An increasing number of hospitals across the country are outsourcing certain medical services to overseas medical experts. This growing trend has profound implications for health care policy and practice and may provide substantial cost reductions for patients.

According to a recent article in the New England Journal of Medicine, advances in technology have made medical outsourcing a viable choice for many types of services. Medicine has traditionally been a local enterprise. However as health care enters the digital age, many services no longer need to be housed within the confines of a hospital or clinic, but can be obtained anywhere, including overseas. With today's technology, activities ranging from diagnostic imaging to the manipulation of laparoscopic instruments have the potential to be rendered borderless.

When a patient in a rural area of Tennessee needs a brain scan in the middle of then night, a doctor in Bangalore India might be asked to interpret the results, according to Dr. Robert M Wachter chief of the medical safety service at UCSF medical center and a professor of medicine. ?The outsourcing trend is spurred by a shortage of US radiologists and an exploding demand for more sophisticated scans to diagnose scores of ailments. Most of the doctors who performed outsourced services are U.S. trained and licensed, although there are some experiments being conduct using radiologists without U.S. training. ?

The outsourcing of medicine raises understandable concern about how to ensure quality and patient confidentiality when the providers are thousands of miles away. There are many checks and balances in place to maximize the effectiveness of outsourced care. Given the quality and cost challenges that are currently plaguing the U.S. healthcare delivery systems, if outsourcing can allow some care to be delivered at comparable quality but a much lower cost, its growth seems inevitable.

Patients may reap substantial advantages from outsourcing, especially where specialized services are concerned. For example, a group of mammography experts could read remotely transmitted mammograms obtained at a small community hospital, instead of the films being read by less specialized radiologists. The expertise offered by outsourcing could have life-saving potential in many cases.

Many hospitals will struggle to improve technical skills and delivery systems to accommodate the outsourcing challenges. At the same time, locally owned hospitals should not miss the opportunity to preserve and enhance the low-tech practices that are best delivered in person. Patients don't part easily with doctors who have demonstrated empathy. The local radiologist who not only reads the films but also discusses important findings in the film with his colleagues who work in the same building is less likely to be replaced by a practitioner living a dozen time zones away. Competition may play a role in making local radiologists more responsive to the needs of patients and colleagues while lowering overall health care costs.

One thing is abundantly clear. The astronomical costs of health care in this country are hurting patients, employers, taxpayers and providers. Something has to change - and the sooner the better. Perhaps medical outsourcing will provide part of the solution to America's health care cost crisis.