{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:05:38Z","timestamp":1792789538240,"version":"4.5.0"},"reference-count":34,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T00:00:00Z","timestamp":1673308800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Open Access Publication Fund of the University of Wuerzburg"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Medical tourism is a rapidly growing sector of economic growth and diversification. However, data on the demographics and characteristics of the traveling patients are sparse. In this study, we analyzed the common demographic properties and characteristics of the inbound medical tourists seeking orthopedic medical care in Germany for the years 2010 to 2019 compared to a domestic group. At the same time, we examined how the COVID-19 pandemic outbreak of 2020 changed the field of medical tourism in Germany. Calculations were performed using administrative hospital data provided by the Federal Statistical Department of Germany. Data were analyzed from the years 2010 to 2020. A total of six elective orthopedic surgery codes (bone biopsy, knee arthroplasty, foot surgery, osteotomy, hardware removal, and arthrodesis) were identified as key service indicators for medical tourism and further analyzed. Factors including residence, sex, year, and type of elective surgery were modeled using linear regression analysis. Age and sex distributions were compared between patients living inside Germany (DE) or outside Germany (non-DE). Between 2010 and 2020, 6,261,801 orthopedic procedures were coded for the DE group and 27,420 key procedures were identified for the non-DE group. Medical tourists were predominantly male and significantly younger than the domestic population. The linear regression analysis of the OPS codes over the past years showed a significantly different slope between the DE and non-DE groups only for the OPS code \u201chardware removal\u201d. With the COVID-19 pandemic, an overall decline in performed orthopedic procedures was observed for the non-DE and the DE group. A significant reduction below the 95% prediction bands for the year 2020 could be shown for hardware removal and foot surgery (for DE), and for hardware removal, knee arthroplasty, foot surgery, and osteotomy (for non-DE). This study is the first to quantify inbound medical tourism in elective orthopedic surgery in Germany. The COVID-19 pandemic negatively affected many\u2014but not all\u2014areas of orthopedic surgery. It has to be seen how this negative trend will develop in the future.<\/jats:p>","DOI":"10.3390\/ijerph20021209","type":"journal-article","created":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T01:57:48Z","timestamp":1673315868000},"page":"1209","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Demographics and Trends for Inbound Medical Tourism in Germany for Orthopedic Patients before and during the COVID-19 Pandemic"],"prefix":"10.3390","volume":"20","author":[{"given":"Tizian","family":"Heinz","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Eidmann","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9362-2914","authenticated-orcid":false,"given":"Axel","family":"Jakuscheit","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tino","family":"Laux","sequence":"additional","affiliation":[{"name":"Distance and Independent Studies Center, Technical University Kaiserslautern, Erwin-Schroedinger-Stra\u00dfe 57, 67663 Kaiserslautern, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4982-6594","authenticated-orcid":false,"given":"Maximilian","family":"Rudert","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5522-0092","authenticated-orcid":false,"given":"Ioannis","family":"Stratos","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.4236\/tel.2018.87088","article-title":"Outward medical tourism: A case of UAE","volume":"8","author":"Ahmed","year":"2018","journal-title":"Theor. Econ. Lett."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Lunt, N., Smith, R.D., Mannion, R., Green, S.T., Exworthy, M., Hanefeld, J., Horsfall, D., Machin, L., and King, H. (2014). Implications for the NHS of Inward and Outward Medical Tourism: A Policy and Economic Analysis Using Literature Review and Mixed-Methods Approaches, Health Services and Delivery Research.","DOI":"10.3310\/hsdr02020"},{"key":"ref_3","unstructured":"Baeten, R., Beek, M., Busse, R., Cucic, D., Ernst, K., Figueras, D., Ginneken, D., Glinos, M., Goffin, M., and Legido-Quigley, H. (2011). Cross-Border Health Care in the European Union Mapping and Analysing Practices and Policies, WHO."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1016\/j.healthpol.2018.09.017","article-title":"An evidence-based policy for improving choice in global health access through medical travel","volume":"122","author":"Ruggeri","year":"2018","journal-title":"Health Policy"},{"key":"ref_5","unstructured":"MedicalTourism.com (2022, December 27). European Competence Centers for Health & Medical Tourism. Available online: https:\/\/www.magazine.medicaltourism.com\/article\/european-competence-centers-for-health-medical-tourism."},{"key":"ref_6","unstructured":"MedicalTourism.com (2022, December 27). The Medical Tourism Index 2020-21. Available online: https:\/\/www.medicaltourism.com\/mti\/home."