Risks and side effects of increased minimum quantity levels decided by Federal Committee of Physicians and Health Insurances

Surgical care in Brandenburg at risk?

Thyroid surgery at ukrb (Photo: MHB/ukrb, by Andreas Kunow)

Rüdersdorf, 8 September 2023

A student team at the Brandenburg Medical School Theodor Fontane (MHB) headed by Prof. Dawid Pieper has published a policy brief on risks and side effects on surgical care as a result of the increased minimum quantities for surgical interventions decided by the Federal Committee of Physicians and Health Insurances. The paper includes suggestions how to deal with these higher minimum levels.

Prof. Dawid Pieper, professor of health services and systems research at the MHB Center for Health Services Research, is in charge of the study. He quotes examples from other countries, like Switzerland, with a stronger impact of political activities on the care system: “Minimum quantities of pancreas or esophagus operations, for example, apply nationwide, but do not take considerable regional differences into account. The Brandenburg government, and its Ministry of Social Affairs, Health, Integration and Consumer Protection in particular, should specify for each hospital the category of surgeries to be performed in future, in consultation with the affected individuals in the respective hospitals.”      

A balanced regional distribution and regional networks, so the student team, may help to prevent a situation where most Brandenburg hospitals would narrowly miss the threshold for pancreas surgery. An active influence of the Brandenburg government in the matter might benefit all parties involved, says Prof. Pieper: “Patients would profit from acceptable travel distances and sufficiently available expertise at the hospital; prospective surgeons would find advanced training in Brandenburg more attractive; and politicians can make active contributions to the provision of health care.”   

In the current debate on the planned hospital reform and minimum quantities, much is said about expected improvements in surgery outcomes on the one hand, and longer trips to the hospital on the other. According to the recently completed study, the expectation among patient representatives, physicians and nursing staff involved in Brandenburg’s care system is that the minimum quantity requirement will have lots of further implications across the region, such as a decline in diagnostic quality and the treatment of complications, and aggravations for medical specialist training.    

For more detailed information on the policy brief and the study see here.


Background
:
The so called minimum quantities for operations of esophagus have been raised from 10 to 26 surgeries per year (starting 2023), and of pancreas from 10 to 20 (starting 2025); one result is the risk that only a very small number of hospitals for surgical treatment will remain in the sparsely populated state of Brandenburg. Nationwide statutory minimum quantities aim to concentrate complex interventions in specialized centers in order to guarantee a minimum quality standard. Pursuant to these regulations (§ 136b SGB V), hospitals are required to submit annual forecasts that they will reach the minimum number of surgeries in the following year and thus be entitled to perform surgery and claim remuneration.

Founded in 2019, the Center for Health Services Research is one of three science centers at the MHB. It fulfils scientific, educational and organizational assignments in the field of patient-oriented and population-related outcomes research, partly in collaboration with MHB hospitals and further cooperating clinics and partner institutions.

Media contact:
Prof. Dr. Dawid Pieper
Professor of Health Services and Health Systems Research
Brandenburg Medical School Theodor Fontane
Director (Brandenburg Center for Health Services Research and Institute of Health Services and Health Systems Research)
E-Mail: dawid.pieper@mhb-fontane.de
Phone: 033638 83992

Dr. Eric Alexander Hoffmann
Head of Communications, University Spokesperson
Brandenburg Medical School Theodor Fontane
E-Mail: presse@mhb-fontane.de
Phone: 03391 39-14160

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