Every year thousands of Americans and other citizens of the developed world pack their bags and head out on vacation. Many are not going there just to sit on the beach, however, they are going because their lives depend on it and their own countries just can't compete. They are medical tourists. While Bermuda could be a potential destination for them to receive the care they need, other jurisdictions currently have a much more compelling product to offer.Medical tourism is defined as the act of travelling to another country to seek specialised or economical medical care, well-being and recuperation of acceptable quality with the help of a support system. The major reasons why these tourists leave their home country for treatment are: cost savings; comparable or better quality care; and /or reduced waiting periods that allow quicker access to care. With healthcare costs skyrocketing in the US, Americans are flooding into jurisdictions where the same treatments and procedures are literally pennies on the dollar.In 2007 an estimated 750,000 Americans travelled abroad for medical care according to study conducted by Deloitte titled “Medical Tourism: Consumers in Search of Value” (http://www.deloitte.com/assets/Dcom-unitedStates/Local%20Assets/Documents/us_chs_MedicalTourismStudy (3).pdf). This amount is expected to expand to 15.75 million in 2017 and represent a potential $30.3 to $79.5 billion spent overseas on medical care. For this cohort of tourists the price is right. Over 35 countries currently offer some form of medical tourism. Countries such as India, Thailand and Singapore offer medical procedures at as little as 10 percent of the cost of comparable care in the United Sates. In fact, “two in five survey respondents said they would be interested in pursuing treatment abroad if quality was comparable and the savings were 50 percent or more”. The most common types of outbound medical procedures undertaken by American medical tourists is elective surgeries such as knee replacements or rhinoplasty (nose-job). According to the Deloitte survey, rhinoplasty outpatient surgery costs around $3,866 in the US but only $1,682 on average in the three lowest foreign jurisdictions including travel costs. The savings on knee surgery are even more pronounced. This procedure costs $4,686 for the outpatient in the US while only $1,398 in the average three lowest foreign countries including travel costs. It is unlikely Bermuda will be able to compete in this regard as travel costs (including hotel stay and flight) alone could exceed the total costs in a low cost jurisdiction. Currently Bermuda does not really offer any cost savings advantage. In addition, 71 percent of hospital costs are for labour, according to a recent World Health Organisation report, and this might be difficult for Bermuda to overcome. Only a draconian series of wage cuts would bring Bermuda more in line with low cost jurisdictions. Bermuda's small population already limits the number of procedures that can be economically performed on the island and it would be difficult to increase volume of procedures significantly.Cost is not everything, however. Quality and safety are primary considerations. The Joint Commission International (“JCI”) is an organisation that effectively evaluates quality and safety metrics and offers accreditation (http://www.jointcommissioninternational.org/JCI-Accredited-Organizations/) to hospital systems. There are over 120 hospitals worldwide, according to the Deloitte study that are accredited through the JCI. Except for its Clinical Lab /Department of Pathology, Bermuda's King Edward VII Memorial Hospital is not one these. Before a plan and marketing strategy is crafted I would suggest all facilities or institutions involved first become accredited to ensure world class quality and safety. Pursuing medical tourism before undertaking this process opens Bermuda up to potential reputational damage. It's also very likely that competitors would use the ‘perceived risk' of seeking care at a non-accredited facility to their advantage during their marketing campaigns.The prospect of using regulatory arbitrage also does not provide Bermuda with any advantages in the medical tourism game and the recent High Intensity Focused Ultrasound (HIFU) offering for prostate cancer is a good example. If the treatment is found to be highly effective and safe, it will eventually be offered in the US as well as other jurisdictions and this regulatory advantage could vanish overnight.At this stage, it is unclear how Bermuda can offer any comparable advantage in the field of medical tourism. As a result it would not appear to offer a viable opportunity for the investment of capital or time in pursuing it further. More focus should be directed towards alternate product offerings such as casinos and short-term retreat packages that help alleviate the seasonality drag that the island suffers from. Many other opportunities potentially exist that would offer a much more compelling return for the island than one that seems to be “dead on arrival”. Bermuda has one of the worlds' greatest potential tourist assets. In my opinion, it is one of the most beautiful tropical islands in the world and has a great deal to offer. Let's focus on its real economic potential opportunities.