ORLANDO, Fla. -

Sam Burnham is on a roll now, sporting a new knee, after a two week stay at a New Delhi hospital.

"I needed to get it done. I could have gone to Costa Rica for about $12,000. I could have gone to Mexico for $12,000," Burnham said.

But Burnham liked the doctor in India, and the $12,000 price tag, because if he had the surgery in the United States, he would have paid between $65,000 and $75,000.

While Burnham paid for his surgery out of pocket, the plan for Osceola County employees is for taxpayers to pick up the cost of the surgery and all travel expenses.

"People all around the world know they can go to India and get fairly safe cosmetic, orthopedic, cardiology procedures and get relatively low prices," David Vequist, the founder of the Center for Medical Tourism Research said.

Vequist said one reason Americans are becoming more comfortable leaving the country for surgery is the fact many doctors working overseas went to school and did their internships in the U.S.  But is it safe?

"It can be," said Dr. Jamal Hakim, Chief of Quality and Transformation for Orlando Health."But there are a lot of 'ifs' and 'buts' before it can be."

Hakim said if something goes wrong after a procedure is done abroad, physicians stateside will tell you to go see the doctor who performed the surgery.

"Who's going to take care of you now?" Hakim said. "Most surgeons are not going to want to accept you because you weren't in their care and they're not going to know exactly what you had done."

But the biggest problem according to Dr. Hakim is that surgeons are not going to want to assume the liability of the complication.

And yet, the competition for medical tourism dollars is fierce.

India, Brazil, Malaysia, Costa Rica, Panama and Turkey all want Americans to have surgery there. Those countries admit that getting people to come, for any reason, is the goal and the mission is to get people to come back.

Turkey is among the most popular medical tourism destinations and not because of the surgeries its doctors offer—it's because of the beaches.