| Verified against primary record | |
| The statistical basis | Trade in travel turns on residence, not nationality[1] |
|---|---|
| What two countries report | Germany and Austria state that their discharge figures include residents and non-residents together[2] |
| Missing definition | The European collection has a non-resident indicator but no common definition of non-resident[3] |
| Records read | A balance of payments guidance note and two statistical metadata sources, 2 October 2026 |
| Independently reported | |
| Effect on counts | One firm’s markedly lower estimates arose from excluding dental patients and expatriates[4] |
| Bands apply only to the rows beneath them. No figure is given for how much of any published count is resident foreign patients, because none was located. | |
Medical travellers and resident foreign patients are two groups that hospital records often cannot tell apart and that promotional figures routinely merge. A medical traveller crosses a border to obtain treatment. A resident foreign patient lives in the country where they are treated and holds another nationality. Their clinical care may be identical and their passports the same, but statistically they are opposites, and counting the second as the first inflates every figure it touches.
Why residence rather than nationality is the test
In international economic statistics the relevant category is residence. Travel credits, under the international balance of payments framework, cover goods and services acquired from an economy by non-residents during visits to that economy.[1] Nationality does not appear in the test.
It follows from that definition that a foreign national who lives in the treating country is not making a visit and is not a non-resident, so their treatment generates no export of travel services at all, however foreign their passport. That inference is sound on the face of the definition, but no source read for this entry states it, and it is offered here as a reading of the framework rather than as a sourced claim.
The practical difficulty is that hospitals record what they need for billing and clinical care, not what a statistician needs. A registration system may capture nationality, or country of birth, or an address, or nothing at all, and only an address reliably answers the residence question.
What the collections actually record
The European hospital activity collection does carry a residence-based indicator, published as the percentage of non-residents among all hospital discharges.[3] What it does not carry is a definition. Neither the methodology page nor the dataset metadata gives any wording defining a resident against a non-resident, or states whether the classification turns on residence or nationality, and no nationality variable is listed among the collected items.
In the country notes accompanying the definitions, Germany and Austria both record that their figures include residents and non-residents.[2] That is a worse situation than a missing variable: the national totals are contaminated rather than silent, and a user cannot tell from the figure how much of it is which.
How much it changes the answer
A review commissioned by an international economic organisation documents the effect directly. It found that published counts of medical tourists worldwide span orders of magnitude, and records that one firm’s markedly lower estimates arose from deliberately excluding dental patients and expatriates.[4] Two methodological choices, one of them precisely this distinction, account for a difference of that scale.
The same confusion has been documented at destination level. A 2014 study of British patients in Thailand carries the finding in its title, that they are not who you think they are, and it excluded expatriates by design in order to isolate people who had actually travelled for treatment.[5] The need to make that exclusion explicit indicates how much of the apparent flow it accounts for.
No figure is offered here for what proportion of any published international patient count is made up of resident foreign nationals, because no source located measures it. The point of the entry is that the question is almost never asked of a figure, and that a figure which cannot answer it is not a count of medical travel.
Related distinctions
Three further groups sit near this boundary and are counted inconsistently. A person treated incidentally while abroad for another reason is not a medical traveller under the purpose-based tourism definition, but will appear in a hospital’s foreign patient figures. A cross-border commuter or a border-area resident using the nearest hospital, which happens to be across a frontier, is a non-resident at that hospital but is not travelling for treatment in any ordinary sense. And a diplomat, a service member or a student on a long placement may be resident for statistical purposes while remaining foreign in every other.
See also
- Expatriate healthcare, the arrangements of the group most often miscounted
- International patient visits and unique patients, the other great conflation
- Cross-border healthcare for border communities, non-residents who are not travelling
- Medical tourism and balance of payments statistics, where the residence test comes from
References
- International Monetary Fund, Committee on Balance of Payments Statistics, Current Account Task Team. Guidance Note C.7: Treatment of Travel Packages, Health-Related Travel, and Taxes and Fees on Passengers’ Tickets. Approved March 2022. Verified against primary record: guidance note opened and read; the manual itself could not be opened and its definitions are quoted as this note reproduces them. Retrieved 2 October 2026.
- Eurostat. Health care activities: definitions and data collection specifications annex. Verified against primary record: statistical metadata annex opened and read. Retrieved 2 October 2026.
- Eurostat. Healthcare non-expenditure statistics: methodology. Verified against primary record: statistical methodology page opened and read. Retrieved 2 October 2026.
- Lunt N, Smith R, Exworthy M, Green ST, Horsfall D, Mannion R. Medical Tourism: Treatments, Markets and Health System Implications: A scoping review. 2011, commissioned by the OECD Directorate for Employment, Labour and Social Affairs. Verified against primary record: officially commissioned review opened and read. Retrieved 2 October 2026.
- Noree T, Hanefeld J, Smith R. UK medical tourists in Thailand: they are not who you think they are. Globalization and Health, 10:29, 6 May 2014. Independently reported: peer-reviewed study. Retrieved 30 September 2026.
Sourcing note: the balance of payments guidance note and the two statistical metadata sources were opened and read on 2 October 2026. The manual the guidance note quotes could not be opened directly, so its definitions are attributed as the note reproduces them. The conclusion that a resident foreign national generates no export of travel services is presented as a reading of the residence-based definition, because no source read states it. The study of British patients in Thailand was opened for earlier work on this site and is dated accordingly. No proportion is given for resident foreign patients within any published count, because none was located.