Cost effectiveness has become a driving force behind the rapidly evolving US health care delivery system. Health care reform, although stalled in Congress, continues under a full head of steam at the state and local levels. Downsizing, mergers and acquisitions, and unique interinstitutional alliances are all part of this hubbub of activity. The public eye focuses on the fact that medical costs are generally increasing while, at the same time, marveling at the spectacular successes that medicine has achieved, such as liver transplantation, which at our institution generates charges in excess of $220,000 per transplant. Today's society expects fiscal accountability from the medical community while demanding better and often more costly forms of effective therapy.

Critical care medicine as practiced in the intensive care unit (ICU) consumes a disproportionately large fraction of US health care resources. The bed capacity of the roughly 7400 nationwide ICUs comprises less than 10% of all hospital beds, yet ICUs consume approximately 20% of total hospital costs. Increases in the US health care delivery costs continue to exceed the gross national product (GNP).<sup>23 Halpern N.A., Bettes L., Greenstein R. Federal and nationwide intensive care units and health care costs: 1986–1992 Crit Care Med 1994 ;  19 : 2001  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> Although total hospital beds are decreasing nationwide, paralleling a decrease in hospital occupancy, the actual number and percentage of ICU beds have increased, paralleling the increase in occupancy. From 1986 to 1992, however, the increases in ICU cost per day were less than the increases in overall health care costs. The percent of gross domestic product occupied by nationwide ICU costs was 0.7% in 1986 and 1988 and 0.9% in 1992.<sup>23 Halpern N.A., Bettes L., Greenstein R. Federal and nationwide intensive care units and health care costs: 1986–1992 Crit Care Med 1994 ;  19 : 2001  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> Finally, “high-cost” surgical patients, often treated in an ICU, are only 5% to 10% of surgical patients but consume 35% to 50% of total resources.<sup>18 Drucker W.R., Gavett J.W. , y al. Toward strategies for cost containment in surgical patients Am Surg 1983 ;  198 : 284

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The foundation for high-quality, cost-effective critical care that attempts to diminish charges generated while the patient is in intensive care will be based on education and behavioral modification of the public and, within the medical community, interactive and creative administration directed by a full-time intensivist, data-driven outcome assessment, continuous quality-improvement projects, case management and critical care pathways, technology use based on cost-benefit analysis, and defined admission and discharge criteria. The physician's role and accountability to ensure cost efficacy and effectiveness will undoubtedly increase. The ultimate success in controlling ICU costs must rest within each unit through multidisciplinary team leadership under the guidance of an effective ICU director.