Medical Tourism in Germany

<div>1 A Dearth of Empirical Investigations ....... 1</div><div>2 Traveling for Treatment: Taxonomy, Patient Flows and Candidate Drivers ... 5</div><div>2.1 Medical Tourists ...................................... 5</div><div>2.1.1 Mode of Delivery ....................... 5</div><div>2.1.2 Treatment Focus .............................. 6</div><div>2.1.3 Elective Care ..................................... 9</div><div>2.1.4 Cross-Border Operations ................... 9</div><div>2.1.5 Time Horizon .................... 11</div><div>2.1.6 Summary ............................. 11</div><div>2.2 Medical Tourism Flows ..................... 13</div><div>2.2.1 World ................................ 14</div><div>2.2.2 Germany ............................. 19</div><div>2.3 Drivers of Medical Tourism .................. 50</div><div>2.3.1 Domestic Availability ..................... 50</div><div>2.3.2 Price .................................................. 51</div><div>2.3.3 Quality ........................................................ 57</div><div>2.3.4 Tourism ............................................. 58</div><div>2.3.5 Facilitation .................................... 60</div>2.3.6 Proximity ............................................ 65<div>2.3.7 Summary ..................................... 67</div><div>2.4 Implications of Medical Tourism .................. 72</div><div>2.4.1 Migration and Local Access .................... 72</div><div>2.4.2 Treatment Quality and Continuity of Care ........... 74</div><div>2.4.3 Legal Aspects ............................ 76</div>2.4.4 Ethics ............................................. 80<div>2.5 Summary ................................. 83</div><div>3 The Sum of Its Parts: A Structured Approach to the Modeling of Destination Choice 86</div><div>3.1 Product Disaggregation ......................... 86</div><div>3.2 Consumer Disaggregation .......................... 89</div><div>3.3 Supplier Disaggregation ......................... 91</div><div>3.3.1 Physician Choice .......................................... 92</div><div>3.3.2 Provider Choice ................................ 94</div><div>3.3.3 Country Choice ........................................... 95</div><div>3.3.4 Destination Choice.................................. 96</div><div>3.4 Summary .............................. 101</div><div>4 Drivers of Medical Travel at the National Level ............. 106</div><div>4.1 The Gravity Model .................................. 107</div><div>4.1.1 Basic Structure .... 107</div><div>4.1.2 Multilateral Resistance ........ 108</div><div>4.1.3 Heterogeneous Firms .......... 111</div><div>4.1.4 Heterogeneous Consumers ...................... 114</div><div>4.1.5 Heterogeneous Products .............. 118</div><div>4.1.6 Measures of Distance ........................ 119</div><div>4.1.7 Summary ....................... 120</div><div>4.2 Specification .......................................... 123</div><div>4.3 Data ........................................ 128</div><div>4.4 Estimation .............................. 133</div><div>4.5 Results ......................................................... 136</div><div>4.6 Summary ......................... 148</div><div>5 Drivers of Medical Travel at the Hospital Level .................. 150</div><div>5.1 Model ......................... 150</div><div>5.2 Data ................................................... 153</div><div>5.3 Estimation and Specification ....................... 162</div><div>5.4 Results ...................................................... 163</div><div>5.5 Summary ................................................. 167</div><div>6 Drivers of Medical Tourism at the Individual Level ................. 168</div><div>6.1 Interviews ............................................. 169</div><div>6.1.1 Hospitals in Germany ............................. 169</div><div>6.1.2 Facilitators in Germany .............................. 171</div><div>6.1.3 Facilitators in Russia .............................. 173</div>6.1.4 Results .............................................. 174<div>6.2 Patient Survey ........................................ 177</div><div>6.2.1 Questionnaire ....................................... 178</div><div>6.2.2 DCE .................................................... 180</div><div>6.2.3 Results ....................................... 188</div><div>6.3 Summary ................................................... 205</div><div>7 Connecting the Dots: Implications for Destinations and Policy Makers ..... 208</div><div>8 References........................................... 215</div>