Pramod Goel likens his dotcom to online travel sites Priceline, Travelocity or Expedia. But go to make your travel plans, and the differences between PlacidWay.com and the others soon become apparent. Rather than choosing a departure date and destination, you'll be asked to:

- Choose a treatment

- Choose a region or country

- Choose a health care option

Depending on your preferences, you will be pointed to places as far away as India and Thailand for procedures that include open-heart surgery and total hip replacement.

The Castle Rock businessman's startup is just the latest stage in the evolution of medical tourism, a booming industry in which sightseeing and surgery collide - or, as his Web site characterizes it, "Exotic journeys to wellness."

For years, Americans have been traveling out of the country to get less costly treatment, most notably to Central and South America for elective procedures such as cosmetic surgery. These days, changes in health care - rising costs at home and higher-quality care abroad - have made medical tourism increasingly mainstream. Not only are more people going, but they are going for medically necessary procedures. Some employers are even offering insurance benefits to employees who seek treatment in other countries.

In 2006, about 150,000 Americans traveled overseas for health care, nearly half of them for medically necessary surgeries, according to the American Medical Association. Jonathan Edelheit, president of the Medical Tourism Association, said as many as a million people worldwide will travel out of their home country for medical care by 2010. A May 2008 study by McKinsey & Company, a corporate research firm, came up with a much smaller number - about 60,000 to 85,000 inpatient medical travelers a year internationally - but still acknowledged the likelihood of growth.

Responding to the trend, the AMA on June 16 approved new guidelines regarding medical tourism: "Until there is significant action at home, patients with limited resources may turn elsewhere for care," said AMA Board Member Dr. J. James Rohack, in a news release. "It is important that U.S. patients have access to credible information and resources so that the care they receive abroad is safe and effective."