Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Health Economics Review
Published in: Health Economics Review 1/2018

Open Access 01-12-2018 | Research

Volume-outcome relationship and minimum volume regulations in the German hospital sector – evidence from nationwide administrative hospital data for the years 2005–2007

Authors: Corinna Hentschker, Roman Mennicken, Antonius Reifferscheid, Jürgen Wasem, Ansgar Wübker

Published in: Health Economics Review | Issue 1/2018

Login to get access

Abstract

Background

This paper analyses the volume-outcome relationship and the effects of minimum volume regulations in the German hospital sector.

Methods

We use a full sample of administrative data from the unselected, complete German hospital population for the years 2005 to 2007. We apply regression methods to analyze the association between volume and hospital quality. We measure hospital quality with a binary variable, which indicates whether the patient has died in hospital. Using simulation techniques we examine the impact of the minimum volume regulations on the accessibility of hospital services.

Results

We find a highly significant negative relationship between case volume and mortality for complex interventions at the pancreas and oesophagus as well as for knee replacement. For liver, kidney and stem cell transplantation as well as for CABG we could not find a strong association between volume and quality. Access to hospital care is only moderately affected by minimum volume regulations.

Conclusion

The effectiveness of minimum volume regulations depends on the type of intervention. Depending on the type of intervention, quality gains can be expected at the cost of slightly decreased access to care.
Appendix
Available only for authorised users
Footnotes
1
The administrative data of §21 KHEntgG was used as part of a cooperation agreement for the further development of the DRG-system from April, 1st 2011 between the RWI and the BKK Federal Association.
 
2
For example, the numbers of knee replacement for 2006 and 2007 are not comparable due to a change in the definition of procedure codes by G-BA. In 2007 two additional procedure codes (5–822.a and 5–822.b) were used for the definition of knee replacement which could yield to an increase in the total number of knee replacements. We do not know exactly whether and to what extent these new procedure codes are responsible for the increase. As a comparison of total case volume between the years might be misleading, we abstain from exploiting longitudinal data in our analysis.
 
