International Report – Germany

Hub of innovation

Germany is Europe’s biggest economy and the healthcare sector is a key part of this. Mathias Marx provides an overview of the healthcare industry in Germany and finds it well positioned to compete in an increasingly global market place.

“Made in Germany” – this traditional trademark is no longer associated exclusively with cars and machinery, but also with healthcare. As a key sector of Europe’s largest economy it has experienced constant growth over the past years and continues to do so. More than 4.6 million people work in what are increasingly referred to as ‘life sciences’, producing an annual turnover of over €250 billion. Business prospects are promising, as demand for quality healthcare products and services continues to grow. This is due to a number of factors: medical and technological innovation, growing health awareness at home and abroad and a higher life expectancy as a result. According to experts, annual turnover in the sector is estimated to almost double by 2020, in due course creating up to one million new jobs.

Future Challenges

Crucially, demographic development in Germany is characterised by a population of 81.8 million, many of whom are increasing living longer, placing a growing burden on the provision of healthcare for this sector of the population. As a result, local health budgets are coming under severe strain. These costs simply cannot be met by general health insurance contributions, which presently amount to more than 15% of the average German’s monthly salary.

Rising costs at home will have to be met with a successful drive towards marketing healthcare products and services abroad that are ‘made in Germany’. For this reason alone, Germany needs to be at the forefront of medical innovation. As a consequence, government and business leaders alike are aware that positioning Germany internationally as a “hub of innovation” is of paramount importance. As it is most research and development activities in the country are primarily geared towards healthcare applications, be it information technology, micro-systems, nano- and bio-technology or genetic engineering.

In a nutshell, healthcare is undergoing a fundamental change: from being a burden on the public purse to evolving into a sector of growth and innovation. In line with Germany’s federal structure, development is increasingly driven by regional clusters of excellence, each with a high level of interdisciplinary convergence of healthcare science and industry, bio- and medical technology.

Medical technology

Thanks to its tradition of high-end industrial engineering and manufacturing, Germany boasts the third-biggest medical technology industry worldwide, next to the US and Japan. Its annual growth rate between 1995 and 2009 was 5.5%. Similarly, Germany holds a 30% share in the European market. This success is based on outstanding expertise in key technologies, high standards of scientific education, of research and development as well as an innovative approach of companies and institutions alike.

The North leads the way

Medical technology is a key part Northern Germany’s industrial setup, with the industrial port city of Hamburg and the adjacent federal state of Schleswig-Holstein to the north leading the way. Here 16,000 professionals employed by over 250 companies account for an annual turnover of close to €4 billion. To the surprise of many, small to medium-sized companies drive innovation as much as big players. Key areas are: medical imaging, operating theatre technology, endoscopes as well as ultrasonic and ventilation equipment.

In Hamburg, production of x-ray tubes dates back to 1896. Today, Philips Healthcare produces top-of-the-range imaging equipment at the site of the original German company. Its portfolio includes ergonomic x-ray systems as well as sophisticated ultrasound tools. With regard to the latter, relative newcomer to the market, Söring is a serious competitor and a good example of the important role small to medium-sized enterprises are playing. The company is the sole patent holder for contact-free cold plasma coagulation.

Two university-college hospitals in this region are also playing a crucial role in innovation: Hamburg’s University Medical Centre Hamburg-Eppendorf (UKE) and its counterpart further north, University Medical Centre Schleswig- Holstein (UK-SH). Together with the Lübeck-based Medical Laser Centre, they focus on the development of innovative imaging techniques.

Minimally invasive surgery

Regarding operating technology, the northern region’s science and industry are very active in advancing minimally invasive surgery. The existence of regional inter-disciplinary clusters of excellence helps to maximise efficiency. Specialists collaborate to produce new solutions for surgery, imaging and supporting systems. The objective is threefold: to reduce operating risks for the patient, improve the quality of surgery and to reduce the treatment period. World market leader Olympus with its high-end endoscopes (both flexible and rigid) is a key company in minimally invasive therapy and cancer screening. At its Hamburg base, it recently presented a completely new operating system called LESS (Laparo Endoscopic Single-Site Surgery). Small incisions in the naval and so-called tri- or quad-ports guarantee almost scar-free operations.

