This story suggests that the often-stated belief that all health care is local is being challenged by global competition.

Earlier this week, a survey conducted by the association of state insurance commissioners suggested that as an estimated 22% of Americans were cutting back on doctors’ visits because of costs uncovered by their health plans. The sample size was under 1,000 people but large enough to be credible. This is an example of people who feel underinsured, whether they are or not. The sticker shock brought on by the new, high deductible health plans is a large factor in this development as these are hitting as the economy falters. Even people who have felt comfortable about their health plans are taking a second look at their coverage. According to the newspaper, they also are shopping.

This long has been the issue of advocates for competition in health care. Competition may not look like those advocates expected. There are some stellar hospitals abroad and there are some which exploit patients looking for a bargain. No different than America, for that matter.

There are two articles on this subject in this week’s issue related to medical tourism.

Be very careful before you travel to another country for care. Check independently on the description of service offerings and outcomes. Find out if your health plan covers care in the location you are considering.

This may be a good thing to do. It may not. Proceed with caution. If you do decide to go abroad for care, you should have someone from home with you, who can speak for you should complications develop. Get a precise understanding about what you should do if there are complications after you return home.