publishes one, and a site that invented one would be selling something.", "today": "The figures above are the ones the records on this site carry: England's at July 2026, Canada's from CIHI's 2024 reporting and its June 2026 update. Both are refreshed by their publishers on a schedule this project does not follow automatically, so a reader checking a decision should go to the publisher rather than to this page." }, "kin": [ { "to": "united-kingdom", "as": "Publishes its queue monthly, which is why it is the one this piece reads first.", "rel": "destination" }, { "to": "canada", "as": "Measures the same thing as a share inside a benchmark, which reads better until you take the complement.", "rel": "destination" }, { "to": "oecd-waiting-times", "as": "The series, and the sentence about where its clock starts.", "rel": "measured-by" }, { "to": "knee-replacement", "as": "The operation the queue sends abroad more than any other.", "rel": "procedure" }, { "to": "hip-replacement", "as": "Its twin on every waiting list that publishes one.", "rel": "procedure" }, { "to": "cataract-surgery", "as": "The highest-volume operation in the world, and a queue in most systems that fund it.", "rel": "procedure" }, { "to": "deciding-whether", "as": "The step where the calendar, rather than the price, is usually what decides it.", "rel": "step" }, { "to": "is-it-cheaper", "as": "The money question this one sits behind.", "rel": "story" } ], "sources": [ "s:nhs-rtt-july-2026", "s:cihi-wait-times-2025", "s:cihi-joint-replacement-waits", "s:oecd-waiting-definitions-2025" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "every figure is carried from the country and dataset records that sourced it; the stretches marked Inference are this project's reading of what those figures do and do not support" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "Half this directory is about money and the other half is about law, and both miss the commonest reason a person with an insured, funded, free-at-the-point-of-use operation available to them gets on a plane anyway: the…", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "united-kingdom", "type": "destination", "name": "United Kingdom", "as": "Publishes its queue monthly, which is why it is the one this piece reads first.", "rel": "destination" }, { "to": "canada", "type": "destination", "name": "Canada", "as": "Measures the same thing as a share inside a benchmark, which reads better until you take the complement.", "rel": "destination" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The series, and the sentence about where its clock starts.", "rel": "measured-by" }, { "to": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The operation the queue sends abroad more than any other.", "rel": "procedure" }, { "to": "hip-replacement", "type": "procedure", "name": "Total hip replacement", "as": "Its twin on every waiting list that publishes one.", "rel": "procedure" }, { "to": "cataract-surgery", "type": "procedure", "name": "Cataract surgery", "as": "The highest-volume operation in the world, and a queue in most systems that fund it.", "rel": "procedure" }, { "to": "deciding-whether", "type": "pathway", "name": "Deciding whether to go", "as": "The step where the calendar, rather than the price, is usually what decides it.", "rel": "step" }, { "to": "is-it-cheaper", "type": "story", "name": "Is it cheaper", "as": "The money question this one sits behind.", "rel": "story" } ], "source_list": [ { "id": "s:nhs-rtt-july-2026", "kind": "gov", "title": "Statistical Press Notice — NHS referral to treatment (RTT) waiting times data, July 2026", "publisher": "NHS England", "url": "https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Jul26-RTT-statistical-press-notice-PDF-578K-97ylx5.pdf", "accessed": "2026-09-16", "note": "published Thursday 10 September 2026. 7.3 million RTT pathways waiting to start treatment at the end of July 2026, an estimated 6.2 million unique patients; 111,379 waiting over 52 weeks, 9,095 over 65 weeks, 235 over 104 weeks; 65.4% waiting up to 18 weeks against a 92% standard; median wait 12.0 weeks. Figures include estimates for three trusts and one independent provider that did not submit." }, { "id": "s:cihi-wait-times-2025", "kind": "report", "title": "Wait times for priority procedures in Canada, 2025", "publisher": "Canadian Institute for Health Information, published 12 June 2025", "url": "https://www.cihi.ca/en/wait-times-for-priority-procedures-in-canada-2025", "accessed": "2026-09-16" }, { "id": "s:cihi-joint-replacement-waits", "kind": "web", "title": "Joint Replacement Wait Times", "publisher": "Canadian Institute for Health Information, data updated June 2026", "url": "https://www.cihi.ca/en/indicators/joint-replacement-wait-times", "accessed": "2026-09-16" }, { "id": "s:oecd-waiting-definitions-2025", "kind": "report", "title": "OECD Health Statistics 2025 — Definitions, Sources and Methods: waiting times for selected elective surgeries", "publisher": "OECD, Health Division", "url": "https://stats.oecd.org/wbos/fileview2.aspx?IDFile=cae608c4-fa81-4f56-8d7f-a0d4d609de80", "accessed": "2026-09-17", "note": "PDF dated 10 September 2025; carries the two waiting-time definitions, the inclusion of publicly-funded patients, the exclusion of the GP-referral-to-assessment stretch, the seven procedures with ICD-9-CM codes, the per-country 'Deviation from the definition' notes and the 'Data not available' entries for Austria, Belgium, Czechia, France, Germany, Japan, Korea, Latvia, Luxembourg, Mexico, the Slovak Republic, Switzerland, Türkiye and the United States" } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "every figure is carried from the country and dataset records that sourced it; the stretches marked Inference are this project's reading of what those figures do and do not support" }, "text.today": { "tier": "cited" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "ireland", "type": "destination", "name": "Ireland", "as": "The queue as the thing that moves patients, published here monthly as a headcount rather than a wait.", "rel": "story" }, { "from": "knee-replacement", "type": "procedure", "name": "Total knee replacement", "as": "The queue at home that sends most knee patients abroad in the first place.", "rel": "kin" } ] }, { "schema": 1, "id": "what-the-data-cannot-see", "type": "story", "names": { "name": "What the data cannot see", "aliases": [ "the does-not-count sentences", "the inventory of the hole" ], "said": "Every dataset record on this site carries a sentence saying what its series leaves out. Read the thirteen in a row and they describe the same hole." }, "region": [ "global" ], "facets": { "kind": "resources" }, "text": { "what": "Thirteen published series supply every chart, map and table on this site. Each has a record, and each record carries one sentence stating what the series does not count. This page collects those thirteen sentences. Not one of the series counts a person who crossed a border to be treated, and the pattern in how they miss it is more useful than the omission itself.", "story": "Begin with the money. The World Bank's current health expenditure per person covers government schemes, compulsory and voluntary insurance and household out-of-pocket payments, divided by population — and excludes capital spending, so a new hospital building does not appear, and excludes anything a foreign patient pays for treatment in that country. In the record's own words, a country can run a large export trade in surgery and show nothing for it there. The out-of-pocket share does the same from the other side: it is a ratio rather than an amount, it does not separate a co-payment inside an insured system from a whole bill paid in cash, and it counts nothing a visiting patient pays, which belongs to the export half of the account. The World Health Organization's Global Health Observatory answered with 3,099 indicator records when its record was written, and no indicator in it counts a foreign patient, a treatment bought abroad, or a payment made in another country's health system.