According to the National Coalition on Health Care, more than 500,000 Americans went overseas for health care in 2005. Sensing a trend, BlueCross BlueShield of South Carolina has contracted with Bumrungrad hospital in Thailand and World Access, a Richmond, Va.-based company, to offer a Web-based service called Companion Global Healthcare. It is essentially a one-stop shop where members can go to make overseas hospital appointments and travel arrangements.

The insurance company is the first in South Carolina, and among the first in the country, to offer that combination of services, according to a BlueCross BlueShield spokesman.

Some see the medical excursions as a way to save money on necessary or, in some cases, elective services. Others see it as another kind of outsourcing that undermines the U.S. economy.

Procedures such as heart-valve replacements cost $9,500 in India but can cost more than $230,000 in the United States. High-quality services such as joint replacements and heart surgery are readily available in countries such as Thailand, India, Costa Rica and Mexico, at a much lower rate, meaning the insurance companies save, too.

Bumrungrad, like other overseas hospitals, offers staff physicians who are American-board certified, and the hospital is accredited by Joint Commission International, the international arm of the Joint Commission, a leader in setting standards for health care.