The spiraling cost of American medical care has birthed the phenomenon known as "medical tourism." It is being employed by individuals who can't afford medical treatment here, or who want better quality care than they can get domestically. Increasingly, it is also being used by employers, who see this as a less expensive way to insure their workers' health.

The destinations of choice are India, Thailand, Singapore, and Malaysia, where the costs of surgery are only a fraction of what they are in the United States.

Reportedly, the best of the hospitals in such areas that have been attracting patients from the U.S. (and, to a lesser extent, other wealthy nations) are staffed with surgeons trained in this country, Great Britain and other countries in which medical care is much more expensive.

It's not just tourists who want to combine a vacation with a face lift or tummy tuck that have been flying off to these hospitals. Patients are going for heart surgery, hip replacements and other medically necessary operations.

I've read that Thailand's Bumrungrad Hospital is as luxurious as any resort hotel and boasts a staff of 500 physicians with international training and state-of-the-art medical technology. India is aiming to lead the world in medical tourism, and its hospital boom is luring back Indian physicians who trained abroad, but are willing to work there for far less than they would earn in the United States or elsewhere in the West.

Not only are these hospitals often better staffed and equipped than most North American hospitals, they also treat clients well. For example, post-operative patients are typically allowed to stay several days longer than they would in America, where early discharges are common because of cost concerns.

Not everyone would opt to fly half way around the world, at considerable cost just for travel, and cope with an unfamiliar culture and often shocking poverty once you leave the comfort and luxury of the new hospitals. There are other downsides: little legal recourse in the form of medical malpractice suits if something goes wrong, and local epidemics of diseases such as malaria, from which you need protection.

But with medical costs in the United States continuing to soar and quality of care declining, it isn't surprising that some patients, employers, and health plans are looking to outsource medical care.