Although considerable recent attention has been given to the phenomenon of patients travelling to developing countries for lower-cost care, international medical travel by individuals in search of high-quality, complex hospital care has a long history and continues to be a thriving global market. Individuals travelling to developed countries for medical care are often in search of ‘solution shop’ medicine, where providers are organized to diagnose any problem. Competitive advantage is a dynamic process for tertiary and quarternary providers in developed countries that attract patients from across the world. Investments in both research and development and the hospital infrastructure draw patients in search of complex medical care, and providers further refine their effectiveness and efficiency. By training providers in other countries, this expertise is disseminated across borders, diffusing the competitive advantage, and new tests and treatments are developed. With this continual introduction of new tests and treatments, and the simultaneous development of local expertise in more common treatments, the types of services for which patients travel across borders also evolves. Competition for international patients with complex medical needs will continue to increase across countries, as risk-adjusted and publicly available quality measures are developed to compare outcomes for providers across countries.