Net profit per treated case = gross commission − lead and ad cost − coordinator time − the cost of cancelled bookings − collection delay and FX loss − services the agency pays for. This free calculator runs that formula for dental, hair transplant, aesthetic surgery, IVF and bariatric cases, draws every deduction as a waterfall, finds your break-even conversion rate and ranks the inputs by how hard they move your net. It runs in your browser, and every pre-filled value is an illustrative example to replace with your own figures.
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A commission rate is a headline, not a result. A medical tourism agency that earns 20% on a 6,000 package does not make 1,200 per patient. It pays for the leads that never booked, for the hours a coordinator spends on quotes, medical files and travel plans, for the bookings that cancel after all that work, for the weeks it waits to be paid, for the currency spread on the transfer, and for the airport pick-ups and interpreters it agreed to cover. This page turns that list into one number — net profit per treated case — and shows where the rest of the commission went.
The calculator sits at the top of this page. Pick a specialty — dental, hair transplant, aesthetic surgery, IVF, or bariatric and other hospital cases — and a currency. Then fill in six numbered groups that match the six numbered bars of the waterfall chart: (1) the package price and either a commission rate or a fixed fee; (2) cost per lead and lead-to-booking conversion; (3) coordinator hours per booking and the loaded hourly cost of a coordinator; (4) the cancellation and no-show rate; (5) days until the commission is paid, your annual cost of money and your FX and transfer loss; (6) the services the agency pays for per case. The chart starts from the gross commission and drops each cost in turn until the net per treated case is left. A live panel shows net per case, the share of the commission you keep, the monthly total for your case volume, the leads and lead spend you need each month, the break-even conversion rate and the highest cost per lead you can afford. Below it, a sensitivity chart moves every input 10% up and down and ranks them, and a comparison strip shows all five specialties side by side with one combined monthly total. Each specialty keeps its own inputs; the coordinator rate, the cost of money and the FX loss are shared.
Everything is calculated per treated case: a patient who completed treatment and generated a commission. Leads and bookings that never got that far are costs, and the cases that did get treated carry them.
When agencies compare clinics or specialties they usually compare commission rates. The lines below rarely make it into that comparison, and together they can be larger than the gap between two commission offers.
The calculator opens on this case, in US dollars. Every figure is illustrative: an example that shows the mechanics, not a market average. A UK or US agency sends aesthetic surgery patients to Türkiye or Mexico. The package costs 6,000 and the agency's agreement pays 20%. Leads cost 30 each and 8% of them book. A coordinator spends 8 hours on each booking at a loaded 25 per hour. One booking in five cancels or does not show up. The clinic pays 30 days after treatment, the agency's cost of money is 12% a year and it loses 2% on exchange and transfer fees. The agency pays 200 per case for transfers and an interpreter, and treats 3 patients a month.
So a 20% commission becomes a 20.5% keep — about 4% of the package price. At three treated cases a month that is a monthly contribution of 736.24, and it needs about 47 leads and 1,406.25 of lead spend every month. Lead cost is the largest single deduction at 31.3% of the commission. Cancellations alone cost 143.75 per treated case, which is more than two extra percentage points of commission would bring in on this package (120).
Set net per case to zero and solve for conversion, and you get the break-even rate: break-even conversion = cost per lead ÷ [(1 − cancellation rate) × (gross commission − collection and FX cost − services) − coordinator cost]. In the aesthetic example the bracket is 0.8 × (1,200 − 35.84 − 200) − 200 = 571.33, so break-even conversion is 30 ÷ 571.33 = 5.25%. Below 5.25%, every treated case loses money, however many you sell.
Turn the same bracket around and you get the ceiling on lead cost: maximum cost per lead = conversion × the same bracket. At 8% conversion that is 45.71. A lead source that charges more than that cannot pay for itself at your current conversion, whatever volume it promises.
When the bracket is zero or negative, no conversion rate can save the case: coordinator time, cancellations, collection cost and services already eat the whole commission. The calculator says so instead of printing a percentage. Fix the commission, the services you give away or the hours per booking before you buy more leads.
The sensitivity chart moves each input 10% up and 10% down, one at a time, and ranks the inputs by how far net per case moves. In all five example scenarios the top of the list is the same: the commission itself (package price or rate), then conversion, then cost per lead.
Two patterns are worth knowing. First, conversion is asymmetric. In the dental example a 10% better conversion adds 22.73 per case and a 10% worse one removes 27.78, because lead cost per booking is cost per lead divided by conversion. Second, in thin-margin cases the swing is larger than the net itself. In the IVF example net is 52.33 per case, and a 10% fall in conversion takes 74.07 off it: the case becomes a loss.
In practice: a better-qualified enquiry is worth more than a cheaper one, and a provider that answers fast and quotes clearly lifts your conversion without touching your ad budget.
High-ticket does not mean high net. The five example scenarios show why: bariatric and hospital cases carry the largest commission (1,350) but also the most coordinator hours and expensive leads, and keep 13.4% of it; hair transplant carries the smallest commission (625) and keeps 40.8%. Your figures will differ. The point is to compare specialties on net per case and break-even conversion, never on commission alone.
Few agencies run a single corridor. In Health onMESSE research (October 2026), covering 997 verified agencies, the average agency sends patients to 2.52 destination countries while the median is 1 — a minority of multi-destination agencies pulls the average up. 339 agencies — 42% of the 807 whose destinations could be identified — send patients to two or more countries. For them the comparison strip is the useful view: each specialty keeps its own inputs, and the strip adds them into one monthly total.
Agencies that run this arithmetic choose providers differently. A clinic that pays commission on time shortens the collection line. One that answers enquiries within hours lifts the agency's conversion. One that includes the transfer and the interpreter in the package removes a whole bar from the waterfall. That is how the clinic that understands the agency's unit economics wins the referral without raising the commission. Exhibit at Health onMESSE to meet agencies that already think this way, and see onMESSE for exhibitors for how participation works.
The two biggest levers in every scenario above are the commission you negotiate and the conversion you get from each enquiry. Both improve when you speak to the provider directly. Health onMESSE is a digital trade fair where agencies hold scheduled one-to-one meetings with clinics and hospitals from six destination hubs: Türkiye, India, Mexico, the UAE, Spain and Germany. Our research maps those hubs across 18 cities, so one meeting calendar can cover every destination you sell.
Agencies register free: join Health onMESSE as an agency, or read how onMESSE works for agencies first. Clinics and hospitals find the participation options on the pricing page. Before you sign a commission agreement, check it against the clinic contract checklist; to choose a destination, read health tourism hubs 2027; and to vet a partner hotel, use the hotel readiness check. Every tool for this fair is listed under Health onMESSE tools.
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