\n\nThe arrivals series is the one readers assume must hold the answer, and it is the furthest from it. The World Bank republishes UN Tourism's international arrivals for 223 country codes. Each trip by the same person counts again, so the total is crossings rather than travellers. Nothing in the series records why anybody came: there is no treatment field and no purpose field, so a patient cannot be separated from a visiting relative. And it counts nobody who crossed by land where a country reports air arrivals only — which removes most of the Mexican border dental trade, one of the largest flows in this directory.\n\nThe two clinical registers that would settle the fertility half of the subject are defined to exclude it. The Human Fertilisation and Embryology Authority has held every IVF and donor insemination cycle performed in a UK licensed clinic since 1 August 1991, 107 clinics in 2023/24. A UK resident who has IVF in Spain, Czechia or northern Cyprus leaves no trace in it, because the clinic is not licensed by the Authority: the one flow this directory exists to describe is the one the register is defined to exclude. The American series has the same shape and states more of its own limits. The CDC counted 435,426 ART cycles on 251,542 unique patients at 457 reporting clinics in 2022; it counts nothing done outside a United States clinic, no intrauterine insemination and no ovulation induction because neither is ART by its definition, nothing from the clinics listed as nonreporters — about 2 per cent of cycles on its own estimate — and its clinic rates describe cycles more than a year old, which the agency says plainly should not be read as any individual's chance of success.\n\nThe capacity series describe a health system rather than a market. Physicians per 1,000 people cannot separate the capital from the province, the private hospital from the district clinic, or the surgeon who operates on visitors from the physician who never sees one; it counts no nurse, records no specialty, and holds no measure of what any of them do. Hospital beds per 1,000 cannot say whether a bed is staffed, equipped or empty, counts no operating theatre, no intensive-care capability, no dialysis station and no day-case chair, and draws no line between the public system a resident queues for and the private wing a foreign patient is admitted to. Forty-seven of the 220 country outlines this site draws carry no bed value at all — Nigeria, the Democratic Republic of the Congo, Côte d'Ivoire, Namibia and South Sudan among them — and absence there is absence of a return rather than absence of beds.\n\nThe series closest to the motive is the one that removes the most. OECD waiting times cover seven elective procedures in the countries that publish them: 6,609 observations from 24 countries, 2000 to 2024. The clock starts after the specialist assessment, so the months between a family doctor's referral and a consultant's opinion sit outside the series by definition. It counts no privately funded patient, which removes the domestic private route competing directly with travelling abroad. It counts no country that does not publish — Austria, Belgium, Czechia, France, Germany, Japan, Korea, Latvia, Luxembourg, Mexico, the Slovak Republic, Switzerland, Türkiye and the United States are all marked data not available, and several of those are among the largest sources of patients travelling for planned surgery. And it counts nobody who left the list: died, gave up, went private, or flew somewhere else. *Inference —* the last exclusion is the whole subject of this directory, removed from the only series that measures the reason for it.\n\nTwo of the thirteen are registers of attention rather than of activity. The Joint Commission International directory counts organisations that applied, paid for the survey, met the standards on the survey date and are inside a three-year cycle: no infection rate, no mortality, no revision rate, no price, no patient volume, no complaint, nobody in it involuntarily, and no public history of the lapsed. The OpenStreetMap harvest holds every named hospital, clinic and dental surgery OpenStreetMap carried within a set radius of each hub on the date it was fetched, and what it does not hold is anything nobody mapped — absence there is absence of mapping, not of hospitals. It carries no accreditation, no ownership, no price, no quality measure, no patient volume and no indication that a place treats foreigners; a clinic that closed last year sits in the file until somebody edits it out; and a row proves only that a point on a map once had that name typed on it.\n\nThe last two are the infrastructure, and they fail quietly. Natural Earth supplies 220 country outlines that join to everything else here through one country code, so a place with no ISO alpha-2 code, or one too small to carry a polygon at this scale, drops silently out of every map and every chart: Northern Cyprus, Kosovo and Somaliland sit here under codes this project invented for them, and Monaco, Macau and the Vatican are not present at all. The exchange-rate table holds 166 currencies against the dollar on one stated date and carries no card spread, no foreign-transaction fee, no cash-advance charge and no airport-counter margin; it holds no history, so a price published in 2019 and converted here is converted at a 2026 rate; and several of its rates are administered pegs rather than traded prices — the dirham at 3.6725, the riyal at 3.75 — with nothing in the file marking which is which.\n\n*Inference —* the omission is structural rather than careless. Every one of these thirteen was built by an institution measuring its own population, its own licensees or its own members, and a patient who crossed a border is by construction somebody else's. What is left to count this trade with is made by the parties holding an interest in the answer: a hospital counting its own patients, a trade council counting member returns, a ministry counting registrations, a hospital association counting what it billed. This site therefore carries those figures with their unit and their collector attached, prints a null as a gap rather than a zero, and publishes a coverage layer on its own map so the distance between what the world reports and what this directory has written up stays visible.", "how": "The sentence lives in one field. Every dataset record carries dataset.counts, in the publisher's own definition, and dataset.does_not_count beside it; the validator warns when either is empty, because that sentence is the point of the record. Licences travel with the data: CC BY 4.0 on the World Bank series, ODbL 1.0 on the OpenStreetMap harvest, public domain on Natural Earth, WHO terms of use on the Global Health Observatory, and an attribution-required open endpoint for the rates. Where a publisher refused an automated request, the