the commission arithmetic: what renting patients really costs

I run an Australian marketing consultancy that builds Thai clinics their own Australian patient channel, so I have an obvious position in this argument. I am going to make the case with the platforms' own model and published treatment prices, flag every number that is commentary rather than published fact, and be fair about what platforms do well. You can check the arithmetic yourself.

How the platform model works

The big patient-referral platforms share a structure. Listing is free. Dental Departures describes a success-fee model: no listing fees, with commission payable on completed appointments, and it claims more than 200 Thai partner clinics. Bookimed's partner material says "you only pay a set commission rate when a patient requested your clinic via Bookimed gets medical services", with the rate disclosed at agreement stage rather than published. MyMediTravel operates on similar undisclosed terms.

So what is the rate? Here is the honest answer: mostly, nobody publishes it. What exists is industry commentary, and it should be treated as a range, not a fact about any named platform. Commentary from medical tourism consultants, including Maria Todd, puts facilitator fees at 7.5 to 30 percent of package price, or flat fees of US$1,500 to US$5,000 per patient. My 1Health is a rare exception that publishes its range: 5 to 15 percent. There are variants too. PlacidWay reportedly runs annual subscription tiers plus a 15 percent case management fee on successful cases (a secondary-source figure, so hold it loosely). WhatClinic sells pay-per-lead from EUR 10. Taken together, the visible spectrum runs from roughly 5 percent to 30 percent of treatment value, and none of the major Thailand-facing platforms states its number in public.

That opacity matters. A clinic can compare two agencies on price in an afternoon. It cannot easily compare two commission agreements it has not yet signed.

The arithmetic at real treatment values

Let's put the commentary range against a published price. Bookimed's own Thailand aggregate for an All-on-4 arch is US$9,000 to US$14,100. Here is what one referred patient costs at commentary-range rates. These are illustrations of a range, not any platform's actual rate.

Now add volume. Four to five All-on-4 patients a month at US$10,000 and a mid-range 15 percent is US$6,000 to US$7,500 a month, roughly A$9,000 to A$11,300. That is not a launch cost that ends. It is a permanent operating cost that scales with your success, and it buys you nothing you keep. Smaller cases follow the same logic: a US$4,000 dental case at 15 to 20 percent is US$600 to US$800 per patient.

For context, serious English-market SEO and advertising from a Bangkok agency already runs THB 80,000 to 200,000 a month, about A$3,400 to A$8,500. The commission leakage at modest volume sits above the entire local agency band, and above every retainer MediSiam publishes.

The costs that never appear on an invoice

Three structural costs come with the commission, and I think they matter more than the percentage.

Pricing parity. Bookimed's partner obligations include pricing parity with direct enquiries. Read that carefully. You cannot reward the patient who found you directly with a better price, which removes your strongest commercial reason for anyone to book direct, which protects the platform's channel at the expense of yours.

The platform owns the relationship. The reviews accrue to the platform's domain. The rankings belong to the platform's pages. The patient's first loyalty is to the marketplace that found the clinic, not the clinic. Every case you serve well makes their asset more valuable and yours no more visible.

Commoditised comparison. On a marketplace you sit in a list beside hundreds of competitors, sortable by price. The platform is structurally indifferent to which clinic wins. Your fifteen years of clinical excellence renders as a star rating and a price field.

What platforms are genuinely good at

Fairness requires saying this plainly. Platforms deliver volume from a standing start. A new clinic with no international presence can be in front of foreign patients within weeks, paying only on results. Dental Departures and Bookimed have real audiences and real booking flows, and a clinic with empty chairs today has a problem that a two-year channel build does not solve. If I were opening a clinic tomorrow with no patient flow, I would probably list too. The commission model is not a scam. It is a rental agreement, and rent is sometimes the right tool.

When owning the channel beats renting it

The crossover is a volume question, and it is honest to put it that way. At one platform patient a month, commissions are cheaper than any serious retainer. At four to five All-on-4-scale patients a month, the mid-range commentary arithmetic above says you are paying the equivalent of A$9,000 to A$11,300 a month, more than MediSiam's top published tier, for a channel you will never own. MediSiam's core Acquisition retainer is US$4,300 a month, roughly three mid-range facilitator commissions on a single All-on-4 arch.

The deeper difference is what happens when you stop paying. Stop paying commissions and the flow stops the same day, because nothing was built. Stop a channel build and you keep the site, the rankings, the reviews on your own profiles, the content answering Australian patients' questions, and the tracking in your own accounts. One is an expense. The other is an asset with an end date on its cost.

The two also compound in opposite directions. Commission cost rises with volume forever. Channel cost is roughly flat while the channel's output grows. Every month you rent, you fund the platform's asset. Every month you build, you fund your own.

Where MediSiam stands

MediSiam never charges a commission. Not a percentage of treatment value, not a per-patient success fee, not ever. Our retainers are published, and the optional performance element on our Acquisition and Growth tiers is US$150 to US$200 per qualified Australian enquiry above an agreed baseline, capped at 30 percent of the retainer. The distinction is deliberate. A capped per-enquiry fee is a marketing fee: it rewards the work, it cannot balloon with your treatment prices, and it keeps us on your side of the table rather than taking a cut of your surgery. A percentage of treatment value makes your marketer a facilitator with an interest in your invoice. We think that conflict is the quiet flaw at the centre of the whole commission model, and we have priced ourselves out of it on purpose.

If you want to see what the rented channel is currently doing for you, start with evidence. The free Australia Visibility Report shows exactly what Australian patients find when they look for your clinic: your visibility in Google Australia and AI answers, your review footprint, and who is winning the searches you should own. No access needed, no commitment. Request your visibility report.