Are casemix developments meeting the needs of paediatrics?

There are many advantages in the use of casemix measures for financing acute hospitals, but there are deficiencies in the diagnosis-related groups (DRGs) classification for paediatrics. Some, such as poor measurement of severity, inability to classify appropriately some operating room procedures and an inappropriate mix of uncommon complex paediatric procedures and common straightforward adult procedures in the one DRG, are intrinsic to the system and not easy to change. Costing studies must be sufficiently sophisticated to determine the increased costs of nursing a child in hospital if cost weights are not to disadvantage children.