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Mike Mitka

JAMA. 2009;302(14):1519.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Each year, thousands of US patients are obtaining health care outside of the country, the vast majority for surgical procedures that range from hemorrhoidectomies to the treatment of brain tumors.

An estimated 60 000 to 750 000 US patients are participating in this exodus, according to Josef E. Fischer, MD, professor of surgery at the Harvard Medical School in Boston. The high cost of US medicine is driving "surgical tourism," especially for persons who lack health insurance, as well as some self-insured businesses and third-party payers, all of whom seek to save thousands of dollars for a procedure. For example, someone without insurance could face a $200 000 bill for heart valve replacement surgery in the United States but would pay only $9500 in India; likewise, someone in the United States charged $90 000 for spinal fusion would pay only $7000 in Thailand (Unti JA. Bull Am Coll Surg. 2009;94[4]:18-25).

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