[Economics in intensive care medicine: rationalization or rationing?]

Four thesis related to economics of intensive care medicine are derived from an analysis of the intensive care unit of the university hospital of Basel, Switzerland, and the respective literature: (1) Intensive care medicine is costly but rationing can be avoided by rationalization. (2) Exemption or withdrawal of intensive care cannot be justified in the absence of accurate predictors of costs and outcomes of individual patients. (3) Intensive care physicians must not act as judges but on behalf of patients incapable of decision making. They must represent patients' interests vis-à-vis authorities and reimbursing institutions. (4) Analyses of cost-efficiency are instrumental for process improvement of intensive care, for negotiations on reimbursement and for the regulatory decisions of the authorities. Tools for economic analyses of intensive care medicine are therefore worthy of further development.