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When I first began studying modern medical tourism in 2004, the countries of Western Europe seemed almost irrelevant to the U.S. market for healthcare services – which was my primary area of interest, given that I was writing a book about medical tourism that was aimed primarily at American consumers.

I knew it was true, of course, that patients from the United Kingdom were traveling abroad for cosmetic surgery, dentistry and other health care that they either could not get at home or could not get in a timely way.

And I knew that medical facilities and doctors in Western Europe were among the world’s finest. However, for the most part, it seemed very probable that they could not compete with the emerging and existing medical tourism leaders in the Far East and Central and South America on price, which would mean they could not tap the potentially huge U.S. market.

Eastern Europe, in 2004, seemed a better bet for becoming a medical tourism center than Western Europe, and it seemed reasonable to speculate that these newer members of the European Union, with their advantages on pricing, would continue to draw patients from Western Europe and, eventually, more from the U.S.

In fact, I considered Hungary for my own dental care in 2004, before choosing Costa Rican dentists with a long track record of treating Americans. Even then, the psychological tug of Europe was strong for me – even Eastern Europe.

Say “Europe” to many Americans from the U.S. and they think, well … we think that, of the people of the world, the Europeans are most like us. Now it is 2007 and it has developed that I was only mostly right about Europe when I was writing my book, “Beauty from Afar.”

I take some comfort in being mostly right – it is about the best one can hope for in speculating about the future. But I have revised my thinking about medical tourism in Europe.

I first became acquainted with João Vilaça Ramos and Duarte Caro de Sousa of Portugal when they called me in January to tell me they were preparing to launch a company that would make Iberia – Spain and Portugal – a major international destination for medical tourists. I listened.

These guys had done their homework, and I could hear the enthusiasm in their voices as they told me about the high quality of medical care available through their network of providers, the beautiful patient recovery facilities they would have as partners and the standards for safety they were developing.

And I was, of course, intrigued. They did not have to sing the praises of Lisbon, Barcelona or Madrid. Though I’d never been in any of them, I knew them as European cities, places I wished to go. I lumped them in with Paris and London … or New York or Chicago.

Still, as I listened, I was waiting to tell them why they were crazy. And finally, it was time for that, when they asked me if I thought Americans would come to Iberia for medical care, eye surgery, dentistry or cosmetic makeovers.