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Sun 30 Jan 2011 10:48 AM

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Travel sickness

Germany is pushing to become the leading medial tourism destination in the world. If the response of Gulf patients looking for cures is anything to go by, it has a very real chance.

Travel sickness
Travel sickness
The German Heart Institute Berlin.

Picture the scene: you wake up and jump on the scales before starting the day. On the way to the kitchen, your iPhone beeps and advises you that data from the scales indicates you have gained weight and you need to exercise more this week. Another message then indicates during the night your heart rate implied you may need to lay off the fatty foods today too. On the way to work, you get a phone call from your doctor telling you he has reviewed the latest data from the pacemaker you had fitted last year in Berlin. “No need to worry, but perhaps you should pop in,” he says.

This may sound like the latest Hollywood blockbuster or some futuristic science fiction vision, but it is actually happening right now and is the reality of the modern healthcare system in Germany.

All German citizens have healthcare coverage and therefore it has one of the highest densities of hospitals in the world, almost twice that in the US where few citizens get free healthcare. In a bid to reduce the burden on the system, telemedicine has become the latest German craze. This involves monitoring patients’ bodily functions and only those in need of medical treatment are called in for further consultation.

For example, ten years ago Berlin-based company Biotronik developed a pacemaker system that has a monitoring device built into it and each day while the patient is sleeping, data on how their heart is performing is sent via a wireless connection to the nearest hospital. The local doctor analyses the results to check for any potential cardiac ailments that might need attention.

Similarly, fellow Berlin company Getemed supplies devices for newborn children with an in-built alarm system which activates if the infant is in medical distress. It also offers heart monitors and telemonitoring devices which are integrated into weighing scales. The cumulative medical data is wired over the internet to a local doctor who keeps a daily watch on the user’s condition.

The devices are currently only offered to patients who already have serious heart conditions and are sold to hospitals and medical institutions. They can also be sold to private patients who simply want to take a preventative approach to their healthcare.

Biotonik reports that their futuristic pacemakers have become popular in the Gulf, especially Qatar, and Getemed isthis month in Dubai hoping to attract potential Arab clients who want to have a more proactive approach to their healthcare.

Such medical advances explain why the German healthcare system is considered one of the best in the world and why the Saudi German Hospitals Group (SGHG), considered the Gulf’s largest private healthcare provider, decided to adopt their approach to healthcare. As a result of the growing popularity of German healthcare, Berlin-based Vivantes International Medicine, the largest state-owned hospital chain in Europe, last year saw a 100 percent rise in the number of Middle East patients and treated around 1000 Arab patients from around the world. The majority came from Saudi Arabia and Dr Andreas Schmitt, general manager of Vivantes International says lifestyle illnesses, such as obesity and diabetes, are common ailments for Arab patients and issues such as strokes, tumors and heart defects are the main reasons why treatment is needed.

Travelling from the Middle East for healthcare is not a new phenomenon but it is big business. The term used in the profession is medical tourism and the World Bank indicates that the sector is already a $6bn worldwide business and is set to grow further with the globalisation of the healthcare industry.

According to 'Patients beyond Borders', considered to be a definitive reference guide to medical tourism, around 28 different countries are competing across four continents for more than two million patients who each year visit hospitals and clinics in countries other than their own.

The UAE is a prominent player as, according to recent surveys by the Healthcare Travel Congress, patients from the UAE spend around $2bn on medical tourism each year.

While Berlin is after a slice of this, it is still early days for it. Figures from VisitBerlin, the city’s tourism marketing authority, show that in the first ten months of last year 16,347 Arabs visited the German city. While this was a rise of 6.6 percent, Arabs only represent about five percent of the total number of foreign visitors to the city.

Hospitals such as the German Heart Institute Berlin and the Heart Centre Brandenburg agree with Vivantes’ estimation that Arab visitors are on the rise, even though they currently only represent about one or two percent of the total number of patients treated.

There are a number of reasons why this is increasing, says Thomas Hohn, the head of administration at the German Heart Institute Berlin. Firstly, increased visa restrictions in the US after the September 11 terrorist attacks saw a dramatic drop in turnover for the American healthcare system as Arabs and other foreigners began to look elsewhere for their healthcare.

It is estimated that between 2002 and 2003 turnover dropped by as much as $700m. Further visa restrictions in the wake of the attempted Christmas Day suicide bombing in 2009 has seen the number of Arabs choosing Europe over the US increase, says Hohn. The new Berlin-Brandenburg airport due to open in June 2012 and the starting of direct flights from Dubai to Berlin will also help increase numbers, he adds.

