Every marketplace has to answer one question: who pays, and when. The three answers in circulation — a monthly listing fee, a price per lead, or a percentage of the booking — look like variations on a theme. They are not. They put the risk in completely different places, and once you see where the risk sits, the right choice for your clinic stops being a matter of taste.
The three models, plainly
Listing fees. You pay a fixed amount per month to appear. The marketplace is paid whether you get one enquiry or two hundred, and whether any of them book. This is the directory model, and it is the oldest one in the industry. Its incentive is to sell listings, not to send you patients.
Pay-per-lead. You pay a fixed price for each contact passed to you — commonly €15 to €60 in this sector, more for high-value procedures. The marketplace is paid on delivery of a name and an email. Whether that name answers the phone, has a budget, or is even in the right country is your problem. The incentive here is volume of leads, and the pathology it produces is exactly what you would expect: the same lead sold to four clinics, and "leads" that are enquiries about a procedure you do not perform.
Commission. You pay a percentage of a booking that actually happened. Nothing sells, nothing is owed. The marketplace only earns when you earn, which is the only one of the three models where the platform's interest and yours point the same direction. The trade-off is honest: on a big booking, a percentage is a big number, and that is what makes clinic owners uncomfortable.
Do the arithmetic before you have the opinion
Take a clinic doing a €3,200 dental package and compare, per model, on a hundred leads with a realistic 10% lead-to-booking rate — ten bookings, €32,000 of treatment revenue.
- Pay-per-lead at €40: 100 × €40 = €4,000, paid up front, regardless of outcome. That is 12.5% of revenue if ten of them book. If only five book — a perfectly ordinary month — it is 25%, and you paid it before you knew.
- Listing fee at €500/month: cheap if the traffic is real, and pure loss if it is not. The number you cannot see when you sign is how many enquiries the listing actually produces.
- Commission at 12%: €3,840 on €32,000 — payable only on the ten that happened. If five book, you pay €1,920. The cost scales down with a bad month instead of amplifying it.
The percentages converge in a good month. They diverge violently in a bad one, and that is the whole point. Fixed costs punish you for the months you can least afford to be punished. This is why a clinic with unstable demand — which, in health tourism, is nearly every clinic — should be structurally suspicious of any model that bills before a patient exists.
The number that actually matters
Stop comparing headline rates and compute your cost per confirmed booking for every channel you run, including the ones you think are free:
- Take the total channel cost for the month — fees, commission, ad spend, and the coordinator hours the channel consumes.
- Divide by the number of confirmed, paid bookings that channel produced. Not enquiries. Not "interested" patients.
- Compare that against your gross margin on the procedure — not against your revenue, which is the mistake that makes a 9% commission sound worse than a €40 lead.
- Then rank the channels. Most clinics discover that the channel they complain about loudest is their cheapest, and the one they consider free is eating a coordinator's entire week.
That last step is where the argument usually ends. A commission is visible — it appears on a statement with your name on it. Sixteen hours of a coordinator chasing dead pay-per-lead contacts is invisible, and it costs more.
Read the fine print on any commission
Not all commissions are the same commission. Before you sign anything, get a plain answer to each of these — in writing:
- What is the base? The treatment price, or the whole package including hotel and transfers? Charging a percentage of a hotel room you booked at cost is a way of quietly inflating the rate.
- When is it owed? On booking, on arrival, or on a booking that was confirmed and paid? A commission owed on a no-show is a fee, not a commission.
- What about cancellations and refunds? If the patient is refunded, is the commission reversed? If the answer is no, the platform is being paid for a booking that did not happen.
- Does it apply to the patient's next visit? Some platforms claim a percentage on every future treatment for a patient you now have a direct relationship with. That is rent, and you should decline to pay it.
- Can you see the calculation? If you cannot download a statement showing each booking, its value, and the fee applied, you are not being charged a commission — you are being sent a number.
On GetClinic: commission is charged only on bookings confirmed and paid through the portal — nothing is owed on an enquiry, a quote, or a patient who never travels. The rate falls as you commit: Free at $0/mo (5 routed leads, 18%), Starter at $69/mo (20 leads, 15%), Growth at $139/mo (50 leads, 12%), Premium at $599/mo (125 leads, 9%). Every payout comes with a downloadable statement showing the bookings behind it. Launch pricing holds until 31 December 2026.
Why the rate falls as the fee rises
Tiered pricing looks like a discount trick until you work out the crossover. A subscription is a fixed cost, so it only makes sense once the commission it saves exceeds it. Run the numbers against your own average booking value rather than a brochure's.
On a €3,200 package, moving from Free (18%) to Growth ($139/mo, 12%) saves roughly €192 in commission per booking. The subscription pays for itself somewhere inside the first booking of the month, and every booking after that is pure saving — but only if you are actually converting the leads. Two bookings a month and Growth is obviously right. One booking every other month and you should stay on Free, because you are not being held back by the commission rate, you are being held back by conversion, and no pricing tier fixes that.
How to decide, in one paragraph
If your demand is lumpy and your conversion is unproven, take the model that only charges you when a patient actually arrives and pays — and accept the higher percentage as the price of carrying no fixed risk. Once you can predict your monthly bookings within a booking or two, buy the rate down, because the fixed fee is now a known quantity and the percentage is the expensive part. And whichever way you go, run the cost-per-confirmed-booking calculation every quarter. It is fifteen minutes of work, and it is the only thing standing between you and paying €4,000 for a hundred names that never called back.