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Jean Pierre Poullier

Bio: Jean Pierre Poullier is an academic researcher from Organisation for Economic Co-operation and Development. The author has contributed to research in topics: Gross domestic product & Per capita. The author has an hindex of 1, co-authored 1 publications receiving 180 citations.

Papers
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Journal ArticleDOI
TL;DR: The United States has the lowest percentage of the population with government-assured health insurance, and it also has the fewest hospital days per capita, the highest hospital expenditures per day, and substantially higher physician incomes than the other OECD countries.
Abstract: In 1997 the United States spent $3,925 per capita on health or 13.5 percent of gross domestic product (GDP), while the median Organization for Economic Cooperation and Development (OECD) country spent $1,728 or 7.5 percent. From 1990 to 1997 U.S. health spending per capita increased 4.3 percent per year, compared with the OECD median of 3.8 percent. The United States has the lowest percentage of the population with government-assured health insurance. It also has the fewest hospital days per capita, the highest hospital expenditures per day, and substantially higher physician incomes than the other OECD countries. On the available outcome measures, the United States is generally in the bottom half, and its relative ranking has been declining since 1960.

183 citations


Cited by
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Journal ArticleDOI
26 Jul 2000-JAMA
TL;DR: The figures regarding the poor position of the United States in health worldwide are robust and not dependent on the particular measures used, and common explanations for this poor performance fail to implicate the health system.
Abstract: INFORMATION CONCERNING THE DEFICIENCIES OF US MEDIcal care has been accumulating. The fact that more than 40 million people have no health insurance is well known. The high cost of the health care system is considered to be a deficit, but seems to be tolerated under the assumption that better health results from more expensive care, despite evidence from a few studies indicating that as many as 20% to 30% of patients receive contraindicated care. In addition, with the release of the Institute of Medicine (IOM) report “To Err Is Human,” millions of Americans learned, for the first time, that an estimated 44000 to 98000 among them die each year as a result of medical errors. The fact is that the US population does not have anywhere near the best health in the world. Of 13 countries in a recent comparison, the United States ranks an average of 12th (second from the bottom) for 16 available health indicators. Countries in order of their average ranking on the health indicators (with the first being the best) are Japan, Sweden, Canada, France, Australia, Spain, Finland, the Netherlands, the United Kingdom, Denmark, Belgium, the United States, and Germany. Rankings of the United States on the separate indicators are: • 13th (last) for low-birth-weight percentages • 13th for neonatal mortality and infant mortality overall • 11th for postneonatal mortality • 13th for years of potential life lost (excluding external causes) • 11th for life expectancy at 1 year for females, 12th for males • 10th for life expectancy at 15 years for females, 12th for males • 10thforlifeexpectancyat40yearsforfemales,9thformales • 7th for life expectancy at 65 years for females, 7th for males • 3rd for life expectancy at 80 years for females, 3rd for males • 10th for age-adjusted mortality The poor performance of the United States was recently confirmed by the World Health Organization, which used different indicators. Using data on disability-adjusted life expectancy, child survival to age 5 years, experiences with the health care system, disparities across social groups in experiences with the health care system, and equality of family out-of-pocket expenditures for health care (regardless of need for services), this report ranked the United States as 15th among 25 industrialized countries. Thus, the figures regarding the poor position of the United States in health worldwide are robust and not dependent on the particular measures used. Common explanations for this poor performance fail to implicate the health system. The perception is that the American public “behaves badly” by smoking, drinking, and perpetrating violence. The data show otherwise, at least relatively. The proportion of females who smoke ranges from 14% in Japan to 41% in Denmark; in the United States, it is 24% (fifth best). For males, the range is from 26% in Sweden to 61% in Japan; it is 28% in the United States (third best). The data for alcoholic beverage consumption are similar: the United States ranks fifth best. Thus, although tobacco use and alcohol use in excess are clearly harmful to health, they do not account for the relatively poor position of the United States on these health indicators. The data on years of potential life lost exclude external causes associated with deaths due to motor vehicle collisions and violence, and it is still the worst among the 13 countries. Dietary differences have been demonstrated to be related to differences in mortality across countries, but the United States has relatively low consumption of animal fats (fifth lowest in men aged 55-64 years in 20 industrialized countries) and the third lowest mean cholesterol concentrations among men aged 50 to 70 years among 13 industrialized countries. The real explanation for relatively poor health in the United States is undoubtedly complex and multifactorial. From a health system viewpoint, it is possible that the historic failure to build a strong primary care infrastructure could play some role. A wealth of evidence documents the benefits of characteristics associated with primary care performance. Of the 7 countries in the top of the average health ranking, 5 have strong primary care infrastructures. Although better access to care, including universal health insurance, is widely considered to be the solution, there is evidence that the major benefit of access accrues only when it facilitates receipt of primary care. The health care system also may contribute to poor health through its adverse effects. For example, US estimates of the combined effect of errors and adverse effects that occur because of iatrogenic damage not associated with recognizable error include: • 12000 deaths/year from unnecessary surgery • 7000 deaths/year from medication errors in hospitals • 20000 deaths/year from other errors in hospitals

