Outsourced

Carl Garrett's planned trip to India has become national news in the United States, and something of a test case for a new aspect of globalisation. The 60 year old paper company worker from North Carolina was set to travel to New Delhi for operations on his shoulder and gall bladder, sponsored by his employer. Both Mr Garrett and his company were keen for the plan to go ahead. Vastly lower healthcare costs in India would have saved both of them money, and the Indian hospital's out comes were as good as those in the US.

Other US firms and insurers were watching to see if this could help tackle the crippling rise in the costs of job based health insurance, which rose twice as fast as wages in 2006, according to a study by the Kaiser Family Foundation. It was of similar interest to many of the 47 million and rising US residents who do not have health insurance.

Mr Garrett's case raised a subject that has been looming on the horizon for some time. India and other low cost, high skill countries have successfully taken …