Bradley Thayer, a retired apple farmer from Okanogan, Wash., traveled 7,500 miles to get his torn knee ligament fixed and said he paid a third of what it would have cost him in a U.S. hospital.

And that included airfare to Bombay.

Thayer, 60, had no health insurance when he fell and injured himself while spending the summer in British Columbia. He said his U.S. doctors told him he would have to wait six months for surgery and pay bills totaling $35,000. So he joined a rising tide of American and European patients heading to India, Thailand and Singapore for top-class orthopedic surgery, plastic surgery, infertility treatment and cardiology that come much cheaper than in the West.

It's the latest in outsourcing -- Asian doctors study in the United States or Britain, acquire their skills and reputations in hospitals there, then take them back to their home countries and wait for the business to come to them.

"Flying halfway around the world is cheaper," said Thayer, beaming from his Bombay hospital bed. "I came straight to India. It's a long way to come without tests, but I feel great."

He had never been to India, and he first had to overcome the stereotypes at home.

"My friends and relatives said I was crazy," he recalled. "They said, 'They'll cremate you along the Ganges.' "

But he already felt familiar with Asian doctors. "In Canada and America, when you read the names of doctors in hospitals, every third or fourth doctor is Indian," he said.

Hospitals in Bombay, New Delhi and Bangalore have been taking these so-called "medical tourists" since the mid-1970s, initially from the Middle East and South Asia, later from Africa, and now from the West.

So far, news has spread largely by word of mouth, or on Web sites set up by patients to extol their Indian experiences. Now the Indian government has joined in, offering one-year medical visas, extendable for an additional year, and organizing exhibitions abroad to advertise Indian hospitals.

It is also planning to create a list of recommended hospitals. While India has top-notch doctors, it is still notorious for its filth and poverty. Even at some top hospitals, nursing care can be poor and hygiene standards dramatically lower than in the West. Patients are advised to shop around.

"Many foreigners are still not completely convinced about India. They worry about safety standards," said Vinod Tenguria, founder of Vedic India, a company that arranges hotels for patients.

Mohan Thomas, a cosmetic surgeon and a member of the government's council for medical tourism, said foreign patients needed to choose carefully.

"Check the doctor's credentials, the hospitals he is attached to and, most important, see some work he has done," Thomas advised. "Check how much effort the hospital takes with cleanliness, starting with the bathroom."

He said 25 percent of his patients were from overseas, primarily Britain, the United States and Africa.

Invariably they go to the best private hospitals and stay in high-end private rooms on different floors from the general wards.

India is a diverse country accustomed to huge disparities, and although public health standards have risen as the economy has boomed, many poor people cannot afford basic medicine, let alone private hospitals. There is no national health system, and government hospitals are overcrowded and under-equipped. A recent outbreak of encephalitis killed more than 700 people in small towns and villages of northern India.

"It's always the poor who suffer whether in India or America," said Sushant Mishra, a health worker in a northern Bombay shantytown. "We saw the poor blacks suffering during the Katrina hurricane. They didn't have access to food, water or even regular medical facilities in the richest country in the world. Life's the same everywhere."

India is still a relative newcomer to the international medical market, attracting 150,000 foreign patients last year, compared with Singapore's 200,000 and Thailand's 600,000.

But India's numbers are increasing. In Jaslok Hospital, one of Bombay's top private facilities , three Americans were recovering from orthopedic surgery in June alone.

Robert Carson, 46, a Texas-born businessman, said he pulled out of hip replacement surgery the evening before it was scheduled in a Bangkok hospital.

A TV program about a new treatment -- hip resurfacing -- convinced him that procedure was less invasive and promised more mobility, since the bone was shaved and not cut as in a traditional hip replacement. The procedure is not offered in Thailand. Three days later, he was in Bombay and being operated on by Ameet Pispati, a British-trained pioneer of the procedure.

"I'd come back in a minute even if costs were equal to the U.S.," he said. "I would come because of the personal care."

He had found his American doctors stingy with information, Carson said, whereas "the doctor here was very communicative. He told me what could go wrong and what he's done before." The absence of long waiting lists also draws patients.

"I could have had total hip replacement done in the States for nothing because I have a health plan. But I found it worth it to come here. I didn't want to stand in line," said Gordon Deboo, a retired NASA research scientist.

Deboo, 73, from Walnut Creek, Calif., was thrilled that his wife could stay in his hospital room at no extra cost.

In some cases, entire families travel with the patient.

"My daughter and son-in-law came with us. They didn't trust us," said Edna Harsha, a 59-year-old school bus driver from Lakeville, Minn., recuperating from hip surgery with her husband by her side.

She lay in a hospital room with a commanding view of the Arabian Sea, looking at photographs of Bombay's sights taken by her family.

Couples from the United States, Ireland and Southeast Asia also head to India for infertility treatment -- with some women bringing frozen sperm in liquid nitrogen containers.

In vitro fertilization can cost $20,000 in the United States and $15,000 in Europe. In India it costs about $2,500.

Edna Harsha, 59, a school bus driver from Lakeville, Minn., who had hip surgery in Bombay, smiles as daughter Tawny Astleford watches.Gordon Deboo, right, a retired NASA scientist from Walnut Creek, Calif., laughs with his wife, Rebecca, after hip surgery in Bombay's Jaslok Hospital.