Globalization has hit the health care industry in several respects – such as the outsourcing of medical record keeping, the reading of x-rays, the recruitment of foreign nurses and medical tourism. Medical tourism is a booming industry and is expected to grow to an estimated $40 billion annually by 2010. Medical tourism, where patients go abroad for medical treatments – from elective cosmetic surgeries at vacation spots to chemical dependency programs to critical care that patients cannot otherwise afford. Major destinations for treatment are India, Malaysia, Singapore, Thailand, the Philippines, Argentina, Brazil, Costa Rica, Mexico and Panama. As a cost-saving measure, large employers offer employees the option of receiving medical care abroad. Recognizing the surge in this industry, the AMA recently issued guidelines setting forth several principles for patient consideration before seeking medical care abroad. The first principle is that the treatment must be voluntary. Another principle is that arrangements must be made for follow-up care to be received at home, including covering the cost of that care. Other concerns the AMA identified are seeking treatment only from accredited facilities, transferring patient medical information (consistent with HIPAA privacy guidelines), informing patients of the risks of combining traveling and “vacationing” with some medical procedures. The AMA intends to introduce model legislation to insure that those who facilitate medical tourism follow these principles. The guidelines are available on the AMA website. In a related vein, employers with employees overseas are increasingly implementing a medical evacuation plan to assist employees who become ill or otherwise need to evacuate from overseas. Evacuation plan insurance is also available.