A dentist's office may not be everyone's idea of a perfect holiday destination.
But a growing number of Europeans are travelling abroad for medical treatment to save money, or maybe to combine a visit to the doctor with some sightseeing, creating a fast-growing market that is still largely untapped by traditional tour operators.
"It was simply cheaper for me to go to a dentist in Hungary," said a 42-year-old physical therapist from Berlin, who did not want to give his name.
He chose the clinic near Budapest from an Internet advertisement, enticed by hundreds of euros in savings compared with the same treatment in Germany. He was happy to find when he got there that the clinic was clean, the staff competent and the work thorough.
Greater efforts by clinics to lure customers from abroad for routine procedures are creating new opportunities for tour operators looking to expand into faster-growing markets.
Helmut Wachowiak, a professor at the International University of Applied Sciences at Bad Honnef in Germany, says the global medical tourism market is worth $40 billion to $60 billion and is growing at about 20 percent per year.
"The medical tourism market is still very much passing by traditional tourism, though it is increasingly recognized as an opportunity for the travel industry," said Wachowiak, an expert on tourism management.
People travel abroad for medical treatment for various reasons: it's cheaper, they face a long wait at home, or the treatment they want is not available in their own country.
Robert MacLaren, professor of ophthalmology at the University of Oxford, said some patients who have immigrated may prefer to return to be close to their families when they undergo surgery.
"People will want to take the opportunity to seek treatment in places where it might be cheaper and where they have relatives who might be able to look after them. I'm seeing that especially with younger people from eastern Europe," he said.
The British-based Medical Tourist Company refers about 100 patients a year to hospitals in India for treatments including cardiac surgery, knee and hip replacement, in-vitro fertilization and dental work.
Chief Executive Premhar Shah reports rapid growth in demand from customers in Africa, where it can be harder to find well-equipped medical facilities for complex surgeries.
Shah, a medical doctor by training, said he competes with hospitals that market directly to prospective patients as well as companies trying to expand into medical tourism.
"It's a very competitive market because everybody wants to jump into it," he told Reuters.
Some countries such as Germany market themselves as a destination for medical tourism.
According to the German National Tourist Board, about 77,000 foreign patients were treated in the country in 2010, spending 930 million euros ($1.47 billion). They came mostly from other European countries, Russia, Gulf states or the United States.
Hospital operator Helios helps organize visas, hotels and sight-seeing trips for patients coming to Germany for treatment, mostly from Russian-speaking countries and the Middle East.
"Many patients specifically opt for a city where they can enjoy what the place has to offer alongside the treatment," Helios manager Stefan Boeckle said. "Provided their medical condition allows for it, of course."
He cited the example of a Kuwaiti businessman who came to Berlin for a check-up in December and booked a hotel and theatre tickets for himself and his son, plus a limousine to take him to hospital during the two-day stay.
Boeckle says patients from the Middle East have tailed off slightly now that countries such as the United Arab Emirates have started building more hospitals to attract medical tourists themselves.
A survey by consultancy IPK International has shown that 3-4 percent of the world's population travels to foreign countries for medical treatment, and as many as 52 percent of Europeans say they could imagine doing so.
"I think booking numbers (in health-related tourism) could rise on a hockey stick-shaped curve in coming years," said Claudia Staedele, a board member of German medical tourism company Dr. Holiday. "There is still incredible room to grow."
Dr. Holiday, part of Germany's second-biggest tour operator Rewe, focuses on vacations that have health-related elements such as exercise classes, but also offers trips to Hungary for dental treatment and to Turkey for laser eye surgery.
Between 2003 and 2007, the number of trips Dr. Holiday has sold sky-rocketed from 300 to 30,000. Since then, growth rates have been double-digit and Staedele said she sees an 18 percent rise this year.
By comparison, overall international tourism grew by 4 percent in 2012, according to the U.N. World Tourism Organisation.
Staedele said the combination of an ageing population and growing acceptance of medical treatments abroad will bolster growth in coming years.
Companies can also help those with chronic conditions enjoy a holiday like everybody else.
Chiara Frattini works for Holiday Dialysis International, part of Germany's Fresenius Medical Care, which arranges dialysis for people on holiday.
The service started in 1996 and has seen growth of around 6 percent a year, she said. Around 2,000 people contact the service each year, with customers mostly from the United States and Japan, where people tend to travel in large tour groups.
She has organized dialysis in destinations such as the Philippines, Senegal, Kenya and Thailand.
"But in the Saharan countries, it can be very difficult due to lack of good water and treatment facilities, and some places are just not politically advisable," she said.
The company sets up dialysis wards on cruise ships with nurses and a specialist doctor on board.
After a lull for the European financial crisis, Frattini is more confident. "If the patient is facing money problems, the first thing they decide to cancel is their vacation. But I expect that this year will be much better," she said.
For some, there is the attraction of free treatment abroad, at which point politics comes into the equation.
In Britain, where most medical care is funded by general taxation and delivered free within the National Health Service, health tourism has become a contentious issue.
Legislators have called for tighter checks on patients arriving for treatment, amid concerns that foreign citizens are travelling to Britain to take advantage of the free service.
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