During the process, an artificial prosthesis can substitute for the damaged joint. A hip replacement is sought after by medical tourists who experience stiffness in their hips, thereby limiting leg movement, have problems with bending and are taking medications that lead to side effects or are not that effective. The package should only come from medical institutions, clinics or hospitals that are accredited by the right agencies, like the JCI, Trent, ISO, etc. The quotation should include the name of the physicians and surgeons conducting the operation, the type of operation to be done, the duration of hospitalization, complete address and contact number of the place and other follow-up treatments and medications required. The cost of care in India is considerably lower compared to other medical tourist spots. Patients can also communicate better with health care providers since majority of Indians are very good at speaking English. Visitors can enjoy their vacation more because of the India's rich culture and unique sights, sounds and attractions. Customers and service or health care providers from the other country usually communicate through informal means, to hasten the process and avoid very strict legal oversight. More than 50 countries have been named as a medical tourism destination. Some of these consider medical tourism as a major industry and are creating better buildings, facilities, equipment, as well as researching newer technologies to stay updated. Germany is another top destination because of its state of the art equipment, very high standards and modern facilities. All citizens have health coverage. Waitlists are also considerably shorter in Germany and cost of treatment is 50% cheaper compared to America. Middle Eastern patients now prefer going to Germany instead of the United States because of the very strict regulations since the September 11, 2001 attack. The Philippines is known for having very qualified doctors and dentists. A number of medical institutions are already accredited by JCI. Expect treatment to be only a fraction of the cost you pay for in the States. Some of the popular procedures done in the country include dental work, plastic surgery and heart surgery.