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The Allocation and Rationing of High-Cost Services

Cory Franklin, MD; Bashir Mamdani, MD; Gerald Burke, MD
JAMA. 1986;256(3):350. doi:10.1001/jama.1986.03380030052022.
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To the Editor.—  The conclusions drawn by the authors of the article entitled "Rationing of Intensive Care Unit Services"1 that physicians effectively ration intensive care beds are inadequately supported by the data presented. As the authors note, "the nature of our study yielded no information about potential poor outcomes for patients never admitted to the ICU [intensive care unit]." Without such information, the total effect of rationing cannot be evaluated.Data from our institution lead us to a diametrically opposite conclusion. In 1983, we expanded our medical critical care 20-bed service by creating a 12-bed intermediate care unit and redirecting lower-risk patients to this area. Twelve months before and 18 months after the intermediate care unit opened, our data indicated that the ICU mortality did not change with the expansion of services (23.5 ±3.94 per 100 admissions to the ICU before to 23.6 ± 3.77 after opening the intermediate


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