I used to be a business journalist. Last year I interviewed Dr Azad Moopen, the founder of one of Dubai's largest private healthcare groups, and the subject of medical tourism came up, since Dubai is keen to develop this sector.

He had some very interesting things to say, though his comments won't apply directly to Kurt's questions about operating just outside  a jurisdiction that forbids certain procedures.

Essentially, he said that to become a centre for medical tourism, you need top medical tech, top doctors and a larger supply patients.

The tech is a matter of capital investment. If your homeworld doesn't have it, import it (and the doctors to apply it). Obviously, planets which already have a significantly higher tech than their neighbours have an immediate an obvious comparative advantage.

The balance between top quality doctors and the number of patients is key. Top doctors are attracted by unusual cases or specialist procedures, and you need a large pool of patients to supply enough to attract them. Patients are attracted by top doctors. Thus, you have a bootstrap issue. It takes time to build the kind of reputation you need to attract the patients, who will attract better doctors to work with you, who will attract more patients...

If you have a high-pop world, you already have the pool you need. High-tech, high-pop worlds will automatically be centres of medical tourism - in the Marches, this will be Glisten, Mora, Trin, Rhylanor.

You might decide certain high-tech, moderate-pop (or even low-pop) garden worlds are wellness retreats. They'll likely need a high-pop world or two nearby to make this really profitable (and they'll charge through the nose for it).

The edge cases get a little more interesting. What if you're the highest tech world in a subsector, but the neighbouring subsector has a higher tech world? Do you import the tech? Will people come to you or head to the higher tech world anyway? If you're using GURPS Traveller: Far Trader, the trade route system might give you an idea.

But trade is generally B2B (business to business), where the only thing that matters is the numbers. Healthcare is B2C (business to consumer). Other factors will come into play - do you have doctors that speak my language? Who know and respect my culture? Will I be comfortable there? These factors might not be as important for life-threatening cases, but will affect elective or cosmetic surgery. Fashion will also affect cosmetic surgery (I kid you not, I've just had an SMS from a healthcare provider saying they now have a celebrity plastic surgeon on staff; well, celebrity chefs are a thing, so why not?)

Back to the question of setting up a medical facility just outside a jurisdiction that doesn't approve of certain procedures.

Firstly, if you are using the Third Imperium, why bother with an offworld facility? Just establish a clinic inside the starport's extrality zone. Patients might have numerous reasons for visiting the starport, and it's a lot cheaper than getting into space. 

But let's assume that for some reason you must establish a space facility. 

If I'm running a medical provider, I'm going to be concerned about how providing such a facility will affect my business's reputation, and by the bottom-line repercussions. Potential patients will not be as concerned with getting the very best tratment, but with getting treated at all - so as a provider, I don't have to worry so much about getting the best doctors with the best tech.

If my firm is based on the planet in question, I may win popular approval (depending on people's views of the laws), but could face punitive fines and government disapproval. How bad the legal tangle will be is going to depend on government type and law level (loss of government contracts, extra inspections and paperwork, ultimately loss of licence and imprisonment). This is fertile ground for drawing in PCs.

An interstellar medical firm (or a non-profit) that doesn't have a local ground presence will be far less concerned about reputation, since the procedures aren't against Imperial law, but will still consider cost and revenue (even non-profits have to balance the books). Does the local population support a permanent facility? Should we visit occasionally with a hospital ship instead? Do we charge full price for the procedures, or will the public relations advantages of CSR (corporate social responsibility) be sufficient.to discount them or even offer them for free?

Then there's the issue of patient accessibility. If they face repercussions at home for getting a procedure outside the jurisdiction, this will affect them. It's hard to disguise the fact you're visiting a dedicated deep-space facility, but you may have other reasons for visiting a facility or other world, which can disguise your intent to have an illegal procedure.