Information about the hospital system and about getting medical treatment in Germany.

Wednesday, 23 October 2013

Help for Glaucoma Impaired Vision?

One of the most frequent causes for partial blindness is glaucoma. Ophtalmologists tell their patients, that the situation, once it has developed, cannot be cured or improved. The reason for this verdict is, that patial glaucoma blindness is caused by damage to the optical nerve - nervus opticus - and current medical standards maintain that nerve damage cannot be repaired.
There is, however, increasing evidence that this view is too harsh. Neuronal plasticity is the word, implying that in the nervous system there is certain ability to repair damage, not making total restitution possible but showing improvement of residual eyesight. And such improvements are possible even many years after the damage occured.
It is a German researcher, Prof. Sabel, who has been exploring ways to utilize neuronal plasticity to rehabilitate the optical system after damage, due to stroke, glaucoma and other causes, for many years. In 2011, he associated a Russian researcher to his group, Dr. Anton Fedorov, who had been working on the use of electro-stimuli for various therpeutic purposes in Russia, and a new treatment scheme was developed. First published results looked promising -
The author of this blog has been following these developments for years and decided to give the new treatment a try in October 2013. A left eye with about 20% residual eyesight after glaucoma has been troubling him since 2008.
One treatment cycle with Prof. Sabel and the method called noninvasive repetitive transorbital alternating current stimulation (rtACS), takes 10 working days, every there is a session of about 30 minutes on the micro-electric stimulus machine, extensive diagnostics before and after the cycle is done to document the initial status and the immediate results.
However, it is made very clear that the treatment concept is a rehabilition treatment, based on the general idea that rehabilitation after many kinds of damage to limbs and/or nerves usually relies on stimulus and training to regain functionality. Equally, rtACS treated patients are encouraged to continue daily training routines for the eye in order to stabilaze and enhance the treatment results.
Before treatment
After treatment
And what are these results? Well, in terms of measurable effects, the author has only achieved modest improvements. 
In anterior diagnostics he managed to see 25% of the light spots appearing in the perimeter test, posterior results were around 29%. Yet, there are definitely new areas where some partial vison seems to be returning, and at the subjective level clear improvements are observed, although not really in the areas which show improvements in the test..

Conclusion: The rtACS method is definitely able to initiate a process of improvement, especially where there is some residual sight to stimulate. Micacles, in the sense of curing blindness, are not possible and not to be expected. But if, like in the author’s case, there is a return of some sight in the lower part of the visual field, that can be a very important result already: You can see, where you are going!
Based on this experience, German Hospital Service will be more than willing to help interested international patients to profit from this novel treatment. There are considerable waiting lists at Prof. Sabel’s Institute already.

Thursday, 11 July 2013

Regional deep hyperthermia could be a treatment for children and adolescents with refractory or recurrent non-testicular malignant germ-cell tumours

Medical researchers at the Paediatric Oncology Clinic, Haematology and Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich- Heine-University Düsseldorf, Düsseldorf, Germany have recently published findings about a study involving 44 patients, aged 7 months to 21 years, where regional deep hypothermia was successfully used to treat malignant germ cell tumours.

In recent years, the survival of children and adolescents with malignant germ-cell tumours has improved substantially. However, the outcome remains poor for patients with refractory or recurrent malignant germ-cell tumours. The Düsseldorf researchers could show that PEI-regional deep hyperthermia can achieve objective tumour response in a study that followed the patients over more than 7 years after treatment. (The median follow-up of surviving patients was 82 months (range 9—195)).

“Of the 35 patients who had sufficient clinical and radiographical data available for response assessment, 30 (86%) had an objective response to treatment (16 patients had complete remission and 14 had partial remission).” However, granulocytopenic fever, which required intercurrent hospital admission, was noted in 29 (66%) of 44 patients and five patients experienced treatment-related grade-3 acute renal toxic effects.

Nevertheless, researchers conclude: “A multimodal strategy integrating PEI-regional deep hyperthermia and tumour resection with or without radiation can successfully treat children and adolescents with refractory or recurrent malignant non-testicular germ-cell tumours. The long-term prognosis of patients with poor response or after first relapse was almost similar to those receiving first-line treatment. This strategy merits further investigation.”

Obviously, this treatment is still in a study phase and not available as standard treatment. But the results are promising and show the high level of expertise regarding child oncology at this big university hospital. German Hospital Service will be happy to assist international patients if they need treatment in Germany for such severe conditions.

The Lancet. July 1, 2013
Dr Rüdiger Wessalowski MD , Prof Dominik T. Schneider MD et al

Friday, 28 June 2013

Do you have to pay VAT on hospital bills?

Recently, this was a question we got from Australia. It appears that a number of patients were being treated in a hospital in Germany, and required to pay the official VAT rate of 19% on top of already high treatment bills.

German VAT is regulated ina law called "Umsatzsteuergesetz". Unfortunately the text is not available in English. Let us try to sumarize what it says about VAT and health care. There is a specific § 4 listing all exceptions to the rule that VAT has to be paid on all deliveries and services in Germany. Here, in section 14, it says:

  • Treatments in human medicine, provided by physicians, dentists, practitioners, physiotherapists, midwwives or similar provideers of medical care is exempt.
  • Hospital treatments and medical activities by physicians including diagnostics, anamnestics, prevention, rehabilitation, obstetrics and hospice services including all activities closely related to such treatments, if the are delivered by public institutions (institutions governed by public law) are exempt of VAT.
  • This exemption is extended to all services delieverd by hospitals and health care centers that have an official accreditaion to serve social security patients, if the services are such as provided under the social security act.
So: Is it possible that you have to pay VAT on hospital services? Yes, but only if you opt to get treatment by an institution that is not affiliated to or accredited for the treatment of patients covered by social security.

As has been pointed out elsewhere, there are basically two definitions of a hospital in Germany. One is in business law, where § 30 Gewerbeordnung requires that anybody who wants run a private health care institution has to have a concession to do so (like the concession to run a bar.) And the second one is in § 108 of Book 5 of the social security act, where the requirements for participating in the provision of hospital services to social security patients are defined.

There is an increasing number of health care providers in Germany who opt out of the social security system, or are not accredited because they provide services which are not within the scope of social sercurity coverage. These institutions are entitled to call themselves hospitals if they have the concession under business law. But their services are not exempt from VAT, so patients have to pay additional 19% (currently).

German Hospital Service will generally not advise customers to consult such institutions as normally there is no need to go there. High level medical treatment can always be obtained by the fully accredited hospitals and most of the really high class institutions are “goverened by public law” anyway: They are the university clinics, universities in Germany being predominantly public institutions.