Visiting thermal springs for medicinal purposes is one of the oldest forms of tourism in many parts of the world, including South Africa. An overview is provided of the concepts of health tourism, including medical and wellness tourism, as well as spa and thermal spring health tourism. Water-based, treatment-based and recreation-based facilities and services offered at selected international thermal spring resorts are assessed and compared to the thermal spring health tourism product in South Africa, where only three out of more than 20 thermal spring resorts offer sophisticated health treatments. It appears that, internationally, the focus of thermal spring tourism is shifting towards wellness activities, although in South Africa it has shifted further, in the direction of recreation. While the product offerings of thermal spring resorts generally contain elements of water-based, treatment-based as well as recreation-based activities, it is suggested that the main focus should be guided by the activity preferences of current markets, which in the case of South Africa are almost exclusively domestic, and South African domestic visitors have far less interest in health facilities and treatments than their counterparts in Europe, although there is a significant minority that would welcome such services. The question therefore arises as to whether thermal spring resorts in South Africa, especially those that do have health-related services, have shifted their product offerings too far in the direction of recreation, and if so, whether South Africa‟s thermal spring tourism product should not be repositioned so as to capture a greater portion of the international, and domestic, health tourism markets.