Fortunately, because healthcare here is accessible, competitively affordable, and has achieved international renown, despite rising medical malpractice premiums for many physicians nationwide, it's no surprise this area consistently sits in the catbird seat.

Northeast Ohio boasts more than 95 healthcare institutions, led by the Cleveland Clinic Foundation, University Hospitals Health System, and the MetroHealth System; residents in the Akron and Canton markets are served, respectively, by The Summa Health System Foundation and Akron's Children Hospital, and Aultman Hospital and Columbia Mercy Medical Center. Consistently, such specialties as cardiology, pediatrics, neonatology, gastroenterology, and orthopedics earn the highest national rankings from peer review groups.

Case Western Reserve University's schools of medicine, dentistry, and nursing are widely known. The Ohio College of Podiatric Medicine is in Cleveland, one of only seven such facilities in the country. The Northeast Ohio Universities College of Medicine, in Rootstown, trains primary care physicians.

Northeast Ohio's healthcare industry is one of the region's top employers, providing more than 100,000 jobs and generating an estimated $9 billion in income.

Annually, the National Institute of Health pours in more than $130 million in research funding.

At least 300 research centers devoted to biotechnology are located here, with expanding international ties that hold high promise.

Northeast Ohio's healthcare costs are lower than those in Portland, Oregon, Los Angeles, Denver, Minneapolis, and Washington, D.C., according to ACCRA's current cost-of-living index. In contrast, they are slightly higher than those in Detroit, New Orleans, and Baltimore.

Even with the area's glowing reputation, relocation specialists suggest, the role that healthcare plays in the overall allure of Northeast Ohio to prospective transplants is changing.

For example, younger executives - men and women in their late 20s and early 30s - share a perspective that differs markedly from those who mulled a move to this area 15 or 20 years ago.

"These Generation X-ers have a different mind-set," says Hannah Sharnsky, president of DATAGroup, an Akron-based relocation firm.

"Years ago, the issues were job promotion and job stability - being 'one of the boys.' Now someone will relocate because it provides individual opportunity to acquire new skills, not so much for continuing to be an employee (with that employer) for the next 30 years. They want to know: 'what are you going to give me?'"

Thus, a new location's "quality of life" - its venues for sports, recreation, the arts, access to shopping or work, and, of course, overall affordability - will always remain crucial. However, in considering a move, an individual is likely to insist on a healthcare package that is transferable on an "apples-to-apples" basis, Sharnsky says.

Obviously, she says, no one wants to experience less coverage at higher premiums, nor have they in Northeast Ohio. Rather, Sharnsky says, "To them, 'healthcare' is not just doctors and hospitals. It could be such ancillary services as child- care and, increasingly, eldercare for aging parents who not infrequently accompany them on their relocation."

Regardless of where a person ultimately chooses to live in the area, healthcare requiring the most sophisticated, specialized treatment is available, she and other relocation specialists say.

One issue challenging local biotechnology companies is attracting, amid fierce competition, top talent with competitive benefit plans, says Joseph M. LaGuardia, regional vice president, corporate sales, Anthem Blue Cross and Blue Shield. Anthem Blue Cross and Blue Shield is Ohio's largest health carrier, covering more than 21,000 employer groups that have from two to 50,000 employees.

For them, LaGuardia says, a healthcare plan must have "cost controls and satisfy employees' health-coverage needs."

And since companies must "think globally" to compete, employers need to offer a plan that includes national and, in many case, international healthcare coverage to prospects. Anthem's system includes 80 percent of all physicians in the United States, 90 percent of the hospitals, and 200 contracted hospitals overseas, LaGuardia says.

Additionally, he says, employers are insisting on "one-stop" plans that cover everything from medical care to life and disability insurance, prescription medications, and dental and vision coverage. Another new feature is providing access to pertinent "personalized" healthcare information through, in the case of Anthem Blue Cross and Blue Shield, myhealth@anthem.com

"They want," LaGuardia says, "someone who will give them a plan with competitive, stable rates because healthcare costs are one of the largest.

"They also would want to know, whatever the healthcare company (the new employee) is enrolled in, that he or she will have someone with all their ducks in a row, so that at 3 a.m. they can say, 'my son is sick' and all they have to do is show a card and I will get the best service."

Thus, in considering Northeast Ohio, an individual should look at a provider that has earned national accreditation, is financially stable, and will provide competitive, stable rates, he adds.

