The USA medical tourism market is developing in new ways by exporting healthcare expertise. Rather than expecting patients to come to the USA, leading hospitals are building overseas networks and partnerships to take hospitals and doctors to overseas patients. After the 9/11 terrorist attacks, when travel visas into the U.S. were delayed, the Cleveland Clinic saw its traffic from abroad slow to a trickle. So it began opening or managing hospitals overseas. Since 2007, it has managed Sheikh Khalifa Medical City, a 750-bed hospital in Abu Dhabi in the United Arab Emirates. In 2015, it opens Cleveland Clinic Abu Dhabi, a 360-bed hospital in the UAE. University of Pittsburgh Medical Center sees going global as a natural extension of UPMC’s services. UPMC operates a multi-organ transplant centre and specialty surgery hospital in Palermo, Italy, that has been responsible for more than 1500 transplants; is collaborating with a Singapore medical centre on a new transplant centre; and runs a radiation therapy clinic in Ireland. Last year the Mayo Clinic added an international hospital, Medica Sur in Mexico City, to its network. Medica Sur is not owned nor managed by Mayo, but had to meet strict criteria for quality and safety, such as low readmission rates, and can use Mayo’s research and expertise Johns Hopkins Medicine International, based in Baltimore, has links and affiliations in a dozen countries, including Brazil, China, Saudi Arabia and Singapore. It part owns cancer hospital Johns Hopkins Singapore and Johns Hopkins Aramco Healthcare in Dhahran, Saudi Arabia. Partners HealthCare International, of the Boston-based health system affiliated with Harvard teaching hospitals Massachusetts General and Brigham and Women’s, is active in seven countries. While some of these links will bring a few medical tourists to the USA, most accept that the vast majority of patients will be treated in their own countries, in hospitals owned or run by top US hospitals, and using US expertise, a sort of cloud based virtual medical tourism where the cloud is knowledge and revenue.