A few years ago, the medical community seemed abuzz about the concept of international medical tourism, or IMT. Why spend tens of thousands of dollars on an operation in your hometown when you could get it done overseas for a fraction of the price? Large employers and health insurers were definitely looking at it, and for good reason: even with travel costs taken into consideration, the savings potential was enormous.

The Medical Tourism Association provides some startling details. As of 2015, a heart valve replacement could average $170,000 inside the United States, but cost only $9,500 in India, a savings of approximately 94%.

Flying all the way around the world is also unnecessary, as savings can be had as close as Costa Rica, which is only a few hours by air from most of the United States. Doing so can drop the cost of heart bypass by almost a hundred thousand dollars. With a life expectancy equivalent to the United States, some would argue health care in Costa Rica is as trustworthy as here.

Even hopping across the southern border into Mexico can save money on both procedures and travel costs. The cost of a gastric bypass drops from $25,000 to $11,500. The costs of hip resurfacing are cut in half, while the costs of hip replacement are cut by two-thirds. When you consider these numbers, it is obvious why some would consider travel for non-emergency care.

Prior to the introduction and debate of the Affordable Care Act, also known as ObamaCare (i.e. how much does Obamacare cost) to some, international medical tourism was a growing concept that had wide attention in the medical community, but also by companies and even some politicians. Many parties were interested in anything that might rein in skyrocketing health care costs. This was especially true of employers whose health care plans were self-insured.

Yet, international medical tourism failed to take off, and this was for multiple reasons. For starters, not all employees or patients were comfortable or even sometimes capable of international travel. In some cases this would be for legal reasons preventing international travel documents to be possible or available. In other cases, the reasons for needing a surgery might also make a prospective patient physically incapable of enduring overseas flights and caring for themselves in another country.

Language differences are also a huge barrier in getting medical work done out of the country. The largest cost savings are often in countries where not only is English not spoken as a primary language, but might not be spoken as a secondary language much either. Even with translators or fluent speakers of English available, the complexity of medical terms and procedures make the ramifications and risks of miscomprehension something to worry about.

International medical tourism is at its most disadvantageous when complications arise. Employees or patients getting work done overseas simply do not have the same avenues or level of protection and legal recourse available to them. Also, if complications arise, they are far from their personal support networks, and are possibly now incapable of travelling home. This is also on top of concerns that medical professionals and healthcare in other nations just might not be up to par with the levels of quality and service that are typical in the United States. In fact, roughly 70% of surveyed workers indicate personal resistance to the idea of traveling overseas for medical care just to save money.

Even though international medical tourism did not take root as anticipated, the concept was not abandoned, as many instead turned to the idea of domestic medical tourism. This largely revolved around buying services in bulk from trusted medical facilities that had a proven track record of success with certain operations and procedures. The savings here were often two-fold, as bulk discounts lowered the average price of a procedure, and the lack of complications after the fact would prevent secondary or further costs from chronic conditions or after-effects.

A number of high-profile companies have struck agreements with so-called center of excellence that has impeccable or highly-regarded track records of success in particular areas of health care. The employees are then offered procedure packages at very little out-of-pocket cost, sometimes with no deductible or co-pay required at all. In certain situations most beneficial to employees, the transportation, travel and temporary housing costs are also included by the company that covers them.

Wal-Mart made some headlines for this back in 2012 when it announced a partnership with various centers of excellence, including Cleveland Clinic and multiple Mayo Clinic facilities. Boeing followed suit not soon thereafter with an arrangement with Cleveland Clinic for heart surgery services for 83,000 non-union workers. Cleveland Clinic struck similar deals with Loweís and HCR ManorCare.

Johns Hopkins Medicine reached an arrangement with PepsiCo, wherein a quarter million Pepsi employees could get free travel to and from Baltimore, Maryland, for both joint replacements and heart surgeries with no out-of-pocket costs. In order to avoid forcing employees to travel against their wishes for medical care, the available medical services that are offered so cheap or even free out of town are still covered by insurance through doctors and hospitals in the employee hometowns. However, regular co-pays, deductibles and financial obligations apply.

Still, even domestic medical tourism is not without drawbacks. A projected 22% of surgical patients suffer from some kind of complication that requires post-operative admittance, and being readmitted to a different hospital carries a one-quarter higher risk of death or fatality within three months. Some companies try to mitigate distance factors by only striking bundle deals within 100 miles of their location, but risks are still there.

Medical tourism, both foreign and domestic, saves money. Centers of excellence that land such contracts also boost their own business by 25% or better. Even with the risks and drawbacks, the need to save and make money means that medical tourism is bound to grow and evolve in the future.