In meeting prospective transplants, Tracie Babarick, marketing director for SummaCare Health Plan, says she frequently fields questions about mixing and matching healthcare options from multiple carriers at competitive rates.

For example, there are many different contracts from different carriers. Some provide access only to the University Hospitals Health System; others have access only to the Cleveland Clinic Foundation and its member hospitals.

Even so, Babarick says, "Lots of employers tend to put two different options together that may offer both of these options. So as an employer offering group benefits, there are a lot of quality choices in the marketplace right now." And since the area has so many carriers, the rates tend to be competitive, a strong selling feature.

SummaCare Health, along with Anthem Blue Cross and Blue Shield and Medical Mutual of Ohio, are three of four area plans that have received the highest accreditation from the National Committee for Quality Assurance, following a rigorous three-year assessment. Having earned the equivalent of the industry's "Good Housekeeping Seal of Approval" also symbolizes the national reputation of Northeast Ohio's healthcare. And it gives Babarick and other marketers plenty of selling options.

"Let's say if someone is new to the area and doesn't have a physician the person is familiar with, we have options that allow them to go outside of our network," she says. "If you then pick a doctor that you are not happy with, and maybe you want to use a doctor from another health system, we, as all carriers do, have plans that allow you to do that - to go out of the network.

She continues: "Another good thing about this area, too, is having so many different carriers out there; there are so many different products that employers can choose from.

"They realize that if they have employees who live outside the area, or that may be moving in, they do have the option of seeing any provider they choose essentially."

Such reassurance adds immeasurable comfort to families whose normal lives are disrupted at "warp speed" when they transfer to a new community as part of the proverbial "career move."

Consistently, a higher cost of living and moving from family are the two major reasons that executives refuse relocation, DATAGroup's Sharnsky says.

"They lose all areas of control," she says. "They knew their doctors, they knew how to get to the hospital, where to shop. Now all of a sudden they move to Northeast Ohio. Sure, they may have heard that Cleveland has the Rock and Roll Hall of Fame and know about the great Cleveland Orchestra. But they never thought they would actually be living here.

"It's so emotional, especially for someone with a young family. It involves not just a move from one desk to another. But it's a whole lifestyle change. So it requires their having to change their mindset literally overnight," she adds.

Most transferees are generally aware of the reputation of Northeast Ohio's healthcare market, even if they lack specifics.

"Nothing, in terms of care, is that far away," Sharnsky says. "If a situation occurs with a family living in Youngstown that requires specialized care, they don't have to travel to the other side of the state. In this case, it's a two-hour drive or less to the Clinic and University Hospitals in Cleveland."

Often, relocating families will ask their physicians for referrals in their new home. Some even select their home based on its proximity to a specific hospital. Young families, in particular, like to do research on various hospitals and the services they offer. Since different states have different requirements for vaccinations, this, too, becomes a topic for discussion in a new community.

Again, their general awareness of the area's strong healthcare reputation provides a "comfort zone" for them.

Only the reputation of a community's schools eclipses healthcare in the minds of many newcomers, says Sharon Orr, director of corporate business development for Realty One's Relocation Division.

"I always touch upon our healthcare here," Orr says, "and the fact that we are recognized around the world as a leader, with the Cleveland Clinic Foundation, University Hospitals, and MetroHealth System. We tell people this area pioneered open heart surgery and kidney dialysis and that Picker International is a leader in imaging.

"So, yes, healthcare is an issue - not the biggest. But it definitely is an asset and is rated A+!"

As a publicist, former newsman George A. Becker has written for national news organizations, emerging companies, and multibillion-dollar corporations for more than 30 years. He can be reached at 216-292-3234.

Akron Children's Hospital (www.akronchildrens.org)

Anthem Blue Cross & Blue Shield (www.anthem.com)

Aultman Hospital (www.aultman.org)

Cleveland Clinic Foundation (www.clevelandclinic.org)

Columbia Mercy Medical Center (www.ohwy.com/oh/h/hx206057.htm)

Metrohealth System (www.metrohealth.org)

Northeast Ohio Universities College of Medicine (www.neoucom.edu)

Ohio College of Podiatric Medicine (www.ocpm.edu)

Summa Health System and Foundation

(www.summahealth.org)

University Hospitals Health System (www.uhhs.org)