Bion J
Queen Elizabeth Hospital, University of Birmingham, UK.
New Horiz. 1994 Aug;2(3):341-4.
The United Kingdom spends less on health care than most other Western nations. Consequently, intensive care, which is seen as a service rather than as an independent discipline, has been neglected and under-resourced. Plans to develop intensive care as a multidisciplinary specialty may change the situation. However, the National Health Service is itself undergoing major organizational reforms with the development of an internal market. In addition, competition between hospital trusts may impose cost constraints that prevent the expansion of intensive care facilities and impede regionalization of intensive care services. Severity-adjusted outcomes indicate that the standard of intensive care in the United Kingdom is high, and good outcomes are achieved at comparatively low cost. However, there is evidence that the underfunding of intensive care is resulting in lost opportunities for preventing avoidable morbidity and mortality. Unless a modest increase in funding for intensive and high-dependency care is made available, formal strategies for rationing and triage may have to be adopted.
英国在医疗保健方面的支出比大多数其他西方国家都少。因此，重症监护被视为一种服务而非独立学科，一直受到忽视且资源不足。将重症监护发展为多学科专业的计划可能会改变这种状况。然而，国民医疗服务体系本身正随着内部市场的发展而进行重大的组织改革。此外，医院信托之间的竞争可能会带来成本限制，从而阻碍重症监护设施的扩张，并妨碍重症监护服务的区域化。经病情严重程度调整后的结果表明，英国的重症监护水平很高，且能以相对较低的成本取得良好的治疗效果。然而，有证据表明，重症监护资金不足正导致失去预防可避免的发病和死亡的机会。除非能适度增加对重症和高依赖度护理的资金投入，否则可能不得不采取正式的资源分配和分诊策略。
