Forth, the rising costs of insuring their workforces are starting to nersuade some large American companies are starting to experiment with payment tor foreign trea ment at internationally accredited hospitals. In 2008 for example, Aetna, a large insurer, launched a pilot scheme in partnership with Singaporean hospitals. Aetna started to give Americans the option to have procedures costing $20,000 or more in the United States performed in singapore, where the company reckons that the quality of care is better than at the average Amopcami hospital.