record says so and states the gap rather than filling it.", "today": "As of 17 September 2026 this site holds thirteen dataset records: five World Bank series, the WHO repository, the OECD waiting-times extract, the UK and US fertility registers, the JCI directory, the OpenStreetMap harvest, the Natural Earth outlines and one dated exchange-rate table. None of them counts a cross-border patient. The site's own coverage figures are published at /coverage/ and /numbers/, and the gap between the two is drawn on the map." }, "kin": [ { "to": "world-bank-health-spending", "as": "Excludes anything a foreign patient pays, which is the flow this site is about.", "rel": "dataset" }, { "to": "world-bank-tourism-arrivals", "as": "Counts crossings with no purpose field, and misses the land border entirely where a country reports air arrivals only.", "rel": "dataset" }, { "to": "oecd-waiting-times", "as": "The series closest to the motive, and the one that removes everybody who left the list.", "rel": "dataset" }, { "to": "hfea-results", "as": "Holds every licensed UK cycle and nothing done abroad, which is the flow by definition.", "rel": "dataset" }, { "to": "cdc-art-results", "as": "The same boundary in the United States, with its own limits stated by the agency.", "rel": "dataset" }, { "to": "world-bank-beds", "as": "Cannot say whether a bed is staffed, or which side of the system it sits on.", "rel": "dataset" }, { "to": "world-bank-doctors", "as": "Cannot say where the doctors are, or which of them ever sees a visiting patient.", "rel": "dataset" }, { "to": "who-global-health-observatory", "as": "Three thousand indicators, none of which counts a foreign patient.", "rel": "dataset" }, { "to": "jci-accredited-list", "as": "A register of purchased inspections, with no outcome, no price and no history of the lapsed.", "rel": "dataset" }, { "to": "osm-facilities", "as": "Where absence is absence of mapping, and a row proves only that somebody typed a name.", "rel": "dataset" }, { "to": "natural-earth-countries", "as": "The geometry every map joins through, and the codes that drop out of it silently.", "rel": "dataset" }, { "to": "counting-patients", "as": "The same problem one layer up, in the figures destinations publish about themselves.", "rel": "story" } ], "links": [ { "label": "OpenStreetMap Overpass, the harvest source", "url": "https://www.openstreetmap.org/" }, { "label": "Natural Earth terms of use", "url": "https://www.naturalearthdata.com/about/terms-of-use/" } ], "sources": [ "s:worldbank-open-data", "s:wb-physicians", "s:wb-hospital-beds", "s:wb-oop-share", "s:wb-tourist-arrivals", "s:un-tourism-statistics", "s:oecd-waiting-definitions-2025", "s:oecd-waiting-sdmx", "s:who-gho", "s:who-gho-odata", "s:who-terms-of-use", "s:hfea-2024-trends", "s:hfea-2024-methodology", "s:cdc-art", "s:cdc-art-2022-summary", "s:cdc-art-interpret", "s:jci-accreditation", "s:osm", "s:odbl-1-0", "s:natural-earth", "s:natural-earth-terms", "s:er-api", "s:er-api-free-terms" ], "provenance": { "default": { "tier": "harvested", "source": "s:worldbank-open-data" }, "fields": { "text.story": { "tier": "cited", "note": "each does-not-count sentence is drawn from the dataset record it belongs to and from that publisher's own definitions page; the closing reading is marked Inference inline" }, "text.how": { "tier": "inference", "note": "this project describing its own field and its own licence handling" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "Thirteen published series supply every chart, map and table on this site. Each has a record, and each record carries one sentence stating what the series does not count. This page collects those thirteen sentences.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "world-bank-health-spending", "type": "dataset", "name": "Current health expenditure per person", "as": "Excludes anything a foreign patient pays, which is the flow this site is about.", "rel": "dataset" }, { "to": "world-bank-tourism-arrivals", "type": "dataset", "name": "International arrivals", "as": "Counts crossings with no purpose field, and misses the land border entirely where a country reports air arrivals only.", "rel": "dataset" }, { "to": "oecd-waiting-times", "type": "dataset", "name": "OECD waiting times for elective surgery", "as": "The series closest to the motive, and the one that removes everybody who left the list.", "rel": "dataset" }, { "to": "hfea-results", "type": "dataset", "name": "HFEA fertility treatment results", "as": "Holds every licensed UK cycle and nothing done abroad, which is the flow by definition.", "rel": "dataset" }, { "to": "cdc-art-results", "type": "dataset", "name": "CDC assisted reproductive technology results", "as": "The same boundary in the United States, with its own limits stated by the agency.", "rel": "dataset" }, { "to": "world-bank-beds", "type": "dataset", "name": "Hospital beds per 1,000 people", "as": "Cannot say whether a bed is staffed, or which side of the system it sits on.", "rel": "dataset" }, { "to": "world-bank-doctors", "type": "dataset", "name": "Physicians per 1,000 people", "as": "Cannot say where the doctors are, or which of them ever sees a visiting patient.", "rel": "dataset" }, { "to": "who-global-health-observatory", "type": "dataset", "name": "WHO Global Health Observatory", "as": "Three thousand indicators, none of which counts a foreign patient.", "rel": "dataset" }, { "to": "jci-accredited-list", "type": "dataset", "name": "The JCI list of accredited organizations", "as": "A register of purchased inspections, with no outcome, no price and no history of the lapsed.", "rel": "dataset" }, { "to": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "Where absence is absence of mapping, and a row proves only that somebody typed a name.", "rel": "dataset" }, { "to": "natural-earth-countries", "type": "dataset", "name": "Natural Earth country outlines", "as": "The geometry every map joins through, and the codes that drop out of it silently.", "rel": "dataset" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "The same problem one layer up, in the figures destinations publish about themselves.", "rel": "story" } ], "source_list": [ { "id": "s:worldbank-open-data", "kind": "dataset", "title": "World Bank Open Data — health and tourism indicators", "publisher": "The World Bank", "url": "https://data.worldbank.org/", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-16", "note": "fetched by tools/harvest_worldbank.py; every indicator's own code and fetch date sit in data/harvest/worldbank.json" }, { "id": "s:wb-physicians", "kind": "dataset", "title": "Physicians (per 1,000 people) — indicator SH.MED.PHYS.ZS", "publisher": "World Bank Open Data", "url": "https://data.worldbank.org/indicator/SH.MED.PHYS.ZS", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-17", "note": "definition and source organisation read off the indicator metadata endpoint https://api.worldbank.org/v2/indicator/SH.MED.PHYS.ZS?format=json — 'Physicians include generalist and specialist medical practitioners'; sourced from WHO Global Health Workforce Statistics, the OECD and country data" }, { "id": "s:wb-hospital-beds", "kind": "dataset", "title": "Hospital beds (per 1,000 people) — indicator SH.MED.BEDS.ZS", "publisher": "World Bank Open Data", "url": "https://data.worldbank.org/indicator/SH.MED.BEDS.ZS", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-17", "note": "definition read off https://api.worldbank.org/v2/indicator/SH.MED.BEDS.ZS?format=json — inpatient beds in public, private, general and specialised hospitals and rehabilitation centres, acute and chronic care in most cases; WHO data supplemented by country data" }, { "id": "s:wb-oop-share", "kind": "dataset", "title": "Out-of-pocket expenditure (% of current health expenditure) — indicator SH.XPD.OOPC.CH.ZS", "publisher": "World Bank Open Data", "url": "https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-17", "note": "definition read off https://api.worldbank.org/v2/indicator/SH.XPD.OOPC.CH.ZS?format=json; source organisation given as the WHO Global Health Expenditure Database, updated December 12th, 2025" }, { "id": "s:wb-tourist-arrivals", "kind": "dataset", "title": "International tourism, number of arrivals — indicator ST.INT.ARVL", "publisher": "World Bank Open Data", "url": "https://data.worldbank.org/indicator/ST.INT.ARVL", "license": "CC BY 4.0", "license_url": "https://datacatalog.worldbank.org/public-licenses#cc-by", "accessed": "2026-09-17", "note": "the long definition and its caveats read off https://api.worldbank.org/v2/indicator/ST.INT.ARVL?format=json, including the sentences on differing national collection methods and on arrivals not being people; source organisation UN Tourism, Yearbook and Compendium of Tourism Statistics" }, { "id": "s:un-tourism-statistics", "kind": "dataset", "title": "Tourism Statistics Database", "publisher": "UN Tourism (World Tourism Organization)", "url": "https://www.unwto.org/tourism-statistics/tourism-statistics-database", "accessed": "2026-09-17", "note": "the Yearbook and Compendium of Tourism Statistics, which the World Bank republishes as ST.INT.ARVL" }, { "id": "s:oecd-waiting-definitions-2025", "kind": "report", "title": "OECD Health Statistics 2025 — Definitions, Sources and Methods: waiting times for selected elective surgeries", "publisher": "OECD, Health Division", "url": "https://stats.oecd.org/wbos/fileview2.aspx?IDFile=cae608c4-fa81-4f56-8d7f-a0d4d609de80", "accessed": "2026-09-17", "note": "PDF dated 10 September 2025; carries the two waiting-time definitions, the inclusion of publicly-funded patients, the exclusion of the GP-referral-to-assessment stretch, the seven procedures with ICD-9-CM codes, the per-country 'Deviation from the definition' notes and the 'Data not available' entries for Austria, Belgium, Czechia, France, Germany, Japan, Korea, Latvia, Luxembourg, Mexico, the Slovak Republic, Switzerland, Türkiye and the United States" }, { "id": "s:oecd-waiting-sdmx", "kind": "dataset", "title": "Waiting times dataflow DSD_HEALTH_PROC@DF_WAITING, OECD SDMX API", "publisher": "OECD", "url": "https://sdmx.oecd.org/public/rest/data/OECD.ELS.HD,DSD_HEALTH_PROC@DF_WAITING,1.1/all?format=csvfile", "accessed": "2026-09-17", "note": "the extract read for this project holds 6,609 observations, 24 countries, 2000-2024, 19 countries reporting for 2024; WTSP 3,925 observations and WTPA 2,684; the 2024 knee-replacement medians quoted in the record were read from it" }, { "id": "s:who-gho", "kind": "dataset", "title": "Global Health Observatory", "publisher": "World Health Organization", "url": "https://www.who.int/data/gho", "accessed": "2026-09-16" }, { "id": "s:who-gho-odata", "kind": "dataset", "title": "GHO OData API", "publisher": "World Health Organization", "url": "https://www.who.int/data/gho/info/gho-odata-api", "accessed": "2026-09-17", "note": "the API at https://ghoapi.azureedge.net/api returned 3,099 indicator records and 202 dimensions on this date; the page carries no licence statement of its own" }, { "id": "s:who-terms-of-use", "kind": "web", "title": "Terms of use", "publisher": "World Health Organization", "url": "https://www.who.int/about/policies/terms-of-use", "accessed": "2026-09-17", "note": "reproduction for research or private study is permitted 'but not for sale or for use in conjunction with commercial purposes'; WHO publications carry CC BY-NC-SA 3.0 IGO" }, { "id": "s:hfea-2024-trends", "kind": "org", "title": "Fertility treatment 2024: trends and figures", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2024-trends-and-figures/", "accessed": "2026-09-17", "note": "published 16 June 2026 from a register snapshot of 6 May 2026; 64,000 patients and over 100,000 treatment and freezing cycles in 2024; average IVF birth rate per embryo transferred 30%, 38% at ages 18-34 and 8% at 43-44; 2024 birth outcomes marked preliminary" }, { "id": "s:hfea-2024-methodology", "kind": "org", "title": "Fertility treatment 2024: quality and methodology report", "publisher": "Human Fertilisation and Embryology Authority", "url": "https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2024-trends-and-figures/quality-and-methodology-report/", "accessed": "2026-09-17", "note": "people are in the Register 'regardless of a person's residence'; 'We do not hold detailed information on partner intrauterine insemination (IUI), or treatments that takes place outside of licensed clinics'; regions are assigned 'based on the location of the clinic rather than patient's residency'; the Register runs since 1991 and is described as the longest running database of fertility treatment in the world" }, { "id": "s:cdc-art", "kind": "dataset", "title": "Assisted Reproductive Technology Surveillance and clinic-level success rates", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/art/", "accessed": "2026-09-16" }, { "id": "s:cdc-art-2022-summary", "kind": "dataset", "title": "2022 Final Assisted Reproductive Technology (ART) Summary", "publisher": "US Centers for Disease Control and Prevention", "url": "https://data.cdc.gov/Assisted-Reproductive-Technology-ART-/2022-Final-Assisted-Reproductive-Technology-ART-Su/9tjt-seye", "accessed": "2026-09-16", "note": "clinic-level and national rows; the national rows carry locationabbr NA. Queried through the Socrata endpoint https://data.cdc.gov/resource/9tjt-seye.json" }, { "id": "s:cdc-art-interpret", "kind": "org", "title": "How to interpret ART success rates", "publisher": "US Centers for Disease Control and Prevention", "url": "https://www.cdc.gov/art/success-rates/interpret.html", "accessed": "2026-09-17", "note": "'Comparison of success rates across clinics may not be meaningful' and 'Clinic success rates do not reflect any one patient's chance of success', with the reasons given" }, { "id": "s:jci-accreditation", "kind": "org", "title": "Joint Commission International — accreditation standards and accredited organizations", "publisher": "Joint Commission International", "url": "https://www.jointcommissioninternational.org/", "accessed": "2026-09-16" }, { "id": "s:osm", "kind": "dataset", "title": "OpenStreetMap", "publisher": "OpenStreetMap contributors", "url": "https://www.openstreetmap.org/", "license": "ODbL 1.0", "license_url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-16", "note": "hospital, clinic and dental points around each hub, fetched by tools/harvest_osm.py" }, { "id": "s:odbl-1-0", "kind": "web", "title": "Open Database License (ODbL) v1.0", "publisher": "Open Data Commons", "url": "https://opendatacommons.org/licenses/odbl/1-0/", "accessed": "2026-09-17", "note": "the share-alike licence OpenStreetMap data carries: attribution, and any adapted database shared under the same terms" }, { "id": "s:natural-earth", "kind": "dataset", "title": "Natural Earth — Admin 0 Countries, 1:110m", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/", "license": "Public domain", "accessed": "2026-09-16" }, { "id": "s:natural-earth-terms", "kind": "web", "title": "Terms