FEDERAL AND NATIONWIDE INTENSIVE-CARE UNITS AND HEALTH-CARE COSTS - 1986-1992

Objectives: To establish Department of Veterans Affairs' intensive car e unit (ICU) costs from a database and to use this information to vali date the Russell equation, the most commonly used method of calculatin g ICU costs. To compare and trend Department of Veterans Affairs' and nationwide (USA) ICU and healthcare costs. Design: Comparison study. S etting: Database analysis of Department of Veterans Affairs' and natio nwide ICUs over a 6-yr period (1986-1992), with biennial evaluations. Main Measures: Costs and bed occupancies of Department of Veterans Aff airs' and nationwide hospitals and ICUs, as well as United States nati onal health expenditures and gross domestic product. Results: Fifty pe rcent of Department of Veterans Affairs' ICU funds were used for nurse and physician salaries. Department of Veterans Affairs' ICU direct an d indirect cost ratios have remained constant (2:1). The Russell equat ion is valid, providing that the ''inpatient only'' cost variable is u sed. ICU costs were consistently lower in the Department of Veterans A ffairs than nationwide, as compared by the Russell equation. A smaller fraction of the hospital budget was allocated to the ICU in the Depar tment of Veterans Affairs than in nationwide institutions. Despite an increasing nationwide ICU patient workload, the percentage of ICU fund allocations has not increased. Health care in the United States incre ases at a rate greater than the increase in gross domestic product. He althcare delivery costs are increasing at a greater rate nationwide th an in the Department of Veterans Affairs. The percentage increase in I CU cost per day, both in the Department of Veterans Affairs and nation wide, was less than the increase in healthcare costs. The percent of t he gross domestic product, national health expenditure, and hospital c ost used by the ICU has increased minimally during the course of this study. Conclusions: The Department of Veterans Affairs has the only na tional ICU Line item cost database available. For the Russell equation calculation to be accurate, inpatient only costs should be used. Unti l customized Health Care Financing Administration analyses become avai lable, nationwide ICU costs are best determined by the Russell equatio n. Department of Veterans Affairs' ICUs have a consistent cost advanta ge over nationwide ICUs. Increases in United States healthcare deliver y costs continue to exceed the increase in gross domestic product. Cos t containment is already occurring in critical care.