For some, medical tourism conveniently pairs sightseeing with a visit to the doctor. For others, medical tourism is a last resort to treat an illness like cancer that may be too aggressive or invasive for treatment back home. Some countries are able to provide medicine or treatments not available elsewhere. Many medical treatments face less strict governmental scrutiny familiar to citizens of places like the United States. They also often have better access to resources, meaning more treatments are available more quickly.
Germany is one such place, featuring the natural delights of forests, rivers, and mountain ranges, but also storied nightlife, vibrant art scenes, and a rich cultural history. And because of their recent success in mitigating the deadly impact of the novel coronavirus outbreak, Germany is set to become a front-runner of the medical tourism industry in a postpandemic world.
But Germany might not be the most obvious destination for Americans seeking alternative cancer treatment. Due to its close proximity, Mexico is the recipient of around 1 million American medical tourists each year, as estimated by Newsweek in May 2019. Cancer treatment centers in places like Tijuana and Baja cater directly to American consumers who have been told by their doctors back home that they are out of treatment options. As reported in issue 5’s “Desperately Seeking Treatment,” many of these clinics offer treatments ranging from ineffective to dangerous, offering little more than hope with an exorbitant price tag.
That’s why those wary of the bad press surrounding Mexico’s alternative clinics often look to Germany. “If you look at the country brand of Mexico and compare it to the country brand of Germany,” begins Irving Stackpole, “the perceptions [are] profoundly different.” Stackpole is the president of the healthcare market research and business development firm Stackpole & Associates. He says this is because Germany is especially known for innovation and engineering. “The German GDP has a higher component of manufacturing contributing to it than the United States,” he says. “Germany isn’t a services-based economy [but] has a very high proportion of manufacturing, and that manufacturing is built on engineering.”
A 2014 article in the Harvard Business Review (HBR) reaffirms this. Germany’s successes in engineering and manufacturing cross diverse industries, from sustainable energy to molecular biotech. German manufacturers infuse “old products and processes with new ideas and capabilities or recombining elements of old, stagnant sectors into new, vibrant ones,” says HBR. The German manufacturing industry employs a large percentage of the population while providing excellent wages and benefits, so the industry flourishes. According to HBR, “Germany innovates in order to empower workers and improve their productivity; the U.S. focuses on technologies that reduce or eliminate the need to hire those pesky wage-seeking human beings.” In short, Germany cares for its citizens, both those who are sick and those whose job it is to make the sick well.
This compassion is reflected in their health care industry. All German citizens are provided with health insurance from the government, with costs relative to their earnings. Employers pay a percentage and employees cover the rest, unless they don’t earn enough — and all receive the same level of care. Wealthier citizens, or those looking for more options, can purchase privatized health care plans in addition to government-provided insurance. The clinics that are most often visited by international treatment-seekers are part of this privatized system, operating outside of the familiarly strict German hospital system. But unlike some alternative treatment centers in other countries, German law requires private treatment centers to employ licensed medical practitioners.
A 2018 piece by Lindsay Gellman on Longreads cites the “long history of embracing unconventional treatment methods” as to why Germany thrives in this industry. Gellman says homeopathy, a medical system based on the belief that the body can heal itself given the right conditions, originated in Germany in the 18th century. It is these natural-type treatments that are traditionally explored after cancer patients are recommended palliative care in their home country. Typically, homeopathic treatments are reimbursable by German insurers. “German law extends robust protections to certified nonmedical practitioners, or heilpraktikers, whose training in alternative healing methods like homeopathy permits them to treat patients with non-infectious diseases, like cancer,” Gellman writes.
And recent events have granted this Western European nation even more notoriety: During the first months of the pandemic, Germany was commonly featured in news headlines for their remarkable efforts in curbing coronavirus-related deaths. As of June 20, 2020, Germany recorded 193,000 cases of coronavirus, with only 9,000 deaths. In comparison, neighboring France recorded 161,000 cases of coronavirus, with 29,000 deaths. Germany’s mortality rate is even lower than South Korea’s — a nation that was so effective with lockdown procedures that other countries used this model to flatten their own curve. As of April 2020, South Korea’s mortality rate was 1.8 percent, far lower than European nations Spain, France and Britain, which all hover around 10 percent. But Germany’s mortality rate is even lower at 1.6 percent.
“The reason [Germany] came out so well in this crisis is because of the peak cultural respect the German citizens have for science,” says Stackpole. “People accepted the science that in order to suppress the reproduction or transmission of the virus, they had to stay home.” It’s a sentiment that throws the U.S. response into sharp contrast, as President Trump repeatedly delivered information to the public contradicting advice from leading medical experts. Germany also promoted widespread testing, at no cost to the patient. This meant that those infected could isolate early, which is imperative to reducing the number of overall infections.
According to an April 4 article in the New York Times, if a person tests positive for coronavirus in Germany and their symptoms are manageable enough to isolate at home, they’ll be visited by a “corona taxi” — medics in protective gear visiting those five or six days into illness. The medics will assess the patient’s symptoms and administer blood tests in which they are “looking for signs that a patient is about to go into a steep decline, [because] the chances of surviving that decline are vastly improved by being in a hospital when it begins.”
It’s no wonder, then, that even before its success in dealing with a pandemic, Germany was a popular destination for medical tourists. A December 2012 article on the New York Times’ website quotes Isabella Beyer, a research associate in medical tourism at Germany’s Bonn-RheinSieg University of Applied Sciences, “We have one of the worldwide best health care systems and people from abroad know that.” Beyer chalks it up to lower prices, high quality care and shorter waiting room times.
That’s why Stackpole believes Germany has the potential to become Europe’s epicenter for medical tourism. “[The pandemic] is all about the science,” Stackpole begins. “Health tourism is really also about the science, but historically [it’s] not so much about the health or wellness part, it’s been about the tourism part. And that may be a big shift going forward in these markets. There may be a renewed, refreshed, increased emphasis [on] science.”