The Romanian health tourism, based on its exceptional natural resources represents an important segment of the tourism industry. Old tradition of valorization of thermal waters, mineral springs, mofettes curative mud spa treatments are intertwined nowadays with various forms of medical tourism, some practiced for over four decades (the Ana Aslan geriatric treatment) and others being more recent (cosmetic surgery, dental care, eye surgery, etc).The main purpose of this article is to analyze the evolution of medical tourism, especially of spa tourism in Romania, one of the richest countries in Europe in terms of extent and excellence of specific natural resources, with old and unsuitable infrastructure if referred to the public spa facilities, but with modern facilities in wellness and medical private units. The research is both quantitative and qualitative. The first method is based on statistical analysis of data provided by the National Statistics Institute of Romania. The qualitative analysis complements the previous one, which is not extremely detailed and is also not available for a long period of time. The research reveals unequal evolution of the Romanian spa tourism, a severe discrepancy between the quality of specific resources and the existing spa infrastructure, contradictory demand, as well as positive trends for the medium-term future. As a research method we used first of all the qualitative analysis – the available statistical data are rather scarce. The research reveals the lack of investments and the necessity of implementation of a whole host of local plans as part of a new national strategy for tourism industry.