How many intensive care beds are enough?

Excerpt

One of the most consistent observations in health care is variation. Ever since J. Allison Glover noted a more than fourfold geographic variation in tonsillectomies in England and Wales in 1936 and observed wide swings in procedure rates over time without apparent detrimental effect, researchers have been reporting on the phenomenon. Marked variations in disease incidence, outcome, rates of medical procedures, aggressive care at the end of life, clinician supply and clinical practice are consistently observed and are not fully explained by observable factors such as population demographics [1]. Variation, even within a single country, is so marked that Dartmouth University generates an atlas of health care variation in the US to document the phenomenon [2]. The “differential diagnosis” of this unexplained variation is broad and generally thought to be multifactorial. Likely candidates include uncertainty regarding the optimal management, patient demand, physician enthusiasm for a procedure, available resources for medical care, funding model for health care, malpractice liability and profit motivation [3]. …