As a research assistant at the Bonn-Rhein-Sieg University of Applied Sciences, Jens Juszczak has been dealing with medical tourism for many years. In this interview, he gives foreign patients some important tips.
No researcher in Germany knows more about medical tourism than Jens Juszczak, because he is the only scientist throughout Germany to have specialized in this area of research. That is why he is being interviewed by radio and television when it comes to medical tourism. But also the German Bundestag (Parliament) appreciates him as a specialist and include his opinion in debates.
Clinic Compass: Medical tourists are people from abroad that travel to Germany to be treated here. How many foreign patients are there every year?
Jens Juszczak: In 2017, around 247,500 patients from 177 countries were treated in Germany on an inpatient or outpatient basis. However, we have to distinguish between planned and unplanned hospital stays. Foreign people who have an accident during a holiday or on transit in Germany are statistically recorded as foreign patients.
Clinic Compass: Patients from abroad need special counselling and support. The findings have to be send to the clinic, the flight has to be booked and the conversations between doctor and patient have to be translated. Partly, patient counselling is done by patient service providers. These are agencies or individuals who specialised in supporting patients from a certain cultural environment. A good patient advisor is not easy to find. In an interview with Deutschlandfunk, a German public broadcasting radio service, in which you also participated, a Russian patient mediator estimates that 80 to 90 percent of the mediators are untrustworthy. Why are there so many black sheep?
Jens Juszczak: Patient referral for a fee has been prohibited by law for several years now. Only services like interpreting or counseling is legally possible. Hoping for easy money and the lack of knowledge about the German health system, the medicine and the processes in the hospital as well as the billing system are an issue in this business area. There are no precise specifications, everyone can work as a patient advisor. Often, residence of several years in Germany is the only qualification that patient mediators can demonstrate. There is a lack of state regulation and control in this area, as is shown by the scandal involving the Clinical Centre Stuttgart.
Clinic Compass: Foreign patients can also contact the International Unit (IU) of a clinic, as they also partly offer complete care packages, including visa application and shuttle service. Nevertheless, the case of the Clinical Centre Stuttgart has shown that mismanagement can also occur in hospitals. The former head of the International Unit of the clinic, Andreas Braun, is now in custody. There is a suspicion that, amongst other things, for the treatment of 371 Libyan war-disabled patients in 2012, funds have been misappropriated because for comparably simple treatments, astronomical sums have been charged. How is it even possible that in this case, for foreign patients completely different costs were charged than for German patients?
Jens Juszczak: Only few international departments offer such service packages like the Stuttgart Clinic. There is a range of legal and tax-related arguments against it. The topic of service accounting is explicitly regulated in Germany by the German Hospital Fees Act (Krankenhausentgeltgesetz). Section 8 subsection 1 sentence 1 of this law states that patients cannot be distinguished on the basis of their origin. Thus, the foreign patient has to be charged the same way as the German patient. Nevertheless, the lawmaker did not specify in which way additional services should be invoiced. That is why these are often charged in the form of flat rates or increased base rates and increase factors of the German Scale of Fees for Doctors for foreign patients. This seems to have been the case in Stuttgart as well. However, the amount of the invoice often surpasses a reasonable level in the cases examined by us.
Clinic Compass: Especially when it comes to medical billing, German patients do not understand everything either. How can a patient from abroad find a trustworthy partner?
Jens Juszczak: Should it be necessary or desired to include an external service provider, it is recommended to directly agree on the scope and the costs of the services with the provider. The quality of the rendered services and the total invoice sum often depend on the expertise of the patient service provider. However, this is often difficult to verify for the patient. Test criteria can be a license to practise medicine, an examination certificate as interpreter or relevant professional training certificates. When verifying the invoice, the patient should check whether only the agreed services have been charged and if necessary mandatory information such as invoice number, tax number and VAT identification number of the invoice issuer are included as well as a reported sales tax. Additionally, it should be checked whether items invoiced by the service provider do not appear again on the clinic invoice.
Clinic Compass: That means that patients from abroad should pay attention to a certain degree of experience when choosing the mediator. Would it be a better choice to contact a big agency, as they often have several years of experience in the field?
Jens Juszczak: No, it’s not as easy as that. The size of the agency, its legal form and its experience only partially indicate their level of seriousness and trustworthiness. Especially the investigations of German authorities and foreign audit offices suggest that the largest service providers may not be the best choice.
Clinic Compass: Given the difficulties of finding a trustworthy patient mediator, how do patients from abroad find the appropriate clinic?
Jens Juszczak: It is recommended to directly contact the clinic, without the interposition of a service provider. Clinics that specialised in foreign patients often have international departments and multilingual websites, where potential patients can place their inquiries. They then receive a treatment plan and a cost estimate from the clinic. As patients mostly contact several clinics, they can compare these with one another. When in doubt, the prices invoiced for single items can be reviewed by a billing specialist or a specialist solicitor for medical law.
Clinic Compass: Mr Juszczak, thank you very much for the interview!
Since 1999, Jens Juszczak has been working as a research assistant at the Faculty of Economics of the Bonn-Rhein-Sieg University of Applied Sciences. He regularly publishes his research results on medical tourism in specialist books and journals.
Picture: @Bonn-Rhein-Sieg University of Applied Sciences