Literature
1.
Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. New Engl J Med. 1979;301(25):1364–9.CrossRef
2.
Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med. 2002;137(6):511–20.CrossRef
3.
Gandjour A, Bannenberg A, Lauterbach KW. Threshold volumes associated with higher survival in health care – A systematic review. Med Care. 2003;41(10):1129–41.CrossRef
4.
Chowdhury MM, Dagash H, Pierro A. A systematic review of the impact of volume of surgery and specialization on patient outcome. Brit J Surg. 2007;94:145–61.CrossRef
5.
Nimptsch, U., Peschke, D., Mansky, T. Mindestmengen und Krankenhaussterblichkeit – Beobachtungsstudie mit deutschlandweiten Krankenhausabrechnungsdaten von 2006 bis 2013. [Minimum Caseload Requirements and In-hospital Mortality: Observational Study using Nationwide Hospital Discharge Data from 2006 to 2013.]. Gesundheitswesen. April 2016. doi:https://​doi.​org/​10.​1055/​s-0042-100731.​ PubMed
6.
Geraedts M, de Cruppé W, Blum K, Ohmann C. Umsetzung und Auswirkungen der Mindestmengen. Deutsches Ärzteblatt. 2008;105(51–52):890–6.
7.
Ohmann C, Verde PE, Blum K, Fischer B, de Cruppé W, Geraedts M. Two short-term outcomes after instituting a national regulation regarding minimum procedural volumes for total knee replacement. J Bone Joint Surg Am. 2010;92(3):629–38.CrossRef
8.
9.
Hentschker C, Mennicken R. The volume-outcome relationship and minimum volume standards – empirical evidence for Germany. Health Econ. 2015;24(6):644–58.CrossRef
10.
11.
12.
de Cruppé W, Malik M, Geraedts M. Minimum volume standards in German hospitals: do they get along with procedure centralization? A retrospective longitudinal data analysis. BMC Health Serv Res. 2015;15(1):1.CrossRef
13.
Peschke D, Nimptsch U, Mansky T. Achieving minimum caseload requirements: an analysis of hospital discharge data from 2005–2011. Dtsch Arztebl Int. 2014;111:556–63.PubMedPubMedCentral
14.
De Cruppé W, Ohmann C, Blum K, Geraedts M. Evaluating compulsory minimum volume standards in Germany: how many hospitals were compliant in 2004? BMC Health Serv Res. 2007;7(165).
15.
de Cruppé W, Geraedts M. Wie konstant halten Krankenhäuser die Mindestmengenvorgaben ein? Eine retrospektive, längsschnittliche Datenanalyse der Jahre 2006, 2008 und 2010. [How Steady are Hospitals in Complying with Minimum Volume Standards? A Retrospective Longitudinal Data Analysis of the Years 2006, 2008, and 2010.]. Zentralbl Chir. 2016;141(04):425–32.PubMed
16.
Barker D, Rosenthal G, Cram P. Simultaneous relationships between procedure volume and mortality: do they bias studies of mortality at specialty hospitals? Health Econ. 2011;20(5):505–18.CrossRef
17.
de Cruppé W, Ohmann C, Blum K, Geraedts M. Auswirkung der Mindestmengenvereinbarung auf die stationäre Versorgungsstruktur. [Influence of minimum volumes on the structure of inpatient care.]. Gesundheitswesen. 2008;70(1):9–17.CrossRef
18.
Geraedts M, de Cruppé W, Blum K, Ohmann C. Distanzen zu Krankenhäusern mit Mindestmengen-relevanten Eingriffen 2004 bis 2006. [Distances to Hospitals Performing Minimum Volume Relevant Procedures in Germany 2004 to 2006.]. Das Gesundheitswesen. 2010;72:271–8.CrossRef
19.
Geraedts M, Kühnen C, de Cruppé W, Blum K, Ohmann C. Unterschreitungen der Mindestmengen 2004: Begründungen und Konsequenzen. [Hospitals Failing Minimum Volumes in 2004: Reasons and Consequences.]. Das Gesundheitswesen. 2008;70(02):63–7.CrossRef
20.
G-BA, Gemeinsamer Bundesausschuss: Vereinbarung des Gemeinsamen Bundesausschusses gem. §137 Abs. 1 Satz 3 SGB V für nach § 108 SGB V zugelassene Krankenhäuser (Mindestmengenvereinbarung) in Kraft getreten am 01. Januar 2005 (2005).
21.
G-BA, Gemeinsamer Bundesausschuss: Vereinbarung des Gemeinsamen Bundesausschusses gem. §137 Abs. 1 Satz 3 SGB V für nach § 108 SGB V zugelassene Krankenhäuser (Mindestmengenvereinbarung) in Kraft getreten am 21. März 2006 (2006).
22.
G-BA, Gemeinsamer Bundesausschuss: Vereinbarung des Gemeinsamen Bundesausschusses gem. §137 Abs. 1 Satz 3 SGB V für nach § 108 SGB V zugelassene Krankenhäuser (Mindestmengenvereinbarung) in Kraft getreten am 01. Januar 2007 (2007).
23.
Leapfrog Group. Factsheet – evidence-based hospital referral, revision 03/21/11. Washington DC: Leapfrog Group; 2011.
24.
