For many children and their families, access to care in a pediatric intensive care unit (PICU) is vital. Unfortunately, as a rival good, it is also limited. This thesis analyzes the group which uses the most of this important and scarce good: long stay patients (LSPs). Using an original survey of PICU practitioners across Canada and an original dataset of a year of PICU admissions from a particular PICU, this thesis applies a unique mix of qualitative and quantitative methods to draw conclusions and generate hypotheses. Two findings are of particularly noteworthy: a new theoretical framework for dichotomizing LSPs into “high-need” and “high-dependency” and the potential existence of “congestion effects” in which additional LSPs at any given time force PICUs to ration the care they can make available to any individual patient.