| Independently reported | |
| Claimed medical tourists (2011) | 48,253, stated by the promotion body Promed, up from 36,000 in 2010[1] |
|---|---|
| Competing figure from the same body | About 40,000 for the same year, in other press interviews[1] |
| Counting method | Hotels, clinics, agencies and restaurants each counted the same patient[1] |
| Effect of removing double counting | The 2011 figure could fall to around 20,000[1] |
| Procedure mix claimed | 42 per cent dental, 22 per cent surgery-related, 16 per cent preventive, 10 per cent cosmetic, 10 per cent other[1] |
| Central America in United States outbound health travel | 18 per cent of destinations, and 10 per cent of inbound source markets in 2011[2] |
| Regional risk record | Dental care is the most common form of medical tourism among United States residents[3] |
| This entry has no primary-record band. No Costa Rican government statistical publication on medical tourism was located; the figures come from an industry promotion body as reported by a trade publication in December 2012, and are therefore both second-hand and more than a decade old. They are reproduced because the dispute about how they were produced is the most instructive thing in the Costa Rican record, not because they are reliable counts. No typical cost range is given. | |
Medical tourism in Costa Rica provides the clearest documented example in this series of how destination patient counts are inflated. The national promotion body claimed 48,253 medical tourists in 2011. A critic within the Costa Rican medical travel industry pointed out that hotels, clinics, agencies and restaurants had each counted the same patient, and that correcting for it could reduce the figure to around 20,000.
The figures claimed
A report published on 14 December 2012 records that Promed, the body for international promotion of Costa Rican medicine, said Costa Rica received 48,253 medical tourists in 2011, up from 36,000 in 2010, which was itself a 20 per cent rise on 2009. It put average spending at 7,000 dollars per tourist, implying about 338 million dollars of revenue, and had reported roughly 252 million dollars for 2010.[1]
The same body gave different figures elsewhere. In other press interviews it claimed 196 million dollars spent on health care plus 84 million on hotels, meals, travel and shopping, and cited about 40,000 tourists for the same year. On the business side it counted 1,223 medical tourism businesses in San Jose averaging 38 procedures a year each, and 109 clinics serving medical tourists in Guanacaste averaging 16.3 tourists each a year. Massimo Manzi of Promed gave the procedure mix as 42 per cent dental, 22 per cent surgery-related, 16 per cent preventive, 10 per cent cosmetic and 10 per cent other.[1]
Two totals from one organisation for one year, 48,253 and about 40,000, is the first warning sign. A difference of that size is not a rounding convention.
How the count was built
Timothy Morales of Costa Rican Medical Care is reported saying these numbers are way out of line, arguing that the implied daily patient volumes, especially for dental work, were implausible and that the same patient was being counted repeatedly. The report records that hotels, clinics, medical travel agencies and restaurants each counted the same patient so that the totals overlap, which Morales called very misleading, and that Promed defended the approach as necessary to total the industry’s revenue and measure economic impact while conceding it could appear misleading.[1]
The report states that Promed needed to revise its figures to count actual patients without double counting, and that by its estimate doing so could reduce the 2011 figure to around 20,000.[1]
The arithmetic check Morales applied is the useful part, and it generalises. Promed’s own business counts imply 1,223 San Jose businesses handling 38 procedures each a year, which is about one procedure per business per fortnight. For a sector described as a major export earner, that is an implausibly thin caseload spread across an implausibly large number of providers, which is the signature of a count assembled by adding up touchpoints rather than patients.
It is worth being precise about what Promed was doing, because it is not simply error. Summing spending across hotels, clinics and restaurants is a reasonable way to estimate the economic impact of a visitor, and that is what Promed said the method was for. The failure is in then reporting the number of touchpoints as a number of people. Revenue impact and patient headcount are different quantities, and a figure built for one cannot be published as the other.
