America’s Intensive-Care Dividend

The U.S. has more ICU beds as it braces for coronavirus cases

Editorial Board March 17, 2020

Americans love to complain about their costly health-care system, but in the coronavirus pandemic that spending could pay off. Hospitals in the U.S. don’t skimp on costly care as they do in countries with socialized systems that are struggling to treat coronavirus patients amid a shortage of intensive-care beds.

Some who favor government-run health care are pointing out that the U.S. has fewer hospital beds per capita than other countries, but that’s in part because more surgeries are performed at outpatient centers where patients are less likely to catch infections. A more important metric is the number of intensive-care units, which have sophisticated equipment and a high staff to patient ratio. These are crucial for patients in respiratory distress.

A 2012 review in the journal Current Opinion in Critical Care found that the U.S. has 20 to 31.7 ICU beds per 100,000 people compared to 13.5 in Canada, 7.9 in Japan and between 3.5 and 7.4 in the U.K. Differences in how countries define “ICU” account for some of the disparity, the article notes, and the U.S. needs more ICU beds because it has a higher incidence of chronic conditions like heart disease. But importantly, the article finds that health spending is correlated “with increasing delivery of critical care.”

Countries with socialized systems ration intensive care. “Studies from Japan and the U.K determined that admissions to ICUs are severely limited for the very elderly and patients perceived to have little chance of survival,” the article says. In the U.K., many patients were “denied intensive care due to a lack of beds” and “discharged from the ICU prematurely.” The U.K.’s National Health Service already struggles each winter to provide adequate care during routine flu seasons, as our Joseph Sternberg documented on Friday.

Reports from Wuhan and northern Italy suggest patients in respiratory distress are more likely to survive with intensive treatment including a ventilator. In Lombardy, the hardest-hit area in Italy, doctors are having to triage patients and connect ventilators only to those with the best chances of survival—mostly younger patients.

U.S. ventilator capacity exceeds its number of ICU beds, according to data from the Society of Critical Care Medicine. Many U.S. ICU beds are currently taken by patients with other illnesses, and hospitals could be overwhelmed if the virus spreads rapidly. Many hospitals are already thinking ahead and canceling elective surgeries to free up beds. The federal government and private business should be planning now to surge beds and ventilators into cities where even hospitals planning ahead are unable to manage virus patients.

But the U.S. is currently better equipped to handle the pandemic because private insurers reimburse hospitals at higher rates than government-run systems elsewhere. If hospitals were compensated for all care at the low rates that Medicare and Medicaid do, Americans who get sick with the coronavirus would be more likely to suffer like the poor Italians now consigned to hospital hallways.




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