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German Hospitals Banking On Sick (And Rich) Foreigners

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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In Northern Kenya, Where Climate Change Is Measured In Starving Children

The worst drought in 40 years, which has deepened from the effects of climate change, is hitting the young the hardest around the Horn of Africa. A close-up look at the victims, and attempts to save lives and limit lasting effects on an already fragile region in Kenya.

Photo of five mothers holding their malnourished children

At feeding time, nurses and aides encourage mothers to socialize their children and stimulate them to eat.

Georgina Gustin

KAKUMA — The words "Stabilization Ward" are painted in uneven black letters above the entrance, but everyone in this massive refugee camp in Kakuma, Kenya, calls it ya maziwa: The place of milk.

Rescue workers and doctors, mothers and fathers, have carried hundreds of starving children through the doors of this one-room hospital wing, which is sometimes so crowded that babies and toddlers have to share beds. A pediatric unit is only a few steps away, but malnourished children don’t go there. They need special care, and even that doesn’t always save them.

In an office of the International Rescue Committee nearby, Vincent Opinya sits behind a desk with figures on dry-erase boards and a map of the camp on the walls around him. “We’ve lost 45 children this year due to malnutrition,” he says, juggling emergencies, phone calls, and texts. “We’re seeing a significant increase in malnutrition cases as a result of the drought — the worst we’ve faced in 40 years.”

From January to June, the ward experienced an 800 percent rise in admissions of children under 5 who needed treatment for malnourishment — a surge that aid groups blame mostly on a climate change-fueled drought that has turned the region into a parched barren.

Opinya, the nutrition manager for the IRC here, has had to rattle off these statistics many times, but the reality of the numbers is starting to crack his professional armor. “It’s a very sad situation,” he says, wearily. And he believes it will only get worse. A third year of drought is likely on the way.

More children may die. But millions will survive malnutrition and hunger only to live through a compromised future, researchers say. The longer-term health effects of this drought — weakened immune systems, developmental problems — will persist for a generation or more, with consequences that will cascade into communities and societies for decades.

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