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Critical care rationing: international comparisons.

Authors
  • Evans, Timothy W1
  • Nava, Stefano2
  • Mata, Guillermo Vazquez3
  • Guidet, Bertrand4
  • Estenssoro, Elisa5
  • Fowler, Robert6
  • Scheunemann, Leslie P7
  • White, Douglas8
  • Manthous, Constantine A9
  • 1 Department of Critical Care, Imperial College School of Medicine, Royal Brompton Hospital, London, England.
  • 2 Respiratory and Critical Care Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy. , (Italy)
  • 3 Universidad Autonoma de Barcelona, Barcelona, Spain. , (Spain)
  • 4 Service de Réanimation Médicale, Paris, France. , (France)
  • 5 Hospital Interzonal de Agudos San Martin de La Plata, Buenos Aires, Argentina. , (Argentina)
  • 6 Sunnybrook Health Science Center, Toronto, ON, Canada. , (Canada)
  • 7 University of North Carolina at Chapel Hill, Chapel Hill, NC.
  • 8 University of Pittsburgh, Pittsburgh, PA.
  • 9 Yale University School of Medicine, Bridgeport, CT. Electronic address: [email protected]
Type
Published Article
Journal
CHEST Journal
Publisher
Elsevier
Publication Date
December 2011
Volume
140
Issue
6
Pages
1618–1624
Identifiers
DOI: 10.1378/chest.11-0957
PMID: 22147820
Source
Medline
License
Unknown

Abstract

Every country has finite resources that are expended to provide citizens with social "goods," including education, protection, infrastructure, and health care. Rationing-of any resource-refers to distribution of an allotted amount and may involve withholding some goods that would benefit some citizens. Health-care rationing is controversial because good health complements so many human endeavors. We explored (perceptions regarding) critical care rationing in seven industrialized countries. Academic physicians from England, Spain, Italy, France, Argentina, Canada, and the United States wrote essays that addressed specific questions including: (1) What historical, cultural, and medical institutional features inform my country's approach to rationing of health care? (2) What is known about formal rationing, especially in critical care, in my country? (3) How does rationing occur in my ICU? Responses suggest that critical care is rationed, by varying mechanisms, in all seven countries. We speculate that while no single "best" method of rationing is likely to be acceptable or optimal for all countries, professional societies could serve international health by developing evidence-based guidelines for just and effective rationing of critical care.

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