the costing has to do with the cost of their indemnity insurance, hospital charges etc.

As a health care professional... I dunno... we have pretty tight infection control standards here in Australia which aren't so stringently followed in other countries. There is also bacteria in other countries I'd be wary of. It is not just the training of the surgeon, but also the nursing staff that would factor into it for me. And also their equipment. Do they reuse equipment? If so, is it adequatley sterilised? Do they have the appropriate and necessary equipment should something go wrong? And do they have the knowledge and skills to deal with any negative side effects? How would I go with a language barrier?

My Mum's friend had a hysterectomy overseas (her husband was working overseas at the time) and it went horribly wrong. She developed an infection they couldn't identify. She was medi-vaced back to Australia. You have probably heard about her - the plane she was on crashed just off of Norfolk Island. She was in ICU for a very long time and nearly died as a result of the surgery... then add the accident into it!

If I DID have to have surgery overseas, I'd be making sure I had adequate insurance to cover any emergency flights home as that would require specialist nurses and doctors being flown from home over there.

FWIW, I work with several doctors trained overseas. Some of them I shake my head in amazement at their skills and knowledge (in a negative way) whilst others I take my hat off to. But there are also many Doctors (and nurses) who have trained here in Australia that have me doing the same thing. We DO have very high standards here in Australia for surgeons to pass before they can be deemed a consultant... but there is a big leap between registrar and consultant!