Titusville resident Sandra Roberts spent her monthlong vacation in India sightseeing along the grand avenues of the capital city, New Delhi, and unwinding in a northern region of the country known as Little Tibet.

Between those traditional tourist activities, however, Roberts also underwent a wellness checkup at India's Apollo Hospital that included diagnostic tests for her heart, several tests for cancer (such as a mammogram and a Pap smear) and "more blood tests than you can imagine." "Everybody was excellent," she said, describing her medical care -- which cost $350 and took about six hours to complete -- as an outpatient at the 695-bed tertiary care hospital in New Delhi last October.

The hospital meets the standards of the international arm of the Joint Commission on the Accreditation of Healthcare Organizations, known as JCAHO.

"If I'd had all these things done here, can you imagine all the running around you'd have to do?" Roberts asked.

She and her husband estimate the cost for the same tests, locally, as somewhere between $4,000 and $5,000, despite being insured.

The 60-year-old Roberts is part of a growing trend in the United States: Americans traveling elsewhere for their medical care either out of necessity -- lacking health insurance or not having enough insurance -- or because, like Roberts, a frequent traveler, they want more affordable care with "a personal touch."

Although numbers are difficult to track, a report by the National Center for Policy Analysis in Dallas suggests at least 500,000 Americans travel to other countries for their medical care annually, an industry that grossed about $60 billion worldwide in 2006.

And revenue from medical tourism is expected to rise to $100 billion by 2012, according to the report, which the nonprofit organization issued in 2007.

"You wouldn't go abroad for a tonsillectomy," said Devon Herrick, the report's author and a senior analyst at the center. "But you might go for a hip replacement," which in India may cost as little as $7,000 to $9,000. In Brevard County, the average charge for a hip replacement is between $41,597 on the low end and $56,258 on the high end, according to the Florida Department of Health.