| Independently reported | |
| Statistical treatment | Residence, not nationality, decides whether care is an export[1] |
|---|---|
| Residence guideline | One year or more suggested as a flexible guideline[1] |
| Formal definition of expatriate | None in the statistical standards; studies invent their own rule[3] |
| No band claims verification against a primary record: the residence rules were read in guidance explaining the standard, not in the standard itself. No provider-supplied figures are used. | |
Expatriate healthcare is care obtained by foreign nationals living in the country where they receive it, rather than by people who travelled there for treatment. The distinction matters for counting. Statistical guidance published by the World Trade Organization states that the residence concept is not based on nationality or legal criteria but on a transactor’s centre of predominant economic interest, and suggests a period of one year or more as a flexible guideline for determining residence.[1]
The same guidance sets out an exception directly relevant to medical travel: the one-year guideline does not apply to students studying abroad or patients receiving health care abroad, who remain residents of their economies of origin even if they stay longer than one year.[1] On that basis a foreign national settled in a country for a year or more is a resident of it, so their treatment is domestic consumption rather than an export of health services, while someone who crosses a border for treatment stays a resident of home however long the stay lasts.
Usage in medical travel
Published counts of medical tourists frequently do not draw that line. NaRanong and NaRanong record that Thailand provided medical services for as many as 1.4 million foreign patients in 2007, a figure that included medical tourists, general tourists and foreigners working or living in Thailand or neighbouring countries, and note that singling out data for medical tourists is difficult because the national data separates Thais from foreigners but not medical tourists from other foreign patients.[2]
Those authors then assume that about 30 per cent of foreign patients were medical tourists, with roughly 60 per cent resident in Thailand and 10 per cent tourists who fell ill, and derive a figure of about 420,000.[2] That split appears in the paper’s method as an assumption for a calculation, with no external source cited for it. It is widely repeated as though it were a measurement of Thailand’s patient mix, and it is not.
Where a study does exclude residents it must invent a rule. Noree, Hanefeld and Smith report that expatriates were excluded from their Thai hospital dataset by permanent postal address in Thailand, a stay of more than six months, and whether the person worked in Thailand.[3] That six-month threshold does not match the one-year guideline in the statistical guidance, so two datasets can both exclude expatriates and still count different people.
The OECD scoping review lists whether to count expatriates, and those funded by multinational employers, among the open questions in defining the count, and records one industry definition that excludes expatriates, unplanned emergency surgery and outpatients altogether.[4]
Related terms
Non-resident patient is the term the statistical standards imply, and it is not interchangeable with foreign national. No official document was identified stating explicitly whether any particular country includes resident foreigners in its published medical tourist total, and the only sources that address the question say the data does not separate the groups.
See also
- International patients, the wider counting problem residence and nationality create
- Diaspora medical travel, travel to a country of origin rather than care where one lives
- Medical travel for older adults, including how pensioners resident abroad obtain care
- Inbound medical tourism, the flow these patients are often counted inside
References
- World Trade Organization. Measuring Trade in Services: A Training Module. November 2010, pages 13 to 15. Independently reported: guidance restating an international statistical standard, not the standard itself. Retrieved 30 September 2026.
- NaRanong A, NaRanong V. The effects of medical tourism: Thailand’s experience. Bulletin of the World Health Organization, 2011, 89(5), pages 336 to 344. Independently reported: peer-reviewed research published by WHO, not WHO policy. Retrieved 30 September 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. DOI 10.1186/1744-8603-10-29. Independently reported: analysis of hospital records. Retrieved 30 September 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, 2011, pages 14 to 15. Independently reported: commissioned scoping review. Retrieved 30 September 2026.
Sourcing note: no claim here has been read from a primary register or from the statistical standards themselves. The residence rules were read in World Trade Organization training guidance that restates them; the underlying manuals could not be retrieved on 30 September 2026. The Thai 60, 10 and 30 per cent split is identified in this entry as an assumption in the cited paper’s method rather than a measurement, because it is commonly repeated as the latter. No national authority’s statement on whether it counts resident foreigners in its medical tourist totals was located.