Der strukturgebende Aspekt von Mindestmengenanforderungen im stationären Sektor

Purpose: German social law ( 137 SGB V) authorised the partners in health care to establish and develop a catalogue of procedures for which quality is associated with volume. There is lack of evidence regarding the volume limits. Other aspects need to be taken into account, first of all by consultation of performance data analysis. Methods: Inpatient-data of hospitals in Baden-Wurttemberg were studied to make out possible effects of volume standard codes on health care provision. For each procedure studied an ICPM- tracer was defined and a volume limit fixed. Results: If a limit affects many hospitals but a small portion of health care to be changed, it means, that only very low volume providers would be excluded. An adequate network of care can be achieved by joining volumes from neighbouring regions. The analysis showed that 39% of the regions offering pancreatectomy come to a minimum volume of ten operations per year. A volume below 5 procedures per year is performed in 12 regions. If these small amounts are brought together, about two thirds of the regions involved in this segment of care could continue with a local offer corresponding to that defined standard. For certain high-risk conditions or procedures centralisation has already taken place (e. g. coronary bypass surgery). Conclusions: Based on appropriate analysis of the data of all partners in health care concepts can be tailored to the needs of the statutory health care system and accompanying activities involved from the very beginning. Risks have to be taken into consideration, including rarefaction of health care offers, disparities in care and on the other hand economically motivated decentralisation, where risk adapted centralisation was necessary.