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Comment & Response
June 11, 2014

Economic Incentives and Use of the Intensive Care Unit

Author Affiliations
  • 1Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia

Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2014;311(22):2336-2337. doi:10.1001/jama.2014.4959

To the Editor Drs Gooch and Kahn1 pointed out an intriguing example of economic incentives driving widely varying intensive care unit (ICU) admission criteria. However, their concept of “demand elasticity” conflated 2 distinct economic phenomena, normal demand and supplier-induced demand, leading them to a draconian policy prescription.

In classic economics, consumers might demand care of little benefit if they are insulated from the cost through insurance, but they will never demand harmful care, such as ICU care for patients with high-illness severity and low survival in the conceptual model. Increased ICU bed availability could only cause increased harm in the presence of supplier-induced demand; eg, when a clinician or hospital system profits by advising a less-informed patient to consume services the patient would not want if he or she knew all the facts.2

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