When Canadian house cleaner Marlene Trithardt needed a tooth replaced, she drove past her local dentist's office in Alberta and flew to the beach paradise of Costa Rica - to save money.
Trithardt is one of a growing number of North Americans who turn south for medical care lured by lower prices, contributing close to 0.8 percent of Costa Rica's gross domestic product.
"I chose to come here because I find in Alberta the prices are about 80 percent higher than in Costa Rica," says Trithardt, 57, who makes $30,000 a year.
Her treatment will cost $4,000. But even including airfare, hotels and meals for two weeks, the total amount is lower than the $10,000 she said she was expecting to pay for the dental care alone in Canada.
In the bargain, Trithardt got to take a few days to visit Costa Rica's national parks.
Around 40,000 medical tourists visited Costa Rica last year, compared to 36,000 in 2010 and 30,000 in 2009. Most of them are American and Canadian, according to the country's tourism institute, ICT.
Of that number, almost 15,000 of them traveled for dental care, said Massimo Manzi, director at Promed, the council for international promotion of medicine in Costa Rica.
Manzi estimates that medical tourism brought in $196 million to Costa Rica's health industry in 2011, with patients spending an additional $84 million in hotels, meals, travel and shopping. That makes for a total of $280 million spent on medical tourism in 2011, compared to $252 million in 2010.
And while some doctors in the United States discourage traveling abroad for cheaper treatment - saying the quality may not be vetted and that follow-up care is lacking - technology and care standards in the private sector are perceived by the medical community and patients alike to be high.