Reforming the Israeli health system: findings of a 3-year evaluation

Israel, like many other European countries, has recently reformed its healt h care system. The regulated market created by the National Health Insuranc e (NHI) law embodies many of the principles of managed competition. The pur pose of this paper is to present initial findings from an evaluation of the first 3 years of the reform (1995-1997) regarding the implementation of th e reform and the extent to which it has achieved its: main goals. The evalu ation was conducted using multiple quantitative and qualitative research to ols: interviews with key informants; analysis of documents and sick fund fi nancial statements; analysis of trends in sick fund membership: and populat ion surveys conducted in 1995 and 1997 to assess the impact of the reform o n outcome measures related to level of services to the public. Data from th e evaluation show that the NHI law achieved a considerable number of its go als: to provide insurance coverage for the entire population, to ensure fre edom of movement among sick funds, and to standardize the way resources are allocated to sick funds. The incentives that are embodied in the law have encouraged the sick funds to improve the level of services provided to the average insuree, and to develop services in the periphery and for some of t he weaker populations. From the financial perspective, concerns: that NHI w ould lead to a rise in the national health expenditure were not realized as of 1997. In the wake of NHI, there has been a decline in the age adjusted per capita expenditure in three sick funds, with no reports by insurees, at least through 1997, on a decline in satisfaction or level of service. Howe ver, the Israeli experience shows that regulating competition does not nece ssarily lead to economic stability and equality. Regulating the competition also did not solve some of the major policy issues in the Israeli health s ystem including level of resources allocated to health, organizational stru cture of the hospital system, manpower planning and the extent of governmen t involvement in system. Additional policy changes may be needed to resolve these issues. Up-to-date information is essential in helping policymakers track the process of reform implementation and results, and identify proble ms which need to be addressed in the future. (C) 2001 Elsevier Science Irel and Ltd. All rights reserved.