Helsana and Barmer call for higher minimum case numbers for inpatient procedures

Inpatient procedures are not always carried out with the necessary routine. This is the conclusion reached by Helsana and German health insurance provider Barmer in their joint report on the use of minimum case numbers for inpatient procedures. The report compares the rules in both countries using knee endoprosthesis to show that higher case numbers result in better quality and greater efficiency. Helsana and Barmer are calling for an improvement in the review of minimum case numbers in their respective countries as well as an expansion of the minimum number of cases.


Experience pays off when it comes to inpatient procedures. However, hospitals in Switzerland and Germany do not always adhere to the requirements for the minimum number of cases. For example, operations were performed on 5,200 patients in Switzerland in 2018 where the minimum numbers of cases for these procedures were not met. Depending on the procedure, this equates to 27% of patients. In Germany, 4,300 patients were affected in 2018, which corresponds to between 2% and 15% of patients. These are the findings of a report on the use of minimum number of cases for inpatient procedures that Helsana and German health insurance provider Barmer have published today. Helsana and Barmer are therefore calling for an improvement to reviews of requirements related to the minimum numbers in their respective countries.

Higher minimum number of cases leads to better outcomes

Using knee endoprosthesis (knee TEP), the insurers looked at such factors as how the defined minimum number of cases affects the quality of the outcome. In Switzerland, depending on the canton, the threshold is zero to 50, while in Germany it is 50. The figures related to quality and efficiency reveal clear differences based on the case numbers per hospital. The amount of time and costs of the knee TEP as well as the follow-up costs are much lower when more cases have been treated. This also applies for patient-oriented outcomes, such as knee-specific readmission rates. In Switzerland, 3% of procedures were performed in hospitals that carried out fewer than 50 cases during the year. In Germany, it was 2% of procedures. In view of these findings Helsana and Barmer believe that the responsible bodies must raise the minimum number of cases for knee TEP in order to achieve better outcomes and lower costs.

“Thanks to the scientific cooperation with Barmer, we have been able to look beyond our own healthcare area. International comparisons always help in better understanding our structures as well as our strengths and weaknesses. Such findings make it possible to improve both the quality of care and efficiency,” says Helsana CEO Roman Sonderegger.

Minimum case numbers are recognised as a quality criterion in both countries

There is scientific evidence of the link between case numbers and the quality of results, particularly for complex surgical procedures. Although minimum case numbers are recognised in both countries as an important quality criterion, to date they have only been agreed for a relatively small share of inpatient benefits. In Switzerland, the share of treatment costs with a minimum requirement is currently 18%, while in Germany it is less than 3%. Helsana and Barmer therefore feel that minimum case numbers should be expanded as a matter of urgency.

The canton of Zurich is currently preparing its hospital planning for 2023. This is the basis for the long-term provision of healthcare to the Zurich population. Fortunately, the canton has minimum case numbers for other procedures, but it has left the existing requirements unchanged. Helsana supports the expansion of the minimum number of cases, but based on the results of the report for knee TEP, it is calling for an increase in the requirement.

Read more at: 

Hospital report 2021

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