of Use", "publisher": "Natural Earth", "url": "https://www.naturalearthdata.com/about/terms-of-use/", "license": "Public domain", "accessed": "2026-09-17", "note": "'All versions of Natural Earth raster + vector map data found on this website are in the public domain.' and 'No permission is needed to use Natural Earth.' The same page disclaims responsibility for accuracy and content." }, { "id": "s:er-api", "kind": "dataset", "title": "Open Exchange Rates API (open.er-api.com)", "publisher": "ExchangeRate-API", "url": "https://open.er-api.com/v6/latest/USD", "accessed": "2026-09-16", "note": "one dated rate table; every converted price on the site names the date" }, { "id": "s:er-api-free-terms", "kind": "web", "title": "Free exchange rate API documentation — open endpoint", "publisher": "ExchangeRate-API", "url": "https://www.exchangerate-api.com/docs/free", "accessed": "2026-09-17", "note": "open endpoint updates once per day and carries time_last_update_utc and time_next_update_utc; attribution to ExchangeRate-API is required on pages using the rates; redistribution of the data is not permitted" } ], "tiers": { "text.what": { "tier": "harvested", "source": "s:worldbank-open-data" }, "text.story": { "tier": "cited", "note": "each does-not-count sentence is drawn from the dataset record it belongs to and from that publisher's own definitions page; the closing reading is marked Inference inline" }, "text.how": { "tier": "inference", "note": "this project describing its own field and its own licence handling" }, "text.today": { "tier": "inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "egypt", "type": "destination", "name": "Egypt", "as": "A trade that exists and has never been counted in public is the case this page stands on.", "rel": "story" }, { "from": "japan", "type": "destination", "name": "Japan", "as": "A rich country with two official series and no answer to the simple question.", "rel": "story" }, { "from": "nigeria", "type": "destination", "name": "Nigeria", "as": "An outflow everybody agrees exists and nobody has measured the same way twice.", "rel": "story" }, { "from": "philippines", "type": "destination", "name": "Philippines", "as": "Forty-eight agencies, no register, no total.", "rel": "story" }, { "from": "singapore", "type": "destination", "name": "Singapore", "as": "A country that stopped publishing a number rather than publish a bad one.", "rel": "story" }, { "from": "spain", "type": "destination", "name": "Spain", "as": "A registry that counts every cycle and cannot say why nine in ten patients came.", "rel": "story" }, { "from": "sri-lanka", "type": "destination", "name": "Sri Lanka", "as": "Good public health statistics and no count of who left.", "rel": "story" }, { "from": "taiwan", "type": "destination", "name": "Taiwan", "as": "A gap this record leaves open rather than fills.", "rel": "story" }, { "from": "colombo", "type": "hub", "name": "Colombo", "as": "A capital with a whole private sector in five kilometres and no count anybody publishes.", "rel": "story" }, { "from": "taipei", "type": "hub", "name": "Taipei", "as": "A hub with no count this project could verify, which is itself the finding.", "rel": "story" }, { "from": "hospital-angeles-tijuana", "type": "facility", "name": "Hospital Angeles Tijuana", "as": "The most-written-about border medical market in the world, and its largest hospital publishes no number about itself.", "rel": "story" }, { "from": "when-it-goes-wrong", "type": "pathway", "name": "When it goes wrong", "as": "Why the denominator under all of this is missing.", "rel": "story" }, { "from": "eshre", "type": "org", "name": "European Society of Human Reproduction and Embryology", "as": "Where national aggregates and clinic-level results are set against each other.", "rel": "story" }, { "from": "eurostat", "type": "org", "name": "Eurostat", "as": "The exclusion sentence, and what it hides, at length.", "rel": "story" }, { "from": "icmart", "type": "org", "name": "International Committee for Monitoring Assisted Reproductive Technologies", "as": "The destinations with no registry, which is most of the ones a fertility traveller is choosing between.", "rel": "story" }, { "from": "isaps", "type": "org", "name": "International Society of Aesthetic Plastic Surgery", "as": "Everything cosmetic done by someone who is not a board-certified plastic surgeon.", "rel": "story" }, { "from": "khidi", "type": "org", "name": "Korea Health Industry Development Institute", "as": "Even this count cannot separate a traveller from a resident foreigner.", "rel": "story" }, { "from": "who", "type": "org", "name": "World Health Organization", "as": "Where the gap between world health data and cross-border care is the subject.", "rel": "story" }, { "from": "natural-earth-countries", "type": "dataset", "name": "Natural Earth country outlines", "as": "A country that has no code has no row, and a missing row looks like an empty country.", "rel": "story" }, { "from": "osm-facilities", "type": "dataset", "name": "OpenStreetMap hospitals, clinics and dental surgeries", "as": "Absence of mapping, read as absence of a hospital, is the commonest mistake this file invites.", "rel": "story" }, { "from": "who-global-health-observatory", "type": "dataset", "name": "WHO Global Health Observatory", "as": "The gap is structural, not an oversight: nobody collects it.", "rel": "story" }, { "from": "world-bank-beds", "type": "dataset", "name": "Hospital beds per 1,000 people", "as": "Twenty-seven countries with no value, and a South African figure dated 2010.", "rel": "story" }, { "from": "world-bank-doctors", "type": "dataset", "name": "Physicians per 1,000 people", "as": "A national average over a population is the clearest case of it.", "rel": "story" }, { "from": "world-bank-tourism-arrivals", "type": "dataset", "name": "International arrivals", "as": "A table with no field for why anyone came.", "rel": "story" }, { "from": "counting-patients", "type": "story", "name": "Counting patients", "as": "The same problem across every series this site draws a chart from.", "rel": "story" }, { "from": "how-this-was-built", "type": "story", "name": "How this was built", "as": "The thirteen series this method draws on, and the sentence each of them cannot answer.", "rel": "story" } ] }, { "schema": 1, "id": "who-travels", "type": "story", "names": { "name": "Who travels", "aliases": [ "the flows that are actually documented", "against the brochure picture" ], "said": "The brochure shows a Westerner on a lounger. The documented flows are mostly regional, mostly short-haul, and mostly not a choice about price." }, "region": [ "global" ], "facets": { "kind": "essay" }, "text": { "what": "The largest flows anyone counts are not Europeans and North Americans buying cheaper surgery. They are patients moving inside their own regions, pushed by a war, by a health system that stopped working, or pulled by a state that pays for its own nationals to be treated abroad and pays their escorts a daily allowance while they are there. This page sets those flows out from the destination records, with the instrument that counted each one.", "story": "The frame came from a title. John Connell's 2006 article in Tourism Management was called \"Medical tourism: Sea, sun, sand and … surgery\", and twenty years of brochure imagery has followed its punctuation: an elective operation bolted onto a holiday, bought by somebody from a rich country who did the arithmetic. That patient exists. The numbers say she is not the centre of the subject.