In 2017 there were said to be around 250,000 foreign patients who brought more than 1.2 billion euros income to German hospitals. Some were visitors who fell ill unexpectedly, but it is estimated that more than 40 percent came for planned treatment, the majority from Poland, the Netherlands or France. There have long been medical tourists from the Middle East. University hospitals and the large municipal clinics, such as University Hospital Freiburg or Vivantes in Berlin, are the most popular destinations. Some require payment in full before they start treatment.