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.

Read the original article in German

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food / travel

The True Horrors Behind 7 Haunted Locations Around The World

With Halloween arriving, we have dug up the would-be ghosts of documented evil and bloodshed from the past.

Inside Poveglia Island's abandoned asylum

Laure Gautherin and Carl-Johan Karlsson

When Hallows Eve was first introduced as a Celtic festival some 2,000 years ago, bonfires and costumes were seen as a legitimate way to ward off ghosts and evil spirits. Today of course, with science and logic being real ghostbusters, spine-chilling tales of haunted forests, abandoned asylums and deserted graveyards have rather become a way to add some mystery and suspense to our lives.

And yet there are still spooky places around the world that have something more than legend attached to them. From Spain to Uzbekistan and Australia, these locations prove that haunting lore is sometimes rooted in very real, and often terrible events.

Shahr-e Gholghola, City of Screams - Afghanistan

photo of  ruins of Shahr-e Gholghola,

The ruins of Shahr-e Gholghola, the City of Screams, in Afghanistan

Dai He/Xinhua via ZUMA Wire

According to locals, ghosts from this ancient royal citadel located in the Valley of Bamyan, 150 miles northwest of Kabul, have been screaming for 800 years. You can hear them from miles away, at twilight, when they relive their massacre.

In the spring 1221, the fortress built by Buddhist Ghorids in the 6th century became the theater of the final battle between Jalal ad-Din Mingburnu, last ruler of the Khwarezmian Empire, and the Mongol Horde led by Genghis Khan. It is said that Khan's beloved grandson, Mutakhan, had been killed on his mission to sack Bamyan. To avenge him, the Mongol leader went himself and ordered to kill every living creature in the city, children included.

The ruins today bear the name of Shahr-e Gholghola, meaning City of Screams or City of Sorrows. The archeological site, rich in Afghan history, is open to the public and though its remaining walls stay quiet during the day, locals say that the night brings the echoes of fear and agony. Others claim the place comes back to life eight centuries ago, and one can hear the bustle of the city and people calling each other.

Gettysburg, Civil War battlefield - U.S.

photo of rocks and trees in Gettysburg

View of the battlefields from Little Round Top, Gettysburg, PA, USA


Even ghosts non-believers agree there is something eerie about Gettysbury. The city in the state of Pennsylvania is now one of the most popular destinations in the U.S. for spirits and paranormal activities sight-seeing; and many visitors report they witness exactly what they came for: sounds of drums and gunshots, spooky encounters and camera malfunctions in one specific spot… just to name a few!

The Battle of Gettysburg, for which President Abraham Lincoln wrote his best known public address, is considered a turning point in the Civil War that led to the Union's victory. It lasted three days, from July 1st to July 3rd, 1863, but it accounts for the worst casualties of the entire conflict, with 23,000 on the Union side (3,100 men killed) and 28,000 for the Confederates (including 3,900 deaths). Thousands of soldiers were buried on the battlefield in mass graves - without proper rites, legend says - before being relocated to the National Military Park Cemetery for the Unionists.

Since then, legend has it, their restless souls wander, unaware the war has ended. You can find them everywhere, on the battlefield or in the town's preserved Inns and hotels turned into field hospitals back then.

Belchite, Civil War massacre - Spain

photo of sunset of old Belchite

Old Belchite, Spain

Belchite Town Council

Shy lost souls wandering and briefly appearing in front of visitors, unexplainable forces attracting some to specific places of the town, recorded noises of planes, gunshots and bombs, like forever echoes of a drama which left an open wound in Spanish history…

That wound, still unhealed, is the Spanish Civil War; and at its height in 1937, Belchite village, located in the Zaragoza Province in the northeast of Spain, represented a strategic objective of the Republican forces to take over the nearby capital city of Zaragoza.

Instead of being a simple step in their operation, it became the field of an intense battle opposing the loyalist army and that of General Francisco Franco's. Between August 24 and September 6, more than 5,000 people were killed, including half of Belchite's population. The town was left in rubble. As a way to illustrate the Republicans' violence, Franco decided to leave the old town in ruins and build a new Belchite nearby. All the survivors were relocated there, but they had to wait 15 years for it to be complete.

If nothing particular happens in new Belchite, home to around 1,500 residents, the remains of old Belchite offer their share of chilling ghost stories. Some visitors say they felt a presence, someone watching them, sudden change of temperatures and strange sounds. The ruins of the old village have been used as a film set for Terry Gilliam's The Adventures of Baron Munchausen - with the crew reporting the apparition of two women dressed in period costumes - and Guillermo del Toro's Pan's Labyrinth. And in October 1986, members of the television program "Cuarta Dimensión" (the 4th dimension) spent a night in Belchite and came back with some spooky recordings of war sounds.