\n\nThe single largest documented flow on this site is regional and overland. India's Press Information Bureau records 507,244 foreign nationals arriving for medical treatment in 2025. Bangladesh supplied 325,127 of them — 64 per cent of the total — followed by Iraq at 30,989, Uzbekistan at 13,699, Somalia at 11,506, Turkmenistan at 10,231, Oman at 9,738 and Kenya at 9,357. Six of the seven named source countries border India, share a flight of a few hours with it, or have a health system that cannot do the work. None of them is a European market.\n\nJordan's trade is a record of other countries' emergencies. The Private Hospitals Association, which has existed since 1984 and does the counting the state does not, put 2025 at almost a billion US dollars from 230,000 foreign patients, naming Iraq, Saudi Arabia, Palestine, Syria, Yemen and Libya as its largest markets. The sector took Iraqi patients through sanctions and after 2003, Libyan patients after 2011 — many of them war-wounded, paid for by a Libyan state that then stopped paying — and Yemeni and Sudanese patients as those two systems collapsed in turn. It has lost them the same way: when Jordan tightened visas for Sudanese, Libyan, Yemeni and Iraqi nationals, the association reported a 40 per cent fall across the first nine months of 2016. *Inference —* the sector's largest single variable is therefore not its prices. It is who can obtain a visa, which is decided by a ministry with no interest in the hospital's revenue.\n\nIn the Gulf the buyer is the state, and one of these programmes is written down in full. Dubai's Administrative Resolution No. 14 of 2017, issued by the Director General of the Dubai Health Authority on 6 February 2017, sets out who will be sent abroad and what the Authority will pay for: the treatment, the physicians, the medicines and devices, interpreting, air ambulance where needed, and repatriation of the body if the patient dies. One escort travels with an adult patient; two accompany a child, or a patient who is elderly, paralysed, comatose or disabled. The schedule at the back sets a daily allowance by destination — 150 euros a day for the patient and 150 for the first escort in European countries, 150 US dollars in the United States, 300 dirhams in India, Thailand and Arab countries. *Inference —* a per-diem schedule that distinguishes Europe from India is a procurement document. The patient in it did not compare prices, did not choose the hospital and is not carrying the risk, and no part of the decision resembles the one the brochure describes.\n\nOn the other side of the same trade are the countries whose patients leave. Kenya's number in this directory is India's, not Kenya's: 9,357 arrivals for medical purposes in 2025, which makes it India's seventh-largest source. *Inference —* what a country loses when its complex cases board a plane is not mainly the money, which is the argument usually made. It is the caseload. A cancer service is built by treating cancers and a cardiac unit gets good by operating; every case that flies out is one the local hospital did not do and the local registrar did not see, and the patients who cannot afford the ticket stay behind to be treated by a service whose experience left with the people who could pay for it.\n\nNigeria is where that argument is loudest and the evidence thinnest. The figure in widest circulation — about two billion US dollars a year lost to treatment abroad — is attributed to Professor Muhammad Ali Pate, Coordinating Minister of Health and Social Welfare, in April 2025. Earlier ministers gave 1.2 to 1.6 billion, and another gave two billion before that. *Inference —* a quantity that moves by a factor of two between cabinet members, with no statistical series named behind it, is a rhetorical instrument in a domestic argument about investment. It may still be roughly right. Nigeria also does not appear among the seven source countries India names, which means either the flow is smaller than the rhetoric implies, or it travels on visa classes India does not count as medical, or it goes to the United Kingdom, Dubai, Egypt or Türkiye instead — three different policy problems that one dollar figure conceals. What is not in dispute is the distribution: the people who fly are the people with foreign exchange, and the Central Bank's allocation of it is as much a part of the mechanism as the health ministry.\n\nOne set of flows is decided by neither price nor visa but by permit. Palestinians from the West Bank and Gaza Strip referred to hospitals in East Jerusalem, Israel or abroad require an Israeli-issued permit to travel, and the World Health Organization counts the applications. Its report to the Seventy-sixth World Health Assembly, dated 17 May 2023, records that in 2022 a third of the 20,295 patient permit applications from the Gaza Strip — over 6,500 — were not approved in time for the hospital appointment, and 15 per cent of the 87,721 applications from the West Bank were denied. Approval varied by what the patient had: 87 per cent for oncology against 58 per cent for neurology among Gaza patients in December 2022. Companions fared worse — 62 per cent of 26,461 companion applications from Gaza were not approved by the date of the appointment. *Inference —* this is the same subject measured by an instrument nobody else uses. Everywhere else in this directory the constraint on reaching a hospital abroad is money; here it is an approval, and it is counted.\n\nThe one flow that does look like the brochure is the American crossing into Mexico, and even there the picture bends. Los Algodones, a town of 5,474 at the 2010 census, holds what the researcher Krystyna Adams counted as \"more than 500 practising dentists\" in \"an intense clustering of dental clinics within a four block radius\", and the trade runs on a walk across a pedestrian border rather than on a flight. Adams's own published conclusion from four months there was not about price: it was that the industry exploits the workers who staff it. Meanwhile the tail of the same border is counted from the American side, by surgeons at San Diego who reviewed 91 patients presenting with complications of bariatric surgery obtained in Mexico between 2014 and 2024. *Inference —* the brochure flow and the counted flow are the same people at different points of the same journey, and only the second point produces a number.", "how": "Each flow in this record is counted by a different instrument, and the instrument decides what the figure can be used for. India counts arrivals by visa purpose, so it counts trips. Jordan's figure is the hospitals' own count of what they billed, published by a body arguing for the sector. Dubai's outbound programme is described by its bylaw and has no published headcount at all, so the inbound and outbound sides of that country cannot be set against one another on like evidence. The permit figures come from a WHO governing-body document and count applications, approvals and refusals rather than patients. Nothing in this record is a rate, because none of these has a denominator.", "today": "As of 17 September 2026 the largest documented single origin-destination pair on this site remains Bangladesh to India in 2025, at 325,127 recorded medical-purpose arrivals. No country on this site publishes a count of its own residents who travelled out for treatment; every outbound figure