| Verified against primary record | |
| Where it sits | A supplementary item under personal travel, within travel in the services account[1] |
|---|---|
| What it covers | Medical and dental services, other health care, food, accommodation and local transport[1] |
| Current standard | BPM7, released 20 March 2025[2] |
| Records read | The IMF guidance note, the IMF release, the United Nations tourism standard and two BEA publications, 2 October 2026 |
| Independently reported | |
| Companions, under BPM7 | Categorised as normal travellers, their spending recorded under other personal travel[1] |
| Bands apply only to the rows beneath them. BPM6 wording is quoted as reproduced in the IMF guidance note, the manual itself being inaccessible. | |
Balance of payments statistics are where almost every official national figure for medical tourism spending comes from, under the heading health-related travel. The category is narrower, and more conditional, than the figures derived from it usually suggest.
Where health-related travel sits
In the international standard, travel credits cover goods and services for own use or to give away acquired from an economy by non-residents during visits to that economy. Within travel, personal travel divides into education-related travel, health-related travel and other personal travel.[3]
Health-related travel is a supplementary item under the standard item personal travel, and by its definition it covers medical and dental services, other health care, food, accommodation and local transport acquired by persons travelling abroad for medical reasons.[1] Two features of that definition matter more than the list itself. It is supplementary rather than a required reporting line, so not every country publishes it. And it is bounded by purpose, so it depends on something no accounting rule can observe.
The IMF’s own account of the problems
The most useful document in this field is the guidance note prepared for the revision of the manual, because it is the standard-setter writing down what does not work. It records that different interpretations of what can and cannot be considered medical reasons, and who can and cannot be considered health travellers, could lead to differences in coverage, and that confusion may arise because health expenditures by those not travelling for a health purpose, such as persons receiving health services during a holiday trip, are included under the other personal travel subcomponent. It states that national compilers have asked that these points be explicitly clarified.[1]
The annex on measurement difficulties is blunter still. Immigration offices cannot segregate patients and companions travelling on tourist visas. Hospitals lack information on companions staying outside the facility. And on estimation it concludes that medical expenses tend to vary tremendously across diseases and treatment techniques, hindering compilers from forming clusters, so that unlike the case of estimating expenses of normal tourists, applying an arithmetic or geometric average of medical expenses to the number of patients would not yield reasonably good estimates of health-related expenses.[1]
That last sentence invalidates the most common method used in commercial market sizing, which multiplies an assumed average spend per patient by an assumed patient count.
What changed in the seventh edition
The new manual was released on 20 March 2025, titled the Integrated Balance of Payments and International Investment Position Manual, the previous update having dated to 2009.[2] Two decisions recorded in the guidance note affect this subject directly.
On scope, the term medical reasons should follow the scope of health and medical care as specified in the United Nations tourism standard, which brings in cosmetic surgeries using medical facilities and services.[1] That settles a long-running ambiguity in favour of including elective aesthetic procedures.
On companions, the option adopted was to categorise patients’ companions as normal travellers and record all companions’ expenses under other personal travel.[1] The practical consequence is that a published health-related travel figure deliberately excludes the spending of the people who travelled with the patient, even though that spending exists and is attributable to the medical trip. Any comparison with a commercial market estimate that includes companions is comparing two different quantities.
The tourism standard underneath it
Because the scope now defers to the tourism standard, that standard’s definitions become operative. A visitor is a traveller taking a trip to a main destination outside the usual environment, for less than a year, for any main purpose other than to be employed by a resident entity in the country or place visited.[4] That single clause is what separates a medical traveller from a resident foreign patient, discussed in medical travelers and resident foreign patients.
Main purpose is defined as the purpose in the absence of which the trip would not have taken place, and for travel parties the main purpose should be the one that is central to the decision to take the trip.[4] Health and medical care is one of eight purpose categories in the classification, and it carries no sub-structure.[5] There is therefore no official breakdown by procedure anywhere in this framework, which is why national series cannot answer questions about which treatments people travelled for. The tourism standard does not itself use the term medical tourism.
How one country actually estimates it
The United States moved health-related travel into travel with the monthly trade report of 4 June 2014, having previously placed it in a category called other personal services, in order to bring the accounts into closer harmony with data produced by trading partners following a recommendation in the sixth edition of the manual. The agency’s own illustration of the category is a foreign person travelling to the United States for surgery.[6]
The estimate itself comes from a survey. For statistics on health-related travel, estimates use data from the Survey of International Air Travelers about the incidence and expenditures of travellers travelling for health purposes.[3] A national account line of this kind is a survey-based estimate of self-reported purpose and spending, not a count of hospital transactions, and its reliability is the reliability of that survey.
See also
- Medical tourism revenue, what the money figures do and do not include
- Medical travelers and resident foreign patients, the residence boundary this framework draws
- Medical tourism market size, the commercial estimates this is often confused with
- Medical tourism surveys, including the passenger survey this estimate rests on
References
- International Monetary Fund, Committee on Balance of Payments Statistics. 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: note and measurement annex read in full, including BPM6 wording as reproduced there. Retrieved 2 October 2026.
- International Monetary Fund. IMF and statistical community release new global standards for macroeconomic statistics. Press release 25/072, 20 March 2025. Verified against primary record: release opened and read. Retrieved 2 October 2026.
- United States Bureau of Economic Analysis. U.S. International Services. Survey of Current Business, October 2020. Verified against primary record: travel component definitions and estimation method read. Retrieved 2 October 2026.
- United Nations and World Tourism Organization. International Recommendations for Tourism Statistics 2008. Series M No. 83 Rev.1. Verified against primary record: visitor, main purpose and travel party definitions read at the cited paragraphs. Retrieved 2 October 2026.
- United Nations Statistics Division. Classification of tourism trips by main purpose. Classifications Registry. Verified against primary record: full category structure read. Retrieved 2 October 2026.
- United States Bureau of Economic Analysis. Health and education-related travel now part of travel. 16 June 2014. Verified against primary record: agency post opened and read. Retrieved 2 October 2026.
Sourcing note: the IMF guidance note, the IMF release, the tourism standard, the classification registry entry and the two BEA publications were opened and read for this entry on 2 October 2026. The sixth edition of the manual is not directly accessible, so its wording is quoted only as the guidance note reproduces it, and the travel text of the seventh edition was not reached. The distinction between a non-resident traveller and a resident foreign national is treated here as analysis, since none of these sources addresses it directly.