Background:  Globally, the healthcare industry is the largest in the world with a market value of approximately $3 trillion each year. Health tourism is an emerging industry consisting of global trade in health services.  It is estimated that $513 billion will be spent in the next 5 years in health tourism.  Annually, 617 million people engage in health tourism globally, representing an annual growth of 3.9% between 2000 and 2005.  This growth is driven by an aging global population with chronic diseases, rising healthcare costs in developed countries, lower costs and improved quality for overseas health services providers, medical labor market fluidity, and greater research and development in health tourism destinations. This growth has significant impacts on national and global economies, health systems, and health equity.  Objectives:  Based on literature review and market research, we propose a framework for sustainable and equitable development of the health tourism industry.  Results:  The four pillars of this framework consist of partnerships, financing, services, and consumer empowerment with an overarching foundation of governance (Figure 1).  Partnerships can be described in terms of international, intersectoral, and public-private collaborations.  The financing pillar should comprise of mechanisms to ensure efficient pooling and purchasing of services.  Health tourism services should be developed with consideration of human resources, technology, research and development, and quality assurance.  Furthermore, consumer empowerment through education, advocacy, and consumer protection must be in place.  Finally, an international governance body is necessary to ensure the regulation, training, contracting and collaboration of key stakeholders.  

Figure 1