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June 1991

Honoring Patient Preferences and Rationing Intensive Care: Are These Compatible Goals?

Author Affiliations

Department of Internal Medicine Section of Pulmonary and Critical Care Medicine Rush-Presbyterian-St Luke's Medical Center 1653 W Congress Pkwy Chicago, IL 60612

Arch Intern Med. 1991;151(6):1061-1063. doi:10.1001/archinte.1991.00400060009001

The health care system that existed in the United States prior to the institution of the prospective payment system in the early 1980s could not have been envisioned by previous generations. Impressive technologic capabilities combined with a generous reimbursement system fostered professional and public expectations for aggressive medical care. Intensive care services have undergone unrestrained expansion in the past two decades. In 1988, there were a total of 6556 intensive care units (ICUs) in the United States, accounting for approximately 7% of all hospital beds.1 This compares to Great Britain, which has approximately 10% of the number of ICU beds per capita as the United States. In this country, a growing number of intermediate care units have also been created to accommodate more stable patients who still require intensive monitoring and/or therapy.

Critical care is expensive. In 1980, for example, Medicare expenditures were approximately $34 billion; it is anticipated that

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