Variation in critical care services across North America and Western Europe.
OBJECTIVE
Critical care represents a large percentage of healthcare spending in developed countries. Yet, little is known regarding international variation in critical care services. We sought to understand differences in critical care delivery by comparing data on the distribution of services in eight countries.


METHODS
Retrospective review of existing national administrative data. We identified sources of data in each country to provide information on acute care hospitals and beds, intensive care units and beds, intensive care admissions, and definitions of intensive care beds. Data were all referenced and from as close to 2005 as possible.


METHODS
United States, France, United Kingdom, Canada, Belgium, Germany, The Netherlands, and Spain.


METHODS
Not available.


METHODS
None.


RESULTS
No standard definition existed for acute care hospital or intensive care unit beds across countries. Hospital beds varied three-fold from 221/100,000 population in the United States to 593/100,000 in Germany. Adult intensive care unit beds also ranged seven-fold from 3.3/100,000 population in the United Kingdom to 24.0/100,000 in Germany. Volume of intensive care unit admissions per year varied ten-fold from 216/100,000 population in the United Kingdom to 2353/100,000 in Germany. The ratio of intensive care unit beds to hospital beds was highly correlated across all countries except the United States (r = .90). There was minimal correlation between the number of intensive care unit beds per capita and health care spending per capita (r = .45), but high inverse correlation between intensive care unit beds and hospital mortality for intensive care unit patients across countries (r = -.82).


CONCLUSIONS
Absolute critical care services vary dramatically between countries with wide differences in both numbers of beds and volume of admissions. The number of intensive care unit beds per capita is not strongly correlated with overall health expenditure, but does correlate strongly with mortality. These findings demonstrate the need for critical care data from all countries, as they are essential for interpretation of studies, and policy decisions regarding critical care services.
Wunsch
Hannah
H
Department of Anesthesiology, Columbia University, New York, NY, USA. hw2125@columbia.edu
Angus
Derek C
DC
Harrison
David A
DA
Collange
Olivier
O
Fowler
Robert
R
Hoste
Eric A J
EA
de Keizer
Nicolette F
NF
Kersten
Alexander
A
Linde-Zwirble
Walter T
WT
Sandiumenge
Alberto
A
Rowan
Kathryn M
KM