But with or without insurance, most are charged higher rates than U.S. patients. They ''usually pay a higher premium for being nonlocal,'' says Rodriguez. ``There are a lot more concierge elements for their care. It's a lucrative market.''

The recession has caused a slight hiccup in international traffic, but not much. Mercy reports ``some foreign patients cancel scheduled inpatient stays and procedures because of the economy, but as a whole, our numbers are actually holding well.''

Cleveland Clinic reported ``a slight decline in January, but international patient visits have since returned to normal levels.''

At Baptist, the number of patients ''is about level with last year, but our revenues are down a bit,'' says Brenteson. These days, international patients ''are checking prices'' at various institutions, looking for the best negotiated rates.

A major problem at Baptist is diagnostics. Wealthy visitors in the past might have sought a CT-scan or magnetic resonance imaging as part of annual checkup, but now are more likely to skip the expensive tests. ''But once they're in house,'' for something like heart surgery, ``they need to do what they need to do.''

Meanwhile, Mount Sinai reports its international business increased 22 percent in 2008, and didn't decline at the end of the year, when the recession hit many other businesses.

At the Cleveland Clinic, Irvin Mason Sr. hasn't worried about the recession. He is one of three generations of a Virgin Island family who have come to the Cleveland Clinic in Weston. His father, wife and daughter have all used the facility, for everything from a hernia operation and eye surgery to a general physical exam.

SATISFIED PATIENT

An employee with Homeland Security in the island government, Mason has insurance coverage for his care. ''The international department was really great,'' says Mason of the Cleveland Clinic.

Trying to attract more people like Mason, the Chamber has teamed up with the Greater Miami Convention and Visitors Bureau to market the region. Their website, now in beta form, is MiamiHealthCare.org.

Baptist Health, Jackson Memorial, the University of Miami Hospital and Mercy have joined the coalition, as well as Florida International University's fledgling medical school, which welcomes its first class in August.

The new effort is considerably different than Salud Miami, hatched in the late 1990s to lure Latin Americans. It had eight hospitals contributing $65,000 annually plus the county throwing in another $100,000. The project had a full-time director. It marketed the program to Latin America and fielded queries from doctors and patients before passing them along to hospitals.

'There was this political correctness, `We can all work together to make the pie bigger,' '' says Rodriguez. ``It had some successes, and then it kind of fizzled.''

It fizzled in 2003 because the hospitals didn't want to work together. Each wanted to grab patients for itself, and they disliked the idea of Salud Miami filtering patients.

Under the new plan, the Visitors Bureau creates a marketing campaign saying what a great destination Miami is for healthcare. If people have questions, MiamiHealthCare.org refers them to the websites of the participating groups.

For this, each group is putting up $12,500 for an initial campaign. ''I'm sure it will cost more money'' as time goes on, Rodriguez says.

INDIVIDUAL EFFORTS

Each hospital, of course, continues marketing on its own. Like many, Baptist sends representatives to regional medical conferences and webcasts live procedures from operating rooms.

''We pioneered this in Latin America,'' says Brenteson. ``And advertising in in-flight magazines, and major Spanish magazines throughout Latin America.''

Thinking beyond the Western Hemisphere, Baptist and the Jackson foundation sent representatives to an international medical association meeting in Dubai. Rodriguez says, ``It probably cost $10,000 for two people to man a booth at the gathering. The Middle East is an important market.''

In fact, Rodriguez says that with international patients paying top rate and Medicaid and Medicare paying low rates for U.S. citizens, he wonders if it wouldn't pay for Jackson to pay to send some local patients overseas for treatment.

``We'd save money. I don't know how it would play politically.''

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