Already, facilities such as Vivantes have begun putting in place special promotional deals and have started working with the airlines and embassies to offer package deals to Arabs to come to Berlin for their medical treatments. However, it is not just rich sheikhs and Arab CEOs that are going to get their treatment in Europe.

Meeting patients at the German Heart Institute, I was introduced to one patient had flown in from Dubai. An Iraqi living in the emirate, the 65-year-old woman was not a rich person and neither were her family.

Her sons say they were left with no choice but to travel to Berlin for treatment for her heart defect. Although the Berlin hospital carries out around 3,500 open-heart treatments every year, it specialises in less intrusive value treatments. Back in Dubai, this woman’s doctor had recommended complicated, expensive and difficult open-heart surgery as the hospital did not have the expertise to offer the value treatments available in Berlin.

After some research on the internet her sons found information on the Berlin hospital and decided to pay the expense to fly from Dubai to avail of the less intensive procedure. While her sons admitted that it was a costly decision, they say they believe it is unlikely she would have survived extensive open-heart surgery, which was the only option in Dubai.

Similarly, in the children’s ward, we encountered a Libyan couple whose son was over for treatment for serious lung and heart defects. As his father read from the Holy Qur’an and his mother held her child’s hand, the couple said they were also left with no other choice but to fly to Berlin for treatment for their five year-old son.

The relationship between Berlin and the Middle East is a two way flow and not only are Arabs coming to the city for healthcare, but German professionals are at the forefront of trying to get a foothold into the Arab healthcare market, which is currently dominated by British and American institutes.

Centrovital is Germany’s first medical therapeutic health centre to combine a healthcare facility with a four-star hotel and managing director Karmen Savor reports that while they have seen an increase in Arab clients coming to the facility for treatment and recuperation, they are also looking to enter the Arab market themselves. Savor says the increase in Arab arrivals has spurred the company to begin franchising the concept and it has already received positive enquiries from potential partners in Kuwait and Lebanon to set up similar facilities in the region.

Vivantes is involved in the development of many hospital projects around the Gulf. Its $1.75bn Academic Medical Campus at the Al Imam University in Riyadh is set to open in 2014 and it has also signed a memorandum of understanding with the Abu Dhabi government to partner of a large hospital facility for the UAE capital.

Schmitt also reports that upon his trip to Doha this month Vivantes will be giving a presentation to the Emir of Qatar for a hospital project. With the country recently winning the rights to host the 2022 FIFA World Cup, he is confident that some of the $57bn planned for investment will come his way. Healthcare is more than just about setting up facilities; it is also about expertise and education.

“Don’t see healthcare as a business… Healthcare should not be for profit,” says Prof Annette Grueters-Kieslich, the dean of Charite, Europe’s largest university hospital.

Grueters-Kieslich, who is the first ever female university dean in Germany and heads up the 300-year-old institution, believes that healthcare should not focus on generating profit and the bottom dollar but on educating students and facilitating medical science.

She can claim a strong pedigree as eight Nobel Prize winning laureates started their medical training at the institution. Therefore, it is for this reason that she reveals that the university has been approached several times to set up a campus in the Gulf and they are currently in talks to establish an outpost in the UAE with a local Arab partner. Her aim is for students from the Gulf to attend courses in the Berlin campus and for her Berlin-based students to gain experience abroad in the UAE. While visiting the various medical institutions in Berlin, the managers and heads of the companies said the recession had not impacted German healthcare. However, some of the evidence did show that the global downturn has taken hold in patient numbers and funding.

Grueters-Kieslich states that Charite, for all its 300-year history and expertise, saw its government funding cut by a third last year and over the next three years the reduction of nearly $120m will impact its growth potential. Similarly, data from the German Heart Institute Berlin showed a dramatic drop in the number of heart procedures carried out since the peak in 2007. The numbers dropped from a high of over 53,000 in 2007 to around 3,500 last year.

The management claimed this is due to the opening of other medical facilities in the region and the introduction of less intrusive procedures. However, the drop in patients and funding is clear. While the German approach that healthcare is not just for profit and should be open to all citizens is admirable, it is easy to understand that the drop in numbers has led to a drive for hospitals to seek more Arab patients and to also look to the region for expansion.

The telemonitoring systems and heart pacemakers that send data directly to were first devised to help reduce the demands on the hospital system in Germany. However, in recession times they also have a basic economic use.

Robert Downes, director at Getemed, points out that when patients with congenital heart defects use the telemonitoring systems, the cost per patient of treatment has been reduced by up to 70 percent.

In the downturn, with demands on every sector, increased efficiency might be the best asset the Germans have to offer the Arab health care system.