Biomedical subjects
J P Poullier
Publications and source records attributed to J P Poullier.
Productivity growth in health-care delivery.
OBJECTIVES: The authors compute and compare productivity growth in the health-care sectors for a sample of Organization for Economic Cooperation and Development countries over the period from 1974 to 1989. The authors compute Malmquist productivity indexes, which allow productivity growth to be decomposed into efficiency changes and technical change. These indexes also allow the use of primary quantity data (recently available from the Organization for Economic Cooperation and Development), rather than expenditure data, which the authors argue reduces bias resulting from distorted prices. METHODS: The authors specify two models. The first model focuses on the hospital sector; inputs include physicians and medical care beds, whereas outputs are the "intermediate" type used in hospital efficiency studies, namely, inpatient days and discharges. RESULTS: For the 19 countries with complete data, the authors found little productivity growth based on this model (with the exception of Denmark, with 15.4% cumulated growth, and the United States, with about 5% from 1974 to 1989). The authors did find, however, that the highest productivity levels are found in the United States (Italy and Finland were also on the frontier of technology in the base period, 1974). The second model uses the same inputs as the first (but in per capita terms), but it specifies simple proxies of health outcomes as outputs: life expectancy of women at age 40 and the reciprocal of the infant mortality rate. CONCLUSIONS: For the 10 countries with complete data for this model, the authors found evidence of much more widespread and rapid productivity growth: Denmark's cumulated growth was close to 33%, with the United States close behind. In both these countries, this growth was due solely to technical change over this period.
Health system performance in OECD countries, 1980-1992. Organization for Economic Cooperation and Development.
U.S. health expenditure levels and rates of increase continue to exceed those of other Western industrialized nations. The pluralistic U.S. health care system has the highest excess health care inflation and opportunity costs of forgone nonhealth consumption and investment when compared with other major industrialized countries. While poor U.S. performance in terms of life expectancy at birth and infant mortality may partially result from social problems, there is little quantifiable evidence of value for money or equity in terms of health system performance.
Eppur si muove: a comment on Baruch Brody and Reider Lie.
The manuscript by Baruch Brody and Reider Lie presents a distorted image of cost comparisons and social accounts. They presuppose a static view of health systems. While there is methodological uncertainty in international comparisons, such uncertainty should not be used to justify a failure to act.
Health spending, delivery, and outcomes in OECD countries.
Data comparing health expenditures in twenty-four industrialized nations show that the United States continues to lead the world in health spending as a percentage of gross domestic product. In 1991 the United States spent $2,868 per person on health care, compared with an average of $1,305 in Organization for Economic Cooperation and Development (OECD) countries. The U.S. figure exceeds spending in Canada, the next-highest spender, by 50 percent. Measures of health care use and health status do not provide convincing evidence that the United States has a superior health care system for its larger expenditure levels.
International health spending forecasts: concepts and evaluation.
Health care depends on the organizational and financial decisions which constituted each national system. Since those decisions were made at various times over the preceding years under different macroeconomic conditions, current expenditures are a distributed lag function of GDP growth and inflation rates. The accuracy of forecasts from such causal econometric models are compared to exponential smoothing, moving average, and ARIMA methods. Data fro 19 OECD countries 1965-79 are used for calibration, and then ex ante forecasts are generated for 1980-87 so that actual forecast accuracy can be tested. The greatest reduction in mean absolute error was obtained with the econometric model estimated in aggregate across all 19 countries, although single-country models, exponential smoothing and international averaging were also effective. A combination of all four forecasts was more accurate than any one alone, reducing MAE by 25% relative to a constant growth projection.
U.S. health expenditure performance: an international comparison and data update.
In this article, the authors present the most recently available data on the health care financing and delivery systems of the 24 industrialized member countries of the Organization for Economic Cooperation and Development (OECD). U.S. health expenditure performance is compared with the performance of other OECD countries. Thirty-six tables of data from 1960-90 are presented on health expenditures, health care prices, availability and utilization of health care services, health outcomes, and basic economic and demographic factors.
Administrative costs in selected industrialized countries.
The costs of health administration are compared across several countries, accompanied by discussion of some of the variations in the definition of health administration. The influence of American health accounting on other countries is examined, and findings are presented regarding the relative costs of insurance-based and direct-delivery systems. Data are presented on health administrative spending providing gross as well as per capita measures.
International health spending: issues and trends.
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Advancing the debate on international spending comparisons.
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Health care systems in twenty-four countries.
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International health care expenditure trends: 1987.
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Overview of international comparisons of health care expenditures.
Health care expenditure and utilization trends in the 24 Organization for Economic Cooperation and Development countries are provided and analyzed in terms of trends in price, population, and volume-intensity. The United States spends more on health than other countries, both in absolute dollar terms and relative to gross domestic product. Moreover, the gap appears to have grown in recent years. Although international comparisons are difficult for a number of reasons outlined in the article, they can be useful in focusing efforts to understand what the United States is getting for its one-half trillion dollar expenditure on health services.
International health spending and utilization trends.
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From risk aversion to risk rating: trends in OECD health care systems.
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The public-private mix in health care.
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Recent trends in international health care spending.
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An income-weighted international average for comparative analysis of health expenditures.
Data from 17 countries across 28 years are used to estimate an international health expenditure function based on real per capita GNP. Actual and expected spending levels are compared for 24 countries. Between 1960 and 1987, it has been rare for health expenditure in any country to be more than +/- 20 per cent from the projected value. The norm is for spending to rise at 1.5 times the growth rate of GDP. Two countries appear to display significant anomalies. Spending in the United Kingdom is consistently 15-25 per cent below normal for all years, and Danish expenditure has declined from 7 to 6 per cent of GDP since 1975.