Perceptions of cost constraints, resource limitations, and rationing in United States intensive care units: Results of a national survey
- 1 February 2008
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 36 (2), 471-476
- https://doi.org/10.1097/ccm.0b013e3181629511
Abstract
To examine cost constraints, resource limitations, and rationing within U.S. intensive care units (ICUs) as perceived by ICU clinicians and the roles of ICU physician and nurse directors in resource allocation decisions. A national survey of hospitals with ICUs. The study included 447 U.S. hospitals with ICUs. ICU nurse and physician directors. None. We randomly selected 447 U.S. hospitals stratified for location and ICU size and contacted them for this survey. The institutional response rate was 63%. When asked to characterize their involvement in budgetary decisions, 55% of nurse directors vs. 3% (p 75% of the time) because of costs or availability. When asked if any rationing occurs in their ICUs (using a prestated definition), only 11% of physician and 6% of nurse directors responded yes. Only 6% of nurses and 5% of physicians said that cost constraints have a significant effect on care. In contrast, when asked how often patients receive “too much” care, 46% of respondents said “sometimes or frequently.” Nurse managers have a larger role in managing ICU costs than physicians. Furthermore, both groups perceive that rationing and other cost-related practices sometimes occur in their ICU, but they more commonly perceived excessive care in ICUs. These data may be helpful for policy makers and administrators and may serve as a benchmark for future studies in critical care or other realms of health care.Keywords
This publication has 28 references indexed in Scilit:
- ‘Rationing' Health CareArchives of Internal Medicine, 1998
- Fair Allocation of Intensive Care Unit ResourcesAmerican Journal of Respiratory and Critical Care Medicine, 1997
- Muddling Through Elegantly: Finding The Proper Balance In RationingHealth Affairs, 1997
- Rational Allocation of Medical Care: A Position Statement from the American Geriatrics SocietyJournal of the American Geriatrics Society, 1997
- Consensus statement of the Society of Critical Care Medicine's Ethics Committee regarding futile and other possibly inadvisable treatmentsCritical Care Medicine, 1997
- Recognizing Bedside Rationing: Clear Cases and Tough CallsAnnals of Internal Medicine, 1997
- Cost-Effectiveness Analysis in a Setting of Budget Constraints — Is It Equitable?New England Journal of Medicine, 1996
- Attitudes of critical care medicine professionals concerning distribution of intensive care resourcesCritical Care Medicine, 1994
- Ethics, economics, and endocarditis. The physician's role in resource allocationArchives of Internal Medicine, 1988
- Rationing of Intensive Care Unit ServicesJAMA, 1986