Fusion is a word commonly associated with restaurants and food. Have you eaten French-Chinese fare? This morning, I reveled over a strawberry burger.

But how does the concept of fusion apply to medicine? Is there an opportunity for us to explore American-Thai medical care? Can you imagine an Orange County-Jaipur cholecystectomy?

No need to imagine. Twelve years ago on a medical tour in India, I witnessed patients coming from the United States to visit their relatives in India. Between visiting family members, they enjoyed laparoscopic cholecystectomies. The anticipated co-pay for a cholecystectomy in the U.S. exceeded the total cost of the trip, including paying cash for the surgery. Yes, the global village affects medical care.

Can physicians take advantage of this opportunity?

The Sept. 18 edition of AMA News reported on insurance companies sending patients to New Delhi for cholecystectomy and rotator cuff repair. As usual, the report raises the fear that the medical sky is falling. Quality medical care couldn't possibly be delivered outside the halls of our great medical institutions! Really? Physicians need to explore this further.

Guess what motivates insurance companies and employers to consider outsourcing medical care? Money. Cheap labor drives business and we need to face the reality that cheap labor abounds in other countries. Just as unions drove Ford and GM to move their operations away from Michigan, our expensive healthcare system drives innovators to seek less expensive operations outside the U.S.

So why fight this rational consumer-driven process? Why don't American physicians set up the systems needed to provide high-quality care in Katmandu, Kiev, Chunking or Namibia? After all, Angelina Jolie did just fine. Why don't medical groups establish well-organized programs in these countries that enable U.S. citizens to visit unusual locations, have their procedures done and return home for follow-up care? If American physicians control the quality, where's the problem?

Many physicians, such as Aisha Simjee, MD, the past president of the Orange County Medical Association, donate their time and effort to treat the less fortunate in other countries. If U.S. physicians establish high-quality medical facilities abroad, then those facilities could provide care for the local population, too. Many countries have a core base of educated people who could be trained to provide ancillary nursing care. This would provide needed employment opportunities for developing countries. These medical time-shares would be a win-win for developing nations and U.S. citizens.

But would our friends at the Association of Trial Lawyers of America lose some business? Would a procedure done in Thailand be subject to Thai law? Would American patients be "protected" by the ATLA if they chose to be treated out of the country? Would ambulance chasing evolve into airplane chasing? Or would foreign tort law apply? I suspect that the ATLA has already established methods to protect U.S. citizens from unscrupulous physicians practicing in foreign countries, but maybe not!

I also envision another opportunity, surgery at sea. Imagine a family going on a cruise. While the kids play at Sea Camp, Dad recovers from a knee arthroscopy or Mom from a cholecystectomy. Would procedures done 200 miles offshore be considered foreign procedures? Could we make a previously uncomfortable procedure so routine that it aided in getting families to take vacations?

Yes, outsourcing medical care creates opportunities for us. A fusion of foreign locations with U.S.-trained expertise might stimulate opportunities for developing nations and partially solve our economic woes. Leading the way in international quality healthcare; promoting excellent international facilities; and fostering global health: Should this be the mantra of the American Medical Association? Rather than doing more handwringing over U.S. regulations and more dodging of domestic crises, we need to broaden our horizon and take an international view.

Lytton W. Smith, MD, editor for the OCMA, is a physician practicing family medicine with the St. Jude Heritage Medical Group in Yorba Linda. Dr. Smith welcomes feedback on his articles and can be reached at editor@socalphys.com.