Cross-border care operations in numbers, 2026

This report collects figures that matter to people who run care across borders. Every number already sits in a note on rolstonpaul.com or in my public dataset. Each one names its source. I have not added any total or percentage of my own.

The reader I have in mind runs a service in more than one market. That could be a hospital group, a clinic network, a facilitator or a franchise. The patient may fly from London, Dhaka or anywhere else. The standard has to hold in all of those places at once.

Medical travel is one domain here. Most of the lessons are about operations: ads, people, contracts, records and safety.

Numbers in this field travel fast and lose their source on the way. A share of visas gets quoted as a share of patients. A count from one year turns up in a story about another. Once that happens, nobody can check the claim.

So every figure below keeps its period and its source. Where two sources disagree, I say so. That is slower to read. It is also the only version I would want quoted.

Each section has four parts. The figure. What it means for an operator. One line on how to use it. The source.

A full table of every figure, with links, sits beside this report as a CSV file.

The figure. The Advertising Standards Authority, the UK body that enforces ad rules, published an enforcement report on 12 March 2026. It said it captured more than 4,000 paid ads for cosmetic surgery across two phases of monitoring. The ads ran on Meta's platforms and came from clinics based abroad. Monitoring ran from December 2024 to December 2025.

What it means. A clinic does not need an office in the UK to fall under UK ad rules. If its ads reach people in the UK, the regulator can see them. The ASA says it tracks these ads with an AI based monitoring system, so this was not a single sweep.

How to use this. List every market your ads reach, and name the regulator for each one.

Source: ASA, Enforcement Report, Cosmetic surgery abroad, 12 March 2026.

The figure. The same ASA report says compliance rose from 61.4% to 86.9% in the first phase. In the second phase it rose from 41.7% to 70.6%. The ASA contacted advertisers whose ads broke the CAP Code, the UK's rulebook for ads, and told them to remove or change the claims. Where they did not reply, it escalated through Meta.

What it means. Most of the fixes came after the regulator got in touch. In my judgement that is a cost a network should not wait to pay. The same edit made before the ad runs costs less and needs no regulator to prompt it.

How to use this. Give every ad an owner and a written check before it runs.

Source: ASA, Enforcement Report, Cosmetic surgery abroad, 12 March 2026.

The figure. ASA guidance describes a 24 hour promotion as giving people too little time to consider what it means for them. CAP guidance says ads for non surgical cosmetic treatments cannot appear in non broadcast media where people under 18 make up 25% or more of the audience. The ASA says rules stopping these ads from being aimed at people under 18 took effect on 25 May 2022.

What it means. A countdown on a surgery offer is not a matter of taste in the UK. It is a named problem. Audience settings are also a compliance control, not only a marketing choice.

How to use this. Ban countdown offers on clinical services, and check the age setting on every campaign before launch.

Sources: ASA CAP, Cosmetic interventions, social responsibility. CAP Bitesize, Rules for advertising Botox. ASA, Cosmetic interventions regulatory statement.

The figure. The General Medical Council, which regulates doctors in the United Kingdom, has had guidance on cosmetic work in effect since 1 June 2016.

What it means. A doctor's own regulator can set duties that travel with that doctor. A network that works with doctors registered in different countries holds more than one rulebook at once.

How to use this. Record each doctor's registering body, and read its guidance for the work that doctor does for you.

Source: General Medical Council, Cosmetic interventions.

The figure. Gallup, in its State of the American Manager report, found that managers account for at least 70 per cent of the variance in employee engagement across business units.

What it means. In a network, the local manager is the standard as staff experience it. A strong manual with a weak site manager still gives a weak site.

How to use this. Put site managers first in any rollout of a new standard, before the front line.

Source: Gallup, Managers Account for 70% of Variance in Employee Engagement.

The figure. In a Center for Creative Leadership study of nearly 300 emerging leaders, almost 60 per cent said they never received any training when they moved into their first leadership role. Delegating and building trust sits on the same body's list of 12 common challenges new managers face.