carried here was produced by the receiving state or by a minister of the sending one." }, "kin": [ { "to": "jordan", "as": "The trade built on other countries' wars, where the binding constraint is a visa rather than a price.", "rel": "destination" }, { "to": "uae", "as": "Buys care abroad for its own nationals under a bylaw that sets the escort's daily allowance by destination.", "rel": "destination" }, { "to": "gcc-sponsored-treatment-abroad", "as": "The rule record for the state-as-buyer route, with the resolution named and dated.", "rel": "rule" }, { "to": "india", "as": "The receiving state that counts by source country, which is why the regional shape of this trade is visible at all.", "rel": "destination" }, { "to": "kenya", "as": "India's seventh-largest source, counted at the Indian border rather than the Kenyan one.", "rel": "destination" }, { "to": "nigeria", "as": "The outflow whose published quantities disagree with each other by a factor of two.", "rel": "destination" }, { "to": "israel", "as": "Where reaching a hospital is decided by a permit, and the permits are counted by WHO.", "rel": "destination" }, { "to": "mexico", "as": "The one flow that resembles the brochure, and the one whose tail is counted from the other side of the border.", "rel": "destination" }, { "to": "los-algodones", "as": "A town of 5,474 with more than 500 dentists in four blocks, reached on foot.", "rel": "hub" }, { "to": "amman", "as": "Where the regional flow lands, and why it went there rather than to Delhi: the staff and the patient share a language.", "rel": "hub" }, { "to": "the-visa", "as": "The step that decides most of this, and the one no price page prices.", "rel": "step" }, { "to": "counting-patients", "as": "What each of these figures actually counts, set out one instrument at a time.", "rel": "story" } ], "links": [ { "label": "WHO report to the Seventy-sixth World Health Assembly, A76/15", "url": "https://apps.who.int/gb/ebwha/pdf_files/WHA76/A76_15-en.pdf" }, { "label": "Press Information Bureau — medical and wellness travel in India", "url": "https://www.pib.gov.in/PressReleasePage.aspx?PRID=2257447®=3&lang=1" } ], "sources": [ "s:connell-2006", "s:openlibrary-connell-medical-tourism", "s:pib-india-mvt-2026", "s:pib-medical-wellness-tourism-2026", "s:agbi-jordan-2026", "s:jordantimes-2016-drop", "s:dubai-resolution-14-2017", "s:dubai-media-office-health-2023", "s:allafrica-nigeria-pate-2025", "s:who-a76-15-opt", "s:israel-moh-medical-tourism", "s:adams-dental-tourism-2017", "s:wp-los-algodones", "s:spurzem-bariatric-tourism-2025", "s:crush-chikanda-2015" ], "provenance": { "default": { "tier": "cited" }, "fields": { "text.story": { "tier": "cited", "note": "every figure is the publisher's own; the readings of what each flow is made of are marked Inference inline" }, "text.how": { "tier": "inference", "note": "this project's account of what each instrument can support" }, "text.today": { "tier": "inference" } } }, "confidence": "high", "updated": "2026-09-17", "blurb": "The largest flows anyone counts are not Europeans and North Americans buying cheaper surgery.", "region_terms": [ { "key": "global", "name": "Everywhere", "note": "use for a node that belongs to no one country — a standard, a word, a risk" } ], "kin_out": [ { "to": "jordan", "type": "destination", "name": "Jordan", "as": "The trade built on other countries' wars, where the binding constraint is a visa rather than a price.", "rel": "destination" }, { "to": "uae", "type": "destination", "name": "United Arab Emirates", "as": "Buys care abroad for its own nationals under a bylaw that sets the escort's daily allowance by destination.", "rel": "destination" }, { "to": "gcc-sponsored-treatment-abroad", "type": "rule", "name": "Gulf state-sponsored treatment abroad", "as": "The rule record for the state-as-buyer route, with the resolution named and dated.", "rel": "rule" }, { "to": "india", "type": "destination", "name": "India", "as": "The receiving state that counts by source country, which is why the regional shape of this trade is visible at all.", "rel": "destination" }, { "to": "kenya", "type": "destination", "name": "Kenya", "as": "India's seventh-largest source, counted at the Indian border rather than the Kenyan one.", "rel": "destination" }, { "to": "nigeria", "type": "destination", "name": "Nigeria", "as": "The outflow whose published quantities disagree with each other by a factor of two.", "rel": "destination" }, { "to": "israel", "type": "destination", "name": "Israel", "as": "Where reaching a hospital is decided by a permit, and the permits are counted by WHO.", "rel": "destination" }, { "to": "mexico", "type": "destination", "name": "Mexico", "as": "The one flow that resembles the brochure, and the one whose tail is counted from the other side of the border.", "rel": "destination" }, { "to": "los-algodones", "type": "hub", "name": "Los Algodones", "as": "A town of 5,474 with more than 500 dentists in four blocks, reached on foot.", "rel": "hub" }, { "to": "amman", "type": "hub", "name": "Amman", "as": "Where the regional flow lands, and why it went there rather than to Delhi: the staff and the patient share a language.", "rel": "hub" }, { "to": "the-visa", "type": "pathway", "name": "The visa", "as": "The step that decides most of this, and the one no price page prices.", "rel": "step" }, { "to": "counting-patients", "type": "story", "name": "Counting patients", "as": "What each of these figures actually counts, set out one instrument at a time.", "rel": "story" } ], "source_list": [ { "id": "s:connell-2006", "kind": "journal", "title": "Medical tourism: Sea, sun, sand and … surgery", "publisher": "Tourism Management, 2006;27(6):1093–1100", "url": "https://doi.org/10.1016/j.tourman.2005.11.005", "accessed": "2026-09-16", "note": "Connell J. Citation confirmed through the Crossref API" }, { "id": "s:openlibrary-connell-medical-tourism", "kind": "catalogue", "title": "Medical tourism — John Connell, CABI, 2010 (ISBN 9781845936600)", "publisher": "Open Library", "url": "https://openlibrary.org/works/OL15571593W", "accessed": "2026-09-16", "note": "a second CABI title under the same name is catalogued at 2013, ISBN 9781780643694" }, { "id": "s:pib-india-mvt-2026", "kind": "gov", "title": "Medical and Wellness Tourism in India — PIB Backgrounder", "publisher": "Press Information Bureau, Government of India", "url": "https://www.pib.gov.in/PressReleasePage.aspx?PRID=2257447®=3&lang=1", "accessed": "2026-09-16", "note": "posted 2 May 2026; gives 2025 arrivals in India for medical purpose in total and for the seven leading source countries" }, { "id": "s:pib-medical-wellness-tourism-2026", "kind": "web", "title": "Medical and Wellness Tourism in India", "publisher": "Press Information Bureau, Government of India", "url": "https://static.pib.gov.in/WriteReadData/specificdocs/documents/2026/may/doc202652862301.pdf", "accessed": "2026-09-16", "note": "backgrounder dated 2 May 2026; carries the 2025 medical-purpose arrival count, the top source countries, the NABH accreditation count and the visa categories" }, { "id": "s:agbi-jordan-2026", "kind": "news", "title": "Middle East drives Jordan's medical tourism earnings to $1bn", "publisher": "AGBI (Arabian Gulf Business Insight)", "url": "https://www.agbi.com/tourism/2026/06/middle-east-drives-jordans-medical-tourism-earnings-to-1bn/", "accessed": "2026-09-16", "note": "published 17 June 2026, reporting Fawzi Hammouri, president of the Private Hospitals Association, as carried by the Jordan Times" }, { "id": "s:jordantimes-2016-drop", "kind": "news", "title": "'Medical tourism sector witnessed 40% drop in first nine months of 2016'", "publisher": "The Jordan Times", "url": "http://www.jordantimes.com/news/local/medical-tourism-sector-witnessed-40-drop-first-nine-months-2016", "accessed": "2026-09-16", "note": "the Private Hospitals Association attributing the drop to visa restrictions on Sudanese, Libyan, Yemeni and Iraqi nationals. The page would not open for this project on the access date; the figure is carried from the publisher's own listing and is flagged for verification." }, { "id": "s:dubai-resolution-14-2017", "kind": "law", "title": "Administrative Resolution No. (14) of 2017 Approving the Bylaw for Sending Patients for Overseas Medical Treatment", "publisher": "Government of Dubai Legislation portal", "url": "https://dlp.dubai.gov.ae/Legislation%20Reference/2017/Administrative%20Resolution%20No.