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Rationing of Intensive Care Unit Services: From Idea to Execution

Navid Namakizadeh Esfahani, Alisina Eghbalnia, Amirhossein Akhavan Sigari, Nima Ghasemi, Nasrin Shaarbafchizadeh

Purpose: The World Health Organization introduces the health service rationing mechanism as a prelude to achieving universal health coverage. Rationing is defined as an intelligent policy in the fair distribution of limited resources. Scientific documents and studies and expert opinions propose beneficial, practical strategies and implementation solutions to establish rationing mechanisms.

Method: Medical databases have been searched for relevant articles in English and Persian. Extracted articles were reviewed by two authors and relevant data have been extracted. The data have been reviewed and agreed upon.

Results & Discussion: Development of clinical guidelines and adjusted protocols, redistribution of human and physical resources such as setting up intermediate care units, and designing and implementing appropriate financial mechanisms are the main strategic proposals in place to control the growing costs of the ICU services.

Originality: Scarcity of ICU beds especially in times of patient overload, such as the COVID-19 pandemic, will inevitably force hospitals to strictly stratify patients to assess the need for ICU care beds. Rationing of ICU care beds either to cut costs or for the sake of improved patient care in the time of overwhelmed health care facilities, requires extensive and careful pilot studies and ethical overviews.