Cost containment: the Pacific. New Zealand.

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.