Volume-outcome relationship and minimum volume regulations in the German hospital sector \u2013 evidence from nationwide administrative hospital data for the years 2005\u20132007

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

doi:10.1186/s13561-018-0204-8

Abstract

BackgroundThis paper analyses the volume-outcome relationship and the effects of minimum volume regulations in the German hospital sector.MethodsWe 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.ResultsWe 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.ConclusionThe 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.

Highlights

This paper analyses the volume-outcome relationship and the effects of minimum volume regulations in the German hospital sector
Knee replacements are the largest subsample with over 120,000 patients treated in around 1000 hospitals each year, whereas liver transplantations are the condition with the smallest total case volume and the lowest number of hospitals
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 supporting the volume-outcome relationship

Summary

Introduction

This paper analyses the volume-outcome relationship and the effects of minimum volume regulations in the German hospital sector. The international literature provides broad evidence for the volume-outcome relationship for various conditions in several disciplines - e.g. transplantation medicine, cardiology, orthopedics, neurosurgery, Due to these international findings, minimum volume regulations were implemented by German hospital policy in 2004. The idea behind these regulations is to exclude hospitals with bad outcomes caused from not performing certain procedures frequently enough. Other German studies focus on different conditions (Hentschker and Mennicken [9], Hentschker and Mennicken [10]) that are not included in the regulations

Methods

Results

Conclusion