India wants 10 million medical travellers. To get there, it must compete on trust, not just price.

Medical arrivals fell in 2025, and two-thirds of them came from a single neighbouring country. Scaling twentyfold means winning patients who have choices and those patients buy confidence, not discounts. A proposal, and a first number: in 31.4 per cent of our own case reviews, the advice was not to travel.

At the inauguration of Sanjeevani 2026 at the Bharat Health Global Expo in New Delhi on September 7, Union Commerce and Industry Minister Piyush Goyal set out a target that deserves to be taken seriously: 10 million international medical value travellers a year. He noted that 3.5 million patients have used India's medical value tourism ecosystem over the past seven years, and argued that India has the doctors, the hospitals and the ecosystem to do far more.

The arithmetic is worth sitting with. Roughly half a million patients a year, to 10 million a year, is a twentyfold expansion.

Two numbers explain why that expansion will not come from the cost advantage alone.

The first is the trend. Bureau of Immigration data shows 644,387 foreign tourist arrivals for medical purposes in 2024. Government figures for 2025 put that at 507,244, around 5.5 per cent of total foreign arrivals. India's medical inflow did not grow last year. It contracted.

The second is concentration. Bangladesh accounted for roughly three-quarters of medical arrivals in 2024 and, on 2025 figures, still around two-thirds. The next largest source markets are Iraq, Uzbekistan, Somalia, Turkmenistan, Oman, Kenya , are each in the five-figure range.

Read together, those numbers describe something more specific than "medical tourism." They describe a regional healthcare catchment. A large share of India's international patients come because India is the nearest place with the required capability at a payable price. That is a real and valuable service. But it is a flow driven by proximity, and it is exposed to visa policy, currency movement and the politics of a single border.

The 10 million patients are different patients. That patient has alternatives at home, or in Thailand, Turkey, the UAE, Malaysia, Singapore or South Korea and is choosing India rather than defaulting to it. Winning that choice is not primarily a pricing problem. Treatment in India can already cost 60 to 80 per cent less than in developed markets, as the minister noted. Price is not the objection.

The objection is risk.

The questions patients are actually asking

A family weighing cancer surgery, a cardiac procedure or a complex spinal operation abroad is not running a price comparison. It is asking a different set of questions: Is the diagnosis right? Is this procedure necessary? Is this the right specialist? How do I verify this hospital from 8,000 kilometres away? What is the total cost, and under what circumstances does it change? Who holds my records? What happens if there is a complication and who is responsible for my follow-up once I am home?

Most of those questions are unanswerable from a website and a treatment quotation. That gap, not capacity, not clinical quality, not cost is the binding constraint on the next 9.5 million patients.

Goyal's own five-point plan pointed in this direction: certified caregivers, hospitals publishing honest and transparent packages on the Heal in India gateway, interpreters so patients can actually be understood, faster reimbursement and cashless payment, and wider use of teleconsultation. His warning was blunter than the target: one instance of a patient being cheated costs India goodwill, business and credibility.

That warning is the strategic insight in the speech. Trust in this market is a shared national asset. Any operator can spend it; no operator can rebuild it alone.

Start the journey before the flight

The most consequential of the minister's points is teleconsultation as an early step in the journey, and it deserves to be pushed further than it usually is.

Today, the process typically starts with the wrong question. A patient receives a diagnosis at home, searches for options abroad, contacts hospitals or facilitators, and begins comparing destinations and packages. The first question becomes where should I travel?

The first question should be do I need to travel at all?

An independent specialist review of the records before the travel decision can produce four honest outcomes: proceed with international treatment; complete additional diagnostics first; consider a different treatment; or stay home, because appropriate care is available locally. A patient-centred ecosystem has to be capable of producing all four including the one that generates no trip.