},{"key":"ref_7","first-page":"21","article-title":"Developments in Health Economics and Public Policy","volume":"Volume 13","author":"Schmerler","year":"2018","journal-title":"Medical Tourism in Germany"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.maturitas.2016.03.001","article-title":"Medical tourism: A snapshot of evidence on treatment abroad","volume":"88","author":"Lunt","year":"2016","journal-title":"Maturitas"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.maturitas.2010.01.017","article-title":"Medical tourism: Assessing the evidence on treatment abroad","volume":"66","author":"Lunt","year":"2010","journal-title":"Maturitas"},{"key":"ref_10","first-page":"33","article-title":"Medical tourism: Globalization of the healthcare marketplace","volume":"9","author":"Horowitz","year":"2007","journal-title":"MedGenMed"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1055\/s-0042-1750472","article-title":"Medizintourismus: Katerstimmung in den International Units","volume":"27","year":"2022","journal-title":"KMA Klin. Manag. Aktuell"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.tourman.2012.05.009","article-title":"Contemporary medical tourism: Conceptualisation, culture and commodification","volume":"34","author":"Connell","year":"2013","journal-title":"Tour. Manag."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"taz049","DOI":"10.1093\/jtm\/taz049","article-title":"Patient care without borders: A systematic review of medical and surgical tourism","volume":"26","author":"Foley","year":"2019","journal-title":"J. Travel Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"566","DOI":"10.3889\/oamjms.2017.126","article-title":"History of the Baths and Thermal Medicine","volume":"5","author":"Gianfaldoni","year":"2017","journal-title":"Open Access Maced. J. Med. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1108\/JTF-01-2020-0006","article-title":"The future of health tourism in the industrial revolution 4.0 era","volume":"7","author":"Wong","year":"2020","journal-title":"J. Tour. Futur."},{"key":"ref_16","unstructured":"Kumar, K.K., and Balamurugan, A. (2019). A case study on prospects of medical tourism with reference to hyderabad city. Recent Research Trends in Social Science, Empyreal Publishing House."},{"key":"ref_17","first-page":"1","article-title":"Wellness Tourism","volume":"31","author":"Smith","year":"2006","journal-title":"Tour. Recreat. Res."},{"key":"ref_18","unstructured":"Smith, M., and Puczk\u00f3, L. (2014). Health, Tourism and Hospitality: Spas, Wellness and Medical Travel, Routledge."},{"key":"ref_19","first-page":"1616","article-title":"Medizintourismus: Patienten weltweit auf Achse","volume":"110","year":"2013","journal-title":"Dtsch Arztebl Int."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Bookman, M.Z., and Bookman, K.R. (2007). Introduction to Medical Tourism. Medical Tourism in Developing Countries, Palgrave Macmillan.","DOI":"10.1057\/9780230605657"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Schmerler, K. (2018). Traveling for Treatment: Taxonomy, Patient Flows and Candidate Drivers. Medical Tourism in Germany: Determinants of International Patients\u2019 Destination Choice, Springer International Publishing.","DOI":"10.1007\/978-3-030-03988-2_2"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.tourman.2013.02.003","article-title":"Toward a typology of medical tourists: A case study of Thailand","volume":"38","author":"Wongkit","year":"2013","journal-title":"Tour. Manag."},{"key":"ref_23","first-page":"24","article-title":"Medical tourism in Thailand","volume":"1","author":"Cohen","year":"2008","journal-title":"AU-GSB e-J."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Bookman, M.Z., and Bookman, K.R. (2007). Offshore Doctors: The Demand for Medical Tourism. Medical Tourism in Developing Countries, Palgrave Macmillan.","DOI":"10.1057\/9780230605657"},{"key":"ref_25","first-page":"65","article-title":"Medical tourism and travel\u2014An interdisciplinary approach","volume":"76","author":"Freyer","year":"2014","journal-title":"Gesundheitswesen"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"30","DOI":"10.2471\/BLT.14.152165","article-title":"Medical tourism in Thailand: A cross-sectional study","volume":"94","author":"Noree","year":"2016","journal-title":"Bull. World Health Organ."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Gaines, J., and Lee, C.V. (2019). Medical Tourism. Travel Medicine, Elsevier.","DOI":"10.1016\/B978-0-323-54696-6.00039-2"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1179\/2047971914Y.0000000076","article-title":"Characteristics of consumers likely and unlikely to participate in medical tourism","volume":"8","author":"Guy","year":"2015","journal-title":"Int. J. Healthc. Manag."},{"key":"ref_29","first-page":"237","article-title":"Gender Bias in Medicine","volume":"4","author":"Hamberg","year":"2008","journal-title":"Women\u2019s Health"},{"key":"ref_30","first-page":"13","article-title":"Medical tourism as a new form of niche tourism in Egypt","volume":"11","author":"Zaki","year":"2017","journal-title":"Int. J. Herit. Tour. Hosp."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"89","DOI":"10.15171\/ijtmgh.2017.19","article-title":"A Study of the Effect of Advertising on Attracting Medical Tourism","volume":"5","author":"Azimi","year":"2017","journal-title":"Int. J. Travel Med. Glob. Health"},{"key":"ref_32","first-page":"4447","article-title":"Medical tourism: Treatment, therapy & tourism","volume":"9","author":"Bagga","year":"2020","journal-title":"Int J Sci Technol Res"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"469","DOI":"10.2190\/HS.40.3.e","article-title":"A European perspective on medical tourism: The need for a knowledge base","volume":"40","author":"Carrera","year":"2010","journal-title":"Int. J. Health Serv."},{"key":"ref_34","unstructured":"UNWTO (2022, July 08). International Tourism and COVID-19. Available online: https:\/\/www.unwto.org\/tourism-data\/international-tourism-and-covid-19."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/2\/1209\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:05:14Z","timestamp":1760119514000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/2\/1209"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,10]]},"references-count":34,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["ijerph20021209"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20021209","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,10]]}}}