A BMJ Open study has reignited debate about the risks of medical tourism, but the underlying data raises important questions. With 99% of reported complications linked to cosmetic and bariatric procedures and more than 520,000 Britons travelling abroad for treatment in 2025, is it fair to draw conclusions about all forms of international healthcare? This article examines the evidence and explores why growing numbers of patients are looking beyond the NHS for treatment.
In January 2026, BMJ Open, an open-access medical journal published by the British Medical Journal, published a paper entitled “Complications and costs to the UK National Health Service due to outward medical tourism for elective surgery: a rapid review“. The study has been widely cited as evidence that medical travel creates risks for patients and costs for the NHS when people return home requiring further treatment.
Patient safety should always come first and any discussion about healthcare abroad must begin with an honest assessment of risk. However, the position advanced by BMJ Open warrants closer examination.
Taken at face value, the underlying premise is that patients who receive treatment abroad are more likely to return to the NHS with complications. This line of reasoning comes perilously close to suggesting that healthcare systems outside the UK are inherently less safe or less effective than those within it. The evidence does not support such a view and, in many instances, the opposite may be true.
Healthcare quality varies by provider, surgeon, hospital, regulatory environment, procedure type, aftercare planning and patient behaviour. It does not simply vary by national border.
A major accredited hospital in Germany, Spain, Lithuania, Greece or Malta cannot sensibly be treated as equivalent to a low-cost cosmetic surgery clinic marketing cut-price procedures through social media. Yet too much public commentary about medical travel collapses these very different categories into one.
That is where the BMJ Open debate needs greater precision.
The BMJ Open review identified 655 patients who required NHS treatment following complications from surgery undertaken abroad between 2006 and 2024 which, at first glance, that sounds significant.
However, of the 655 patients identified, 385 had undergone bariatric surgery and 265 had undergone cosmetic surgery. The authors found only five ophthalmology patients and effectively no meaningful evidence relating to orthopaedic surgery, spinal surgery, cardiac surgery or most of the elective specialties that form the core of MMG’s offering.
In other words, approximately 99% of the patients examined had travelled abroad for weight-loss surgery or aesthetic procedures. Furthermore, 61% of all reported complication cases involved treatment undertaken in Turkey.
This distinction is crucial because the BMJ Open paper is not primarily a study of consultant-led orthopaedic surgery in accredited European hospitals. It is overwhelmingly a study of cosmetic surgery tourism and bariatric surgery tourism, which are two very different markets.
There is another important point often missed in the debate about medical travel.
One of the inherent risks of travelling overseas for cosmetic surgery is not only the procedure itself. It is what happens afterwards.
Aesthetic surgery, hair restoration and body-shaping procedures require careful recovery, monitoring and post-operative follow-up. Patients need to remain close enough to the treating clinic and surgeon for long enough to ensure that swelling, infection, wound-healing issues, bleeding, pain or other early complications can be identified and managed quickly.
Too often, the problem in low-cost cosmetic surgery tourism is that patients leave the destination country too soon.
They fly home before the safest recovery window has passed. They return without adequate documentation. They may not fully understand the post-operative instructions. They may not have easy access to the treating surgeon once they are back in the UK. That creates exactly the situation the BMJ Open paper highlights: a patient arrives back in Britain with a complication and the NHS becomes the default emergency safety net.
MMG’s own work with highly experienced healthcare providers in plastic surgery and hair restoration shows that this is one of the major risk factors in cosmetic medical travel. It is often not simply a question of whether the original surgical technique was good or poor. It is whether the patient remained under appropriate clinical supervision for long enough after the procedure.
That distinction goes to the heart of the matter.
MMG works with providers who understand the clinical importance of recovery planning, post-operative monitoring and realistic travel timelines. In Athens, MMG has access to some of the most highly qualified surgeons in the world operating in plastic surgery and hair restoration. The emphasis is not on “fly in, have surgery, fly out”. It is on appropriate medical assessment, safe treatment planning and structured post-operative care. This is the opposite of unmanaged cosmetic surgery tourism.
Perhaps the most important question raised by the BMJ Open review is not why some patients experience complications abroad: it is why so many patients are leaving the UK in the first place. The numbers are increasing every year. According to ONS data, approximately 520,000 UK residents travelled abroad for medical treatment in 2025, almost double the level seen in 2020.
The obvious question is why. Patients do not usually choose to travel overseas for healthcare because it is convenient. Travelling for surgery involves significant expense, flights, hotels, logistics, recovery away from home and separation from family support networks. People travel because they believe the alternative is either unacceptable or unaffordable.
The NHS currently reports a waiting list of around 7.2 million treatment pathways. The true number is likely closer to 9 million once hidden demand and delayed referrals are considered. Patients waiting for orthopaedic surgery, spinal procedures, ophthalmology treatment and diagnostics often face delays measured in months and, in some cases, years.
