After years of taking a wait-and-see approach, large employers are beginning to offer employees the option of receiving medical care overseas.

Americans with limited or no health insurance have for years sought elective surgery in foreign hospitals, pioneering so-called medical tourism in places like India, Thailand and Costa Rica where patients recover in five-star hotels and beach resorts.

Now, the cost savings offered by overseas hospitals have won over several large employers.

“We want people to have options,” says Jacqueline Moye, vice president of human resources at Doctors Care, which operates health clinics primarily in South Carolina. Doctors Care has offered employees a medical tourism option since January. “It’s an opportunity for people to go someplace new, see things differently and have a tremendous cost savings.”

None of the 1,000 employees and dependents covered by Doctors Care have chosen to go abroad for medical care since the company started making the option available though its health insurer, BlueCross BlueShield of South Carolina. The insurer offers the service through medical travel company Companion Global Health Care and sends patients to Joint Commission International-accredited hospitals in Thailand, Singapore, Turkey, Ireland and Costa Rica.

Doctors Care, based in Columbia, South Carolina, covers five procedures abroad: heart bypass surgeries, hysterectomies, total knee replacements, total hip replacements and spinal fusions.

The potential savings are significant. In the U.S., a hip replacement surgery can cost $30,000 to $40,000 for uninsured patients, according to BlueCross BlueShield of North Carolina, compared with about $9,000 in India and $12,000 in Singapore.

A spokeswoman for Aetna says the Hartford, Connecticut-based health insurer has launched a pilot program with Portland, Maine-based Hannaford Bros. supermarkets to allow its 27,000 employees to go overseas for surgery.

Another medical tourism company, California-based Planet Hospital, has signed several medium-size employers, including Snow Summit Ski Corp. in Big Bear, California. Planet Hospital president Rudy Rupak says the company is conducting a pilot program with a large self-insured California school system.

Though the foreign hospitals provided to Doctors Care employees are accredited by the Joint Commission International, concerns about quality remain, as do questions regarding the legal recourse patients would have should they suffer a medical error.

Rick Wade, a spokesman for the American Hospital Association, advises patients and employers to ask about the training and experience of foreign hospitals and their doctors before seeking care.

“Medical mistakes are not confined to this country,” he says. “If there is poor treatment or medical errors, what are your alternatives?”

Doctors Care, confident its health insurer is contracting with safe foreign hospitals, plans to expand coverage next year to include more surgeries at foreign hospitals, Moye says.