544 citations

Journal ArticleDOI
TL;DR: It is argued that providers' and patients' information and decision support needs can be satisfied only if primary care providers use electronic medical records (EMRs), and that implementing specific policies can accelerate utilization of EMRs in the U.S.

398 citations

Journal ArticleDOI
TL;DR: Increases in health care expenditure are significantly associated with large improvements in infant mortality but only marginally in relation to life expectancy, according to a fixed effects model conducted on a panel data set for the former 15 members of the European Union over the period 1980–1995.
Abstract: The relationship between health care expenditure and health outcomes is of interest to policy makers in the light of steady increases in health care spending for most industrialised countries. However, establishing causal relationships is complex because, firstly, health care expenditure is only one of many quantitative and qualitative factors that contribute to health outcomes, and, secondly, measurement of health status is an imperfect process. This study reviews key findings and methodological approaches in this field and reports the results of our own empirical study of countries of the European Union. Our analysis examines life expectancy and infant mortality as the ‘output’ of the health care system, and various life-style, environmental and occupational factors as ‘inputs’. Econometric analyses using a fixed effects model are conducted on a panel data set for the former 15 members of the European Union over the period 1980–1995. The findings show that increases in health care expenditure are significantly associated with large improvements in infant mortality but only marginally in relation to life expectancy. The findings are generally consistent with those of several previous studies. Caveats and improvements for future research are presented.

323 citations

Journal ArticleDOI
13 Oct 2004-JAMA
TL;DR: Length of stay for inpatient rehabilitation decreased substantially from 1994 to 2001, and efficiency for functional outcomes improved but mortality at follow-up increased.
Abstract: ContextChanges in reimbursement have reduced length of stay (LOS) for patients receiving inpatient medical rehabilitation. The impact of decreased LOS on functional status, living setting, and mortality is not known.ObjectiveTo examine changes in LOS, functional status, living setting, and mortality in patients completing inpatient rehabilitation.DesignRetrospective cohort study from 1994 through 2001 using information submitted to the Uniform Data System for Medical Rehabilitation.Setting and ParticipantsData were analyzed from 744 inpatient medical rehabilitation hospitals and centers located in 48 US states. A total of 148 807 patient records from 5 impairment groups (stroke, brain dysfunction, spinal cord dysfunction, other neurologic conditions, and orthopedic conditions) were examined. Patients’ mean age was 67.8 (SD, 15.8) years; the sample was 59% female and 81% non-Hispanic white.Main Outcome MeasuresDischarge setting, follow-up living setting, change in functional status, and mortality.ResultsMedian LOS decreased from 20 to 12 days (P<.001) from 1994 to 2001. The proportional decrease in median LOS was greatest (42%) for patients with orthopedic conditions. Mean days to follow-up remained constant from 89 in 1994 to 90 in 2001. Functional status was clinically stable, while efficiency (functional status change divided by LOS) increased significantly (P<.001). Rates of discharge to home and living at home at follow-up remained stable, ranging from 81% to 93%. However, mortality at 80- to 180-day follow-up increased from less than 1% in 1994 to 4.7% in 2001.ConclusionsLength of stay for inpatient rehabilitation decreased substantially from 1994 to 2001. Effectiveness as measured by change in functional status did not change clinically, and living setting did not change. Efficiency for functional outcomes improved but mortality at follow-up increased.

235 citations

Journal ArticleDOI
TL;DR: The USA may learn from countries more economical in their allocation of healthcare resources that more is not necessarily better, and finds that the USA can substantially reduce inputs while maintaining the current level of life expectancy.

211 citations