Seeking complex surgery in a foreign land where construction materials are still transported by elephant and travelers are warned that even bottled water might not be safe to drink may seem illogical. Foolhardy, even.

But two Triangle entrepreneurs hope to build a business persuading patients who can't afford U.S. health care to do just that.

IndUShealth will help patients arrange to have heart surgery, hip replacement and just about any other medical or surgical procedure at top private hospitals in New Delhi, India.

The hospitals can charge 10 percent to 30 percent of what the same procedures cost in the United States because the cost to do business is so much lower in India. Instead of paying $55,000 or more for heart bypass surgery in the United States, patients would pay about $6,000 for it in India.

Rajesh Rao, the company co-founder and chief executive, thinks the potential savings will appeal to many of the 45 million people in the United States who do not have health insurance. About 17.5 percent of North Carolinians are uninsured.

Clinics in Argentina, Barbados, Singapore, Malaysia, South Africa and elsewhere have been wooing U.S. residents with more affordable medical care for years. India is now considered the lead country seeking international patients. One consulting firm has projected that India's global health-care business could reach $2 billion by 2012.

"This type of activity has always existed -- what's interesting is it used to be East to West," said Dr. Michael Cuffe, vice president of medical affairs for the Duke University Health System, which cared for members of the Saudi royal family in Durham in 1993 and treats hundreds of patients each year who travel from other countries. "If U.S. health-care costs can't be controlled, this is only going to continue," Cuffe said of the United States' emerging role as an exporter of patients.

Losing uninsured patients, many of whom couldn't pay their hospital bills anyway, to India likely wouldn't worry most hospitals. But they could get nervous if the practice spreads to the insured, who bring hospitals most of their revenue.

IndUShealth's leaders think some insured patients -- people who pay 20 percent or more of most medical bills, for example -- will find Indian health-care prices are still less than they'd pay using insurance here.

"It's a long-term challenge for the U.S. health-care system, maybe not tomorrow, but two to five years down the road," Cuffe said. "It should challenge American health care to continue to improve and maybe drive down costs."

Some U.S. hospitals have responded to criticisms about the prices uninsured patients pay by offering discounts on care. In August, UNC Health Care in Chapel Hill started offering a 25 percent discount to all patients without insurance, regardless of income.

IndUShealth's customers must have enough money to pay for care, Rao said. Clients will be required to prepay their entire Indian medical bill, though hospital and physician fees are refunded if the patient changes his or her mind. Clients must cover the cost of airfare to India, typically about $1,100 per round-trip ticket.

More than 8 percent of people without health coverage nationally have annual incomes of more than $75,000, according to Census data.

"We believe there is a market," said Tom Keesling, IndUShealth's co-founder and president.

Maggi Grace of Durham agrees. She and her longtime partner, Howard Staab, are the target demographic. Last year, Grace organized a medical journey to India for Staab that received national and international media attention. Staab, a self-employed carpenter and contractor who does not have health insurance, had a potentially fatal leak in his heart repaired in New Delhi. His bill came to $6,700, including hospital charges, physician fees and room and board for himself and Grace. Durham Regional Hospital had estimated physician and hospital costs would run $200,000.

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