Before you rely on it
If your second opinion is free, who paid for it?
Somebody paid the specialist for their time. That is worth knowing before you make a decision about surgery, and it is a fair question to ask anyone, including us.
A free second opinion is never free to produce. A specialist reading your scans and writing an opinion is doing skilled work, and that work gets paid for. If the fee did not come from you, it came from somebody else. In medical travel, that somebody can be the hospital which stands to receive you as a patient.
This does not make the opinion wrong. Plenty of good doctors work inside arrangements like this. It does mean the opinion was commissioned by a party with an interest in one particular answer, and you deserve to know that before you weigh it.
Medically reviewed
Reviewed by Dr Gunjan Patel, MBBS, registered with the Gujarat Medical Council (G-65059). Reviewed for accuracy only. This page is general information, not advice about your own case, and Dr Gunjan Patel does not diagnose, prescribe or treat.
The structure
Where the money comes from in medical travel.
This is one commercial structure used in the industry. It is not a secret, and it is not an accusation against anyone.
Some companies arranging treatment abroad are paid by the hospital, through a referral fee, and not by you.
Referral fees
can be paid to a medical travel facilitator by the hospital abroad, and a review of the research on facilitators, published in 2012, says patients may not know how much, or in what manner, a facilitator is paid
A review of earlier research, read as the authors’ manuscript. It says some facilitators are paid by their clients and others by facilities or physicians abroad, gives no proportion and no rate, and says there is little evidence on whether such payments influence recommendations. We found no readable source that gives a commission percentage, so we do not print one. The book is dated 2012 and the university repository record 2013. A consultant’s account of price padding shown elsewhere on the site is hers, attributed to her, and not a rate we have verified. Commission is one model in this market, not the only one, and we never say every company works this way.
Where a company is paid that way, the free consultation is a sales cost, and the company has a financial reason to want you to go ahead.
There is nothing unusual about a business absorbing a cost up front to win a customer. Estate agents do it. Mortgage brokers do it. The reason it matters more here is that the product is an opinion about whether you need an operation.
The question underneath
If a company earns a share of your treatment when you travel, and earns nothing when you stay at home, then one of those two answers pays for the office and the other does not.
That is a structural fact about incentives, not a claim about anyone’s honesty. Good people work in conflicted structures every day. The structure still shapes what gets said.
Five questions
How to find out who paid, in one conversation.
Ask these of any company offering you an opinion about treatment abroad. Ask them of us too. A company that answers all five plainly is telling you something real.
Who pays you, and how much?
Not whether you pay them. Who pays them. The useful follow up is whether the amount changes depending on which hospital you choose.
How is the specialist who reads my case paid?
A flat professional fee that is the same either way is a very different arrangement from a fee that only exists if you go on to have treatment.
What happens to your income if I decide not to travel?
This is the question that separates the models. Listen for whether the answer is specific or whether it moves to a different subject.
Has anyone been told not to travel? What happened next?
A company that genuinely gives that answer will have a process for it, and will be able to describe it.
Can I see the opinion in writing, with the reasoning?
A written opinion with the reasoning shown can be taken to your own doctor and checked. A verbal summary cannot.
Print this and take it into every conversation you have, ours included. The answers will differ more than the marketing does.
In fairness
Sometimes a free opinion is exactly what you need.
We would rather tell you when the free option serves you well than pretend it never does.
A free consultation is worth taking when
- You want a rough sense of what a procedure costs abroad before thinking seriously about it
- You are checking whether a hospital treats international patients at all
- You already have a clear diagnosis and a settled plan, and you only need logistics
- You are early enough that you are gathering impressions, not making decisions
Paying for the opinion earns its keep when
- The real question is whether you need the operation at all
- You have been given two different recommendations and need a tiebreak
- The procedure is complex, or it is a revision of earlier surgery
- You want the reasoning in writing so your own doctor at home can read it and respond
- You want the person advising you to have nothing riding on the answer
Our own answers
The same five questions, answered about us.
It would be a strange article that asked you to interrogate everyone else and skipped itself.
Who pays us
You do, and only you. No hospital, clinic or surgeon pays us anything in any form, and our fee does not change depending on which hospital you choose. You can ask any hospital we work with whether they pay us. The full detail is here.
How the specialist is paid
A flat professional fee for reading the case and writing the opinion. It is identical whether they recommend surgery or advise against it, and they hold no share of your case.
If you decide not to travel
You keep the written opinion and we earn nothing further. That outcome is budgeted for rather than avoided, which is the only way the advice can be worth having.
What you receive
A written opinion with the reasoning shown, in plain language, that you can hand to your own doctor. What is included, in full.
Questions
What people ask about this.
Are you saying free second opinions are dishonest?
No. We are saying they are paid for by somebody, and that it is reasonable to find out who. A specialist working under a commission arrangement can still give you a careful and correct opinion. You are simply better placed to weigh it once you know how it was funded.
Why would I pay for something offered free elsewhere?
For one specific thing: an answer that costs the person giving it nothing to deliver either way. If your question is what a procedure costs, a free consultation may answer it perfectly well. If your question is whether you need the operation, that is worth buying from someone with nothing riding on the answer.
How do I check what a company told me?
Take the written opinion to your own doctor at home. That is the strongest check available to you, it is free, and it is the reason we insist on giving you the reasoning in writing rather than a verbal summary.
Do you ever tell people to stay at home?
Yes, and it is written into how we are paid so that it costs us nothing to say it. For a straightforward procedure, once you count flights, a companion, accommodation and recovery time, travelling often does not add up. When that is the answer, it is the answer you get.
Which companies take commission?
We will not name companies. Our source supports a statement that some facilitators are paid this way, not a claim about any individual business, and we are not willing to blur that line. Ask the five questions above and judge each company on what it tells you.
Ask us the five questions yourself.
Thirty minutes, free, and no medical records needed to start. If the honest answer is that you should stay where you are, that is what you will hear.