“15天再入院率”攀升！

Core Viewpoint - The article discusses the complexities and challenges surrounding the issue of "decomposed hospitalization" in the healthcare system, particularly in the context of the DRG/DIP payment reform, highlighting the increase in readmission rates and the ambiguity in defining and regulating such practices [3][4][5]. Summary by Sections Hospitalization Costs and Readmission Rates - In 2024, the average personal burden of hospitalization costs is expected to decrease by 5%, while the total number of individuals enjoying hospitalization benefits is projected to increase by 4.48% [3][4]. - The decline in average costs raises questions about whether it reflects genuine improvements in medical service efficiency or if it is a result of hospitals engaging in practices like low-standard admissions and decomposed hospitalizations [4]. DRG/DIP Reform and Its Impacts - Since the implementation of DRG/DIP payment reforms, there has been a notable increase in the "readmission rate," which rose from 11% before the reform to 14.41% in 2023 in a specific province [7][8]. - The increase in readmission rates is linked to the financial pressures hospitals face under the DRG system, leading to practices that may not align with the intended cost-control objectives of the reform [9][10]. Challenges in Defining and Regulating Decomposed Hospitalization - There is no clear definition or standard for "decomposed hospitalization," making it difficult for regulatory bodies to monitor and enforce compliance effectively [14][15]. - The ambiguity in defining decomposed hospitalization allows hospitals to exploit loopholes, such as changing primary diagnoses to avoid penalties for repeat admissions [10][12]. Regulatory Approaches and Observations - Some regions have adopted a data-driven approach to flag potential cases of decomposed hospitalization, marking instances of readmission within a specific timeframe as "suspected decomposed hospitalization" [21][22]. - Effective governance of decomposed hospitalization requires not only stringent monitoring but also appropriate compensation policies to address the underlying financial incentives that drive such practices [22][23]. Variability in Readmission Rates Across Hospital Types - Readmission rates tend to be higher in secondary hospitals compared to tertiary hospitals, indicating that the financial pressures and motivations for decomposed hospitalization may vary significantly based on the type of institution [24].