Social Hospitalizations in Chile’s Public Hospital System: an Analysis Based on Diagnosis-Related Groups, 2019–2024

Abstract

Objective: To quantify social hospitalizations in Chilean public hospitals that use Diagnosis-Related Groups (DRGs) for coding, by analyzing their magnitude, trends over time, geographic distribution, diagnostic profile, and associated costs. Materials and Methods: A retrospective observational study of 3,006,058 adult discharges (≥15 years) from 2019 to 2024. Two criteria for social hospitalization were applied: Criterion A (length of stay ≥60 days) and Criterion B (actual length of stay ≥1 standard deviation above the expected length of stay, excluding atypical cases). Costs were estimated using the 2024 DRG base value (CLP $2,827,422). Results: Criterion A identified 34,873 cases (11.60‰) and Criterion B identified 195,777 (65.13‰). The rate was 3.3 and 2.0 times higher for emergency admissions than for scheduled admissions, respectively. Men had a higher rate under Criterion A (M/W ratio = 1.48). Criterion A peaked in 2022 (16.57‰ for emergency visits) and subsequently declined, while Criterion B decreased by 34% between 2019 and 2024. The predominant diagnoses were COVID-19, schizophrenia, and traumatic brain injury (Criterion A) and cholelithiasis, appendicitis, and acute myocardial infarction (Criterion B). The cumulative cost was USD 496 million (Criterion A) and USD 560 million (Criterion B). Conclusions: Social hospitalization accounts for a significant proportion of public hospital activity, with marked geographic variability and distinct diagnostic profiles depending on the criterion adopted. Addressing this issue requires interventions outside the hospital setting and within surgical processes.