Streat S, Judson J A
Department of Critical Care Medicine, Auckland Hospital, New Zealand.
New Horiz. 1994 Aug;2(3):392-403.
New Zealand is a small nation with an extensive state-funded system of health, education, and welfare that is currently under "reform." The healthcare system remains largely government-funded and is free to all New Zealand residents. Healthcare spending accounts for approximately 7.4% of the country's gross domestic product and has not changed in the last 5 yrs. Ninety-three percent of New Zealand's ICUs are in public hospitals, where ICU beds constitute 0.9% of the total number of beds. In all, there are 43 ICU beds/1 million inhabitants. Between 1989 and 1992, the number of public hospital beds decreased by 19% and the number of ICU beds decreased by 5%. ICU Resources have been limited for many years, and clinicians have responded by attempting to prevent disease and limit its severity, by vetting (and declining) requests for ICU admission, by reducing length of ICU stay of both survivors and nonsurvivors, and by reducing marginal costs. Both limiting and actively withdrawing therapy are well established practices in New Zealand ICUs. The country's physicians are conservative in their use of new technology but demand excellence and value in equipment. ICU technology and knowledge diffuse easily throughout New Zealand because of the country's geography and population distribution, in addition to the activities of the Australian and New Zealand Intensive Care Society (ANZICS) and the defined specialty training pathways for intensive care. Hospital care is relatively cheap and nurse extenders, respiratory therapists, and ward pharmacists are not used. Flow charts in the ICU are custom-designed and not computerized, but computers are increasingly being used for clinical databases and ICU policy development.
新西兰是一个小国，拥有广泛的由国家资助的医疗、教育和福利体系，目前该体系正在进行“改革”。医疗体系在很大程度上仍由政府资助，新西兰所有居民均可免费享受。医疗支出约占该国国内生产总值的7.4%，在过去5年中没有变化。新西兰93%的重症监护病房（ICU）位于公立医院，其中ICU床位占总床位数的0.9%。总体而言，每百万居民中有43张ICU床位。1989年至1992年间，公立医院床位数减少了19%，ICU床位数减少了5%。多年来，ICU资源一直有限，临床医生采取了多种应对措施，包括试图预防疾病并限制其严重程度、审查（并拒绝）ICU入院申请、缩短幸存者和非幸存者的ICU住院时间以及降低边际成本。在新西兰的ICU中，限制治疗和积极撤掉治疗都是既定的做法。该国医生在新技术的使用上较为保守，但对设备要求卓越且注重性价比。由于该国的地理和人口分布，以及澳大利亚和新西兰重症监护协会（ANZICS）的活动和明确的重症监护专科培训途径，ICU技术和知识在新西兰很容易传播。医院护理相对便宜，且不使用助理护士、呼吸治疗师和病房药剂师。ICU的流程图是定制设计的，没有计算机化，但计算机越来越多地用于临床数据库和ICU政策制定。
