Germany: hospitals hit by international patient drop

Germany was one of Europe’s most popular medical travel destinations, but numbers have fallen. According to surveys by the medical tourism department at Bonn-Rhein-Sieg University of Applied Sciences (H-BRS), 65,586 medical tourists from abroad received in-patient treatment in Germany in 2020. In 2019, the number was 97,300.  Much of this drop is due to the pandemic, but several German hospitals had begun to pivot away from medical tourism even before the COVID-19 outbreak.

According to surveys by H-BRS, the number of outpatient treatments fell from 145,000 to 97,000 in 2020. This gives rounded totals of 42,000 in 2019 and 163,000 in 2020, although these are all estimates rather than actual figures. Plus, they are all international patients rather than just planned medical tourists.

In 2019, income from foreign patients amounted to €1.2 billion (US$1.24 billion). In 2020 it was only €800 million (US$826 million).

The university’s study is based on its own surveys and data from the Federal Statistical Office. These are only available with a delay of around one and a half years. Detailed figures for 2021 and 2022 are not yet available.

The main reason for the decline is the COVID-19 pandemic, bringing with it severe entry restrictions.

International patients to Germany are mainly from the East. In the decade before the pandemic, the majority of foreign patients were from Russia, Ukraine and Kazakhstan. This market grew steadily. The number of inpatient medical tourists from these three countries fell by half in the pandemic year 2020 compared to 2019 (Russia by -62%, Ukraine by – 24%, Kazakhstan by -32%).

The number is likely to continue to decrease from all three due to the war in Ukraine. It is difficult to predict how severe the decline will be in the long term. A few Russian patients continue to go to Germany for complex medical treatments.

In addition to Russia (over 2,000), Ukraine (1,400) and Kazakhstan (240), medical tourists also came from Saudi Arabia (500) Poland (10,400 inpatient admissions) and the Netherlands (5,800).

Patients come because of lack of treatment options in the home country and the high quality of treatments in the German health system.

The most frequently requested medical specialties are orthopaedics, internal medicine, cardiology and surgery.

In addition to the pandemic, other reasons for the reduced number of patients are the changes in oil prices, currency stability and real wage developments.

German hospitals have taken a financial hit from the pandemic. University Clinic Freiburg, which runs a unit specifically for treating non-EU patients, saw a marked drop in admissions. In 2020, more than 1,000 international patients were treated at the clinic, but that number dropped to 800 in 2021. Most of these individuals were from Ukraine and Russia.

Several German hospitals had begun pivoting away from medical tourism even before the COVID-19 outbreak. The University Hospital of Dusseldorf stopped targeting foreign patients several years ago, saying proceeds from this area were no longer relevant in terms of magnitude and medical tourism was not a strategic field for it.

In March 2022, Berlin’s Vivantes shut its Vivantes International Medicine unit, which specifically catered to foreign patients, in light of falling demand which made the unit financially unviable. In 2020, fewer than 1,000 non-EU citizens sought medical treatment there, down from 1,200 per year from 2016 to 2019.

It is not clear when and to what extent medical tourism will rebound in Germany in the wake of the COVID-19 pandemic, and with the continuation of the war in Ukraine.