If anyone still doubts that medical travel and tourism are having a serious impact on discussions about the future of healthcare delivery in the United States, perhaps they should click on over to this “Let’s Talk Health Care” blog post by Charlie Baker, president and CEO of Harvard Pilgrim Health Care, Inc., one of New England’s leading non-profit health plans. I know the discussion about medical travel has been going on within Harvard Pilgrim for some time, having discussed it last year with Jim Sabin, chairman of the company’s Ethics Advisory Group, who has also blogged about the subject.

Baker notes that — according to a study by the Deloitte Center for Health Solutions — the number of people leaving the U.S. to access care in other countries is now growing at a faster rate than the number of people coming from other countries to the US to seek care. “A lot faster,” he says, and he goes on to discuss the profound implications this may have for healthcare in America. The Deloitte study suggests that U.S. healthcare providers will lose almost $16 billion in revenue in 2007 to outbound medical tourism.

“If Deloitte’s trends are correct, the size of that loss will grow to almost $70 billion by 2010 — as much as 10% of total revenues by 2010,” Baker says.

Vic Lazzaro, CEO of BridgeHealth International, thinks that the Deloitte conclusions are perhaps alarmist

“That under this scenario there will be a loss of revenue to hospitals and facilities in the U.S., over time, cannot be denied,” Lazarro commented. “We also would be surprised, though, if that impact was significant for any one hospital or physician.

“We would hope those factors in the U.S. would result in increasing focus on quality, outcomes reporting, service and cost reduction, as this is now what is being delivered at the international hospital destinations.”

The Deloitte study found that nearly 40 percent of American healthcare consumers would be willing to travel outside the country for care if the quality was comparable and the cost was cut in half or more. Highlights of the study include:

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Medical travel and tourism continues to be poked and prodded in the U.S. media and, increasingly, the news is catching up with the most significant trend in the nascent industy.

And that is, that patients can go outside of the United States for high quality medical care at far lower costs than at home is becoming part of how businesses, insurers and consumers — together — are fighting to contain costs for needed healthcare. The May issue of Fast Company covers the topic and the issues it raises, in considerable depth, in an article headlined, simply, Medical Leave. The article is a snapshot of U.S. healthcare at a crossroads:

“The phrase “medical tourism” was once used to describe early retirees jetting in to Bangkok or Bangalore to have a little work done before recuperating on the beach. That image doesn’t jibe with the numbers today. As many as half a million Americans streamed abroad last year in search of affordable alternatives for hip replacements or prostate surgery. And they went not for the postsurgical tanning but for the savings: up to 90% off the going rates in the United States. They went because 47 million Americans lack insurance and can’t pay for surgery to fix a bad back or clogged arteries. Or because they have insurance but can’t begin to pay the soaring deductibles a major surgery entails. They’re fleeing a system that is by far the most expensive in the world and growing more so by the hour, with diminishing returns in quality of care.”

The FastCompany.com article makes it clear — U.S. businesses and insurers are integrating medical travel into healthcare offerings at whatever pace that consumers will accept — and as consumers learn more about healthcare outside the U.S., they accept or even embrace it.

That has also been the experience of Stephanie Sulger, BridgeHealth International vice president, who has been helping patients get the care they need at a cost they can afford for the past six years.

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The decline of the value of the American dollar vs. other major world currencies has prompted more than one prospective medical tourist to ask me if “it is still worth it” to go out of the country for medical care. The very short answer is: “Yes, it is still worth it.” The dollar has not declined nearly enough to offset the enormous gap between prices for medical services in the United States and medical tourism destination countries.

But it is worth a closer look, because currency exchange rates do have an impact on costs of medical travel to and from different countries.

The dollar has declined sharply in the past two years against other major world currencies, which generally has the effect of making foreign goods and services more expensive for people who are spending dollars, whether in the U.S. or when they travel abroad. In a feature article in the New York Times on April 21, “If Only the Dollar Were Stronger,” Americans who are living overseas talked about how the fall of the dollar has eroded their buying power. Healthcare costs, the article said, has hit Americans who have retired overseas hard:

“Americans think that health care anywhere but in the U.S. is cheap,” said Daniel Prescher, publisher of International Living, a monthly magazine focused on living overseas. “Yes, it’s less expensive, but when you need it often as a resident in a foreign country, it’s something you still need to plan for as part of your budget.”

Note that this is rather a general statement, and that living abroad as a retiree who must pay out of pocket for regular health care is not at all the same as traveling abroad for one-time surgery or care. Specifically, much of the consternation about the falling dollar is about how it has fallen vis-à-vis the Euro, to record lows recently, with little prospect for recovery in the near term.

But the value of the dollar has not fallen as drastically vs. the currencies in medical tourism destination countries and, even where it has fallen, prices for medical services, surgery and dental treatment have remained at a drastic discount from those in the United States.

In Costa Rica, a prime destination for medical tourists, the dollar has been relatively steady against the colon. In fact, the dollar has risen in value vs. the colon for most of the last decade, and prices of medical services to tourists have remained quite stable. Real estate prices have ballooned in recent years in Costa Rica, but not the prices of dentistry and plastic surgery.

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