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

Rebecca A. Gooch, MD1; Jeremy M. Kahn, MD, MSc1,2
[+] 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.
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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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A Conceptual Model of Demand Elasticity in the Intensive Care Unit

The left upper quadrant represents the target patient population for the intensive care unit (ICU), ie, patients who have high illness severity and survive with ICU care. The left lower quadrant represents the patient population that has low illness severity and survives regardless of ICU care. The right upper quadrant represents the patient population that has high illness severity but does not survive despite ICU care. The right lower quadrant represents patients with low illness severity but who do not survive—a rare occurrence in an ICU population. Under a model of demand elasticity, the populations in the left lower quadrant and the right upper quadrant will increase in the ICU with high ICU bed availability and decrease if there is low ICU bed availability.

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