The researcher described the experience of one pediatric intensive unit(PICU) in China. The past decade saw the achievement across the world, increasing private shares of medical costs. Payment schemes have not kept pace with the increased availability and demand. As a result, a substantial number of parents, in the face of financial constraints, choose to withdraw the medical care of children even when recovery is expected.

Critical Care

The past decade saw great improvement in the availability of critical care in China. These advances include the establishment of intensive care units, including pediatric intensive care units (PICU), across the vast nation. This development is in the context of a rapidly growing economy.

Medical Services

Chinese economy has grown substantially since the liberation of the market place in the 1980’s. Between 2007–2012, the gross domestic product increased by 10.2% annually. Concurrently medical services have expanded. Payment schemes for medical services have also been evolving. Out-of-pocket expenses have increased relatively and absolutely.

Current challenges include inability to access health care, distrust of the medical professionals, suspicions about efficacy and authenticity of pharmaceuticals, high out-of-pocket medical expenses, and increasing disparities among different regions and different socioeconomic status

Economic Factors

During the two-year period 883 patients were admitted to the PICU. One hundred one (11%) patients died during their hospital stay. Of these 69 (68%) died after parents elected to withdraw care. A large proportion (33 out of 69 48%) cited economic factors as a reason behind the decision.

Compared with the non-withdrawal group the cases had lower disease severity at admission and on the day of death. On the day of death 34% in the withdrawal group had lower disease severity than at admission, showing clinical improvement. The mean hospital charge for the ICU stay was RMB35,000 (~$5600).

Children Care

In this study, they demonstrated that a significant number of parents elected to withdraw the care of their children in an urban PICU due to economic burdens. While the current study focused on a PICU in one large tertiary care hospital, this is in the context of larger, evolving social and economic changes in China.

Patients Died

A substantial proportion of patients in a Chinese urban PICU died after parents chose to withdraw their care in the face of financial hardship, even while some were showing clinical improvement. The society has an obligation, and, likely, an economic incentive, to share this burden.