Minimum case numbers in Germany

Minimum case numbers

One of the G-BA’s tasks is to identify hospital services that can be planned (i.e. not emergencies), where there is a connection between the frequency of treatments and the quality of care.

For these services, the G-BA sets minimum case numbers per doctor and/or location of a hospital.

SHI funds will only reimburse the services for a hospital in the next calendar year, if the hospital will likely reach the required minimum case number. Every year, the hospitals have to share their prognosis with the associations of SHI funds. As an exception, hospitals can also provide the service, if it is the first time that they offer the intervention, or if the G-BA has awarded the status of “high quality” for the service.

Aim of minimum case numbers

The idea behind these minimum numbers is quality assurance, i.e. particularly difficult interventions are provided only by clinics whose doctors have sufficient experience with them. The numbers are intended to ensure that a hospital does not only occasionally carry out complex, technically highly demanding and complication-prone operations. Because the lack of routine at one location can mean that the patient has a lower chance of survival, suffers serious complications or that subsequent interventions are necessary.

Introduction or amendment of minimum case numbers

The G-BA reviews the minimum case numbers from time to time. The basis for the numbers are IQWiG assessments on the relationship between case numbers and treatment outcomes. In addition, the G-BA uses model data analyses by the IQTiG to estimate how many hospital locations would continue to offer the services when changing the minimum case numbers and how this would affect distances and travel times to receive care.

If the G-BA does introduce or change minimum case numbers, there is a grace period of 12 to 24 months before hospitals have to comply with the new amount.

G-BA determines minimum case numbers for breast and lung cancer

The latest addition to the directive are minimum case numbers for breast and lung cancer.

In December 2021, the G-BA published their conclusion that there is a correlation between case numbers and treatment outcomes for surgeries for these cancers. Therefore, they introduced a minimum of 100 breast cancer operations and 75 lung cancer operations per year per hospital. This means that these complex interventions are carried out several times a month, which should ensure that the treatment teams have a sufficient degree of routine, which ultimately guarantees safe and high-quality care.

The IQTiG modelling showed that, for most patients, the distances or travel times are only marginally longer:

• In 2019, there were 732 hospitals in Germany that carried out surgical treatments for breast cancer. The new numbers would reduce this to around 355 hospitals. The average travel time to the nearest clinic increases from 15 to 18 minutes.
• 328 hospitals performed surgical treatments for lung cancer in 2019, which is expected to be concentrated at around 90 hospitals with the new numbers. The average travel time for patients to the nearest clinic increases from 20 to 31 minutes.

In addition, the G-BA increased the existing minimum case number for complex operations on the pancreas from 10 to 20.

The new directive came into force on 1 January 2022, but the new minimum case numbers only apply from 2025 onwards.