The why and the wherefore.

Through their clearly defined gatekeeper role, GPs have considerable market power to influence the flow of revenue associated with referrals and prescriptions. For this reason, and because the whole healthcare industry is going through a transition from a cottage industry to a more commercially sophisticated structure, corporatisation of general practice is on the increase. If properly and ethically run, corporatised general practices can provide high-quality, efficient primary care. There are four far-reaching, potential consequences of general practice corporatisation--an increase in healthcare spending; limitation of GPs' choice of practice environment; difficulty justifying GPs' legitimate fee increases; and de-skilling of GPs.

The problem of neonatal diagnosis related groups.

There is, as yet, no satisfactory set of Diagnosis Related Groups to measure the casemix and consumption of hospital resources in the care of newborn infants. To obtain further information, infants less than 28 days when admitted to the Royal Children's Hospital and Royal Women's Hospital, Melbourne were analysed. Both Refined Diagnosis Related Groups and Pediatric Modified Diagnosis Groups were used. Neonatal groups of the Pediatric Modified system included all infants aged less than 28 days on admission, whereas Refined Diagnosis Related Groups includes only those newborn infants who have diagnoses specific to the newborn period. Refined Diagnosis Related Groups and their higher order contained 1,237 discharges. Standard deviation and coefficient of variation and length of stay in these RDRG were high. However, if the patients in these RDRGs were further grouped according to PMDRGs, there appeared to be more homogeneous missing. The R2 values were four times higher. It is recommended that a satisfactory form of neonatal DRGs is to regroup patients in neonatal RDRGs through a PMDRG grouper.

Diagnosis related groups, refined diagnosis related groups and pediatric modified diagnosis related groups in specialist children's hospitals.

The value of Diagnosis Related Groups, Refinement Diagnosis Related Groups and Pediatric Modified Diagnosis Related Groups in measuring the output of specialist children's hospitals was evaluated by the examination of discharge data for 1987-88 from three major Australian children's hospitals and four district hospitals. The study included all patients aged 0-18 years but excluded those with specific neonatal diagnoses. Findings indicated that Refinement Diagnosis Related Groups seem to give a better measure of the output of specialist children's hospitals than Version 5 Diagnosis Related Groups in that they explained a higher proportion of variation of length of stay. Pediatric Modified Diagnosis Related Groups developed in the United States of America for specialist children's hospitals overall did not seem to have major advantages over Refinement Diagnosis Related Groups but there were some specific Pediatric Groups that appeared beneficial. Further modification of the Refinement Diagnosis Related Groups could allow these advantages to be incorporated. Overall it seems preferable for there to be a similar system measuring output of both children's hospitals and general hospitals and this could be achieved by some minor changes to the Refinement Diagnosis Related Groups.