Like a lot of out of border trades, Medical tourism has long relied on middlemen. Their purpose was to oil the angles with a deeper knowledge of all particularities of parties involved. In Medical tourism, this middleman is rightfully called “the facilitator”, often presented as “agencies”, developing their own brand and their own marketing. A lot like the wholesaler in china making the bag in the shenzhen factory, and the french luxury brand sticking a logo on it at the end. The agencies are “selling and branding” the treatment abroad in their local market , while the service is being outsourced to the medical provider abroad. 

Although this element of the chain has been an indispensable brick in the industry’s launch, it might be time to wonder if the industry’s rocket ship should now consider dropping the launch boosters…  

Has the facilitators become a burden to industry acceleration or is it still pushing forward ? We believe that the role of facilitators is deeply changing and that the roles and responsibilities are being redistributed today. 

It’s a new deal, and the actor’s cards have been changed.  

The Agent Reflex

Let’s quickly summarize the past purposes of agents in our industry. The primary role of agents in medical tourism has been simple: to bridge the geographical and cultural gap between patient and provider. A local “facilitator”, bridging the gap with an unknown clinic in an unfamiliar country makes sense and strengthens the chain of service. 

An agent is supposed to be the local support. The agent is familiar to the patient: language wise , geographically and culturally. Before and after the treatment abroad, the agent is here and has a reassuring role.

And that matters: medical treatment abroad is, by nature, intimidating. By anchoring the service chain in the patient’s home country, the facilitator makes the entire experience feel less daunting. This is the historical first and most important ADDED VALUE of the facilitator. 

Comparison With the Parent Industry: Tourism

Just like the tourism industry, the most successful facilitators had offices to physically see potential clients, and made the human bridge between the fancy website pictures and the client’s expectations.

That was no more than 10 years ago only. Travel agencies still exist. But who really uses them anymore? Most consumers now book flights and hotels directly online.

Why? Because these platforms have empowered the client’s decisions making and accompanied a general shift in consumer behavior. 

Consumers have changed the decision factors and stripped the old fashioned travel agent from its added value. 

Consumer choose for themselves!

Hence, is using a medical facilitator today just like buying a plane ticket through an agent back in the 1990s?

Some will argue: “medical treatment is not the same”, “patient needs the human touch” , or “I care for my clients”. Really? Are we in the business of boutique hand-holding, or in an industry dealing with international medical law, financial exchanges, and insurance claims?

The temptation to romanticize the agent is strong, just as we all fantasize about vintage cars. Everyone would love to channel Robert Redford’s coolness in a 1968 Porsche (Spy Game). But reality looks different: most of us are driving a connected SUV, CarPlay plugged in, Waze tracking our route, and Spotify running in the background.

The Three Pillars of Medical Tourism: Money, Time, Availability

This market is first and foremost driven by cost-efficiency.

• Money: finding the lowest price for acceptable quality.

• Time: avoiding endless waiting lists in domestic health systems.

• Availability: accessing techniques, or expertise not available at home.

In such a cost-driven market, how many middlemen can be tolerated before the service becomes too expensive, or inefficient? Especially when provider countries are facing runaway inflation. Take Turkey: in August 2025, the official annual inflation rate hit 32.95%. In a market where patients are counting every euro, every extra layer of commission quickly turns from “added value” to “added burden.”

The Facilitator’s Business Model

Let’s look at economics plainly.

• Facilitators live off a commission deducted from the medical act.

• Rarely more than 15–20% gross margin.

• Almost never billed directly to the patient (who would never willingly pay a “brokerage fee”).

The result? A fragile, dependent, and often grey model. Clinics do not always declare the full commission. Cash flows off the record. The market remains partially invisible, preventing serious industry-level growth or investment.

The Consequences

• On a micro scale: some of these actors could buy himself a Lamborghini in fresh cash ( in some countries) and no one will be the wiser.

• On a macro scale: an entire industry cannot structure itself or attract serious investors, for lack of transparency and measurable projections.

Of course, the facilitator isn’t personally responsible for this dysfunction. But the business model itself, and the habits it has created, are.

Undefined Roles and Responsibilities

The facilitator is indispensable for reassuring the patient, yet trapped in a double paradox:

1. Underpaid for over-service. In most industries, margins are designed to cover risk. Think of the bag made in China: by the time a luxury brand stamps its logo, the margin has multiplied two, three, sometimes tenfold. Basically enough to absorb returns, handle complaints, and fund growth! Facilitators, by contrast, work on razor-thin margins that leave no room to scale or absorb shocks.

2. Responsibility without definition. Who manages a post-op complication? the facilitator or the clinic? In medicine, responsibility is normally crystal clear: the doctor is licensed, insured, and accountable. The facilitator? No license, no insurance, maximum exposure.

I recall a conference two years ago where a facilitator advised his peers to “put a little aside” from each commission in case of complications. The sheer irresponsibility of that statement is staggering. First, if a patient dies or suffers permanent injury, a small contingency fund won’t even scratch the surface. Second, it effectively admits liability for a treatment the facilitator is not qualified to provide. In other words, a perfect case study in what not to do. If i was asked for a advice to give, i would probably say “do the exact opposite of what that statement is suggesting”.

In the end, the facilitator becomes the perfect scapegoat: blamed by the patient, tolerated by the clinic. then one day….. everything blows. 

What About Tomorrow?

In short : 

• Digitalization: integrated platforms are replacing agents, centralizing quotes, documents, and follow-up.

• Regulation: sooner or later, the industry will have to comply with fiscal and legal rules, shrinking the space for “grey” intermediaries.

• Value-added service: only those facilitators who can provide a clear, premium service with genuine patient follow-up and contractual responsibility will survive.

  
  

In details : The future of facilitating won’t be decided by regulation or technology alone. These are just the conditions of the game.

The real driver will be value-added service. Facilitators who bring nothing more than a name and added cost will disappear. 

But those who reinvent their role, by creating genuine patient support, integrating technology, and taking on clear responsibility, will not only survive, they will strengthen the industry as a whole.

Digitalization will accelerate this shift, pushing out the passive middlemen. Regulation will enforce it, closing the space for “grey” practices. But in the end, it’s the creative players, the ones who add something tangible to the chain, who will carry the industry forward.

A Final Word

If you are a clinic: consider building partnerships only with local actors who bring real added value for patients. Make your product stronger, but also make sure responsibilities are clearly defined and secured within a proper legal framework.

If you are a facilitator: ask yourself whether you have truly explored the full scope of your capacity to enhance services. Economic dynamics are forcing change. If reading this article made you reflect on the new features and services you already offer compared to the “classic” facilitator model, then you are likely on the right path, because you are already thinking in terms of industry development, not survival.

In short: “the inconvenient necessity” of yesterday has two choices, fade into irrelevance, or evolve into tomorrow’s key actor by inventing new added value to the service.