Q. Where are the international hotspots for delivering care to U.S. citizens, and why? Are there new locations projected to become popular during the next five years?

A. The countries emerging as leaders in medical tourism include India, Thailand, Singapore, Costa Rica, Korea, Taiwan, Philippines, Malaysia and Mexico. There are several other countries which are just starting to get into this marketplace, including Israel, Jordan, Arab Emirates, Colombia and New Zealand.

Q. What are some surgical procedures not currently high in terms of volume for medical tourism that might become popular during the next five years?

Q. Do you anticipate a regulatory backlash fueled by the American hospital and physician lobbies, pushing more restrictive legislation against delivering international care to U.S. citizens?

A. Not at all. American hospitals aren't even looking at this industry. If anyone asks the American Hospital Assn., the response is that they are not looking at medical tourism and have no interest in it. The American Medical Assn. is looking at medical tourism but from their initial report it is clear that they know medical tourism is here to stay, and they need to find a way to work with it. One example of this is their recommendation to create specific CPT codes for after care when Americans go overseas for surgery and then come back to America.

Also, 25% of physicians in the United States were foreign trained. Many of our U.S. doctors and nurses are foreign, so it will be tough for anyone to take a stance and say foreign trained doctors and hospitals offer inferior quality of care and Americans shouldn't go to them. America has already outsourced our healthcare to foreign doctors and they are used to it.

The only association attempting to take a stand is the American Society for Plastic Surgeons, which created a dramatized video of an American who went overseas for healthcare and had a bad experience with complications. We think that videos like this show that medical tourism is growing, and a certain segment of doctors are nervous. On the other side, many doctors and U.S. physicians are excited about medical tourism and help refer patients overseas. Many of them believe our healthcare system is broken and U.S. hospitals charge too much.