| Verified against primary record | |
| The governing instrument | The WHO Global Code of Practice, adopted by resolution WHA63.16; the Code is voluntary[1] |
|---|---|
| Its operative provision | Member States should discourage active recruitment from developing countries facing critical shortages[1] |
| What it does not cover | A targeted read of the Code found no reference to medical tourism or patient mobility[1] |
| Safeguards list, 2023 edition | 55 countries, selected on workforce density and service coverage thresholds[2] |
| Records read | The Code, two WHO publications, a governing body report and three research papers, 9 October 2026 |
| Independently reported | |
| The internal brain drain claim | Concerns exist, with little empirical evidence of whether it is happening[4] |
| Bands apply only to the rows beneath them. The count of countries on the 2026 edition of the safeguards list is not published here, because no WHO-hosted page stating it was located. | |
Medical tourism and health workforce migration are routinely discussed together, usually by way of an instrument that does not in fact address the connection. Two distinct mechanisms are involved, and only one of them is covered by international policy.
Two different mechanisms
The first is international recruitment, where a clinician trained in one country is hired by a health system in another. That is the subject of global policy. The second is internal movement, where a clinician trained and remaining in their own country moves from the public sector to a private hospital serving foreign patients. That is the mechanism medical tourism is accused of driving, and it is not an international migration at all.
Conflating them is the commonest error in this area, and it matters because the available instrument addresses only the first.
What the international instrument says, and does not say
The World Health Organization’s global code of practice on the international recruitment of health personnel was approved by member states in resolution WHA63.16 and is intended as a core component of bilateral, national, regional and global responses to the challenges of health personnel migration. Its stated objective is to establish and promote voluntary principles and practices for the ethical international recruitment of health personnel, and it states plainly that the Code is voluntary.[1]
Its operative recruitment provision asks that member states discourage active recruitment of health personnel from developing countries facing critical shortages of health workers, and that destination countries collaborate with source countries on sustaining health human resources. Elsewhere it asks member states to work towards effective workforce planning, education, training and retention strategies that will reduce their need to recruit migrant health personnel.[1]
The finding that matters most for this entry is an absence. A targeted read of the Code for medical tourism, patient mobility and private hospitals serving foreign patients returned nothing; the nearest wording concerns public and private sectors in the context of training health personnel.[1] The instrument most often invoked in medical tourism workforce debates does not mention medical tourism. Nor does the organisation’s most recent report to its governing body on the Code’s operation.[3]
The safeguards list, and a figure not to quote
Attached to the Code is a list of countries for which active international recruitment is discouraged. The 2023 edition comprises 55 countries, described as facing the most pressing health workforce challenges related to universal health coverage, selected on two criteria: a density of doctors, nurses and midwives below the global median, given as 49 per 10,000 population, and a universal health coverage service coverage index below a threshold.[2]
The organisation presents a 2026 edition as current, restating the thresholds and recommending that recruiters refrain from active international recruitment from countries on the list, while noting that member states can request exemptions so the final list can differ from the technical criteria.[2] No page hosted by the organisation and retrievable for this entry states how many countries the 2026 edition contains, so no count for it is published here. A figure of 36 circulates from a member state consultation letter which describes it as provisional; it is not reproduced as current.
One detail is widely mis-stated and worth fixing: the figure of 49 per 10,000 is a comparison threshold derived from the global median, not a recommended workforce density.
The scale of the underlying imbalance is documented. Countries on the 2023 list hold only 5 per cent of the world’s doctors, nurses and midwives, while high-income countries hold 23 per cent with 9 per cent of the world’s population. Approximately 72,000 foreign-trained physicians and 164,000 foreign-trained nurses originated from list countries. Of member states reporting, 66 of 85 indicated that international recruitment is a national concern and 48 of 85 that migration has been increasing, with 94 bilateral agreements reported. The same report names geographical maldistribution within countries as a distinct problem, and notes that private recruitment agencies play a key role.[3]
The internal brain drain claim, and its evidence
A review commissioned by the OECD states the position squarely: there are concerns that medical tourism will cause an internal brain drain from public to private systems, and there is little empirical evidence of whether this is happening. It notes the argument that this is possible since hospitals catering for medical tourists can offer competitive salaries, and records two studies pointing in different directions, one finding an internal brain drain in Thailand’s system and another attributing the effect mainly to domestic private patients rather than foreign ones.[4] That review is from 2011.