%20(14)%20of%202017%20Approving%20the%20Bylaw%20for%20Sending%20Patients.html", "accessed": "2026-09-16", "note": "issued 6 February 2017 by the Director General of the Dubai Health Authority; sets eligibility, what the state pays, escort entitlement and a daily allowance schedule by destination country" }, { "id": "s:dubai-media-office-health-2023", "kind": "gov", "title": "Dubai welcomes more than 691,000 international health travellers in 2023", "publisher": "Dubai Media Office, Government of Dubai", "url": "https://mediaoffice.ae/en/news/2024/august/19-08/dubai-welcomes-more-than-691k", "accessed": "2026-09-16", "note": "Dubai Health Authority figures released 19 August 2024; gives arrivals, spend, regional split and the leading specialties. The release does not publish the counting rule behind the headline number." }, { "id": "s:allafrica-nigeria-pate-2025", "kind": "news", "title": "Nigeria Loses $2bn Annually to Medical Tourism — Govt", "publisher": "allAfrica", "url": "https://allafrica.com/stories/202504160076.html", "accessed": "2026-09-16", "note": "April 2025, attributing the figure to Professor Muhammad Ali Pate, Coordinating Minister of Health and Social Welfare. The page would not open for this project on the access date; the attribution is carried from the publisher's own listing and is flagged for verification." }, { "id": "s:who-a76-15-opt", "kind": "org", "title": "Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan — Report by the Director-General (A76/15)", "publisher": "World Health Organization, Seventy-sixth World Health Assembly", "url": "https://apps.who.int/gb/ebwha/pdf_files/WHA76/A76_15-en.pdf", "accessed": "2026-09-16", "note": "dated 17 May 2023; paragraphs 21 and 22 carry the 2022 permit application and approval counts for patients and their companions. Permit data for the Gaza Strip is attributed in the report to the Health Liaison Office of the Palestinian Ministry of Health." }, { "id": "s:israel-moh-medical-tourism", "kind": "gov", "title": "Medical Tourism in Israel", "publisher": "Israel Ministry of Health", "url": "https://www.gov.il/en/pages/medical-tourism-israel", "accessed": "2026-09-16", "note": "published 15 November 2021, updated 20 March 2023; carries the Ministry of Tourism's arrivals estimate and the ministry's account of the 2018 law" }, { "id": "s:adams-dental-tourism-2017", "kind": "web", "title": "Dental tourism industry exploits workers in Mexico", "publisher": "Krystyna Adams, The Conversation, 12 October 2017", "url": "https://theconversation.com/dental-tourism-industry-exploits-workers-in-mexico-85071", "accessed": "2026-09-16" }, { "id": "s:wp-los-algodones", "kind": "encyclopedia", "title": "Los Algodones", "publisher": "Wikipedia", "url": "https://en.wikipedia.org/wiki/Los_Algodones", "accessed": "2026-09-16" }, { "id": "s:spurzem-bariatric-tourism-2025", "kind": "journal", "title": "Getting more than what you pay for? Managing complications of bariatric tourism at an academic center near the US-Mexico border", "publisher": "Spurzem GJ et al., Surgical Endoscopy, 2025, doi:10.1007/s00464-025-11850-x", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12222374/", "accessed": "2026-09-16" }, { "id": "s:crush-chikanda-2015", "kind": "journal", "title": "South–South medical tourism and the quest for health in Southern Africa", "publisher": "Crush J, Chikanda A. Social Science & Medicine 2015;124:313–320", "url": "https://pubmed.ncbi.nlm.nih.gov/24973022/", "accessed": "2026-09-16", "note": "argues that movement to South Africa from the region is larger, in numbers and in money, than the flow from the global North. The abstract page would not open on the access date; the citation and finding are carried here from the publisher's listing and are flagged for verification." } ], "tiers": { "text.what": { "tier": "cited" }, "text.story": { "tier": "cited", "note": "every figure is the publisher's own; the readings of what each flow is made of are marked Inference inline" }, "text.how": { "tier": "inference", "note": "this project's account of what each instrument can support" }, "text.today": { "tier": "inference" } }, "primary_image": null, "tag_facts": [], "recognition_facts": [], "acclaim": 0, "kin_in": [ { "from": "indonesia", "type": "destination", "name": "Indonesia", "as": "A source market whose government counts the money leaving, not the people.", "rel": "story" }, { "from": "jordan", "type": "destination", "name": "Jordan", "as": "The case that undoes the bargain-hunting picture of who a cross-border patient is.", "rel": "story" }, { "from": "kenya", "type": "destination", "name": "Kenya", "as": "The patients who can buy the ticket, and the ones left with what remains.", "rel": "story" }, { "from": "nepal", "type": "destination", "name": "Nepal", "as": "A survey that puts how a patient was treated ahead of what they were charged.", "rel": "story" }, { "from": "romania", "type": "destination", "name": "Romania", "as": "The diaspora trip that is half of this country's inbound trade.", "rel": "story" }, { "from": "south-africa", "type": "destination", "name": "South Africa", "as": "The regional patient this country's larger flow is made of, against the one the brochures show.", "rel": "story" }, { "from": "dubai", "type": "hub", "name": "Dubai", "as": "Why a city can be a source market and a destination in the same week.", "rel": "story" }, { "from": "havana", "type": "hub", "name": "Havana", "as": "Most of Havana's foreign patients come from Latin America, not from the country ninety miles north.", "rel": "story" }, { "from": "johannesburg", "type": "hub", "name": "Johannesburg", "as": "Why a referral patient and an elective patient should never share one arrivals figure.", "rel": "story" }, { "from": "warsaw", "type": "hub", "name": "Warsaw", "as": "Why an arrivals count describes half a city.", "rel": "story" }, { "from": "king-hussein-cancer-center", "type": "facility", "name": "King Hussein Cancer Center", "as": "A caseload that is Syrian, Palestinian, Iraqi and Yemeni before it is anything else, and a literature of displacement rather than of price.", "rel": "story" }, { "from": "gcc-sponsored-treatment-abroad", "type": "rule", "name": "Gulf state-sponsored treatment abroad", "as": "The half of the subject where the state, not the patient, is the buyer.", "rel": "story" }, { "from": "john-connell", "type": "person", "name": "John Connell", "as": "The question his 2006 paper set, and the one this site keeps returning to.", "rel": "story" } ] } ] }