What it means. Networks often promote their best clinician or best coordinator to run a site. Without training, that person keeps doing the work instead of leading it.

How to use this. Pair every first time site lead with a written handover and a named coach for the first months.

Sources: Center for Creative Leadership, How to Be an Effective Boss. Center for Creative Leadership, 12 Common Challenges of New Managers.

The figure. Reidel Law Firm notes that a default notice in a franchise agreement starts a clock. A typical agreement allows 30 days to fix a breach, with longer periods where local law requires them.

What it means. A standard without a written cure period is a wish. The clock also differs by country, so one network may run several clocks.

How to use this. Put the cure period for each market in the standard itself, next to the rule it enforces.

Source: Reidel Law Firm, The Significance of Default and Cure Provisions in Franchise Agreements.

The figure. The WHO Surgical Safety Checklist asks the whole team to pause at three points: before anaesthesia, before incision and before the patient leaves the operating room. The WHO also encourages teams to adapt the checklist after local consultation, as long as a changed version drops the WHO logo and credits the original.

What it means. Here is one standard that already works across borders. It is short, it is timed to the work, and local teams may adapt it within clear limits.

How to use this. Treat the three pauses as fixed in every market, and let each site adapt only the wording.

Source: WHO, Safe surgery tools and resources.

The figure. A 2023 paper in the International Review of Social Psychology repeated an older experiment with 692 online participants. People rated decisions with good outcomes more favourably than the same decisions with bad outcomes. The effect held, and it was larger than in the original study.

What it means. A network that only reviews cases that went wrong will learn the wrong lessons. A good result can hide a poor decision.

How to use this. Write down the reason for a big decision before the result is known, then review the reason as well as the result.

Source: International Review of Social Psychology, Outcomes Affect Evaluations of Decision Quality.

The figure. Army Regulation 25-50, the US Army's rulebook for letters and memos, puts the main point at the start. It asks for sentences of about 15 words on average, paragraphs of no more than 10 lines and one page for most letters and memos.

What it means. A regional head reads updates from many markets. If each one opens with the decision needed, the head can act on all of them in one sitting.

How to use this. Make the first line of every market report the decision you need and the date you need it by.

Source: Army Regulation 25-50, Preparing and Managing Correspondence.

The figure. A policy brief by ICRIER, a research institute, found that Bangladesh accounted for 69% of India's medical tourists in 2022, as reported by Business Today. Business Today, citing Ministry of Tourism data, reported that medical value travel to India fell 43% on the year in November 2024 and 59% in December 2024. Business Standard reported that Crisil Ratings estimated revenue from patients in Bangladesh fell 30 to 35 per cent in the 2024 to 2025 financial year. It also quoted ICRA saying international patients make up 3 to 9 per cent of revenue at most listed hospitals.

There is a counting trap in the same market. Factly reports medical visas, which the Ministry of External Affairs issues. The Ministry of Tourism counts arrivals. A visa is permission to travel, not a trip made, so one should never be read as a share of the other. For 2024 the sources also disagree on arrivals: the ministry's table gives 6,44,387, and Business Standard gives 625,000.

India also has a written standard for the agents who sell its care abroad. NABH, the national hospital accreditation board, publishes empanelment standards for medical value travel facilitators. The second edition has seven sections and a checklist of 43 objective elements.

What it means. When one country sends most of the patients, one border decision moves the national total. Any market can have this exposure, not only India. The counting trap is also general: permits, bookings and arrivals are different numbers in every country.

How to use this. Report each market's share of patients by source country every quarter, and never mix visa counts with arrival counts.

Sources: Business Today, India's medical tourism takes a hit as patient arrivals from Bangladesh plunge amid visa restrictions, 2 March 2025. Business Standard, Bangladesh political unrest hits India medical tourism, 4 June 2025. Factly, Medical visas issued by India down more than 20% in 2024, 28 February 2025. PIB, Ministry of Tourism reply in the Lok Sabha, 9 February 2026. NABH, Empanelment standards for Medical Value Travel Facilitators, 2nd edition.