“15 天再入院率”攀升：分解住院的认定迷雾

Core Insights - The average out-of-pocket expense for hospital stays is expected to decrease by 5% in 2024, indicating a potential improvement in healthcare cost management [1] - However, the total number of hospitalizations is projected to increase by 4.48%, raising concerns about whether the decrease in average costs reflects genuine efficiency improvements or potential manipulation of hospitalization practices [2][3] Group 1: Hospitalization Trends - The increase in hospitalization rates alongside a decrease in average costs suggests a complex relationship that may involve questionable practices such as low-standard admissions and fragmented hospital stays [2][3] - The "15-day unplanned readmission rate" is proposed as a metric to assess the severity of fragmented hospitalizations, although its application is contentious [2][4] Group 2: Regulatory Challenges - The ambiguity in defining and regulating fragmented hospitalizations complicates oversight, as overly strict regulations may lack flexibility while lenient standards could allow for exploitation [3][10] - The lack of a clear definition for fragmented hospitalizations hampers effective regulation, with existing guidelines providing limited clarity [10][11] Group 3: Data Monitoring and Analysis - Research indicates that the readmission rate has risen significantly post-DRG/DIP reform, suggesting a correlation with increased fragmented hospitalizations [4][5] - Monitoring practices have evolved, with a focus on dynamic indicators rather than fixed thresholds for readmissions, reflecting the complexities of hospital practices [11][16] Group 4: Local Insights and Variability - Local healthcare officials recognize that fragmented hospitalizations are likely to increase under DRG payment systems, as hospitals seek to mitigate financial losses from cost overruns [7][17] - The effectiveness of managing readmission rates varies significantly across regions, with some areas achieving notable reductions while others struggle with high rates [14][18]