Tourism, a great invention… or not? (III): When healthcare also generates tourism. Puerto Rico as an example

In our previous reflections on the impact of tourism on healthcare, we have analyzed how millions of people temporarily moving to a territory can modify their healthcare demand.

Because tourists are not part of the resident population, but for a few days or weeks they are part of the population that may need health care.

Puerto Rico is a good example for further developing this relationship. And not precisely because tourism is a minor phenomenon there.

In 2025, it received 8,1 million visitors , 8% more than the previous year, marking its fifth consecutive year of record tourism. This figure is especially significant for an island with a resident population of around 3,2 million.

Furthermore, Puerto Rico decided years ago to take a further step and make healthcare itself part of its tourism strategy . Far from being a spontaneous phenomenon or an isolated initiative by a few hospitals, the country identified the characteristics of its healthcare system as an opportunity to attract patients from abroad and developed a specific medical tourism strategy, supported by legislation, public agencies, provider certification, and promotional activities.

In this way, Puerto Rico deliberately established a two-way relationship between tourism and health.

• On the one hand, the millions of visitors it receives each year constitute a floating population likely to need assistance during their stay: TOURISM → HEALTHCARE DEMAND
• At the same time, Puerto Rico decided to leverage its hospital infrastructure, its significant private network, and especially its connection to the U.S. healthcare system to take the opposite path: HEALTHCARE OFFER → ATTRACTING PATIENTS → TOURISM

And precisely to understand why Puerto Rico considered that it could compete in this market, it is worth first examining the particular characteristics of its health system.

A healthcare system with very particular characteristics

Puerto Rico is a U.S. territory, and its healthcare system is closely linked to the U.S. model. Its healthcare regulations, the accreditation of facilities and professionals, and many of its funding mechanisms are governed by this framework.

The very legislation through which Puerto Rico promoted medical tourism highlighted precisely as one of its competitive advantages that the island shared the legal structure and federal standards applicable to the US health industry.

Added to this is another particularly relevant characteristic: the significant weight of private provision.

Puerto Rico has an extensive hospital infrastructure distributed throughout the island. At the end of 2025, the Department of Health estimated the entire hospital ecosystem at 66 hospitals and more than 9.288 beds.

There is a public network, which includes reference centers and university hospitals —including the University Adult Hospital, the only supratertiary hospital in the public system—, but a very significant part of hospital care is provided through private hospitals and organizations.

We therefore have a rather unique combination:

• A major tourist destination
• An extensive healthcare infrastructure
• A powerful private hospital network
• Standards linked to the US system.

And it is precisely this combination that leads us to a new dimension of the relationship between tourism and health.

When a tourist needs medical assistance

The first scenario is the one we've been discussing. A person travels to Puerto Rico to enjoy its beaches, visit San Juan, take a cruise, attend an event, or spend their vacation, and during their stay, they need medical assistance.

You may have an accident, develop an infection, experience a flare-up of a chronic illness, or require any other type of care:

The reason for the trip was not medical. But the trip has generated a demand for healthcare.

And when a territory receives millions of visitors, this floating population becomes a variable that should be incorporated in some way into the planning of its health resources.

When healthcare is the reason for the trip

Puerto Rico has been exploring precisely this second possibility for years.

In 2010, it passed a Medical Tourism Law and subsequently developed various initiatives to position itself as a destination for patients from other regions. This strategy is quite understandable when we consider the characteristics of its healthcare system.

Puerto Rico could offer hospitals and healthcare professionals adhering to U.S. standards, bilingual care, geographic proximity to the United States and the Caribbean, and costs that its own legislation deemed substantially lower than those in the continental United States. Healthcare could thus become another element of its appeal as a destination.

In 2015, in fact, Puerto Rican legislation expressly incorporated medical tourism among the modalities that the Tourism Company should promote along with cultural, sports, gastronomic, nature, luxury or convention tourism.

A year later, the Medical Tourism Corporation already had 54 certified healthcare providers , including hospitals, dentists and laboratories, as well as hotel establishments prepared to participate in this activity.

Here the relationship is reversed. The person is no longer traveling and, circumstantially, needs healthcare. They travel because they need—or want to receive—that healthcare. Therefore: HEALTHCARE SUPPLY → PATIENT TRAVEL → TOURISM

Healthcare becomes a generator of mobility.

Two tourists, two completely different demands

This distinction is particularly interesting from a healthcare planning perspective. We might encounter two people from abroad using the same hospital, yet the situations could be completely different. One arrived on vacation and ended up needing medical care. The other arrived specifically to receive that care.

The tourist who needs assistance versus the patient who travels to receive it.

Both increase activity in healthcare facilities, but the origin of that activity is different. Their funding, predictability, the services they use, their geographical concentration, and the way healthcare providers organize their response can also differ.

And another fundamental difference also appears: The first demand is, to a large extent, an externality of tourism that the health system of the receiving territory must be able to absorb.

The second may constitute an economic activity deliberately sought , planned and promoted by hospitals, companies and administrations.

The relationship between tourism and healthcare is more complex than it seems

Puerto Rico is just one example. Other countries have developed strategies to attract international patients, and some destinations have made this a significant part of their offerings. Turkey is probably one of the best-known examples.

Spain is no stranger to this phenomenon either. Although there is no equivalent model developed uniformly as a national strategy, Spanish hospitals and healthcare groups have international patient units and carry out activities specifically aimed at people who travel from other countries to receive care.

Therefore, rather than focusing exclusively on so-called health tourism , the example of Puerto Rico allows us to incorporate another variable into our analysis of the impact of tourism on health :

• First we discovered that to understand the health demand of a territory it is not enough to know how many people reside in it.
• We then found that not all tourists generate the same impact: the volume, seasonality, geographical concentration, duration of stays, visitor profile, and the characteristics of the destination itself all matter.
• Now we must add that the reasons for travel also matter. Because not all healthcare demand associated with displaced persons arises accidentally during a vacation. Sometimes, Healthcare itself is the reason for the trip.And then a curious two-way relationship develops: Tourism generates demand for healthcare, but healthcare can also generate tourism.

This is one more variable to understand why, when we talk about the impact of tourism on healthcare systems, visitor numbers matter a lot. But they never tell the whole story.