"Many companies see it as a natural extension of the competition they've faced in other aspects of their business," he added.

    Some American hospitals already import foreign doctors and nurses. They also use countries such as India for X-ray readings and other diagnostics. But the U.S. health care industry has been largely immune to overseas competition -- just one reason behind soaring costs.

    Employer-sponsored health coverage premiums have skyrocketed 87 percent over the past six years, according to the Kaiser Family Foundation, increasing costs for companies and employees. Family health coverage now runs about 11,500 U.S. dollars annually, with each worker contributing nearly 3,000 dollars.

    But some critics are already preparing to fight any possible mass exodus of Americans seeking low-cost health care in foreign countries.

    In September, Canton, N.C.-based Blue Ridge Paper Products Inc., was ready to send one of its employees to India for a gall bladder operation. Carl Garrett would have been the first U.S. employee sent abroad for medical care through an employer-sponsored pilot program, which would have allowed him to share the company's savings.

    Just before Garrett was set to leave, the United Steelworkers, America's largest union, stepped in.

    "We don't want to expose our members to the risks associated with providing health care in the Third World," said Stan Johnson, a union spokesman. "This is perceived to be voluntary, but voluntary programs tend to lead to mandatory programs."

    Blue Ridge dropped its plan for union members, but several other U.S. businesses and insurance companies are starting to explore the option of exporting patients.

    "I get the impression that they're all waiting for someone else to take the first step," said Jason Yap, director of health care service for the Tourism Board in Singapore, another major medical tourism destination. "They're all interested in doing the homework now so they can move ahead when the time comes."

    United Group Programs, a Boca Raton, Fla.-based company that sells self-insurance policies to small businesses, is already offering a program that sends patients to Bumrungrad International hospital in Bangkok, Thailand. UGP says the plan will save employers more than 50 percent on major medical costs and reduce employees¡¯out-of-pocket expenses to zero.

    Blue Shield of California and Health Net of California also offer lower-cost policies to members seeking medical care in Mexico.

    David Boucher, an assistant vice president at BlueCross BlueShield of South Carolina, traveled to Bangkok for a close-up look at Bumrungrad in June. The Thai hospital began heavily recruiting overseas patients after the 1997 Asian financial crisis. It drew 400,000 foreigners last year -- including 55,000 Americans.

    "I was thoroughly impressed," Boucher said. "We're taking a serious look at this as an alternative" for the health plan's 1.5 million members.

    West Virginia lawmaker Ray Canterbury plans to propose legislation next year that would give government employees the option of traveling abroad for necessary procedures, which could save the state up to 2 million dollars annually. He wants to offer incentives, including extra sick leave and 20 percent of the cash saved by going abroad -- allowing workers to actually make money on the deal.

    (Agencies)