After a deliberate hiatus from ITB Berlin, I will attend the event again this March. For those unfamiliar, ITB (International Tourism Börse/International Tourism Fair) is the world’s largest tourism industry gathering. Years ago, the organizers introduced a modest—truly modest—Health Tourism Pavilion.

My first visit to the Health Tourism Pavilion left me disheartened. This is not a criticism of the organizers, whom I know to be dedicated and resourceful under challenging circumstances; rather, my disappointment arises from the systemic issues that repeatedly surface. Historically, Europe - and Germany in particular - was a leading destination in health and medical tourism. German healthcare was universally acknowledged for its excellence, and its reputation was almost self-evident. Germany’s natural prestige meant that, for a long time, little effort was needed to promote its healthcare services internationally. This might explain why only a few German healthcare providers attended that time.

However, as the industry expanded and international competitors emerged, Germany missed the critical opportunity to market itself actively. The golden era faded, and the complacency born of past successes resulted in a significant decline: from a top-tier destination to a peripheral consideration.

Admittedly, this shift is not solely attributable to a lack of enthusiasm; structural changes within the healthcare system have also played a role. Legislative changes have diminished the attractiveness of medical tourism for all parties involved, and many German hospitals and clinics now struggle to compete with modern facilities available elsewhere. A lawsuit in Germany led to a court decision that caused major uncertainty in the medical tourism industry. Moreover, key stakeholders in Germany have often overlooked the importance of ambience and accommodations, factors that are vital to today’s discerning international patients. Additionally, the German healthcare system began to struggle domestically, waiting times increased, patients were unsatisfied and instead of seeing medical tourism as the lucrative extra-budgetary earning opportunity it was, people started to see it as a nuisance.

Whereas medical tourism to once operated out of necessity, travelling to Germany for medical purposes is no longer a foregone conclusion, as reflected by the steady decline in international patients. The international competition is large, skilled and motivated. Often supported by their governments, other destinations have emerged and are reigning superior. While Germany used to offer an unbeatable combination of quality and price, this is no longer the case. Another reason German hospitals could no longer compete is the time it takes them to reply to international inquiries as well as the level of service provided to foreign patients. Go to the big medical tourism destinations on the globe and you will experience a level of service unseen. They do understand that travelling for medical reasons is beyond stressful and do their best to alleviate patients' concerns by assisting them step by step. An art that has unfortunately not found itself into the German healthcare system.

So, what does this mean for ITB? Numerous initiatives have sought to reposition Germany on the global map, yet I have observed a persistent reluctance - especially among hospitals - to actively engage in these efforts. The Health Tourism Pavilion at ITB stands as one of the few events in Germany dedicated to health and medical tourism, and it is disheartening to see many German providers refrain from participating or even offering a simple fam-trip. In contrast, numerous non-German and even non-EU institutions readily seize the opportunity to promote themselves in Berlin. This combination of complacency, ineptitude, and a failure to adapt has contributed significantly to the current state of affairs.

It remains to be seen whether German hospitals are now willing to embrace change. I look forward to attending ITB this year to observe which institutions are ready to take a proactive step in the right direction.