If you want to have an operation on the NHS, and you want to have one quickly, this is how to do it. Grow a vicious but very localised cancer. Run out into fast-moving traffic. Develop a fatal heart defect at an early age. Offer to donate a kidney to a stranger. And that's pretty much it.

Then there's how to have an operation on the NHS and wait a long time for it. Ah, where to start? Varicose veins (nasty problem, very nasty op, but not life-saving, so don't hold your breath); cataracts (you'll regain your sight in the 20 minutes or so it takes to carry out - how does a year's wait sound?); a hip or knee replacement, a hysterectomy . . . really any surgery for something which is truly niggling, depressing, painful or crippling but is not, at least in the short term, fatal.

And so to the drip drip drip, word-of-mouth, watercooler phenomenon that is health tourism. There are no firm figures here, because no one is required to keep them. There is no government guidance, because the government would rather strip out a varicose vein in a Cumbrian farmyard than be seen to encourage it. There is only anecdotal evidence, which suggests numbers of health tourists who are prepared to pay for surgery - but aren't prepared to pay British prices - are rising fast. Then there are the internet companies, offering surgery with a luxury holiday on the side.

So where are people going? And how do they arrange it?

India

Despite the sub-continent's fearsome reputation for violently unpleasant gut disorders, this is a popular destination for sick Brits. You can get to Delhi or Bombay for about £500 return, sometimes much less. The doctors speak English and receive world-class training, many new facilities are excellent and, most important of all, private healthcare there is, relatively speaking, dirt cheap.

Navdeep Suri, spokesman for India's high commission in London, says that while members of Britain's Asian communities have long taken advantage of Indian healthcare, all sections of British society are getting in on it now. "There are some very good hospitals offering treatment at affordable prices," he says. "You can pretty much do your bookings in advance and get very quick treatment, and the economics works out well."

And does he approve? Yes - the hospitals, he says, "welcome the revenue", and it's a good way of keeping Indian doctors at home. "Up to now we've been exporting doctors to the US and the UK. There are about 50,000 in the US. That's a big loss, when medical training in India is so heavily subsidised."

As a starting point for would-be health tourists, the high commission's website has a health section (www.hcilondon.org/Healthcare_India.htm) with links to some of the country's private hospitals. "These services are available at extremely competitive prices, encouraging patients not only from developing countries but even from a number of developed ones to come to India for specialised treatment," it says.

Hip replacements (about £800) and heart bypasses (about £1,000) are particularly popular options. Cataract operations cost about £60 - compared with around £3,000 if you have them done privately in Britain. Even with the cost of flights and accommodation - and the chance that something goes wrong and you need extra care - it's still likely to be significantly cheaper than having your surgery done at home.

Costa Rica

This small Central American country vigorously promotes health tourism - it's estimated that one in 20 tourists has some kind of surgery while he or she is in town. There's even an official website for health tourists (www.cocori.com/healthtourcr/). "Costa Rica is well known throughout the world for high-quality, low-cost health care. Its healthcare system - with well-equipped modern clinics and hospitals, and medical personnel trained in the finest international teaching centres - provides excellent medical service to citizens and foreigners alike," the site boasts.

The country's 1,000 or so doctors are required to give some of their time to the government healthcare system, but most spend a good part of the remainder in the highly-profitable private clinics. Eye surgery and cosmetic dentistry are popular package holiday choices. On the downside, Costa Rica is at least 12 hours away, and if it all goes nasty, you're a long way from home. Most of the country's health tourists are from America and Canada.

South Africa

The very nice man at the South African embassy in London seems genuinely shocked by the idea of Brits flying to Cape Town or Jo'burg for surgery. "My God!" he says. "I can't get my head round that one." But it's a relatively popular option. The country (which pioneered human heart transplants) offers top quality surgery at competitive prices, most people speak English and the climate is wonderful if you're not feeling all that well.

John Yates, a grandfather of six, has just paid £5,000 to fly more than 5,000 miles to South Africa for a replacement hip, rather than risk an 18-month wait on the NHS. The 70-year-old from Tamworth, Staffordshire, was "in agony" when he went to see a specialist about his right hip last October. He was expecting to be told there would be a delay in getting treatment because he had had to wait three months for his left hip to be replaced five years ago.

"You could have blown me down when the specialist said it could be up to 18 months this time," he says. Like many health tourists, he turned to the web. First he tracked down hospitals and clinics in America, France and Germany - but prices ranged between £12,000 and £15,000. "Then I came across the Morningside Clinic in Johannesburg on the internet. I emailed Dr Ian Dymond there and he emailed me back the price. He said he could do the operation as soon as I wanted for £4,250. So I flew out to Jo'burg in March and had the operation six days later. The hospital had discounted accommodation available at a wide variety of places locally, but I had friends nearby so I stayed there for four weeks. Then I flew home. The service out there was absolutely brilliant."

Dr Dymond, who treats around 40 Brits a year at his clinic, says he has been so encouraged by the influx that if the trend continues he will approach BA or Virgin Atlantic about the possibility of offering package "sun surgery" trips.

Garden Route Medicare (www.gardenroutemedicare.com/) arranges health tourism trips to South Africa, if you'd rather not contact a clinic directly.

Germany

While many countries can use the promise of cut-price private medicine to lure wealthy foreigners, Germany cannot. The businesslike response of the country's private hospitals, faced with excess capacity, has been to set up a deluxe service, GerMedic, which promises not only to help foreigners arrange operations but to sort out hotel accommodation for their relatives and organise translators. The scheme is controversial, but the chairman of the Committee for the Promotion of German Medicine Overseas, Dieter Thomae, is unrepentant. "Illness knows no frontiers," he says. "We are proud of the trust that people have in the quality of our services. In health, as elsewhere, modern care is increasingly subject to the international division of labour."

Cuba

In spite of America's best efforts, or perhaps because of them, Cuba's healthcare system - like its organic farming system - is flourishing. Its doctors and scientists are plentiful and innovative, and the country's state-run clinics are now starting to offer specialist treatments, such as one for night blindness, to European patients. It is a long way to go though - popping back for aftercare is not going to be easy - and you may regret not speaking Spanish. Sites such as www.cubanacan.cu/servimed/servime1.html offer more information.

America

Not a cheap option, but an option for those who can't get the operation they want anywhere else - either because no one else knows how to carry it out, or no one else is prepared to do it.

With the British, it is popular for radical, last-ditch surgery. There's little point in travelling to the US for anything mundane, such as a hip replacement - you will be asked to pay more than you would have to here. Wealthy customers from developing countries, however, are more than happy to pay US prices, and they of course make up the vast bulk of America's health tourism trade.

There are professional brokers who can help you find the operation you want, but all the big teaching hospitals welcome foreign patients and have websites. Many have special deals with travel agents and will make sure you're looked after throughout your trip.

Thailand

Specialist British company Medplex (www.medplex.org/list.htm) claims to offer surgical procedures with a five-star holiday on the side in tropical Thailand.

The rest of the world

There are now international broker companies which say they will find patients the operation they want and where they want it. Try HealthTourism (www.healthcareland.com/HCC/health_tourism.htm), which offers surgery in the Crimea, Jerusalem, Switzerland...you name it.