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Volume-outcome relationship and minimum volume regulations in the German hospital sector: Evidence from nationwide administrative hospital data for the year 2005-2007

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

Abstract

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

Suggested Citation

  • Hentschker, Corinna & Mennicken, Roman & Reifferscheid, Antonius & Wasem, Jürgen & Wübker, Ansgar, 2017. "Volume-outcome relationship and minimum volume regulations in the German hospital sector: Evidence from nationwide administrative hospital data for the year 2005-2007," Ruhr Economic Papers 720, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    • Handle: RePEc:zbw:rwirep:720
    DOI: 10.4419/86788840
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    References listed on IDEAS

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    1. Mesman, Roos & Faber, Marjan J. & Berden, Bart J.J.M. & Westert, Gert P., 2017. "Evaluation of minimum volume standards for surgery in the Netherlands (2003–2017): A successful policy?," Health Policy, Elsevier, vol. 121(12), pages 1263-1273.
    2. Carine Milcent, 2005. "Hospital ownership, reimbursement systems and mortality rates," Health Economics, John Wiley & Sons, Ltd., vol. 14(11), pages 1151-1168, November.
    3. Corinna Hentschker & Roman Mennicken, 2015. "The Volume‐Outcome Relationship and Minimum Volume Standards – Empirical Evidence for Germany," Health Economics, John Wiley & Sons, Ltd., vol. 24(6), pages 644-658, June.
    4. David Barker & Gary Rosenthal & Peter Cram, 2011. "Simultaneous relationships between procedure volume and mortality: do they bias studies of mortality at specialty hospitals?," Health Economics, John Wiley & Sons, Ltd., vol. 20(5), pages 505-518, May.
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    Cited by:

    1. Justus F. A. Vogel & Max Barkhausen & Christoph M. Pross & Alexander Geissler, 2022. "Defining minimum volume thresholds to increase quality of care: a new patient-oriented approach using mixed integer programming," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(7), pages 1085-1104, September.
    2. Huguet, Marius, 2020. "Centralization of care in high volume hospitals and inequalities in access to care," Social Science & Medicine, Elsevier, vol. 260(C).
    3. Kaiser, Florian & Schmid, Andreas & Schlüchtermann, Jörg, 2020. "Physician-leaders and hospital performance revisited," Social Science & Medicine, Elsevier, vol. 249(C).

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    More about this item

    Keywords

    Volume; hospital quality; mortality; access to care;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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