Medical Tourism in Germany: Determinants of International Patients' Destination Choice

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