How employers are cautiously testing the medical tourism waters:

Despite the five-star facades of some hospitals — fountains, white marble floors, even a Starbucks and McDonald’s inside Bumrungrad’s lobby — the comfort of having a major surgery near home with family at the bedside is a far cry from the experience in the developing world, where culture shock alone can be stressful.

Pollution, poverty and insane traffic are all part of the experience when visiting hospitals like the Indian-owned Max Healthcare facilities in New Delhi, where it’s not uncommon to see people urinating along roadsides. Jet lag, traveler’s diarrhea and strange foods also can be coupled with the unpredictable, such as September’s bloodless military coup in Thailand, which ultimately had little impact on daily life.

Language and cultural barriers also can make communication with doctors and nurses frustrating for some Americans, who are used to being direct with their physicians, often peppering them with tough questions and expecting straightforward answers.

Some Asian cultures also rely more on hints and subtleties to communicate, and doctors in some countries are regarded as authority figures who often aren’t questioned. Follow-up care back in the U.S. also can be an issue for some patients.

“There are a lot of risks,” said Rick Wade, a senior vice president at the American Hospital Association. “What happens if something goes wrong?”

In countries like Thailand and India, medical malpractice claims are rare and multimillion dollar awards are nonexistent.

“If there’s a mistake, we fix it,” said Curtis Schroeder, an American who is group CEO of Bumrungrad hospital, which requires all doctors to carry malpractice insurance. “But the idea of suing for multimillions of dollars for damages is not going to be something you can do outside the U.S.”