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

ISBN-13: 9783030039875 / Angielski / Twarda / 2019 / 248 str.

Klaus Schmerler

Spis treści

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

O autorze

Dr. Klaus Schmerler is a researcher at Martin Luther University Halle-Wittenberg, Germany. His research focuses on the empirical investigation of medical tourism and trade in health services, a topic at the intersection of health economics, econometrics and international trade.

Blurb

This book examines the drivers of inbound medical tourism in Germany. In light of growing international trade of medical services, it provides a quantitative analysis of the determinants of international patients’ choice of destination. It develops coherent definitions of medical tourism and medical travel, and presents multiple unique data sets to identify inbound medical travelers in Germany. Further, it introduces an empirical modeling framework for investigating and quantifying the drivers and effects of a patient's choice of destination at the national, hospital and individual level. A particular focus of the analysis lies on cultural proximity and personal networks as key channels to convey trust in a destination’s service. In addition, real consideration sets of international patients are presented. The findings presented are embedded in a global context and will help inform future empirical investigations and modeling.