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Before Diane Paul flew to Cuba in October for knee surgery, she had to make a trip to her local video store. Choice Medical Services, the Winnipeg-based company that arranged the trip for the 57-year-old Haligonian, had recommended that she watch Michael Moore's Sicko.

The 2007 documentary depicts the Cuban health-care system as providing a level of treatment far superior to that available to most people in the U.S. The movie has helped put the Caribbean nation on the map for medical tourists such as Paul, who was unwilling to wait a year to have the surgery at home.

According to one estimate, as many as 300,000 Canadians travel abroad each year for medical or dental procedures - most of them, like Paul, frustrated by the long wait times at Canadian hospitals.

Of course, not every country is fortunate enough to be given the star treatment by an Academy Award-winning filmmaker.

But thanks to the Internet, a handful of up-and-coming medical-tourism destinations are luring patients away from traditional destinations such as India and Thailand.

"It's 100 per cent attributable to the Internet," says Renee Stephano, general counsel for the U.S.-based Medical Tourism Association and editor of the Medical Tourism Magazine. "You would not be seeing patients travelling abroad unless they could do research online."

Jeff Schult, author of Beauty from Afar: A Medical Tourist's Guide to Affordable and Quality Cosmetic Care Outside the U.S., says people who go to other countries for medical procedures choose destinations based on three criteria: cost, closeness and culture.

"If you can choose where you are going to know the language, or you have relatives there or you've always wanted to go there, that's where you are going to choose," Schult says.

CUBA

That's basically how Paul chose Cuba for her surgery. She researched other countries in which to have the procedure, but she did not want to venture too far from home.

"I would love to see India. I would love to see Thailand. But I chose Cuba, not because I really wanted to see it, it was just close for me," she said.

In fact, seizing on its proximity to Canada, Cuba has partnered with Choice Medical Services to attract more medical tourists.

Cuba has also partnered with similar firms in Germany and Spain, cracking into the Western market by highlighting its excellent health-care system and low cost of care. According to Choice Medical Services, a hip replacement in Cuba costs about $10,000, compared with $39,000 in the U.S.

Last year, the Caribbean nation hosted nearly 20,000 medical tourists, according to Cubanacan Tourism and Health, the umbrella organization that promotes Cuba's health tourism facilities.

And Schult says Sicko has significantly raised Cuba's profile for U.S. residents. "It's definitely put Cuba on the map for medical tourists here."

COSTA RICA

Costa Rica has been a popular destination for dental and cosmetic surgery since the early 1980s. Now, Schult says, "there are a number of hospitals there that are seeking to capitalize on the country's reputation as a medical-tourism destination."

Two hospitals in particular, Clinica Biblica and CIMA Hospital, are leading the charge. Clinica Biblica is working on a plan to dedicate an entire wing for international patients.

While the country's pristine beaches may be the biggest draw for most tourists, for people seeking medical treatment, Costa Rica's proximity to North America and its relatively cheap cost of care are the main draws.

The price of medical procedures there tends to be 40 to 70 per cent less than what you would pay in North America, Stephano says.

Those benefits are appealing to medical tourists. According to Costa Rica's Tourism Bureau, the number of visitors coming for medical treatment has doubled since 2003.

Its universal health-care system provides a range of services. The government runs 30 hospitals and 250 clinics, and the country is now becoming known for procedures such as back or spinal surgeries and knee and hip replacements.

PORTUGAL AND SPAIN

"Until the beginning of this year, medical tourism to the Iberian Peninsula mainly consisted of people going to Barcelona for cosmetic and dental surgery, as well as people seeking treatment in Mallorca," says David Hancock, author of The Complete Medical Tourist.

But both countries have realized that their health-care systems are ripe for exploitation. In the World Health Organization's ranking of the health systems of 191 member states, released in 2000, Spain ranks seventh and Portugal 12th.

Last year, 137,000 people went to Iberia for medical treatment - a large number but still a small fraction of the 63 million holidaymakers who flock to the area each year.

That looks set to change thanks to Fly2Doc, a medical-tourism company launched this year that arranges medical procedures throughout the Iberian Peninsula, an area that includes Spain, Portugal, Andorra and Gibraltar.

"Fly2Doc could be just the first of many medical-tourism operators to see the advantage of Spain and Portugal, with their excellent climates for recuperation and their incredible number of quality hotels in which to do it," Hancock says, adding that medical costs on the Iberian Peninsula are significantly lower than in Britain and the U.S.

The health-tourism industries in Portugal and Spain are also likely to benefit from a proposed piece of legislation that would allow anyone in the European Union who is on a waiting list for treatment in their own country to be treated in any other EU country, with their home government picking up the bill, Hancock says.

"This is a boon for patients in the U.K. and Ireland, where waiting lists are the longest, and Britain's National Health Service could benefit because costs are lower on the Iberian Peninsula," he adds.

SOUTH KOREA

Although experts say South Korea's medical-tourism industry is still in its infancy, the country has been aggressively promoting its hospitals through the Council for Korea Medicine Overseas Promotion, an organization launched in March, 2007.

Funded by the government and 28 private hospitals, the organization is targeting the approximately 440,000 uninsured Korean Americans, Japanese patients seeking alternative medicine and cosmetic surgery, and Chinese patients seeking cosmetic surgery.

While it may be a distant destination for most North Americans, South Korea has an excellent health-care system, with several prominent hospitals specializing in ophthalmology, cancer treatment and dental surgery, Stephano says.

However, South Korea is focusing its attention largely on the Asian market, where it is not greatly cost-competitive, she says.

TAIWAN

In September, 2004, Taiwan's Department of Health and the Taiwan Non-Governmental Hospitals and Clinics Association launched the Health Tourism Guidance Task Force, a group set up to promote medical tourism.

Since then, the country has been aggressively pushing itself as a medical-tourism destination.

This summer, the TNHCA announced that, based on figures provided by the Department of Health and Taiwan's Council for Economic Planning and Development, the medical-tourism industry will generate more than $93-million this year and almost $9.4-billion by 2015 for the country's economy.

"Taiwan is coming out very, very strong as an up-and-coming destination for medical tourism," Stephano says.

Yet while it boasts well-trained physicians and state-of-the-art equipment, hospitals in Taiwan are doing little to attract North Americans.

"For the most part, they are looking to attract European patients and Chinese patients, first and foremost because of proximity but also because there's not as much as a cultural barrier," Stephano says.

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For more information

BOOKS

BEAUTY FROM AFAR: A MEDICAL TOURIST'S GUIDE TO AFFORDABLE AND QUALITY COSMETIC CARE OUTSIDE THE U.S.

This book by journalist Jeff Schult offers a comprehensive guide to doctors and facilities providing cosmetic surgery around the world. Guiding the prospective medical tourist on every part of the journey, it offers tips on how to interview surgeons and research hospitals.

THE COMPLETE MEDICAL TOURIST: YOUR GUIDE TO INEXPENSIVE AND SAFE COSMETIC, MEDICAL AND DENTAL SURGERY OVERSEAS

Although written with a U.K. audience in mind, David Hancock's book provides detailed accounts of cosmetic procedures and examines two dozen countries where such procedures are performed.

WEBSITES

WWW.MEDICALTRAVELTODAY.COM

A newsletter about the medical tourism industry written and edited by experts (including Jeff Schult), it is updated twice a month and keeps readers up to speed on trends, new business, legal issues and a host of other topics.

WWW.MEDICALTOURISM-GUIDE.ORG

An excellent introduction to medical tourism. The site looks at the benefits and risks, offers tips on how to research a doctor's credentials and reviews several countries that are popular medical tourism destinations.