Cost containment: Europe. The United Kingdom

The United Kingdom spends less on health care than most other Western nations. Consequently, intensive care, which is seen as a service rather than as an independent discipline, has been neglected and under-resourced. Plans to develop intensive care as a multidisciplinary specialty may change the situation. However, the National Health Service is itself undergoing major organizational reforms with the development of an internal market. In addition, competition between hospital trusts may impose cost constraints that prevent the expansion of intensive care facilities and impede regionalization of intensive care services. Severity-adjusted outcomes indicate that the standard of intensive care in the United Kingdom is high, and good outcomes are achieved at comparatively low cost. However, there is evidence that the underfunding of intensive care is resulting in lost opportunities for preventing avoidable morbidity and mortality. Unless a modest increase in funding for intensive and high-dependency care is made available, formal strategies for rationing and triage may have to be adopted.