New horizons (Baltimore, Md.)
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For many years, the evolution of Argentina's healthcare system has been influenced by political and economic instability. Inflation and hyperinflation have led to anarchic development of both health administration systems and hospitals. Critical care grew in a similar manner, resulting in a mix of > 500 critical care units with very different levels of technology and trained personnel. ⋯ The country's private hospital system is extremely heterogenous, ranging from little, simple institutions with a 20- to 30-bed capacity to great private institutions with international standards of care. Cost-containment efforts have been sporadic and isolated, and statistical data to analyze the results are lacking. In order to formulate a strategy of cost-containment in the near future, accreditation and categorization of critical care units and human resources training are being implemented by health authorities and the Argentine Society of Critical Care Medicine.
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Through prepaid compulsory insurance managed by the central government, Italy's National Health Service (NHS) provides full coverage, free accessibility, and no or limited copayment by individuals when receiving health services. Although Italy spends less than other countries on health care (< 8% of the country's gross national product), the present NHS faces considerable difficulties, and its performance regarding quality, outcome, and spending has come under question. ICUs account for < 2% of total hospital beds, and the proportion of ICU patients is < 2.5% of all hospital patients (2.5% of all Italian hospital patients receive ICU care at some time during their hospital stay). ⋯ Innovations focus mostly on cost containment and quality initiatives. These innovations will likely produce a new health service in which regions will have a more important role than in the past. Actions planned in a large Italian region by the local government are used as an example to explain the potential impact of this new trend on critical care medicine.
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New Zealand is a small nation with an extensive state-funded system of health, education, and welfare that is currently under "reform." The healthcare system remains largely government-funded and is free to all New Zealand residents. Healthcare spending accounts for approximately 7.4% of the country's gross domestic product and has not changed in the last 5 yrs. Ninety-three percent of New Zealand's ICUs are in public hospitals, where ICU beds constitute 0.9% of the total number of beds. ⋯ ICU technology and knowledge diffuse easily throughout New Zealand because of the country's geography and population distribution, in addition to the activities of the Australian and New Zealand Intensive Care Society (ANZICS) and the defined specialty training pathways for intensive care. Hospital care is relatively cheap and nurse extenders, respiratory therapists, and ward pharmacists are not used. Flow charts in the ICU are custom-designed and not computerized, but computers are increasingly being used for clinical databases and ICU policy development.
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Resources allocated for health care in Canada are about to be decreased. In recent years, the Canadian healthcare system has been consuming a progressively greater share of the country's gross domestic product. ⋯ Increasing efficiency and reducing inappropriate use may not be enough to contain costs. More difficult decisions need to be made.
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The German healthcare system offers a social network guaranteeing almost complete healthcare coverage to the German population (prevention, treatment, and rehabilitation). The system is supported by a multistructured network of public and private healthcare insurers. Fees for public insurance are equally paid by employers and employees. ⋯ These expenses are fixed by official, standard wages. Cost containment by further restricting the number of personnel impairs the care provided. Improvements in organization and management may contribute to a higher degree of personal motivation for employees and, in turn, may result in higher working efficiency.