Regional position
A 2015 briefing by an economist in the United States International Trade Commission’s Office of Industries, published as the author’s own views and not the Commission’s, records Central America as 18 per cent of destinations for outbound United States health travellers and 10 per cent of source markets for inbound travellers in 2011, with the Caribbean at 44 per cent of inbound source markets and 19 per cent of outbound destinations, and South America at 26 per cent of outbound destinations. It gives the global estimate of roughly 3 million patients travelling for healthcare each year.[2]
The Centers for Disease Control and Prevention records that dental care is the most common form of medical tourism among United States residents, which fits Promed’s claim that 42 per cent of its traffic was dental, and names several South American countries, the Caribbean, Mexico and Canada as the most common destinations.[3]
So the shape of the Costa Rican claim is plausible even where its magnitude is not. A dentistry-led destination serving United States patients is exactly what the regional pattern would predict, which is why the inflation of the headline figure matters: it discredits a real activity by overstating it.
Limits of the evidence
Everything in this entry about Costa Rica comes from a single trade publication report from December 2012, which is both second-hand and more than a decade old. No Costa Rican government source was located, whether from the social security institute, the health ministry or the tourism institute, and no Costa Rican accreditation register was found. Whether Promed revised its method after 2012 could not be established. The figures are reproduced for the methodological dispute they document, not as current measures of the sector.
See also
- International patient visits and unique patients, the distinction Promed collapsed
- Medical tourism revenue, the quantity the method was actually built for
- Dental tourism, 42 per cent of the claimed traffic
- Medical tourism statistics, and how destination counts are inflated
- Conflicts of interest in medical tourism research, where the counter is also the promoter
References
- International Medical Travel Journal. Costa Rica medical tourism numbers under question. Published 14 December 2012. Independently reported: the report was opened and Promed’s figure of 48,253 medical tourists in 2011 against 36,000 in 2010 and a 20 per cent rise on 2009, the average spending figure of USD 7,000 per tourist implying about USD 338 million and the roughly USD 252 million reported for 2010, the competing claims in other press interviews of USD 196 million on health care plus USD 84 million on hotels, meals, travel and shopping with about 40,000 tourists for the same year, the counts of 1,223 medical tourism businesses in San Jose averaging 38 procedures a year each and 109 Guanacaste clinics averaging 16.3 tourists each a year, the procedure mix attributed to Massimo Manzi of Promed, the criticism by Timothy Morales of Costa Rican Medical Care that these numbers are way out of line and that implied daily volumes especially for dental work were implausible, the finding that hotels, clinics, medical travel agencies and restaurants each counted the same patient so that totals overlap, Morales’s description of this as very misleading, Promed’s defence that the approach was needed to total industry revenue and measure economic impact while conceding it could appear misleading, the statement that Promed needed to revise its figures to count actual patients without double counting, and the estimate that doing so could reduce the 2011 figure to around 20,000 were read directly. No government tourism institute is named in the report. Retrieved 23 October 2026.
- Chambers, A. Trends in U.S. Health Travel Services Trade. Office of Industries, United States International Trade Commission, Executive Briefing on Trade, August 2015. Independently reported: the briefing was opened and the 2011 source market shares for inbound United States health travellers of Caribbean 44 per cent, Europe 24 per cent and Central America 10 per cent, the outbound destination shares of South America 26 per cent, Caribbean 19 per cent and Central America 18 per cent, and the global estimate that roughly 3 million patients are thought to travel for healthcare each year were read directly. The briefing states that the views expressed are those of the author and not those of the Commission. Retrieved 23 October 2026.
- Stoney, R. J. and Leidel, L. Medical Tourism. CDC Yellow Book: Health Information for International Travel, 2026 edition, United States Centers for Disease Control and Prevention. Page dated 23 April 2025. Independently reported: the chapter was opened and the statement that dental care is the most common form of medical tourism among United States residents, the list of most common procedures sought comprising cosmetic surgery, dental care, cancer treatment, fertility treatment and organ transplantation, and the naming of Mexico, Canada, the Caribbean and several South American countries as the most common destinations were read directly. Retrieved 23 October 2026.
Sourcing note: the Promed figures are reported here as contested claims and never as counts, and the entry sets out the arithmetic that makes them implausible rather than simply asserting that they are wrong. It also states what was defensible about Promed’s method, because the error was in how the output was labelled rather than in the summing itself. The source is more than a decade old and second-hand, and both facts are stated. Nothing has been estimated.