As medical tourism promoters come to terms with the fact that few people are willing to go to foreign countries for medical procedures, they are starting to shift their focus a little closer to home.

So-called domestic medical tourism appears to be on the rise as medical travel facilitators continue to hunt for the best deals for patients willing to look beyond their hometowns for care they think is better and less expensive.

Meanwhile, hospitals are looking for ways to attract not only new patients from the U.S. but also international patients seeking care they can't find at home.

"As sexy as medical tourism sounds ... people don't travel. Are you really going to get on an airplane to get a knee replacement in India?" said Darren Tomey, spokesman for Healthplace America.

That was the conclusion Global Choice Health Care reached in January when it changed its name to Healthplace America to focus on domestic, rather than international, medical tourism. The Lisle, Ill.-based company had gotten few bites from American patients and employers willing to cross oceans for surgical and other procedures.

Tomey said that when he asked one employer who had a medical tourism plan in place for more than a year how many employees had traveled for care, the employer replied, "Not one." Yet several of the company's employees had procedures that year that would have fit within the medical tourism program.

Jon Edelheit, president of the Medical Tourism Assn., a trade group for those involved in medical tourism, said he has seen the increased interest in domestic medical tourism, but it's not being driven by a lack of interest in patient's going abroad.