Mansky T, Niptsch U, Winklmair C, Vogel C, Hellerhoff F. G-IQI – German inpatient quality indicators (version 3.1). Berlin: Technische Universität Berlin; 2011.
25.
Cash H, Slowinski T, Buechler A, Grimm A, Friedersdorff F, Schmidt D, Miller K, Giessing M, Fuller TF. Impact of surgeon experience on complication rates and functional outcomes of 484 deceased donor renal transplants: a single-Centre retrospective study. BJU Int. 2012;110(8b):E368–73.CrossRef
26.
Fechner G, Seifert I, Hauser S, Müller SC. Impact of a learning curve model in kidney transplantation on functional outcome and surgical complications in a small volume Centre: does size really matter? Int Urol Nephrol. 2012;44:1411–5.CrossRef
27.
Smith BR, Hinojosa MW, Reavis KM, Nguyen NT. Outcomes of esophagostomy according to surgeon’s training: general vs. thoracic. J Gastrointest Surg. 2008;12:1907–11.CrossRef
28.
AOK-Bundesverband, Forschungs- und Entwicklungsinstitut für das Sozial- und Gesundheitswesen Sachsen-Anhalt (FEISA), HELIOS Kliniken and Wissenschaftliches Institut der AOK (WIdO). Qualitätssicherung der stationären Versorgung mit Routinedaten (QSR), Abschlussbericht, Bonn. 2007.
29.
Ash AS, Posner MA, Speckman J, Franco S, Yacht AC, Bramwell L. Using claims data to examine mortality trend following hospitalization for heart attack in medicare. Health Serv Res. 2003;38(5):1253–62.CrossRef
30.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRef
31.
Cram P, Hillis SI, Barnett M, Rosenthal GE. Effects of weekend admission and hospital teaching status on in-hospital mortality. Am J Med. 2004;117(3):151–7.CrossRef
32.
Milcent C. Hospital ownership, reimbursement systems and mortality rates. Health Econ. 2005;14(11):1151–68.CrossRef
33.
Heyder R. Die Bedeutung der Universitätskliniken in der regionalen und überregionalen Versorgung. In: Klauber J, Geraedts M, Friedrich J, Wasem J, editors. Krankenhaus-Report 2015: Strukturwandel. Stuttgart: Schattauer-Verlag; 2015. p. 99–114.
34.
Geraedts M, de Cruppé W, Blum K, Ohmann C. Distanzen zu Krankenhäusern mit mindestmengen-relevanten Eingriffen 2004 bis 2006. Gesundheitswesen. 2010;72:271–8.CrossRef
35.
de Cruppé, W., Ohmann, C., Blum, K., and Geraedts; M.: Auswirkung der Mindestmengenvereinbarung auf die stationäre Versorgungsstruktur. Gesundheitswesen. 70: 9–17 (2008).CrossRef
36.
Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, Kremers W, Lake J, Howard T, Merion RM, Wolfe RA, Krom R. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124(1):91–6.CrossRef
37.
Seider, H., Gaynor, M. and Vogt, W. B.: Volume-outcome and antitrust in US health care markets, Unpublished working paper (2004).
38.
Mesman R, Faber MJ, Berden BJJM, Westert GP. Evaluation of minimum volume standards for surgery in the Netherlands (2003–2017): a successful policy? Health Policy. 2017;121(12):1263–73.CrossRef
39.
Krautz C, Denz A, Weber GF, Gruetzmann R. Influence of hospital volume effects and minimum caseload requirements on quality of Care in Pancreatic Surgery in Germany. Visceral Medicine. 2017;33(2):131–4.CrossRef
Metadata
Title
Volume-outcome relationship and minimum volume regulations in the German hospital sector – evidence from nationwide administrative hospital data for the years 2005–2007
Authors
Corinna Hentschker
Roman Mennicken
Antonius Reifferscheid
Jürgen Wasem
Ansgar Wübker
Publication date
01-12-2018
Publisher
Springer Berlin Heidelberg
Published in
Health Economics Review / Issue 1/2018
Electronic ISSN: 2191-1991
DOI
https://doi.org/10.1186/s13561-018-0204-8

Other articles of this Issue 1/2018

Health Economics Review 1/2018 Go to the issue

Research

Health care service provision in Europe and regional diversity: a stochastic metafrontier approach

Research

Factors for healthcare utilization and effect of mutual health insurance on healthcare utilization in rural communities of South Achefer Woreda, North West, Ethiopia

Research

Regret-sensitive treatment decisions

Research

Potential gains in life expectancy by eliminating deaths from cardiovascular diseases and diabetes mellitus in the working life ages among Slovak population

Research

Prenatal care and socioeconomic status: effect on cesarean delivery

Research

Understanding the adoption of new drugs decided by several stakeholders in the South Korean market: a nonparametric event history analysis