Three calculations, one record
At least three separate money flows revolve around a single medical tourism patient, and they are frequently confused with one another:
- Agency commission. The share paid to an external partner who introduced the patient.
- Consultant bonus. The internal sales representative's earning.
- Partner hospital settlement. What is owed to the institution delivering the treatment.
All three come out of the same patient's revenue. Kept in separate spreadsheets, nobody can say at month-end which patients actually made money. The right design attaches all three to the patient record.
Agency commission
Working with external introducers is common and is where disputes most often arise. Four points to settle in writing:
- When is it earned? On arrival, or on full collection?
- On what base? The whole package or the treatment fee only? Are accommodation and transfer included?
- Cancellations and refunds. What happens to commission if the patient cancels or is partially refunded?
- Attribution period. If a patient introduced by the agency returns directly a year later, is commission due?
All four should appear in the contract and be configured the same way in the CRM. Ledger tracking shows the balance per agency.
Consultant bonus
Bonus structure drives behaviour, so when designing it ask: what behaviour does this rule reward?
| Structure | Behaviour it rewards | Risk |
|---|---|---|
| Percentage of revenue | Higher-value sales | Closing via discounts, margin erosion |
| Fixed per patient | Volume | Drift toward smaller cases |
| Percentage of profit | Protecting margin | Transparency and complexity |
| Tiered targets | Consistency | Bunching at period end |
The combination that works in practice is a revenue percentage tied to collection, with discount authority governed by rules. Granting that authority through defined codes makes it both traceable and bounded.
Reconciling with partner hospitals
Month-end reconciliation arguments come from the two sides keeping different records. What largely solves it:
- A shared reference number per patient that both parties quote.
- Recording at the point of service. The amount is confirmed and entered at hospital discharge, not at month-end.
- Document matching. Discharge summary and invoice attached to the patient record with tags.
- Weekly partial reconciliation. A small weekly confirmation instead of one large monthly dispute.
The process runs through Meto Operation and pre-accounting.
Seeing real profitability
With all three tied to the patient record, these become answerable:
- What is gross profit by treatment? Is the best seller also the most profitable?
- How does net contribution differ between agency-introduced and direct patients?
- Which partner hospital leaves the better margin after settlement?
- How much margin are discounts consuming?
Combine that table with patient acquisition cost and growth decisions stop being guesswork. See reporting.