Forty-five million Americans are currently uninsured and health expenditures in the United States are rising faster than wages and inflation. Despite spending more on health care than any other industrialized nation, in 2000 the United States ranked 37th in the World Health Organization's evaluation of health care systems around the globe. Reforming domestic health care has been a big issue in the 2008 U.S. presidential campaign, yet a growing number of Americans and insurance providers are turning to international solutions.

Approximately 750,000 Americans traveled overseas for medical treatment in 2007, and the number of so-called medical tourists could increase to more than 15 million in 2017. In previous decades, the medical tourism industry was dominated by cosmetic and dental procedures. Today everything from knee replacements to major heart surgery can be obtained in developing countries where internationally accredited health centers provide high-quality treatment with lower costs and shorter waiting periods than in the United States.

A heart-valve replacement priced at $200,000 or more in an American hospital can cost $10,000 in India, according to the University of Delaware, including airfare and a post-operative vacation package. Average savings in Thailand are about 70 percent compared with the United States, and between 50 and 75 percent in Latin America.

Thailand's Bumrungrad Hospital treated 400,000 international patients in 2007, including 65,000 Americans. Thanks to an increase in foreign patients, the hospital's total revenue for 2008 is predicted to rise to $618 million.

Overall the effects of medical tourism are mixed. On the one hand, the industry can boost a developing country's gross domestic product and investment in health facilities. Upgrades in a country's hospitals also tend to decrease external brain drain, as top physicians find local jobs instead of leaving for employment in developed nations.

A study by the Confederation of Indian Industry predicts that by 2012 the medical tourism industry could add up to $2.3 billion to the country's annual GDP. The head of India's Wockhardt hospitals, which cater to foreigners, reported two dozen Indian doctors returning from the United States and Britain to work in his facilities.

In many cases, however, medical tourism threatens to exacerbate unequal access to quality health care in developing countries. Although relatively cheap by most Western standards, the private hospitals that treat foreigners are out of reach for the majority of people, and the revenue they bring in rarely makes its way to the public sector. According to a 2006 report by the World Health Organization, less than 4 percent of India's total government spending in recent years has gone toward health.