Honoring Patient Preferences and Rationing Intensive Care

Abstract

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.¹This 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