For many patients, the choice is not between NHS treatment next week and treatment abroad next week. It is between treatment abroad within weeks or remaining in pain on a waiting list for many months, possibly longer.
While the BMJ Open paper focuses heavily on the costs associated with complications arising from treatment abroad, it does not adequately address is the systemic failure within the UK healthcare system that is driving hundreds of thousands of patients to seek alternatives.
Britain has suffered from decades of inadequate workforce planning and insufficient expansion of clinical capacity relative to rising demand. The result is not difficult to understand. Too many patients are competing for too few appointments, too few operating theatres and too few treatment slots.
The consequence is not simply longer waiting lists, it is the rationing of access to treatment itself. Any balanced discussion of medical travel should therefore examine both sides of the equation. What are the risks of treatment abroad? But equally, what are the risks of delayed treatment at home? For too many patients living with chronic pain, deteriorating mobility or progressive disease, waiting also carries significant risks.
The Canadian experience, which was touched upon by BMJ Open in its paper, provides an important comparison because it suffers from many of the same structural problems as the NHS, but with an even more restrictive patient-access model in some respects. Canadian patients routinely face long waits for specialist consultation and treatment. In 2025, the median wait from GP referral to treatment was reported at 28.6 weeks, the second-longest wait ever recorded in that series.
Public Canadian data also shows that many patients still do not receive priority procedures within recommended benchmarks. In 2024, 68% of hip replacements, 61% of knee replacements and 69% of cataract surgeries were completed within recommended timeframes. That means large minorities of patients were still waiting longer than the benchmark for major quality-of-life procedures.
Canada also illustrates a major problem with healthcare systems that restrict patient mobility. In the UK, NHS patients can at least, in principle, travel to another part of the country if a bed, diagnostic slot or surgical appointment becomes available.
In Canada, the provincial structure can make that much more difficult. Healthcare funding, referral routes and access rights are organised through provincial systems. Patients who need treatment cannot always move freely from one province to another to secure faster care without administrative, funding or practical barriers. In that respect, Canada can be even more restrictive than the NHS.
It is therefore not surprising that some of the strongest resistance to medical travel comes from countries such as the UK and Canada. These are systems where patients are promised universal access but are often denied timely access. When a healthcare system cannot provide treatment within a reasonable timeframe, it has a powerful incentive to criticise the alternatives.
The BMJ Open review identifies 655 published complication cases accumulated over an eighteen-year period. That figure should be viewed within the context of the broader medical travel market. Approximately 520,000 UK residents travelled abroad for medical treatment during 2025 alone.
Even if international patient travel from the UK had averaged only 250,000 people annually between 2006 and 2024, that would represent well over 4.5 million medical travellers during the period covered by the review. Against that backdrop, the 655 published cases examined by the BMJ Open authors represent a miniscule 0.015% of overall patient activity.
This does not mean complications do not occur, because clearly they do, nor does it mean every overseas provider operates to the very highest standards. But it does mean caution should be exercised before drawing sweeping conclusions about all forms of international healthcare from a dataset dominated almost entirely by cosmetic surgery and bariatric surgery cases.
The most important distinction for MMG is that we have created our platform specifically to address many of the concerns highlighted by the BMJ Open review.
MMG is not a cosmetic surgery holiday company. MMG does not market heavily discounted aesthetic procedures through social media campaigns. MMG does not facilitate treatment through unregulated clinics operating outside established healthcare systems. Instead, MMG focuses on accredited hospitals and specialist clinics operating within strictly regulated European Union healthcare frameworks.
Patients access consultant-led treatment pathways, transparent pricing, clearly defined treatment packages and hospitals operating under established national regulatory systems. The majority of patient enquiries relate to our current list of 49 treatments over eight different specialties, including orthopaedics, spinal surgery, ophthalmology, general surgery and other medically necessary procedures designed to improve mobility, reduce pain and restore quality of life.
Where MMG works in aesthetic, hair restoration and plastic surgery procedures, the same principles apply: qualified surgeons, appropriate facilities, realistic recovery planning and clear post-operative care. Fundamentally, for MMG the difference is not cosmetic versus non-cosmetic, it is between managed medical travel versus unmanaged medical tourism.
The BMJ Open paper raises legitimate concerns and should be welcomed as a contribution to an important discussion. Patients considering treatment abroad deserve clear information about both benefits and risks. However, the debate should also recognise that not all international healthcare is the same.
There is a substantial difference between travelling overseas for a low-cost cosmetic procedure advertised on social media and accessing consultant-led treatment within an accredited European hospital or specialist clinic.
The BMJ Open study is primarily examining one segment of the medical travel market. MMG operates in another. The distinction is not merely important. As more than 520,000 UK residents demonstrated in 2025, patients are increasingly willing to look beyond national borders for healthcare solutions. The real question is no longer whether patients will continue to travel but how we may ensure they do so safely, transparently and through healthcare providers they can trust.
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