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Previous Volume 355:1637-1640 October 19, 2006 Number 16 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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The mainstream media have begun to highlight the plight of some new refugees: seriously ill Americans who receive treatment at advanced private hospitals in low-income countries. These patients are not "medical tourists" seeking low-cost aesthetic enhancement. They are middle-income Americans evading impoverishment by expensive, medically necessary operations, as health care services are increasingly included in international economic trade.¹

At a recent Senate hearing, two stories were recounted that illustrated the physical and financial perils driving patients to pursue care abroad.² In the first story, Howard Staab, a self-employed, uninsured, middle-aged carpenter from urban North Carolina who considered health insurance premiums . . . [Full Text of this Article]

Source Information

Dr. Milstein is the chief physician at Mercer Health and Benefits and medical director of the Pacific Business Group on Health — both in San Francisco. Dr. Smith is the president and chief executive officer of the California HealthCare Foundation, Oakland, CA.

This article has been cited by other articles:

• Singh, S. N., Wachter, R. M. (2008). Perspectives on Medical Outsourcing and Telemedicine -- Rough Edges in a Flat World?. NEJM 358: 1622-1627 [Full Text]  
• Milstein, A., Smith, M. (2007). Will The Surgical World Become Flat?. Health Aff (Millwood) 26: 137-141 [Abstract] [Full Text]