title: Critical care rationing: international comparisons.
abstract: Every country has finite resources that are expended to provide citizens with social "goods," including education, protection, infrastructure, and health care. Rationing-of any resource-refers to distribution of an allotted amount and may involve withholding some goods that would benefit some citizens. Health-care rationing is controversial because good health complements so many human endeavors. We explored (perceptions regarding) critical care rationing in seven industrialized countries. Academic physicians from England, Spain, Italy, France, Argentina, Canada, and the United States wrote essays that addressed specific questions including: (1) What historical, cultural, and medical institutional features inform my country's approach to rationing of health care? (2) What is known about formal rationing, especially in critical care, in my country? (3) How does rationing occur in my ICU? Responses suggest that critical care is rationed, by varying mechanisms, in all seven countries. We speculate that while no single "best" method of rationing is likely to be acceptable or optimal for all countries, professional societies could serve international health by developing evidence-based guidelines for just and effective rationing of critical care.
authors.affiliation: Department of Critical Care, Imperial College School of Medicine, Royal Brompton Hospital, London, England.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Evans
authors.affiliation: Respiratory and Critical Care Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Nava
authors.affiliation: Universidad Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Guillermo Vazquez
authors.initials: GV
authors.lastname: Mata
authors.affiliation: Service de Réanimation Médicale, Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
authors.affiliation: Hospital Interzonal de Agudos San Martin de La Plata, Buenos Aires, Argentina.
authors.forename: Elisa
authors.initials: E
authors.lastname: Estenssoro
authors.affiliation: Sunnybrook Health Science Center, Toronto, ON, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Fowler
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Leslie P
authors.initials: LP
authors.lastname: Scheunemann
authors.affiliation: University of Pittsburgh, Pittsburgh, PA.
authors.forename: Douglas
authors.initials: D
authors.lastname: White
authors.affiliation: Yale University School of Medicine, Bridgeport, CT. Electronic address: pcmant@bpthosp.org.
authors.forename: Constantine A
authors.initials: CA
authors.lastname: Manthous
mesh_terms: D001118:Argentina; D002170:Canada; D003422:Critical Care / Q000191:economics*; D004739:England; D005602:France; D015276:Health Care Rationing / Q000191:economics* / Q000331:legislation & jurisprudence*; D005102:Health Expenditures / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D007558:Italy; D013030:Spain; D014481:United States