Olympus recently introduced the fully integrated Endoalpha operating theatre control system, which provides technical assistance and communications alike. The system has been acquired by a number of Middle Eastern hospitals. Another company specialising in advanced operating microscopes is Möller-Wedel. By combining precise electronic imaging with maximum performance in a very condensed period of time, it has developed a winning formula. The design of highly advanced secure ventilation systems is another feat of innovation originating from this region.

Anaesthetics and lab equipment

Among others, neighbouring Schleswig- Holstein boasts global player Dräger. This company with some 11,000 employees worldwide produces anaesthetic and ventilation systems, patient monitoring and IT solutions.

Highly reliable laboratory equipment is also produced in Germany’s north. The world over, hospital staff will in all likelihood have used pipettes and disinfectants from Eppendorf and Bode respectively, two medium-sized firms from Hamburg. The latter sprang to public attention during the recent H1N1 virus crisis, when its disinfectants were much sought after. Its first marketable rub-in alcoholic hand disinfectant was first produced 40 years ago and continues to be the market leader in Europe.

The capital: Berlin

Thanks to renowned hospitals such as the Charité University Hospital founded more than 300 years ago, Berlin is well on the way to positioning itself at the forefront of innovation. This holds especially true for medical technology. For example, the Trauma Hospital Berlin (UKB) is Germany’s first fully digitised hospital. Another example is the German Heart Institute, which is an international Centre of Excellence specialising in artificial heart transplants.

Clear vision for the South

In Southern Germany, the technological focus is on bio-materials, biological compatibility, surface functionalization, endoprosthetics, cardiovascular implants and tissue engineering. Medical electronics and IT innovation has a focus on homecare, e-health telemedicine, hospital logistics, microsystems technology and sensors. Diagnostics also feature prominently in terms of innovation. Here, particular attention is given to in-vitrodiagnostics, point-of-care testing and chip technology. In Bavaria alone, well over 250 firms compete in the fields of medical technology and pharmaceuticals.

In medical imaging, the focus is on navigation and robotics, CT, MRT, PET, ultrasound, molecular imaging, endoscopy, minimally invasive surgery as well as computerassisted surgery. According to Bavaria’s MedTech Pharma network, telemedicine services are becoming increasingly important. One such system is called “exdicomed”, and is used in a cluster project involving teaching hospitals and companies. Devised as a tele-radiological concept for both hospitals and individual consultants, it allows for the instant transfer of PACS-based images within a designated network. The system is in use in a pilot scheme linking 25 regional hospitals. As a result, the efficiency of trauma surgery, for example, has been enhanced considerably.

Strong rehabilitation focus

Furthermore, Bavaria has firmly established itself as Germany’s leading centre for medical rehabilitation. This is partly due to its stunning geographic features and a favourable climate. A 300-plus network of institutions with a total capacity of nearly 33,000 beds, attracts patients from all over the world. High quality services and care have made Bavaria a particular favourite with patients from the Arabian Peninsula. In addition, they can choose between 47 leading health resorts – a unique feature to advanced rehabilitation.

Pioneering knowledge transfer

Many German hospitals are focused on attracting wealthy foreign patients to boost their revenue and reputation. However, Hamburg’s UKE Consult and Management (UCM), a subsidiary of the renowned University Medical Centre Hamburg-Eppendorf, follows a different and rather unique path in this respect. As the company does not consider global medical tourism alone to be sufficient, it promotes the export of medical expertise and hospital planning and operating competence. In this context, the wider Middle East has become one of its key partner regions. Services are provided to private clients, state institutions and investors alike.

How does the approach work? Consultants examine the viability of a planned or existing facility. They then optimise the business plan, medical workflow, logistical solutions and so forth. They get involved in the purchasing process and assist in quality management. This may include advice on new buildings, alterations, etc. Crucially, foreign colleagues are then trained in Hamburg by local doctors, nurses and administrative staff. In the final stages, German staff travel to temporarily work on site for the project. Remote support via electronic data transfer is provided. Assistance even includes management of the so-called tertiary sector such as transport, cleaning and catering. On request UCM deals with the whole medical and commercial management of either an entirely new project or one that requires restructuring.

