As the U.S. medical-cost crisis deepens, more patients are leaving the country for elective surgical procedures, with Thailand, India, Puerto Rico, Argentina, Mexico and Cuba becoming the most popular medical destinations.

Beyond cosmetic surgery, these procedures range from the simple to the complex and include everything from dental implants, cataract removal and knee replacements to cardiac, orthopedic and ophthalmic surgery, neurosurgery, infertility treatment and organ and bone marrow transplants.

The benefits of outsourcing surgical procedures are clear. The total cost — including airfare, surgery, hospital and hotel recovery stays — is often one-tenth to one-third the cost of the same procedure in the United States. And the short waiting time for scheduling and completing elective surgery abroad appeals to many patients in Canada, England and the United States who are tired of the long waits and insurance approval requirements for elective surgery at home.

Health insurance companies are taking note of this trend, and several are starting to offer coverage for foreign procedures, citing economic value, shorter wait times, highly trained medical staff and more personalized care. But there are risks, and patients need to do their homework before taking advantage of this alternative.

To cater to an international clientele, many private hospitals abroad are applying for accreditation from the Joint Commission International, the global arm of the institution that accredits U.S. hospitals and ensures minimum standards for patient care quality. Some foreign hospitals have also affiliated with leading U.S. medical care institutions such as Johns Hopkins International, Harvard Medical International and the Cleveland Clinic. Many foreign hospitals employ physicians with U.S. training and certification.

Bumrungrad Hospital in Bangkok, which earned JCI accreditation in 2002, is attracting a growing number of American patients — so many, in fact, that it will expand its capacity by 20 percent by 2012 and is building alliances with American insurers to cover the costs of medical travel for their members.

India has a large pool of doctors (approximately 600,000), nurses and paramedics with the required specialization, accreditation and expertise to perform a variety of complicated surgeries. Many speak English fluently. India’s private hospitals have gained international recognition for state-of-the-art facilities and diagnostic centers. The treatment of cardiac disease has become a specialty with healthcare centers such as Escorts Heart Institute and Research Centre, All India Institute of Medical Sciences and Apollo Hospitals India. Leading cardiologists and cardiac thoracic surgeons use the latest technology to provide thorough care from basic services such as coronary angioplasty to the most complicated robotic cardiac surgery.

Nonetheless, like many developing countries, India has some challenges to overcome — such as improving its roads, sanitation, power back-up supply, guest housing and public utility services — to become a premier medical tourist destination. Patients need to consider if a member of the healthcare team lives in an area with unhygienic conditions and could possibly bring infections or illness to the hospital.

In many cases, post-operative care is nearly as important as the surgery itself. Physicians caution against flying for at least seven to 10 days after minor procedures and at least 10 to 14 days after major surgery. If you’re planning a transcontinental or international flight, the amount of time may increase depending on your condition and recovery.

Since it can be difficult to get post-operative care at home after having surgery abroad, a few medical tourism organizations refer their patients to U.S. physicians in the patient’s home area who will perform follow-up care. Some insurance companies are also paying for a companion to be with the patient to assist in recovery and act as a patient advocate abroad.

Medical travelers need to consider the consequences if something goes wrong or they suffer complications after surgery. Patients treated in the United States have legal recourse for medical malpractice, but overseas medical facilities are not under U.S. legal jurisdiction. It is unclear who is responsible if something goes wrong when someone travels abroad for medical care.

Patients can coordinate their treatment through medical travel intermediaries, many of which use the Internet to recruit patients. These services work like specialized travel agents, investigating healthcare providers and assessing patients’ physical ability to travel. Some intermediaries are affiliated with specific medical providers and send patients exclusively to those providers. Intermediaries often have doctors and nurses on staff to assess medical appropriateness of the procedures and help patients select physicians and hospitals.

Visit www.medicaltourismassociation.com.

Before You Check In

• Check credentials.
• Select qualified, trained, properly certified surgeon and anesthesiologist.
• Select accredited facilities.
• Check for availability of English-speaking translators 24/7.
• Check quality of follow-up care and monitoring abroad.
• Arrange for adequate recovery time before flying.
• Arrange for follow-up care at home.
• Be informed of patient rights and legal recourse.