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On the hunt for new customers: German hospitals are increasingly turning to Russian, Middle Eastern and other wealthy patients from abroad

high-tech heart monitoring equipment

By Karen Merkel


BERLIN - Inoperable. It's probably the hardest word for any parents of a sick two-year-old girl to hear. In Russia, the doctors all agree that the young girl's liver cancer has progressed too far. Her parents, desperate for help, decide to take her to Berlin. Here, German cancer specialists study the situation and come to a very different conclusion: surgery may save the girl's life, but it's going to cost 55,000 euros.

With the German healthcare industry in a constant struggle with tight budgets, hospitals have recently started to look to international patients - who pay out of their pockets – as a vital new source of revenue. Foreign patients often come to Germany because the treatments they need are not available in their home countries – these include complex cancer surgery, kidney transplants and heart surgery. "Patients can't find the expertise they need in their homelands," says Hans-Jochen Brauns, CEO of the Network for Better Medical Care (NBMC), a consortium of seven Berlin hospitals dedicated to the care of international patients.

According to the Federal Statistical Office, 67,000 patients came to Germany for inpatient treatment in 2008. Although a 4.6 percent drop from the previous year, the number has been steadily climbing since 2004, when only 50,700 foreign patients found their way to German hospitals. "International patients provide at least 300 million euros annually to German hospitals," estimates Jens Juszczak of the Department of Economics, University of Bonn-Rhein-Sieg in St. Augustin.

This increase in foreign patients benefits all patients in the German health system, which sets fixed prices for treatments. "Treatments in Germany are cheaper on average than elsewhere in the international arena," says Brauns. Through the fixed price system, foreign patients pay the same amount as Germans, which is significantly less than in other countries. For example, the same prostate cancer surgery costs about 15,000 euros in Germany and up to 44,000 euros in the United States.

Low prices and high quality medical care are important competitive advantages over U.S. and Asian hospitals. Additionally, German hospitals seek out the coveted yet demanding upper-class patients who are used to privileged treatment in their home countries. Russia and the United Arab Emirates are the most important sources of patients, and even former Soviet republics such as Azerbaijan are contributing more and more to the German medial system.

The German Heart Institute of Berlin (DHZB) is well known in Russia because of former president Boris Yeltsin, who underwent treatment for five bypass surgeries there. The institute provides luxurious single suites, a multilingual staff, and even limousine service to wealthy international patients. In the private ward, leaders and celebrities are accommodated in rooms outfitted with the latest in security technology. International patients routinely receive Chief Medical treatment at the German Heart Institute Berlin, as they often do in German hospitals.

For the heart center, it's all worth the effort: about six to eight percent of its patients are from abroad, representing a turnover of around six million euros. This sets the DHZB apart within the German hospital landscape. Even the University Hospital Hamburg-Eppendorf (UKE), which has a separate Moscow office, keeps only about one percent of its beds occupied by foreign patients. Overall, only 0.4 percent of patients in German hospitals reside abroad.

Medical tourism remains niche market

Despite the growing popularity of German clinics abroad, "medical tourism" remains a niche practice. It is only since the reform of hospital financing in the 1990s that it has been seen as a good business opportunity for German hospitals to seek patients from other countries, and many hospitals still need more time to develop their strategies towards this market. The UKE in Hamburg established its international office only five years ago. "Even Berlin's hospitals have not seen the need to strive for international patients until just recently," says Brauns.

However, since the introduction of new hospital budgets, expenditures may not exceed the revenues of hospital health insurance. Unfortunately, this means that the costs of the clinics are not always covered. And as the financial situation of many hospitals is precarious, international patients are being increasingly coveted - and courted.

Reaching patients online

One key to advertising German hospitals to international patients has been the Internet. Russian patients exchange their experiences – both positive and negative – through Internet forums and social networks such as Facebook. In a survey conducted by the University of Bonn-Rhein-Sieg, 72.6 percent of respondents named the Internet as an important communication channel in contacting hospitals outside their home country.

Language is often the most restricting barrier. When the University of Bonn-Rhein-Sieg examined the websites of 30 university hospitals, it found that one third of all home pages were only available in German. Information about treatment options, payment terms, and interpreter services were only found on every third site. Similar Southeast Asian clinics that were audited in parallel sold themselves much more effectively even though their medical offerings were nowhere near as comprehensive.

Another barrier to medical tourism is the high cost of logistics associated with patients. Hospitals must provide assistance to patients when they are applying for visas, and provide multilingual and culturally trained personnel for their care. "There is a minimum amount of patients that we need to make it worth the effort," says Mehrdad Goudarzi, who takes care of commercial issues relating to medical tourists at DHZB. But for larger and more specialized clinics such as the Heart Institute of Berlin, the Charité or the UKE, Goudarzi sees good business opportunities: "A doubling of sales within the next five years would not be impossible."

Overcoming these barriers will not only benefit German clinics but the tourism industry as well. The German tourism board has declared 2011 the year of medical tourism, specifically to draw attention to this expanding field. It might be worth it: a study by the University of Bonn-Rhein-Sieg has determined that Arab tourists lengthen their visit to Germany from an average of 2.3 days to nine days when their stay is motivated by a medical treatment. The regions therefore benefit from the patients, who often follow up treatment with a short vacation, as well as from accompanying persons, who spend money and take advantage of German cultural offerings.

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For Cairo, Qatar had been part of an “axis of evil,” with anger directed at Al Jazeera, the main Qatari outlet, and others critical of Egypt after the Muslim Brotherhood ouster. But the vitriol is now gone, with the first ever visit by Egyptian President al-Sisi to Doha.

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