The high number of uninsured or underinsured Americans and the spiraling cost of healthcare in the United States has spurred growth in patients traveling abroad for affordable healthcare, which has become known as medical tourism. It is projected to become a $21 billion a year industry by 2011. Overseas prices for most procedures, including airfare, are often half the cost of those performed in the United States; some procedures are 80% less. International facilities in India, Thailand, and elsewhere are obtaining Joint Commission International (JCI) accreditation and aggressively marketing to Western customers and insurance agencies and advertising high quality standards and personalized service. The acceptance of medial tourism is growing, with a recent poll showing more than 40% of US healthcare consumers willing to travel abroad for care. Insurance companies have begun to integrate foreign care into their coverage, offering discounts to patients agreeing to overseas travel. Physician groups have been slow to respond, even though estimates are that medical tourism may represent $162 billion in lost spending in America by 2012. Some experts think the continued US healthcare cost crisis will drive an increase in medical tourism and international competition, significantly impacting domestic physicians and hospitals.