The concept of health equity involves the recognition that unfair and avoidable health differences between groups of people are linked with social, economic or environmental disadvantages. This chapter discusses evidence that many of the purported economic and health system benefits of the medical travel trade for LMICs are not being realized, rather growth of medical travel exacerbates already existing inequities within health systems. It proposes a framework for conceptualizing factors influencing the impact of medical travel upon local health system equity, including a range of local supply-side factors, local policy settings and foreign demand-side factors affecting health system resources, access and utilization. There is growing evidence of the profound effects of the trade upon the human resourcing and access for local populations in destination countries. There is an urgent need for better empirical evidence of the effects of trade on equity. The chapter concludes that policy coherence across all sectors is necessary to divert medical travel from causing foreseeable harms and that, to the extent possible, governments of sending countries need to develop policies which limit the demand for medical travel from their own citizens.