Medical Tourism Patient Flows

Medical tourism patient flows are the movements of patients between countries: who goes where, in what numbers and in which direction. Only one region measures them systematically, and what it measures looks very little like the picture presented in medical travel marketing.

What the measured flows look like

The European Commission’s data collection under the cross-border healthcare directive states the pattern in one sentence: cross-border healthcare concerns mostly neighbouring countries. For reference year 2022 the busiest flows of patients requiring prior authorisation ran from Slovakia to Czechia and from Luxembourg to Germany, and the busiest flows not subject to prior authorisation from France to Spain, Italy and Belgium, from Denmark to Germany, and from Poland to Czechia.^[1]

A later trend report covering 2021 to 2023 finds the same shape, recording that most countries treating more than 100 cross-border patients share a border with Germany or Luxembourg, the two states receiving the most prior authorisation requests in that period.^[4] The European Court of Auditors reached the same conclusion about geography and put the scale in context, reporting that the majority of patient mobility has been between neighbouring member states and that approximately 200,000 patients a year use the systems put in place under the directive, representing less than 0.05 per cent of European Union citizens.^[2]

Every one of those named flows is a journey between adjacent countries, several of them short enough to make by car. This is the single most consistent finding in the measured data, and it sits awkwardly beside the long-haul model that organises most writing about medical travel. Where patient movement is actually counted, it is overwhelmingly a regional phenomenon.

Direction and concentration

Flows are also concentrated in a small number of origin and destination countries. For 2020 the leading countries of affiliation for prior authorisation were France with 1,646 requests, Ireland with 924 and Luxembourg with 597, and the leading destinations were Germany, Czechia, Spain and the United Kingdom.^[5]

Two cautions belong with those numbers. The French figure is not clean, because France could not separate requests made under the directive from those made under the social security coordination rules, and France is the largest single contributor. And 2020 was severely affected by the pandemic, so it should not be read as a typical year.^[5]

What these figures do not cover

The European data describes activity recorded under one legal instrument, which is a narrow slice of the whole. It excludes privately funded travel entirely, which is most of what the medical travel industry consists of. It records requests, authorisations, reimbursements and amounts, but has no field for the reason for travel and no breakdown by disease. Eight member states operated no prior authorisation system at all, and several could not answer parts of the questionnaire, which the Commission notes may lead to an underestimation.^[5]

It also cannot be assembled into a global picture, because nothing equivalent exists elsewhere. A 2010 peer-reviewed review states that there is no reliable hard data on patient numbers, flows, treatment types and success rates, and that estimates of patient and currency inflows are wildly varied because definitional issues confound the attempt to determine the scale of the industry.^[3]

So the honest summary is narrow but firm. Within one bloc, for publicly funded care, under one instrument, the flows are measured, small relative to the population, and almost entirely between neighbours. Beyond that, the direction and magnitude of patient movement is not known.

See also

• Source markets in medical tourism, the origin side of a flow
• Destination markets in medical tourism, the receiving side
• Cross-border healthcare for border communities, which much of this movement actually is
• Medical tourism statistics, the overview of what is measured

References

1. European Commission, Directorate-General for Health and Food Safety. Member State data on cross-border patient healthcare following Directive 2011/24/EU. Reference year 2022, final version January 2024. Verified against primary record: official statistics publication opened and read. Retrieved 30 September 2026.
2. European Court of Auditors. EU actions for cross-border healthcare: significant ambitions but improved management required. Special Report 7/2019. Verified against primary record: audit report opened and read. Retrieved 30 September 2026.
3. Johnston R, Crooks VA, Snyder J, Kingsbury P. What is known about the effects of medical tourism in destination and departure countries? A scoping review. International Journal for Equity in Health, 9:24, 2010. Independently reported: peer-reviewed scoping review. Retrieved 2 October 2026.
4. European Commission, Directorate-General for Health and Food Safety. Member State data on cross-border patient healthcare: Trend Report, reference years 2021 to 2023. Final version September 2025. Verified against primary record: official statistics publication opened and read. Retrieved 30 September 2026.
5. Olsson J, De Smedt L, De Wispelaere F. Data on patient mobility under Directive 2011/24/EU: Trend report, reference years 2018 to 2020. European Commission, December 2021. Verified against primary record: official data collection opened and read. Retrieved 2 October 2026.

Sourcing note: the Commission data publications, the trend reports and the audit report were opened and read for this site, the two 2021 to 2023 and 2022 publications on 30 September 2026 and the rest on 2 October 2026. The named flows and country figures are reproduced with the limitations the Commission itself states, including that France cannot separate requests under the two legal routes and that 2020 was pandemic-affected. The figures describe publicly funded activity under one instrument and exclude privately funded travel, which is stated rather than glossed. No global flow figures are given, because none exist.