Coherent Market Insights values the North America outbound medical tourism services market at USD 153.10 billion in 2026 and projects USD 750.71 billion by 2033, a compound annual growth rate of 25.5 percent. Numbers like that say a great deal about where vendors think the money is and almost nothing about why patients get on the plane. The why is the better story, and it splits neatly along the 49th parallel. Americans leave because of the bill. Canadians leave because of the queue.

A forecast with a credibility problem

Start with what the report actually claims. Coherent Market Insights, the Pune-based research firm behind the figure, names cancer treatment as the largest revenue segment, which it attributes to the cost of oncology care in the United States, and lists India, Mexico, Thailand and Costa Rica as the main destinations for North American patients. Its favourite illustration of the push factor is a striking one: mean hospital charges for a heart transplant in the US run to USD 808,770.

Now set that against the most careful patient-level count available. Patients Beyond Borders, which has tracked this industry for two decades, put the entire global medical travel market at USD 63 to 88 billion in 2023, built on roughly 21 to 22 million patients crossing a border for care and spending an average of USD 3,510 per visit including transport and accommodation. It estimates 1.8 million Americans travelled abroad for medical care in 2023.

I cannot make those two pictures fit. The CMI valuation for North American outbound alone is nearly double the high end of the Patients Beyond Borders estimate for the whole planet. Run the arithmetic the other way: 1.8 million American travellers would each need to spend around USD 85,000 a trip to justify the 2026 figure, about 24 times the measured global average. Definitions explain part of the gap, since a services market can bundle facilitation fees, travel, insurance products and aftercare, but no definition stretches that far. My reading is that the 25.5 percent CAGR measures vendor optimism, not patient behaviour. The direction is real. The magnitude is marketing.

Americans leave over price

The push factor on the US side is documented well beyond the market research. KFF’s May 2025 Health Tracking Poll found 44 percent of American adults saying it is difficult to afford health care, and 36 percent reporting that they skipped or postponed care they needed in the past 12 months because of the cost. Among uninsured adults, three quarters did. KFF’s health care debt survey found about four in ten adults carrying debt from medical or dental bills. These are the customers the forecast is counting.

The savings on offer are not subtle. Patients Beyond Borders puts the discount against US prices at 40 to 65 percent in Mexico, 45 to 65 percent in Costa Rica, 50 to 75 percent in Thailand and 65 to 90 percent in India, across a range of specialties. The CDC’s Yellow Book, the US government’s clinical reference for travel medicine, notes that millions of US residents travel internationally for medical care each year and that dental work is the most common purchase, in part because a substantial share of Americans have no dental insurance at all.

Dental is the detail that convinces me this is structural. Nobody flies to Los Algodones for the experience of a root canal; they fly because the procedure is uncovered at home and a fraction of the price abroad. Travel concentrates exactly where coverage is thinnest. High-deductible plans have quietly extended that logic to general medicine: an insured patient staring at a USD 6,000 deductible is, for practical purposes, a cash buyer, and cash buyers compare prices across borders the way they compare flights.

Canadians leave over time

Canada supplies the cleaner experiment, because price cannot be the motive. Care at home is prepaid through taxes, so every Canadian who buys treatment abroad is paying twice. The Fraser Institute’s Waiting Your Turn survey for 2025 measured a median wait of 28.6 weeks from GP referral to treatment, the second longest it has ever recorded, down from 30.0 weeks in 2024 but roughly triple the 9.3 weeks of 1993. The wait splits into 15.3 weeks to see a specialist and another 13.3 weeks from specialist to treatment. Ontario patients waited least at 19.2 weeks; New Brunswick patients waited 60.9. An MRI alone took a median 18.1 weeks.

The same institute estimates, in figures reported by The Hub in January 2026, that 105,529 Canadians received non-emergency medical treatment outside the country in 2025, a 66 percent increase over the past decade, with Ontario accounting for 51,538 of them. That is about 2.1 percent of patients nationally.

Paying twice is the most honest measure I know of what a seven-month wait is worth to the person inside it. And the provincial split undercuts the lazy reading that only the worst queues drive people out. Ontario has the shortest waits in the country and still sends the most patients abroad, which mostly reflects its population, but also this: the best-performing province in 2025 still keeps patients waiting twice as long as the national norm of 1993. When the benchmark itself has slipped that far, even the winners lose patients.

Aftercare is the missing line item

The one restraint Coherent Market Insights flags deserves more attention than its growth curve. Patients returning from treatment abroad struggle to find physicians willing to manage complications from operations they did not perform, and that gap in follow-up care is the strongest argument the stay-home side has. Every savings table above assumes the procedure goes well. When it does not, the revision happens at home, at full domestic prices, and no line of the original invoice covered it. The costs of failed work abroad land first on the patient and then on the home system, which is a quiet subsidy running underneath every discount in this industry.

What This Means

Strip away the forecast and two engines remain, and they run on different fuel. The American engine is price: 36 percent of adults skipping care over cost is a standing reservoir of demand that discounts of 40 to 90 percent will keep draining southward and eastward. The Canadian engine is time: 105,529 people paid twice rather than wait 28.6 weeks, and that number has grown 66 percent in a decade. I would track those two indicators, KFF’s cost-skipping share and Fraser’s median wait, before I read another market report, because they lead the patient flow the way bookings lead arrivals. The forecast’s USD 750 billion is a number I do not believe; the direction underneath it is one I do. And the destinations that win the next decade will not be the ones with the cheapest operating theatres. They will be the ones that solve aftercare, because the follow-up gap is the last rational argument for staying home.