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].

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]