UCM in the Middle East

 undertaken a feasibility study for the construction of a new medical city. In the UAE, based on Hamburg’s UKE prevention centre, plans have been tabled to build a similar centre in Dubai. In Yemen’s capital Sana, UCM has been managing a 120-bed hospital since 2008. Remarkably, training and teaching exchange programmes for German and Yemeni hospital staff continue in spite of the political turmoil in Yemen. And in Saudi Arabia, UCM is in prime position to bid on the planned construction of dozens of new hospitals around the kingdom.

A bright future

With a sound regulatory framework and investment climate, enormous diversity within the sector as well as strong emphasis on scientific research, Germany’s economic powerhouse is well-positioned to successfully compete in an increasingly global healthcare market.

A specialist centre for the treatment of obesity

Extreme overweight is a lifestyle disease which affects more and more people worldwide. As regards the Arab World, this problem has, by comparison, increased disproportionally over the past few decades due to changed regional living conditions. For patients, obesity often means a minimized participation in social life and a restricted quality of life. There is additionally the danger of consequential diseases like diabetes, hypertension with the risks of a cardiac infarction or stroke or the premature wear of joints and spine.

The vicious cycle consists of an excessive supply of high-calorie food, increasing body-weight, lack of physical activity with a subsequent further increase of bodyweight. A sustainable weight reduction regarding these cases can almost exclusively been reached by means of a surgical intervention in respect of the gastrointestinal tract. Since obesity is a very complex disease of patients with an increased surgery-risk, an optimal treatment of these patients requires specialised departments at the hospitals. In Berlin, the state-owned hospital-group Vivantes has accepted this challenge and established a centre for obesity surgery at the Vivantes Hospital Spandau.

Two distinguished experts, Prof. Dr. Ferdinand Köckerling and Prof. Dr. Volker Lange, organised the establishment of the Vivantes obesity centre. Prof. Lange is a renowned specialist regarding different surgical methods of the obesity treatment: From the insertion of an intragastric balloon over the implantation of a gastric banding device to the application of a gastric bypass or a sleeve gastrectomy.

“Surgery is often the only treatment option in case of patients with a bodymass- index over 40. A body-weight of such dimension cannot, in most of the cases, be treated exclusively by means of diet and additional physical activity,” says Prof. Lange, who has performed more than 1,200 operations of this kind.

Minimally invasive surgery

Ninety-nine per cent of the surgeries at the Vivantes obesity centre are minimally invasive surgeries. Prof. Köckerling and Prof. Lange have gained a good reputation internationally in the field of minimally invasive surgery over the last 20 years.

“The technique does not injure skin and soft tissue” says Prof. Köckerling. “This is particularly important regarding the treatment of obese patients since the healing of major surgery wounds is normally very problematic with this group of patients.”

The whole infrastructure of the centre takes heavyweight patients into consideration, i.e. in addition to OP-tables with a capacity of more than 250kg, the centre has particularly stable beds and seating as well as extra-long surgical instruments. Prof Lange says: “This location provides optimal medical treatment.”

The Regional Director of Vivantes, Dr. Andreas Schmitt, says the new centre is among the top 5 regarding the treatment of adiposity in Europe. “We appreciate the fact that we could engage the leading medical specialists in order to implement our quality-strategy. The new department will therefore offer treatment to almost 500 obese-patients in its first year which means that we already belong to the market-leaders both in national and international respect. And we have great plans in addition. Due to the striking therapeutic successes, we are being booked not only on the part of German clients but increasingly also on the parts of patients from abroad, e.g. from the Gulf region.”


A comfort clinic had been built at the same location in order to enhance the attractiveness for privately insured and international patients, which is available for state-insured persons as well. The rooms offer a superior hotel-ambience, the multilingual staff is multi-culturally trained, the meals which are served at the clinic’s restaurant are adapted to individual, religious and cultural needs and also Russian or Arabic TV can be received in the rooms via satellite in addition to the availability of iPads, etc.

