The Cleveland Clinic just announced plans to develop a hospital near Buckingham Palace in London. Cruise ship spas are now staffed by medical doctors and licensed acupuncturists.

The United States once had the world's market share of in-bound patients seeking healthcare from "the best healthcare system in the world." Now that the U.S. is well-acknowledged to be the most expensive healthcare system in the world, medical tourism is both in-bound and, increasingly, out-bound, with at least 1.4 million Americans seeking healthcare abroad in 2016, according to Visa. Visa estimated that the U.S. out-bound healthcare market was valued at $439 bn in 2015, and will grow 25% a year in the next decade.

The Cleveland Clinic has been one of the most popular in-bound site for healthcare for foreign nationals seeking world-class heart surgery. On the virtual care front, Cleveland Clinic has also offered a telemedicine service for second opinions which has garnered an international reach. The Clinic even has a website with information on "international patient services." With the launch of the Clinic's London-based hospital, the institution is signalling that they see demand for their healthcare brand outside of the U.S., and geographically closer to prospective patients. The new London location can attract the emerging self-paying patients traveling from Eastern Europe, the Middle East, and Asia.

Recognizing the growing opportunity for US-bound medical touring patients, more overseas hospitals are gaining credentialing from the Joint Commission International, part of The Joint Commission, a U.S.-based accrediting agency. The Joint Commission is widely recognized as a sort of Good Housekeeping seal of approval for health care quality. The Singapore National Eye Center; Bumrungrad International in Bangkok, Thailand; and several Fortis Hospitals in India are all accredited by JCI, along with over 800 other health care providers from the world over.

Medical tourism increasingly takes place beyond hospitals. Forging a new definition of "mobile health," cruise ships now boast medical doctors aboard providing services well beyond Dr. Adam Bricker, ship's doctor on "The Love Boat," solving sea-sickness and sore throats. Acupuncturists operate aboard the Norwegian Cruise Line Breakaway, along with board-certified dermatologists that administer the latest versions of aesthetic procedures going beyond Botox. I recently interviewed the Spa Manager aboard The Breakaway, who told me that the ship, which regularly disembarks from Chelsea Piers in New York, attracts consumers-cum-patients from the tri-state area who seek perennial visits with the ship's acupuncturists to help deal with pain and other chronic ailments.

Hotel chains, too, are expanding their approaches to health and wellness through healthy food options on the menu, yoga mats in the rooms, and spa services. The Marriott in downtown Atlanta recently completed a $78 mm renovation that includes two full hotel floors dedicated to health and wellness known as "StayWell rooms." The concept is based on evidence-based research into health and wellbeing, including air purification, circadian lighting, vitamin C shower infusers and aromatherapy. Marriott also offers nutrition, sleep, and stress management programs developed by -- guess who? -- Cleveland Clinic.

The Westin Hotel, part of Starwood, has long offered the Heavenly Bed (promoted to improve a restful night's sleep). The chain has been working with various health and wellness experts -- runners, coaches, nutritionists - for informing its "Move Well" concept. In fact, Westin is driving wellness concepts across a range of hotel programs including "Sleep Well" (that Heavenly Bed), "Eat Well," "Feel Well," "Work Well," and "Play Well."