Six years after the death of an ambitious joint effort to make Miami a major healthcare destination for wealthy foreigners, a new group has formed to try to do the same thing -- for less money and without any attempts to disguise the fierce competition among local hospitals to lure well paying international patients.

''We're going to be the world's No. 1 international gateway for healthcare,'' says Rolando D. Rodriguez, who is spearheading the effort for the Greater Miami Chamber of Commerce. Four hospitals are participating in the effort. ``And we're not going to cooperate with each other at all. This is just like good old American capitalism.''

The upshot may not only be a boost to the economy but also improved healthcare for local residents as providers seek to upgrade services to compete on a global scale.

Consider Pier Penalba, 58, a sugar mill manager in Nicaragua, who has international health insurance. He had already bought his plane ticket to visit his daughter in Miami when his wife suggested, ''Check up a little bit on your heart.'' Men in his family had a history of dying of heart attacks.

His local doctor recommended a Miami-Dade cardiologist, who ordered a stress test that that led to the discovery that he had three clogged arteries. He went to Baptist Hospital to have stents put in. ''It's a good hospital,'' he said, hours after getting the stents.

By picking Baptist, Penalba had selected the most popular destination for international patients. The Baptist system, which includes four other hospitals, had 12,000 foreign patients from 100 foreign countries in 2008. Cleveland Clinic had about 5,000. Other hospitals did not give specific numbers.

Almost all South Florida hospitals catering to international patients offer concierge services -- picking them up at the airport, finding hotels, showing relatives where to shop while the patient is recovering.

''You have to have much more customer-friendly service in order to attract foreign patients,'' says Rodriguez, who is president of the Jackson Memorial Foundation, which handles much of the public hospital's international business. ``Your lobby has to be nice; things have to look good. You can't look like a typical public hospital.''

The University of Miami has started an ambitious program to attract not only foreigners but also Americans wanting quality care.

''We have an opportunity to become a medical destination,'' says Pascal Goldschmidt, the medical school dean who has brought in scores of specialists and engineered the purchase of a hospital to accomplish that goal. ``And that will upgrade the quality of medicine for everybody.''

Emilio Nuñez, UM's director of international medicine, says its international traffic has gone up about 20 percent since Goldschmidt's expansion.

MOST ARE INSURED

Hospitals generally offer some kind of discount on their gross charge rates for for uninsured foreigners, if they pay in advance. But these days Cleveland Clinic reports that only 10 percent of its foreign patients don't have coverage. Mount Sinai says 60 percent of its international patients are insured.

''We used to have 100 percent self-pay,'' says Allen Brenteson, vice president of the Baptist Health International Center of Miami. ``Now 70 percent have insurance. It happened very fast. Even wealthy people would rather pay an insurance premium than $500,000 in cash.''

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