The strongest quantified source-country case is older still and is careful about its own limits. A 2004 study reported a survey finding 470,000 foreign patient visits at seven hospitals, a 38 per cent increase from 2000, suggested the total for 2001 could be around 1 million, and estimated that the workload was equivalent to 3 to 4 million Thai patients, around 3 per cent of the system’s total workload in 2001, projecting that it might reach 12 per cent within five years if growth continued. It reported a rural district-hospital bed-to-doctor ratio rising from 7.1 in 1988 to 15.3 in 1998, and physician losses relative to new ministry recruits of 4.5, 7.6 and 32.2 per cent in 2000, 2001 and 2002.[5]
Three conditions belong with that. The paper does not directly count doctors who moved to private hospitals; its migration evidence is indirect, from ratios, income differentials and recruitment data. Its data are from 2001 and 2002. And a figure of around 4,000 additional full-time-equivalent doctors, often quoted from it, is a government proposal the authors cite rather than their own estimate.
More recent work in an emerging destination measured expectations rather than outcomes. A study based on 50 interviews in Guatemala reported participants anticipating that competition would oblige physicians to raise their level, that better-paying facilities would attract staff, and that migration would occur out of lower-salaried public sector positions. Its authors describe their contribution as early, forward-looking insight and note that the spillover-benefit literature is typically speculative in nature and such benefits are rarely evidence-based.[6] Those are stakeholder perceptions of anticipated effects, not measured movement.
What is not established
No source located for this entry quantifies movement of clinicians from public to private employment attributable to medical tourism. The organisation’s projected global shortfall of 11.1 million health workers by 2030 is a universal health coverage projection and is not attributed by it to medical tourism,[7] so placing the two side by side without saying so would imply a link the organisation does not make.
See also
- Medical tourism and local access to care, the displacement question this feeds into
- Medical tourism and health system capacity, capacity effects more broadly
- Medical tourism and public subsidies, who pays for the training these clinicians received
- Medical tourism and health equity, the distributional framing
References
- World Health Organization. WHO Global Code of Practice on the International Recruitment of Health Personnel, adopted by resolution WHA63.16; publication record dated 20 May 2010. Verified against primary record: articles read, and the absence of any reference to medical tourism or patient mobility confirmed by a targeted read of the document. Retrieved 9 October 2026.
- World Health Organization. WHO health workforce support and safeguards list 2023, published 8 March 2023, with the organisation’s questions and answers page, dated 5 August 2026. Verified against primary record: the 2023 count and criteria were read, and the questions and answers page was read and found not to state the 2026 count. Retrieved 9 October 2026.
- World Health Organization Executive Board, 156th session. Report on the WHO Global Code of Practice on the International Recruitment of Health Personnel, document EB156/14. Verified against primary record: workforce distribution figures and member state reporting read; the report contains no reference to medical tourism. Retrieved 9 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. OECD Directorate for Employment, Labour and Social Affairs, document DELSA/HEA/WD/HWP(2011)3, 2011. Verified against primary record: the internal brain drain discussion read, including its characterisation of the two studies it cites. Retrieved 9 October 2026.
- Wibulpolprasert S, Pachanee C, Pitayarangsarit S, Hempisut P. International service trade and its implications for human resources for health, a case study of Thailand. Human Resources for Health, 2004;2:10, published 29 June 2004. Independently reported: peer-reviewed study read in full, including the attribution of the additional-doctors figure to a government proposal. Retrieved 9 October 2026.
- Crooks VA, Labonte R, Ceron A, Johnston R, Snyder J, Snyder M. Medical tourism and health workforce in Guatemala. Human Resources for Health, 2019;17:53. Independently reported: peer-reviewed qualitative study read; the quoted expectations are interviewees’ words reported by the authors. Retrieved 9 October 2026.
- World Health Organization. Health workforce. Undated topic page. Verified against primary record: the projected shortfall figure read; the page makes no attribution to medical tourism. Retrieved 9 October 2026.
Sourcing note: the Code, the safeguards list and questions and answers page, the governing body report and the three research papers were opened and read on 9 October 2026. The absence of any reference to medical tourism in the Code and in the governing body report is reported as the result of targeted reads of those documents. No count is published for the 2026 edition of the safeguards list, because no page hosted by the organisation and retrievable for this entry states one; a figure circulating from a consultation letter is described there as provisional and is not reproduced. The Thai figures are from 2001 and 2002 and the review characterising the evidence is from 2011, and both are dated in the text.