The excellent standard of the centre has recently also been recognised on the part of institutional clients. The Komfortklinik functions as referenceinstitution of the Association of Private Health-Insurances since 2010 and the biggest state-insurance (AOK) has concluded a direct integrated treatmentagreement regarding the adiposity centre with Vivantes in 2011. The leading outpatient centre of the renowned specialist Dr. Rosenthal has been committed to perform the outpatient diagnostics, preparation and after-treatment. This ensures the trans-sectoral quality of the treatment and often reduces the waiting period regarding the therapy. The Vivantes centre is also a symbol for the potential of the healthcare metropolis Berlin, i.e. as a very good example of the development from local to regional significance up to international excellence.

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Vivantes offers knowledge transfer to
the Middle East

The healthcare markets in MENA countries and emerging markets are characterised by immense dynamism, great willingness to invest and sufficient demand in know-how. This applies both to the public and private sectors.

The governments of countries like Saudi Arabia, UAE or Qatar have recognised the challenges that arise in healthcare in the mid- and long-term perspective and target the sector as one of their priorities. A great demand on approaches in modernisation and optimisation goes hand-in-hand with growing requirements in efficiency. The visionary ideas of the rulers shape the actual healthcare master plans and open great opportunities for long-term strategic partnerships between the Middle East and Germany.

Due to a long tradition of high-end medicine and its innovative power, German healthcare services are in high demand on the international market. During the past few years Vivantes has become one of the big players on the international healthcare stage.

Founded 2001 out of a merger of several healthcare facilities, Vivantes now is the biggest state-owned healthcare provider in Germany, caring for around 500,000 patients per year in nine hospitals and offering an almost full spectrum of firstclass medical and nursing care.

The scope of the services that Vivantes has to offer goes far beyond patient treatment and wellbeing services. Answering to the increasing demand for international knowledge transfer in the field of health care, Vivantes offers, aside from the educational programmes in Berlin, assignments of its experts abroad.

The Vivantes brand stands for largescale healthcare projects in Middle East countries such as in KSA, Abu Dhabi and Russian speaking countries. Healthcare consulting and management services are being offered to the international market by the 100% subsidiary Vivantes International GmbH, which performs highly complex projects, e.g. the conception of hospitals, their repositioning, reorganisation, merger or management, as well as staff services.

Al Imam University

Al Imam University, one of the leading Islamic universities in the world is in the process of establishing an independent Al Imam Academic Medical Campus to meet the Kingdom of Saudi Arabia’s growing higher education needs. The campus will consist, among other things, of a central university hospital with 1,000 beds, an education campus for more than 3,000 students and an independent research centre. A specific performance strategy, including pilotstatus, international education programme and a long-term know-how association will be initiated prior to the building phase. This should enable Al Imam Academic Medical Campus to gain a national and international leading position in respect of education, research and medical quality.


Another example is the running project in Abu Dhabi that aims to bring a unique combination of medical rehabilitation services and outpatient services to the emirate. In contrast to the hospital, the rehabilitation clinic puts its focus not on the treatment of the patient’s primary disease alone, but on restoring the patient’s full ability to function in his normal surroundings, and restore the patient to a state of physical and mental well-being. In light of the development of medical care in Abu Dhabi and the introduction of the new reimbursement system for hospitals, which as a result will increase the pressure to reduce average length of stay, a new approach for planning healthcare facilities has to be pursued. The planned medical centre will not only cover the market niche for highquality rehabilitation services, but could also become a structural and quality benchmark for further facilities in the region.

As bitter experience shows, expensive and modern-equipped facilities can be inefficient. Only system solutions which go beyond the planning phase into the operation can guarantee efficiency and long-term quality.

Both of the above projects have the advantage of a turn–key approach and access to the profound knowledge base of Vivantes and its partners in each phase of the project – starting from the strategic concept, through the planning phase, the educational concept and training of specialists, up to ramp up, operation and management; all taking into consideration local conditions. Such a comprehensive approach can only be pursued if the structural quality, the size and the experience of the partner allows this.

 Date of upload: 15th Nov 2011


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