Gur Emir, a conquerer’s mausoleum - Uzbekistan

photo of Gur Emir (Tomb of Timur) i

Gur Emir (Tomb of Timur) in Samarkand, Uzbekistan

Chris Bradley/Design Pics via ZUMA Wire

The news echoed through the streets and bazaars of Samarkand: "The Russian expedition will open the tomb of Tamerlane the Great. It will be our curse!" It was June 1941, and a small team of Soviet researchers began excavations in the Gur-Emir mausoleum in southeastern Uzbekistan.

The aim was to prove that the remains in the tomb did in fact belong to Tamerlane — the infamous 14th-century conqueror and first ruler of the Timurid dynasty who some historians say massacred 1% of the world's population in 1360.

Still, on June 20, despite protests from local residents and Muslim clergy, Tamerlame's tomb was cracked open — marked with the inscription: "When I Rise From the Dead, The World Shall Tremble."

Only two days later, Nazi Germany invaded the Soviet Union, with the people of Samarkand linking it to the disturbing of Tamerlane's peace. Amid local protests, the excavation was immediately wrapped up and the remains of the Turkish/Mongol conqueror were sent to Moscow. The turning point in the war came with the victory in the Battle of Stalingrad — only a month after a superstitious Stalin ordered the return of Tamerlane's remains to Samarkand where the former emperor was re-buried with full honors.

Gamla Stan, a royal massacre - Sweden

a photo of The red house of Gamla Stan, Stockholm, Sweden

The red house of Gamla Stan, Stockholm, Sweden


After Danish King Kristian II successfully invaded Sweden and was anointed King in November 1520, the new ruler called Swedish leaders to join for festivities at the royal palace in Stockholm. At dusk, after three days of wine, beer and spectacles, Danish soldiers carrying lanterns and torches entered the great hall and imprisoned the gathered nobles who were considered potential opponents of the Danish king. In the days that followed, 92 people were swiftly sentenced to death, and either hanged or beheaded on Stortorget, the main square in Gamla Stan (Old Town).

Until this day, the Stockholm Bloodbath is considered one of the most brutal events in Scandinavian history, and some people have reported visions of blood flowing across the cobblestoned square in early November. A little over a century later, a red house on the square was rebuilt as a monument for the executed — fitted with 92 white stones for each slain man. Legend has it that should one of the stones be removed, the ghost of the represented will rise from the dead and haunt the streets of Stockholm for all eternity.

Port Arthur, gruesome prison - Australia

a photo of ort Arthur Prison Settlement, Tasmania, Australia

Port Arthur Prison Settlement, Tasmania, Australia

Flickr/Eli Duke

During its 47-year history as a penal settlement, Port Arthur in southern Tasmania earned a reputation as one of the most notorious prisons in the British Empire. The institution — known for a brutal slavery system and punishment of the most hardened criminals sent from the motherland— claimed the lives of more than 1,000 inmates until its closure in 1877.

Since then, documented stories have spanned the paranormal gamut: poltergeist prisoners terrorizing visitors, weeping children roaming the port and tourists running into a weeping 'lady in blue' (apparently the spirit of a woman who died in childbirth). The museum even has an 'incidence form' ready for anyone wanting to report an otherworldly event.

Poveglia Island, plague victims - Italy

a photo of Poveglia Island, Italy

Poveglia Island, Italy

Mirco Toniolo/ROPI via ZUMA Press

Located off the coast of Venice and Lido, Poveglia sadly reunites all the classical elements of a horror movie: plagues, mass burial ground and mental institute (from the 1920's).

During the bubonic plague and other subsequent pandemics, the island served as a quarantine station for the sick and anyone showing any signs of what could be Black Death contamination. Some 160,000 victims are thought to have died there and the seven acres of land became a mass burial ground so full that it is said that human ash makes up more than 50% of Poveglia's soil.

In 1922 a retirement home for the elderly — used as a clandestine mental institution— opened on the island and with it a fair amount of rumors involving torture of patients. The hospital and consequently the whole island was closed in 1968, leaving all the dead trapped off-land.

Poveglia's terrifying past earned it the nickname of 'Island of Ghosts'. Despite being strictly off-limits to visitors, the site has been attracting paranormal activity hunters looking for the apparition of lost and angry souls. The island would be so evil that some locals say that when an evil person dies, he wakes up in Poveglia, another kind of hell.

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