Authors Rebecca Gooch, MD, department of critical care medicine at the University of Pittsburgh School of Medicine, and Jeremy Kahn, MD, department of health policy and management at the University of Pittsburgh Graduate School of Public Health, suggest the American organization of ICUs creates a demand that is not actually necessary for patients, an example of demand elasticity.
Demand elasticity measures how the demand for a good or service changes in response to another changing factor. In the case of ICU beds, the authors say more ICU beds lead to more use of the beds, even if patients do not need to be admitted to the ICU.
The authors present the example of ICU beds in the United Kingdom versus ICU beds in the United States. The U.K. has five ICU beds per 100,000 people, while the United States has 25 ICU beds per 100,000 people. Patients admitted to the ICU in the U.K. generally are at high risk for death, but U.S. ICU patients are often observation status, according to the article. Additionally, more ICU patients in the U.S. die in the ICU than in the U.K., according to the article, and the authors suggest that simply having more ICU beds “reduce[s] the incentive to keep dying patients out of the ICU.”
Authors suggest patients who should be admitted to the ICU are those with high illness severity and high survival chances instead of transferring patients to the ICU just because beds are available.
Furthermore, the authors suggest limiting ICU bed supply can help reduce the overall cost for hospitals simply because it would prevent unnecessary ICU use.
The authors suggest more research is needed to further examine the relationship between ICU supply and the critical care demand.
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