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].

一位国家医保局官员在最近的一次公开发言中透露，2024年次均住院费用的个人负担占比明显下降，降 幅达到了5%。 但可喜的数据背后，有学者结合另一项数据提出隐忧：2024年享受住院待遇总人次却增加4.48%。 两个数据的一增一减，背后是另一层隐秘：次均费用的下降，究竟是医疗服务效率提升、成本优化的真 实体现，还是医疗机构通过低标入院、分解住院等异常行为导致的 "数据虚像"？ 答案是模糊的。 而在医保相关从业人员的共识中，随着DRG/DIP改革的深化，若论存在的异常诊疗行为，医疗机构冲 量、低标入院、分解住院等是无法绕过的话题。在医院端这些"变形动作"中，分解住院的隐匿性最强。 要想量化分解住院，"15天非计划再入院率"（下文简称"再入院率"）是一个相对可靠的选择——统筹区 内有多少住院患者，出院时没有合理的再住院计划，却在15天内第二次住院，一定程度上反映了当地分 解住院是否严重。 但这一指标的应用也充满争议。用大白话来说：当患者在出院 15 天内再次入院，究竟是医院为追求利 益诱导患者重复住院？还是因当地医疗水平限制，患者确实需要二次治疗？ 很多情况下，要判断究竟是分解住院还是正常的诊疗行为，并无绝对正确的答 ...