JANUARY

ISRAEL
• Using electronic health records effectively, particularly in the community
• Purchasing pharmaceuticals in bulk and relying heavily on generics
• Setting maximum hospital reimbursement rates (government), negotiating discounts (health plans), and
instituting hospital global revenue caps
• Explicitly prioritizing public funding for new technologies included in the NHI benefits package
• Aligning organizational and financial incentives between clinicians and the hospitals or health plans for whom
they work (see below).
Although clinicians are rarely given explicit financial incentives to contain costs, reliance on salary and capitation
(rather than fee-for-service) may reduce incentives to over-treat. Moreover, the health plans have various internal
processes to discourage care that provides poor value.
Of recent concern to some experts, however, is the recent growth of private medical care and private financing,
which is seen as potentially jeopardizing Israel’s success in containing cost growth.
What major innovations and reforms have been introduced?
Mental health: In July 2015, mental health care was added to the set of services that the health plans must
provide within the NHI framework, making access a legally guaranteed right rather than a government-supplied
service whose availability is subject to budget constraints. Because of this new mandatory package of mental
health services, government funding for health plans has been increased substantially to cover the additional
costs. The main objectives of the reform are to improve the linkage between physical and mental care, increase
the availability of mental health services, and increase efficiency. An external evaluation will ascertain the extent
to which the objectives are achieved and whether various concerns are realized (Rosen et al., 2008).
Comparative data on hospital performance: In 2015, the MoH began publishing comparative data on
hospital quality, and there are plans to rapidly expand the indicator set in the years ahead. In 2014, the Ministry
published the results of a nationwide survey of hospitalized patients regarding their care experience. It is also
assembling a database of waiting times for surgical operations, with the intention of publishing comparative
data in 2016. The objectives of all these efforts are to provide hospitals with information to help identify
problem areas, enhance consumer choice of hospitals, and provide hospitals with incentives to improve
performance.
Reducing surgical waiting times: Long waiting times are perceived as one of the major causes of the recent
growth in private financing and care provision. Motivated by a desire to improve public confidence in the
publicly financed health care system as well as quality of care, the MoH is planning a major initiative to reduce
surgical waiting times. This will involve additional funding to expand hours of operation for surgical theaters as
well as a series of organizational changes to improve efficiency.
Improving service levels in hospital EDs: As part of a broader effort to improve patient-centered care and
service levels, the MoH is launching a major effort to reduce waiting times between patient arrival and the first
contact with a health care professional. Strategies are to include enhanced physician, nurse, and physician
assistant staffing, as well as engaging operations management experts to improve workflow.
Long-term care insurance: Israel’s long-term care system is seriously fragmented, with service gaps, duplication
of care, inefficient incentives, and inadequate investment in prevention and rehabilitation. The government is
working on a plan to add institutional long-term care to the set of NHI benefits for which the health plans are
responsible, with the plans also serving as the budget holders for institutional LTC.
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The Commonwealth Fund