The United States healthcare system in 2008 gets an overall grade of 65 out of 100, according to a study relased late last week by the Commonwealth Fund’s Commission on a High Performance Health System. The U.S. ranked last among 19 nations surveyed in the number of deaths that may have been avoided with the proper care in 2002-2003, falling from 15th place in 1997-98.

I wince when I type sentences like that. Anyone familiar with my work knows that I’ve gone out of my way on more than one occasion to NOT say that healthcare in other countries is somehow “better” than that available in the U.S.  I note U.S. strengths in high-end care and technology and its leading role in medical research. I know overseas surgeons who have told me that, all other things being equal, they consider their peers in the United States to be the most advanced.

The problem is that all other things are not equal. The United States lags behind, badly, in the commission’s 37 different indicators of healthy lives, quality, access, efficiency and equity, compared to other countries.

Here’s some coverage of the study by major media:

• While the U.S. Spends Heavily on Health Care, a Study Faults the Quality (New York Times)
• U.S. health system scores a D in new report card (CBS Marketwatch)
• U.S. Health Care Still Ill, Survey Finds (HealthDay, Washington Post)

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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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Erik Steele, D.O., a physician in Bangor, Maine is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region. He has a terrific article in the Bangor Daily news, headlined, “Consider medical tourism a warning.” in which he discusses the recent news that Hannaford Bros., a supermarket chain with 27,000 employees, is offering a medical travel option as part of employee benefits. The story, initially reported out of Maine, was picked up by the Associated Press and made national news. (Link here.)

Says Dr. Steele:

“Rather than curse Hannaford for its self-interested decision, we would do well to see Hannaford as a corporate canary chirping frantically about the deteriorating conditions brought on by high health care costs in the coal mine of American business. Its action is a warning of things to come. If unheeded, it will not be Hannaford’s action that has brought about the ruin of some hospitals, but the failure of health care and other leaders in this country to listen to the canary.”

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The first BridgeHealth International web seminar on medical travel and tourism, held Friday, was a big success. More than 40 people stopped in, and I know Will Garin and Stephanie Sulger were working overtime to answer the follow-up questions. The company expects to make the so-called “webinars” a regular event.

If you weren’t there (or even if you were) the webinar was an online slide presentation with an hour of commentary by Garin, BridgeHealth’s vice president of marketing, and Sulger, vice president of the consumer division. You can hear the whole show below, though the slides are too large to fit properly in the blog format. If you want to download the whole presentation with the slides, here’s the link to a windows media file:

BridgeHealth Webinar May 30: 73MB, wmv format

Here’s a link to a file that users should be able to download and play on a Mac or IPod:

BridgeHealth Webinar May 30: 26MB, IPod (m4b) format

Here’s an mp4 file that should play nicely in Quicktime, and includes small versions of the slides:

BridgeHealth Webinar May 30: 34MB, QuickTime (mp4) format

And here’s the inline, on-blog audio (MP3 format.) I’m told it may be unlistenable for Mac users, who are best off with the file downloads above.