Setting priorities for the adoption of health technologies on a national level - the Israeli experience

The rapid development of new and expensive health technologies together wit h the limited resources available for the health care system, makes priorit y setting or rationing inevitable. The Israeli Health Insurance Law, enacte d in 1995, determined a basic list of health services to be provided to all residents by public funding. Although the Israeli health care system has r eached a high standard of medical care as expressed by parameters such as l ong life expectancy and low infant mortality, the social and professional d emand for new and expensive health technologies is increasing. Towards the fiscal year of 1999, the Medical Technologies Administration of the Ministr y of Health recommended a list of new technologies to be added to the list of health services. The Ministry of Finance allocated that year US$ 35 mill ion for this purpose, while a rough assessment found that there are new imp ortant technologies to be added at a cost of more than US$ 350 million. The Medical Technologies Administration took a systematic approach of health t echnology assessment ad-hoc teams were established for evaluating clinical safety, efficacy and effectiveness, conducting needs assessment and cost-ef fectiveness descriptions. Assessment of the data was based on evidence-base d medicine. A set of criteria was determined in order to enable the priorit izing of the assessed new technologies. This procedure led to a list of tec hnologies suggested for inclusion. The Minister of Health appointed a publi c committee whose purpose was to decide the technologies to be added to the list of health services. The committee, made up of representatives from th e government, the sick-funds and the public, had to evaluate each technolog y, based on the analysis submitted to the committee, taking into considerat ion clinical, economic, social, ethical and legal aspects according to pred efined criteria. The thorough work of the Medical Technologies Administrati on enabled the committee to adopt its recommended list with minor changes w ithin a limited timeframe. In conclusion, we propose a practical and pragma tic model for the inclusion of new health technologies at a national level, based on health technology assessment and explicit priority setting. (C) 2 000 Elsevier Science Ireland Ltd. All rights reserved.