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February 12, 2014

ICU Bed Supply, Utilization, and Health Care Spending: An Example of Demand Elasticity

Author Affiliations
  • 1Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 2Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
JAMA. 2014;311(6):567-568. doi:10.1001/jama.2013.283800

Intensive care is a substantial financial burden on the US health care system, with spending on critical illness exceeding $80 billion per year, approximately 3% of all health care spending and nearly 1% of the gross domestic product.1 In contrast, the United Kingdom spends only 0.1% of its gross domestic product on critical care services, with no evidence of worse patient outcomes and similar life expectancies as in the United States.2 Although there are many differences between these 2 countries, one significant difference is intensive care unit (ICU) bed supply. The United States has 25 ICU beds per 100 000 people, as compared with 5 per 100 000 in the United Kingdom.3 As a result, ICU case-mix differs substantially. In the United Kingdom, the majority of ICU patients are at high risk for death, whereas in the United States, many patients are admitted to the ICU for observation.4 At the same time, compared with patients in the United Kingdom, substantially more patients in the United States die in the ICU, suggesting that increased bed availability appears to reduce the incentive to keep dying patients out of the ICU.4

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