Around that sit three other things that are, in practice, the product: verifiable providers, where NABH accreditation and Heal in India listing are presented so an overseas family can actually check and compare them; a total-cost package where implants, extra hospital days, diagnostics, complications, rehabilitation and follow-up are priced or explicitly excluded before boarding, not discovered afterwards; and portable records, so the reviewing physician, the treating team in India and the doctor handling follow-up at home are not reconstructing the case from WhatsApp threads and printouts.

And there must be a stated plan for complications: whom to call, what is covered, who talks to the patient's local clinician before departure. Complication planning is not fine print. It is part of the product.

The incentive problem, and a metric for it

There is a structural issue the sector will eventually have to address directly.

If every participant in the chain earns only when a patient travels and is treated, who is paid to tell a patient not to come?

This is not an allegation that hospitals or facilitators push unnecessary treatment. It is an observation about structure: an arrangement in which no one is compensated for the "don't travel" answer will be read by sophisticated patients as a conflict of interest, whether or not one operates in practice.

There is a straightforward structural fix. Separate the clinical review from the travel transaction. Pay the reviewing specialist the same fee whether the conclusion is "travel," "don't travel" or "we need more information." Then publish the resulting rate.

Call it the don't-travel rate: the share of reviewed cases in which the patient was advised that international travel was not necessary.

Publishing such a figure looks commercially perverse. It is closer to the opposite. An organisation willing to tell prospective customers not to buy its highest-value service is making the most credible claim available to it.

I will put the first number on the table. At Healing Tourist, the second-opinion platform I founded, specialists advised against international travel in 31.4 per cent of 412 completed case reviews during January to June 2026. Those patients were directed instead to appropriate care closer to home, to further diagnostics before any decision, or to a different treatment path altogether. A review counts in the denominator once a panel specialist has examined the records and issued a written opinion, and the specialist is paid the same fixed fee whichever way that opinion goes.

That figure is not a benchmark, and it should not be read as one. One operator's case mix is not the sector's, and 412 reviews is a small base. It is published because a metric no one reports is not a metric, and because the only way to find out whether 31 per cent is high, low or ordinary is for other hospitals and facilitators to publish theirs on a comparable definition. If several did, the sector would have something it currently lacks: a public, checkable signal of clinical independence that a family in Lagos or Chicago can actually weigh.

It would also give India a differentiator no competitor country can undercut on price.

The larger opportunity

India already has the pieces ; the Heal in India gateway, e-medical visas, NABH standards for both hospitals and medical value travel facilitators, and a government actively pressing for transparent packages. Assembled deliberately, these amount to something more durable than a tourism industry: the operating infrastructure for cross-border healthcare.

The distinction matters. Medical tourism conjures a patient boarding an aircraft. Cross-border healthcare begins digitally when records move securely, specialists reviewing cases remotely, patients obtaining independent opinions with travel as one possible outcome of an international clinical relationship rather than its starting point.

Ten million patients a year will require more hospitals, more specialists, trained caregivers, interpreters, smoother visas and better payment and insurance mechanisms. But infrastructure alone will not decide whether patients come.

Healthcare carries an unusual asymmetry. Patients make consequential decisions while frightened, unwell and uncertain, and international patients make them without the familiarity of their own health system or any easy way to evaluate the people advising them. That asymmetry is precisely why trust functions as an economic asset here.

India's clinical expertise and cost structure will get the world's attention. Independent review, verifiable providers, transparent total pricing, meaningful consent, portable records, complication planning and genuine continuity of care would earn something more valuable and much harder to copy.

The countries that lead global healthcare in the next decade may not be the ones offering the cheapest procedures. They will be the ones patients trust to tell them the truth including when the truth is that they need not come at all.

Chida Khatua is the founder of Healing Tourist (healingtourist.com), a medical second-opinion and treatment-facilitation platform that charges a fixed specialist review fee irrespective of whether the patient is advised to travel. The figures cited are the company's own and will be published with the full methodology and specialty breakdown in its first quarterly transparency report. Views are personal.